Failure to Thrive Case Report - The “Tip of the Iceberg”
The “tip of the iceberg” phenomenon is a common description in medicine to portray the mostly unseen phenomenon of disease. I would like to share with you a recent peer-reviewed case report I did that aims to drill through this phenomenon. The case report involves the effects of chiropractic care in an infant with gastroesophageal reflux disease (GERD), infantile colic and failure to thrive.
Infantile regurgitation and colic are two of the three most common functional gastrointestinal disorders with the third being functional constipation. Half of all infants suffer from at least one FGID (functional gastrointestinal disorders) or related signs and symptoms during the first year of birth. FGIDs are the most common motivation for parents to consult a healthcare professional in the first months after birth.
The mother came to our office with her 3-month-old daughter for consultation and possible care. The infant was medically diagnosed with infantile colic, GERD and failure to thrive. Symptoms were first noticed when the parents took the child home from the neonatal intensive care unit. The baby spent 13 days in the NICU and was fed via a tube since birth. Issues had only worsened since they brought her home. Parents were having a difficult time dealing with the child’s symptoms. This resulted in a lack of sleep, feelings of frustration and anxiety for the parents. Since birth, the child was unable to hold down more than 3 ounces of formula per feeding without spitting up and/or crying.
An ultrasound imaging of the womb determined that the umbilical cord was wrapped around the infant’s neck twice. She was then delivered prematurely by C-section at 34 weeks. After 3 weeks at home since leaving the NICU, the parents took the infant to her pediatrician. The pediatrician first prescribed Zantac. After 4 weeks of use, the child had no improvement. The pediatrician then prescribed Prilosec and Pepsin. After two weeks of Prilosec and Pepsin, no improvement was noticed.
The mother came to the office alone since the husband was very hesitant to take their child to a chiropractor. He “didn't believe” that chiropractic care for babies had any merit. When the child came into my office she was slightly agitated and crying. She had a noticeable right head tilt when doing a visual postural examination. Hypertonic muscles were felt throughout the upper cervical region, notably on the right side. With motion palpation testing, the C1 vertebra had restricted motion on the right, both with rotation and lateral flexion.
Utilizing the Kale Upper Cervical Specific Protocol, I performed Neurocalometer and Chirometer testing. Neurocalometer indicated at 4 point break to the right. Chirometer readings were 85.5 degrees F on the left and 86.5 degrees F on the right. An Upper cervical X-ray series was then performed. This consists of 2 views, a Lateral cervical and Anterior-Posterior Open Mouth (APOM). Analysis showed that the C1 vertebra was misaligned 1 mm to the right and 1 degree superior from normal standard measurements.
Contacting the posterior arch of the C1 vertebra, I delivered a gentle toggle torque with recoil adjustment. 20 minutes after the adjustment, testing revealed a 3 point break to the left with the Neurocalometer and a Chirometer reading of 87.5L/87.0R. 30 minutes after the adjustment, another set of tests indicated a 1 point swing to the Right and 87 bilateral Chirometer readings. Infant attended care for 3 visits over a 2 week period. Only one adjustment was given. Scans on the other two visits indicated no subluxation present.
The mom noted when they returned home after the child’s adjustment, her daughter went immediately to sleep and took a long nap. This was unusual for her to take a long nap during the day. After waking from a nap, the infant ate without difficulty and went back to sleep. On the second visit 5 days later, the infant was still maintaining sleep and the mom noticed overall improvement. She was able to consume 4 to 5 ounces without any issues. The child was actually able to consume 6 ounces on the morning of the visit. By the third visit 12 days after adjustment, the baby was consuming 6 ounces of food regularly without issue. That morning she was able to take 8 ounces of food. Her sleep and mood had continually improved as well. The infant went for a check-up later that week and the medical doctor was surprised by formula consumption, weight gain and resolution of failure to thrive symptoms. The family has since moved out of town and I lost track of the child’s progress.
Issues of infantile colic and failure to thrive are consequences of GERD. Both infantile colic and failure to thrive are diagnoses of exclusion. This means their diagnosis is usually determined from a process of elimination. When there is a failure to find the cause of a child’s excessive crying or failure to feed properly, a diagnosis of either colic or failure to thrive is provided.
Studies show that pharmacological treatment of GERD with drugs such as Zantac, Prilosec, and Pepsin has little to no effect. There are also significant risks and adverse effects associated with these drugs. Pediatricians are not practicing to published evidence. Only 2% of pediatricians completely adhere to Pediatric, Gastroenterology, Hepatology, and Nutrition guidelines. 56% of pediatricians prescribe Proton pump inhibitors (PPIs) to infants with unexplained crying and/or distressed behavior. 38% of pediatricians prescribe PPIs to infants with uncomplicated recurrent regurgitation and vomiting. In one study, 79% of pediatricians surveyed actually report to overprescribing PPIs.
Adverse effects have been reported in at least 34% of those treated with proton pump inhibitors (PPIs). These include headaches, diarrhea, nausea, and constipation. Acid suppression may place immune-deficient infants and children at risk for the development of lower respiratory tract infections and nosocomial sepsis. In comparison, adverse effects have been reported in 0.83% of those patients under Chiropractic care. Adverse effects under Chiropractic care usually consist of self-limiting events such as muscle soreness that does not require medical attention.
In conclusion, I hope this case report provides an educational vehicle and evidence on the successfulness of chiropractic care of an infant suffering from GERD, infantile colic, and/or failure to thrive.
- Jarek Esarco, D.C.
Dr. Jarek Esarco is a pediatric and family wellness Chiropractor. He is an active member of the International Chiropractic Pediatric Association (ICPA). The ICPA is an organization of chiropractic family practitioners dedicated to advancing public awareness and the family wellness lifestyle. Dr. Jarek also has post-graduate certification in the HIO Specific Brain Stem Procedure technique through The TIC Institute. Dr. Jarek is happily married to his wife Regina. They live in Youngstown, Ohio with their daughter Ruby.