Ask Doctor Donohoe
I’ve been in practice now for 15 years. Over all those years I’ve been asked to answer LOTS of questions. Neighbors Newspaper has graciously agreed to open up their publication to me and YOU! Starting this month we will be accepting questions on all subjects health related. As readers of my column already know, I specialize in pediatric and pre-natal chiropractic care. However, my office is a family practice. I take care of patients young, old and everyone in between. We invite your questions on health and fitness, diet and nutrition, kids care, adult care and any alternative medicine issue. Please email your questions to info@neighborsnewspaper.com. I will try to answer one or two every month in this column. This month I will kick it off with a question about a case I see a lot of in the office; pediatric reflux.
Question: Submitted by Andrew H.
My 4 day old son was hospitalized for a possible blockage in his intestines, but it turned out to be just reflux. I heard chiropractic care can help. Is that true? If so, does it have a good success rate?
Great question Andrew! The short answer is YES, and I have a high success rate! But really, we need to discuss this subject a little more to get a better understanding of the mechanisms behind pediatric reflux and how chiropractic care can help.
There are 4 primary mechanisms that I evaluate with every case of pediatric reflux. The nerve supply from the brain to the upper gastrointestinal tract, the position of the stomach organ under the diaphragm muscle, the function of the valves at the top and bottom of the stomach and the possible irritation to the GI system caused by food sensitivities found in mommy’s milk or formula. I will find one or more of these mechanisms present in every case of pediatric reflux. Let’s discuss each individually.
1) The nerve supply from the brain to the upper GI tract.
The main nerve supply for the gut is derived from the Vagus Nerve, the tenth cranial nerve. This nerve comes off the brain itself and travels down to the abdomen to supply the esophagus, stomach, pancreas, bile duct, small intestine and upper colon. Also, branching off the spinal cord at the level of the sixth thoracic vertebra (T6) is nerve supply to the stomach itself.
When I evaluate this condition, I always start with a cranial and spinal examination to look for potential irritation to these nerve pathways. If the brain cannot communicate properly with an “end organ”, in this case the stomach, that organ cannot perform the actions the brain is asking it to properly. The result is organ dysfunction of some type.
The treatment is chiropractic adjustments and cranial therapy designed to free up the nervous system to do its job as it was intended to.
2) The position of the stomach organ under the diaphragm muscle.
This one I find with every case of reflux. I have hypothesized that the increase in cases of pediatric reflux may be tied to the increased rate of labor induction in mommies. Many mommies are given pitocin to stimulate uterine contraction and induce or speed up labor. Pitocin causes contractions of the uterus that are much stronger and longer lasting than normal oxytocin derived ones. During delivery a contraction can take place (even in the absence of pitocin) causing a “squeeze” to the baby’s abdomen. The soft tissue abdominal contents are pushed away from the squeeze, much like a tube of toothpaste, and the stomach is pushed up high under the diaphragm.
This can cause a couple of problems. First, the diaphragm can torque or go into spasm. This can cause interference with the function of the valve at the top of the stomach known as the cardiac valve. When the cardiac valve doesn’t work right, it can become “insufficient” which allows acidic material from the stomach to come up into the delicate esophagus which, in turn, causes irritation and pain. Secondly, the same insufficiency can be the result of the cardiac valve becoming trapped within the diaphragm itself. This is much like what happens to adults that suffer a “hiatal hernia”.
The treatment is to “pull down” the stomach. This is considered organ manipulation and is performed gently to reposition the stomach away from the possible interference of the diaphragm. Once free and receiving proper nerve supply, the cardiac valve can do its job as it was intended to.
3) The function of the valves at the top and bottom of the stomach.
The cardiac valve was discussed above, but there is another valve at the bottom of the stomach, the pyloric valve. Both of these valves are sphincter muscles. They are designed to open and close to allow the passage of materials through the GI tract. The cardiac valve should open only long enough to allow the entry of foods into the stomach. Then it should clamp down to prevent reflux of acidic material from the stomach into the esophagus. All the while, the pyloric valve stays shut to keep foods in the stomach where the acidic environment breaks down foods in preparation for absorption in the small intestine. After the appropriate time, the valve opens to dump the stomach contents into the small intestine.
When the pyloric valve isn’t working right, the stomach contents stay in there longer than they should contributing to the increased likelihood of reflux. This condition is known as pyloric stenosis and comes in differing levels of severity.
The treatment consists of various soft tissue manipulation techniques to relax the sphincter valve or even surgery in severe cases. Every case I’ve addressed in my office has resolved without surgery. Once the valve is receiving the proper nerve supply and is relaxed to a normal tone, it can do its job as it was intended to.
4) Possible irritation to the GI system caused by food sensitivities.
Readers of my column will be familiar with my recent articles on gluten and food sensitivity testing. Well this is one of the many possible manifestations of food sensitivities. If mommy is consuming foods she is having reactions to, she can pass that irritation on to her baby. Specific foods in her diet can cause the baby distress. These foods are not always the gas producing ones like beans and broccoli, but can be anything she tests positive to. Only food sensitivity testing can reveal the culprits. The same situation can apply to formula fed babies, but it’s not connected to the mommy’s weaknesses. Rather, the baby can be sensitive to the protein or any of the many chemical constituents of the formula.
Treatment consists of identification and elimination of the offending foods/agents.
I cannot think of any case of pediatric reflux that failed to respond when all avenues have been properly evaluated and treated. That means that my success rate in treating the condition is high, very high indeed!
Thanks again for the question Andrew! Please get more questions in to info@neighborsnewspaper.com and let’s get this column rolling!
Dr. Donohoe is a family practice chiropractor who specializes in the unique needs of pregnant women and children. His office is located at 41880 Kalmia St., Suite 135 in Murrieta. He can be reached at 951-677-6500 or through his website at www.DonohoeChiropractic.com.