Chiropractic and Otitis Media in Kids

What is Otitis Media (OM)?

It is just a fancy word for an ear infection. These infections are usually caused by bacteria and  present when fluid builds up behind the eardrum. In children it usually follows a sore throat, a cold or upper respiratory infection. The middle ear is the target for most of these infections but the Eustachian tubes (the passages that connect the middle ear to the upper throat area and supply fresh air to the middle ear, drain fluids and keep air pressure steady between the nose and the throat) and Adenoids  are also commonly affected. Boys are usually more affected than girls and recurrent OM is defined as 3 episodes within 6 months or 4 episodes within 1 year.

You will come across 3 types of infection.

1)      Acute Otitis Media (AOM)- The infected fluid build up causes earache and it is commonly associated with fevers

2)      Otitis Media with Effusion (OME)- This occurs when the initial infection has passed but the fluid has remained trapped behind the eardrum(blocked Eustachian tube). This commonly has no symptoms although in kiddies it may lead to sleep disturbances, impaired hearing and popping sounds in the ears. It is also more common than AOM

3)      Chronic OM with Effusion (COME)- This is fluid remaining in the middle ear or returning again and again even with no infection thus making it harder for kids to fight infections. It may lead to hearing loss effecting speech and language development.

 Why Children?

Kids have smaller Eustachian tubes but more than that the tubes in children are more horizontally angled than in adults, making it harder for them to clear the fluids. The tubes often become blocked by mucus when kids initially get sick and the tubes swell, leading to blockages. Without fresh air the middle ear becomes great environment for infection.

Another factor contributing to OM in kids is that their immune systems are still developing and not as functional as in adults. In addition to this, bacteria can get caught up in the adenoids causing chronic infection that moves to the Eustachian tubes and middle ear.

Which Kids are at Risk?

Obviously kiddies with frequent upper respiratory tract infections top the pile in terms of risk. Colder months give rise to more cases as more colds and flu are seen. Kids at daycare are at higher risk as are bottle fed babies( especially if they are fed in a horizontal position with one ear facing the floor) in oppose to breastfed babies.  

Home Diagnosis?

It is tough to home diagnose OM in kiddies that can’t talk yet but kids who pull/tug consistently on their ears especially after having just had an upper respiratory infection are prime candidates for a trip to a medical specialist. If the child is older they may complain of ear pain/discomfort, a ‘fullness’ in the ear, decreased hearing and show general irritability. Fever is not diagnostic of an ear infection.

Chiropractic?

First and foremost I do not see treat these kiddies until they have been seen by an ENT, Homeopath or GP and the diagnosis has been established. I am not an ear specialist and do not diagnose this kind of condition. My role is to correct function, not to be poking around in ears.

The Eustachian tubes are controlled by muscles that are in turn controlled by nerves that have connections to tracts in the upper cervical (neck) area. The logic states that misalignment in the upper neck area can lead to inappropriate nerve supply to these muscles and an inability of the tubes to clear fluids. Eustachian tubes can also have their function impaired by swelling of the neck’s lymphatic tissue. This not only affects the lymph drainage but in turn the immune system as well. By correcting the mechanics of the neck you are able to correct the functions of the Eustachian tubes and the lymphatic system. I personally use an activator tool on these upper vertebrae. I find it less invasive and more suitable for the job.

I always send my kiddies back to the ENT, Homeopath or GP after Chiro treatment for them to sign off on the success of the treatment. 

 

What is Reflux

Imagine you had to drink about 14 liters of milk a day and were made to lie on your back for up to 20 hours of that day? You guessed it: Reflux

 Reflux is the tracking of stomach contents back up the esophagus instead of moving, like they should, into the small bowel. Babies with reflux may vomit or they may not and each of these types comes with its own challenges. The pain of reflux is related, not to the vomiting itself, but to the stomach acid that comes with it. Baby’s stomach is an acidic environment and has linings to protect it from being burnt. The esophagus does not share these linings and becomes burnt when acid from the stomach continually makes its way through the upper stomach valve into the esophagus. You may have come across the terms GER and GERD, they stand for Gastro-esophageal Reflux and Gastro-esopahgeal reflux disease.

So what kinds of reflux are there?

Emetic reflux: This is when the stomach contents make their way up the esophagus and out of the mouth. If baby is producing more than a mouthful at every feed they are said to have reflux. This may or may not be associated with crying. ‘Happy Chuckers’ are babies who vomit constantly but do not seem to be fazed by it. In these children the acid is either of a small enough quantity that it does not cause burning or the acid itself is being chucked out so quickly that it does not bother them. The biggest issue with this type of reflux is that babies may begin to slow their growth or even lose weight. If this happens they need to be taken to a medical professional.

