Reflux chiropractic baby infant

For Educated Mothers: The Real Cause of GERD

Why A Trip to the Chiropractor Should Be on Your Radar

One would think that chiropractors are reserved for older adults who have neck or low back pain. The reality is, chiropractic is the most popular form of practitioner-based complementary alternative medicine therapies for children. Infants and babies may have spinal issues and they may not be so obvious. Because infants can’t communicate their feelings clearly, it makes it challenging to notice when something is wrong or if they are in pain. Some mothers may have safety concerns regarding chiropractic care for their child so first we’ll discuss the safety and efficacy of chiropractic care for the pediatric population.

Dr. Kelly Duffner of Family First Spine Center in Cincinnati, OH

How safe is Chiropractic for Pediatric patients?

First, we must evaluate the safety of chiropractic care for infants and children. Reports and studies of adverse reactions to pediatric chiropractic care are rare. One study found that adverse reactions during a chiropractic treatment were less than 0.12% of office visits in an outpatient clinical setting as reported by parents. Another study of 921 Chiropractic offices across Europe that treat pediatric patients found adverse reactions were reported at an estimated incidence of 0.23%. In conclusion, minor adverse reactions to chiropractic care in the pediatric population are rare and moderate or severe reactions are even rarer.

Infant Reflux or GERD

Gastroesophageal reflux or GERD is defined as the passage of stomach contents into the esophagus with or without accompanied regurgitation (spitting up) and vomiting. It may or may not cause symptoms such as regurgitation or occasional vomiting. Infant reflux may lead to complications, such as inflammation of the esophagus, strictures, respiratory complications, failure to thrive, and, rarely, Barrett esophagus and esophageal cancer. It affects roughly half of all infants under 3 months old. One key piece of anatomy in infant reflux is the lower esophageal sphincter or LES for short. When the stomach expands because of large-volume feedings, it causes the LES to shorten and relax or reduce in pressure. This relaxation allows food and acid to pass through into the esophagus and increases the chances for regurgitation.

What causes infant reflux?

The most common cause of GERD, other than a hiatal hernia, is considered to be transient lower esophageal sphincter relaxation. The lower esophageal sphincter (LES) normally has a higher resting tone than the stomach, thus preventing the reflux of gastric contents into the esophagus. It has been proposed that patients with GERD have altered autonomic nervous function and, more specifically, have reduced parasympathetic activity. As a person eats, the stomach fills and distends causing the esophagus to shorten and increases the chances of gastric contents entering the esophagus. This becomes especially important if the infant has altered autonomic nervous system function.

Other complications that cause infant reflux are distractions while feeding and the bottle size that is used. As parents become more distracted while feeding their infants, they become less attentive to fullness cues from their baby. One study found that parents who were occupied with other distractions during feeding tended to overfeed their infant which may contribute to infant reflux. Another study found that using a larger bottle over a smaller bottle increased the amount of liquid during feeding and may result in reflux complications.

How is infant reflux diagnosed?

The diagnosis of GERD is usually based on parent reported symptoms that are attributable to reflux and are troublesome to the infant. Diagnostic testing is generally not necessary because it has not been found to be more reliable than the history and physical examination for diagnosing gastroesophageal reflux or GERD. Common symptoms of reflux include frequent regurgitation or vomiting, post feeding irritability, prolonged feeding or feeding refusal, or back arching.

Signs & Symptoms of GERD in Infants

Since infants cannot verbalize exactly what they’re feeling we have to rely on common behaviors that have been shown to be signs and symptoms of infant GERD. Here are the major signs and symptoms of reflux in infants:

  • Irritable and excessive crying within a few minutes of feeding possibly due to heartburn and acid reflux/abdominal pain.
  • Infant may prefer to sit upright; dislikes the tummy time position and demonstrates mild arching related to feeding.
  • Frequent, recurrent vomiting, regurgitation; re-swallowing; may bite lip, show acid burns on lip; retching, choking, frequent cough; tongue thrusting nipple or pacifier; occasional sweating while feeding
  • Occasional bloody stools or in vomit; occasional failure to thrive
  • Rarely responds to medication under 2 years of age

Can Chiropractic Help With Infant Reflux?

Chiropractic treatment of infant reflux is not uncommon in a chiropractic office and digestive issues account for approximately 13% of all pediatric visits to the chiropractor. There are many case reports in the literature of improvements of GERD under chiropractic care in children. One study in particular involved a 3 month old with interrupted sleep, excessive intestinal gas, frequent vomiting, excessive crying, difficulty breastfeeding, plagiocephaly and torticollis. Previous medical care consisted of Prilosec prescription medication that did not resolve the infant reflux. The study highlights notable improvement in the patient’s symptoms were observed within four visits and total resolution of symptoms within three months of care.

How Does Chiropractic Help with Infant Reflux?

We must first understand the importance of the contrasting sides of the nervous system. These are the sympathetic and the parasympathetic nervous system.

