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Background: Gastroesophageal reflux (GER) is a digestive disorder consisting of reflux of gastric contents into the esophagus 1. GER is also more commonly known as acid reflux and is considered a normal physiologic process that occurs in healthy people of all ages and affects approximately 50% of healthy, full-term newborns 2. The acid reflux occurs as a result of transient relaxations of the lower esophageal sphincter or when the sphincter tone adapts inadequately to changes in abdominal pressure 3. The acid reflux becomes known as a disease process (i.e., gastroesopahageal reflux disease) only after the acid reflux becomes symptomatic or causes pathological consequences for the patient 4.
Gastroesopahageal reflux disease (GERD) may be present in infants with initial signs and symptoms of frequent vomiting, poor weight gain, and persistent irritability. Regurgitation is also a common manifestation of GERD in those younger than 12 months of age 5. Some less common signs and symptoms of advanced GERD in infants include hematemesis, anemia, persistent cough, recurrent ear infections and torticollis 6.
The incidence of GERD in infancy has been estimated at approximately 18% and becomes more common as children become older. One possibly for this may be due to the ability of the older patient to report symptoms more accurately 7.
Given the growing pediatric incidence and prevalence of GERD, multiple treatment options have been proposed, from both allopathic and non-allopathic clinicians. Debate continues regarding non-allopathic approaches to the care of pediatric patients, particularly the use of chiropractic pediatric care. In the interest of evidence-based practice for chiropractic pediatric, we present the successful care of a pediatric patient with subjective complaints consistent with GERD.
Clinical Features: A 3-month old girl was provided with chiropractic and cranial sacral care at the request and consent of her mother for symptoms associated with medically-diagnosed GERD. The patient exhibited frequent vomiting, difficulty with breast feeding, interrupted sleep, generalized muscle rigidity, and frequent high-pitched crying. The patient previously received chiropractic care elsewhere as well medically managed with the prescription of Prilosec. The infant’s condition was unaffected by these previous treatments to the point that, according to the patient’s mother, the infant’s condition was adversely affecting the family dynamics in a variety of ways.
Intervention and Outcome: The patient was treated with site-specific, low amplitude, high velocity chiropractic adjustments to sites of vertebral subluxations, particularly at the atlas and the 4th thoracic vertebra. The patient was also cared for with low-force cranial sacral therapy to the mandible, temporal, and parietal cranial plates. The patient responded favorably to care with reduction in frequency of vomiting, improved feeding, decreased generalized muscle rigidity, and decreased high-pitched and frequency of crying. The above notable changes were observed within four patient visits and with total resolution of symptoms within approximately three months of care.
Conclusion: This case study demonstrates that pediatric patients suffering from gastrointestinal disorder such as GERD may benefit from a clinical and theoretical framework of adjustments to sites of vertebral subluxations.
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Joel Alcantara, DC 1 and Renata Anderson, DC 2
Research Director, International Chiropractic Pediatric Association, Media, Pa and Private Practice of Chiropractic, San Jose, CA, USA
Private Practice of Chiropractic, Onalaska, WI, USA
Presented at ACC-RAC Conference in Las Vegas, NV March 17-20, 2005.
Accepted for publication, The Journal of the Canadian Chiropractic Association, December 2009.