Silent Reflux: In this case the digested milk is still going up but not making its way to the top of the esophagus, rather sitting midway and causing irritation. These babies often make a throat clearing sounds and seem uncomfortable. The acid is not cleared and this often leads to crying and unhappiness after feeds.

In both cases, babies do not like to put in a horizontal position after a feed because this causes more milk to flow past the valve and leads to more irritation. They will also turn their heads away during feeding as the new milk coming in flows past the burnt sections of the esophagus causing them to halt the feeding and start to cry.

Reflux is more prevalent in premmy babies and babies who have been tube fed, as this opens the valve and keeps it pushed open for long periods. Reflux can develop from birth and last up to 12 months depending on the cause.

Leaky valves are one such cause but there are others such as food intolerance. In this case babies may projectile vomit and empty the stomach of a whole feed. Over feeding is also a hidden cause of reflux, baby can only take in so much and if over fed may trigger vomiting.

If you suspect, or have had baby diagnosed with reflux: Try feeding your baby at a more vertical angle to allow gravity to keep the milk moving downward. Hold baby upright for at least 20 mins after a feed for the same reason and raise baby’s bed slightly so that milk does not slosh back and forth over the valve while they sleep. You may also want to break the feed into 4 or 5 sessions with winding in between to allow the contents to move to the bowel in smaller quantities. Winding baby before a feed can also be tried to make sure that air in the stomach is not causing pressure and leading to vomiting.

There are many ant-acids on the market that do a good job of neutralizing the acid but be warned that ant-acids do not stop the vomiting. Milk thickeners can be beneficial but some studies suggest that they may keep acid in the esophagus for longer periods by making the milk too thick to vomit up thereby leading to more burning, so if you find that the vomiting is less but the crying gets worse this may be the reason. There are also great homeopathic reflux products as well as great books for more information.

When does Crying become Colic?

The first step in deciphering whether your baby has colic or not is to listen out for the sound of the cry.

 The cry of attention, which is associated with hunger, boredom, mild discomfit and loneliness, has a droning quality. It is a lower pitched sound which can be associated, with practice, to the need it requires (Dunstan baby talk is a great tool for learning these cues www.dunstanbaby.com/).

The Colicky cry of pain or overstimulation is a very different beast. It is high pitched (watch out for a seriously high pitched sound as this can be a sign of bigger things). It warbles and changes its tempo in much the same way as an ambulance does and for the same reasons.

Be careful not to judge your baby’s condition on the basis of crying alone. As with adults most of what babies communicate is not verbal. Body language is a huge indicator of baby’s state of being and needs to be incorporated into the picture to correctly asses their message.

Often times babies will wail like mad but their hands are open, arms are away from the torso and the legs are limp (not contracted up into the belly). This is an example of a basic need (hunger, wet nappy etc) that is has not been met and is rapidly becoming priority number one. Baby is verbally moving into the high pitched register cry but the body is not responding the same way.

Babies do not know where pain comes from. It is a new experience and not something they have had to deal with before. After seeing literally hundreds of these children it seems to me that they adopt a defensive position when confronted with it. Arms up the torso, hands clenched and knees to the chest are all physical signs of Colic but they are also all shielding mechanisms to protect the body. As I say this is what I have seen in practice, they may not be trying to protect themselves at all but it is a good reference to have when deciding whether your child is trying to communicate pain.

The last factor I want to talk about is the inconsolability of the fussiness. Inconsolable means exactly what it says – anything you do to help your baby does not work. Clean nappies, bottles of milk and holding them  should have no effect on the colicky baby. Some babies just have a hard time moving from sleep to wake and back again but they can be calmed eventually by means of distraction or constant attention. Colicky bouts appear from nowhere and disappear just as quickly no matter what you try. If you find yourself in this position you need to get help. Talk to your local Nurse, Paediatricain, Homeopath or Chiropractor about your child’s symptoms. We are all there to help.

Chiropractic: What’s in a name?

Quite a bit actually. I strongly believe that the word CHIROPRACTIC has a lot to do with the stigma attached to the profession. Where as the word Physiotherapy sounds like it should involve a day of relaxation topped off by a long drink with a tiny umbrella in it, Chiropractic comes across as harsh and something likely to end in bruising. It is also an odd word that doesn’t translate from noun to verb as it should. Physiotherapists practice Physiotherapy as Radiographers practice Radiography but Chiropractors most definately do not practice Chiropractory, much as Lawyers do not practice Lawyery! We practice Chiropractic, you receive Chiropractic treatment and it is performed by a Chiropractor. Not Chiropractory, not Chiropractice and I am definitively not a Gyroprat (which i have been called once.)