The parasympathetic nervous system is known as the rest and digest part of the nervous system. This is most active during sleeping, eating, and digesting food. Our blood pressure lowers, relaxation hormones are released, and blood is shoveled to the organs of digestion. The parasympathetic nervous system consists of brainstem (Cranial Nerves III, VII, IX, X) and the sacral spinal cord S2, S3, and S4 or the craniosacral area.

The sympathetic nervous system is known as the fight or flight part of the nervous system. This is most active when we are faced with immediate danger like a bear chasing us. Heart rate and blood pressure increases, blood is shunted from the digestive organs and shoveled to the extremities to prepare for battle. The sympathetic nervous system consists of cells with bodies from T1 to L2 or the thoracolumbar area.

Chiropractic Adjustments and Their Effect on the Autonomic Nervous System

A preliminary study suggested that cervical or neck adjustments may result in parasympathetic responses, whereas thoracic or mid back adjustments result in sympathetic responses. Furthermore, it appears that these responses may demonstrate the relationship of autonomic responses in association to the particular spinal segment(s) adjusted.

Another study found that spinal manipulation exerts an influence on the autonomic nervous system depending on the stimulation site and type. A greater parasympathetic response was found when stimulation was performed in the cervical and lumbar regions, whereas a greater sympathetic response was found when stimulation was performed in the thoracic region.

Since the most common cause of GERD is considered to be transient lower esophageal sphincter relaxation due to reduced parasympathetic activity; it can be proposed that spinal adjustments specifically to the craniosacral or upper neck and lower back area may help restore autonomic function and help with infant reflux. Preliminary data from previous studies warrants further investigation into the effects of spinal adjustments on the restoration of the autonomic nervous system and the reduction in GERD symptomatology.

Signs and Symptoms of Altered Autonomic Nervous System Dysfunction

Altered autonomic nervous system function can result with abnormalities or dysfunction of the following:

  • Blood pressure
  • Heart and breathing rates
  • Body temperature
  • Digestion
  • Metabolism (thus affecting body weight)
  • The balance of water and electrolytes (such as sodium and calcium)
  • The over or under production of body fluids (saliva, sweat, and tears)
  • Urination
  • Defecation

Neck Injury During Birth in Infants

One study found the occurrence of major trauma during birth to be 3.16% with clavicle fracture being the most common trauma followed by brachial plexus injury. Another lesser known but more common trauma birth trauma is a condition known as Kinetic Imbalance due to Suboccipital Strain or KISS Syndrome.

The younger the age, the more flexible the spine is. Hence neural damage occurs in children much earlier than musculoskeletal injury. As age increases the likelihood of cervical cord injury decreases with up to 75% of injuries occurring in infancy up to 8 years old. This is because the fulcrum of cervical mobility moves progressively downward with the child’s increasing chronological age.

  • Children have a different fulcrum due to a large head
  • Children’s vertebra is incompletely ossified
  • Their ligaments are firmly attached to articular bone surfaces that are more horizontal.

Babies may injure their upper cervical spine during the birth process. This is because the upper cervical spine is considered to be the “weak spot.” The potential for injury to the upper cervical spine is greater when there is intrauterine misalignment, multiple fetuses, prolonged labor, and the use of extraction aids such as forceps and vacuum extraction. Children differ from adults with respect to fulcrum of cervical mobility is as follows:

  • Younger than eight years: C1 and C3
  • Eight to 12 years: C3 and C5
  • Older than 12 years: C5 and C6

The suboccipital area comprises the upper neck area involving the occiptal bone, first cervical vertebrae, second cervical vertebrae. This area is highly complex encompassing important neurological and vascular components. It is highly susceptible to injury during birth because of its high mobility and because it is the fulcrum of cervical mobility during birth.

Typical early signs displayed by babies with upper cervical injury include:

  • asymmetric posture
  • tilted head
  • torticollis
  • using only one posture for sleeping
  • asymmetries of movement patterns
  • asymmetries or swelling of the face / head
  • asymmetries of the gluteal muscles
  • asymmetric development and range of movement of the hips
  • fever of unknown origin
  • deformities of the feet
  • fussiness when picked up
  • the baby wakes up crying every hour
  • extreme sensitivity of the neck to pressure
  • loss of appetite
  • the baby does not eat or drink well

Conclusion

Injury to the upper neck area seems to elicit a sympathetic dominant state causing signs and symptoms of autonomic nervous system dysfunction. One of these symptoms being dysfunction of the lower esophageal sphincter. This dysfunctions allows stomach contents to backup into the the esophagus and create infantile reflux. Spinal adjustments and manual therapy to the craniosacral area or upper neck and lower back have been shown to elicit an increase in parasympathetic nervous system activity. This may help regulate proper function of the lower esophageal sphincter. Spinal adjustments along with mindful feeding habits can help with infant reflux and GERD, and warrants further investigation. It may provide a viable option to families looking for alternatives to prescription medication.

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Summary
For Educated Mothers: The Real Cause of GERD
Article Name
For Educated Mothers: The Real Cause of GERD
Description
Why a trip to the Chiropractor should be on your radar if your infant suffers from reflux and you don't want them on medication.
Author
Publisher Name
Family First Spine Center