Chiro- meaning hand, Practic- to practice/done by: Therefore the literal translation of Chiropractic is ‘done by hand’. The reason it is called this is that all adjustments, stretches, mobilizations and massage are done by hand in oppose to giving tablets or using machinery. This is all well and good but it still sounds like you are going to get murdered under a bridge. In recent times I have noticed many patients forsaking the ‘practic’ bit and talking rather about ‘going to the Chiro’. This, i must admit, has a sweeter tone about it and sounds more like what a sane person might do for backpain. 

The other side of the coin is that the word is to some extent onomatopoeic. When said fast, and with feeling, the ‘Prac’ part sounds a good deal like a neck getting adjusted, which is great if you like that sound but as with the smell of petrol stations some do but most don’t.  This reminds me of an orthopedic theatre nurse I saw a while back who told me that she felt great relief after the treatment but couldn’t bear the sound of her joints being adjusted. I said I thought it was weird that she had an aversion to this sound but was fine with the sound of a bone-saw hacking its way through a hip socket. We both agreed that skeletal treatment was not all about acoustic appreciation. 

The sound of an adjustment is not the world’s most beautiful noise, I will concede this, but then again neither is the sound of a dentists drill. It is about the quality of life we wish to have that is more important than what the treatment or the name of the profession might sound like. In my working experience Chiropractic treatment is a complete 180 degrees to what it sounds like. The treatment is gentle yet effective. Like any profession it has evolved into something that suits the world we live in. We no longer hang people upside down or attempt to throw them through the windows, nor do we take your head and see if it is detachable just for the fun of it. Adjustments are performed because they are necessary to your postural well-being.

You don’t have to drive your car off a cliff for it to need a service and similarly you don’t need to be in that car to need postural realignment. Our daily lives include sitting for long periods and not taking in enough active exercise which leads to functional problems with our chassis’s. 

So next time you hear the word please don’t shiver uncontrollably, it is just a word. Come to think of it ‘Being Audited’ sounds like a great way to spend a weekend, it isn’t.

Winding your Baby

Winding or burping a baby is a skill that you have to pick up quite quickly if you want a peaceful nights rest. All babies respond differently to different winding techniques but there are one or two tricks and tips you can try when it comes to getting that ‘big belch’. To start off it is necessary to understand the working parts involved.

Your Baby’s Tummy is not just a Bag

 

The stomach is not round as you can see from the pic. It is more bean shaped with a dome at the top and the esophagus entering at an angle. This is important to know because now we can see why, even if baby is upright during winding, that air can be trapped above the connection to the esophagus.

 

Have you ever wondered why baby tends to burp after the nappy change during a feed? Or why when baby has been fussing in the cot after a feed she burps when you pick her up? It is because you have changed baby’s position to horizontal and back to vertical again allowing the air trapped in the dome to be released. No matter how hard you tap a baby on its back whilst burping you will not remove this excess air that is the cause of frustration to many parents.

 

Tip 1

Change baby’s positioning.

From what we have just read you can see that it is important to change baby’s positioning during winding. I recommend 5 minutes upright and then put baby on her back (slightly raised) and lightly bicycle the legs for 10 seconds, then upright again (to shoulder or lap). This may cause a slight amount of regurgitation but it is better than being up all night.

Tip 2

Make Sure the Pipes are Straight.

It is virtually impossible to wind a baby when she is bent over double on your lap. Think about yourself trying to stifle a burp? You bend your torso and flex your head. This is the same position we hold babies in when winding and it works the same way. Try holding the head up by the chin and placing your other hand on baby’s back to straighten her spine and ‘pump’ slightly with that hand instead of patting or tapping.

Tip 3

Bounce Bounce Bounce

Having baby upright is all good and well but we need a way of getting the bubbles to the surface of the milk in her tummy. Slight bouncing of your leg (heel up and down) is enough to help these tiny bubbles make their way through the feed and coalesce at the top into the ‘big belch’. Be careful of not bouncing to vigorously especially with reflux babies

Tip 4

Take Your Time

It has been stated that you have up to 20 minutes to burp your baby. 20 minutes is a long time, don’t give up before this even if you get one or two burps. 20 minutes now might mean 3-4 hours of peace later.

Tip 5

Break the Feed

Sometimes the amount of wind consumed in a whole feed is too much for baby to process. Try breaking the feed into 4 or 6 mini feeds with burping in between (these winding sessions should last 4-5 minutes if that)

Tip 6

Try Winding Before the Feed

Babies take in air during grumbling or crying. Trying to feed a baby who is already full of air will cause problems. Try winding a little before a feed to make sure the tummy is clear

 

I hope these tips will help at your next feeding sessions.

So…what exactly is this Colic thing?

The first time I had colic explained to me by may father who has treated babies for 14 years,  I started shaking like an epileptic trout. It sounded like some sort of chinese torture nightmare thrust upon you as punishment for all the babymaking practice. Granted I was still a student when I heard about it and had no experience in babies apart from that I knew they were small and that they seemed to cry about everything.

As my studies progressed I came to learn a great deal about colic, the anatomy involved, the physiology behind the infant cry and how to  ‘effectively’ deal with it. To this point it was still all very academic and sounded good enough to me. The problem was that I was confronted with textbooks and lecturers and not a screaming child, much the same way as a pregnant mom-be-be is when swotting up on her childcare skills.

Unfortunately the biggest problem you will find with textbooks (or any book on childcare for that matter) is that the babies dont read them. They respond to what is happening TO them not what the book says SHOULD be happening to them. Each baby is unique and has its own set of triggers. As with adults, some things irritate some babies more than others. Some of these triggers are easy to spot and some are downright impossible but remember that newborns are pretty truthful little guys and if they say something is wrong then something is wrong.

This leads us to the definition of colic (uncontrollable crying for 3 hours a day, for 3 days in row, for 3 weeks) which was set out in the 1940′s. This was an era before 24 clinics, access to medication and widespread information on parenting. Today things are different. I am hard pressed to think of one parent who has left their child screaming for up to 3 weeks before seeking medical attention.

However, the biggest issue with the current definition is that it leaves out one very important factor in the condition

the crying cabin

…YOU. Colic is not a ‘thing’ that just affects your child, it is a disruptive force the size of a hurricane that affects your whole family dynamic. Whatever the cause, it can put your household under massive strain and is not helped by freinds and family who try to helpfully downplay it or make you feel even worse because they tell you you are doing it wrong. YOU ARE NOT DOING IT WRONG! You are doing the best you can under very trying circumstances.

This is my working definition of colic that is given to the moms who visit my practice and is born out of many hours of research: “Your baby has ‘Colic’ when you are no longer able to soothe him/her by normal methods and your ability to interact positively with your child has become compromised” This is the point when you should seek help from your pediatrican, chiropractor, nursing sister, pharmacy…whoever, but dont think you are any less capable for doing this, we cant all fix computers, we cant all service our cars and we cant all be baby specialists (especially if weve only been at it a few days!).

I realize this definition deviates from the classic ‘rule of 3′ that is used medically but it is applicable to the real world. Instead of colic (I hate that word) I call it irritable baby syndrome because that is what it is. 

The causes of colic are vast and contradictory as anyone who has googled it for half an hour will tell you. Some say it is gas, some say it is temperament, some  say it doesnt even exist. What is true is that  it is a frustrating and humbling experience but you need not shoulder the burden alone. There are any number of experienced healthcare providers for you to turn to and we all have one goal: For you to enjoy your baby.

Which babies end up at the Chiro?

For a long while I was under the impression that cesear babies were by far and away the most in need of chiropractic care. This assumption was born out of 90% of by pediatric patient base being of cesear birth.

After making contact with the local hospitals and doing some research, I have found that their stats are much the same as mine. What I mean is that around 90% of the babies born at my local hospitals are infact cesear births.

Now where does that leave me as a practitioner? Am I indeed only seeing a cross-section of the population?

What I can say with certainty is that I almost never see babies whose birth history is perfect. What constitutes perfect?

1) Mom to Baby weight ratio is correct (Large babies are at risk of not being stretched through the birth canal properly)

2) No Alteration of Passage through Birth Canal ( No use of Forcep or Ventousse during delivery)

3) 1 Hour of pushing time (Less or more can influence the babies spinal mechanics)

4) No distress to baby during birth process

5) Actual Time Spent in Birth Canal (no cesear)

It seems that any alteration to the normal mechanics of the birth process may lead to abnormal mechanics within the infant spine.

It is my opinion, however, that it was what occurs in the spine within the first two weeks that can lead to irritation in babies. The vast majority of babies I see in practice all have one thing in common, Hyperextension of the spine within the first weeks. It is my belief that this hyperextension puts pressure on the immature thoracic (midback) vertebrae and this in turn influences the neural supply from this region to the tummy and intestines.

As treatment progresses there is a marked decrease in the hyperextension as babies become generally more relaxed.

 

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