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Chiropractic Journal of Australia : CJA September 2012
Chiropractic Journal of Australia Volume 42 Number 3 September 2012 111 JAUNDICE AND CHIROPRACTIC BERNARD · ALCANTARA In the case presented, use of phytotherapy to address the infant’s jaundice following its frst recognition as such was successful but not completely. Some 6 weeks later, it was again recognised that the child exhibited signs of jaundice and diagnosed with breastfeeding jaundice. The child’s jaundice was resolved with a temporary change from breastmilk to bottle-feeding over a 48 hour period only. According to Gartner,17 breastfeeding jaundice is the result of insuffcient caloric intake resulting from maternal and/or infant breastfeeding diffculties that result in increased serum unconjugated bilirubin concentrations. In the case reported, the child had breastfeeding diffculties due to a failure to properly latch. The child received chiropractic care in the frst two weeks and then only after the second episode of medical intervention and resolution of jaundice. Implications of Chiropractic Care By addressing the infant’s problem of failure to adequately latch with his breastfeeding, it is the authors’ professional opinion that chiropractic care resulted in preventing further challenges to the child’s development. The importance of breastfeeding cannot be overstated. Smithers and McIntyre22 summarised the research on breastfeeding [2004-2009] and found that evidence from a large cluster randomised trial demonstrated that breastfeeding is associated with higher intelligence quotient at 6 years of age. Breastfed infants initially grow more slowly than artifcially fed infants, but anthropometrical differences do not persist into childhood, suggesting other factors may have a stronger infuence on anthropometry. Observational studies indicate that cholesterol and blood pressure are moderately lower in adults who were breastfed in infancy. Breastfeeding for 4 months or longer was found to be associated with improved developmental outcomes for children including milestones (i.e., motor development, visual, cognition and memory) that continue well even into adult life. 23-25 As reported in this case report, the child's ability to latch onto his mother's breast improved with chiropractic care. In essence, chiropractic care promoted his ability to breastfeed and as such may play a role in preventing the consequences of breastfeeding diffculties as described above. As further context to the case report presented here, a review of the literature was preformed on the chiropractic care of infants with jaundice as well as breastfeeding diffculties. The authors consulted the databases Index to Chiropractic Literature [1984-2011], MANTIS [1964-2011] and Pubmed [1966-2011] using the search terms “jaundice, “breastfeeding”, “breastmilk”, “breast -nonfeeding jaundice”, “breastmilk jaundice”, “breastfeeding diffculties”, “failure to latch”, “latching” and related words in Boolean combination with “chiropractic”. To the best of the authors’ knowledge, this is the frst reporting in the peer-reviewed literature of the positive impact of chiropractic care in an infant with breastmilk jaundice and/or breast -nonfeeding jaundice. A number of papers address an infant’s diffculty with breastfeeding (i.e., failure or diffculty to latch). Miller and colleagues26 described the circumstances, clinical features, role, and results of chiropractic care of 114 infants who were referred to a chiropractic clinic for failure to adequately breastfeed. The most common age of referral was 1 week (mean age = 3 weeks; age range: 2 days-12 weeks), with the most common physical fndings being cervical posterior joint dysfunction, temporomandibular joint imbalance (36%), and inadequate suck refex (34%). All children showed some improvement with 78% (N = 89) being able to exclusively breast feed after 2 to 5 treatments within a 2-week time period. Valone27 described the biomechanical dysfunction of 25 infants with breastfeeding diffculties relative to 10 infants without breastfeeding difficulties. Valone found that biomechanical dysfunction of the articular or muscular structures involved in suckling will affect the ability to suckle. Valone27 advocated that soft tissue work, cranial therapy and spinal adjustments may have a direct result in improving the infant’s ability to suckle effciently. Holtrop28 described the care of a 6-month-old boy with a 41/2 -month history of aversion to suckling. Chiropractic examination discovered segmental dysfunctions at the C0-C1 and C1-C2 functional spinal unites. The patient was cared for 5 times in a manner similar to the case presented – adjustments to the upper cervical spine and cranial therapy. According to Holtrop, the patient’s suckling intolerance resolved immediately after the frst offce visit and did not return. Sheader29 described the chiropractic care of an infant with symptoms of colic and breastfeeding diffculties. An immediate improvement of the child’s symptoms was observed following the frst adjustment with complete resolution within fve days. A recurrence, with exacerbated presentation, (as reported by the mother) was noted within three hours of the infant receiving his second Hepatitis B vaccine. The patient's response to chiropractic care was not immediate as was the case when the child frst presented for chiropractic care. The infant did not respond well to the chiropractic care during the stress-reaction phase to the vaccine. Once the infant was past this reaction phase, the patient's response to chiropractic care was more easily observed. Hewitt30 presented a case series of two infants with dysfunctional nursing who were able to breastfeed normally following chiropractic care. The first case involved an 8-week-old-girl who was unable to maintain suction while breastfeeding since birth. Chiropractic diagnosis was cranial subluxations. The second infant was a 4-week-old boy unable to suckle effectively since birth. He was diagnosed with spinal and cranial subluxations. Both infants received Diversifed spinal adjusting and/or craniosacral therapy based on the clinical fndings. The 8-week-old-girl was able to nurse normally after receiving 2 chiropractic adjustments over 14 days. The second infant suckled immediately following his frst adjustment and received a total of 4 adjustments in 21 days. Cuhel and Powell31 described the chiropractic care of a twelve day-old male with feeding diffculties from his mother’s right breast. The patient's mother described her son as “fussy” and reported that he was producing excess bowel gas. It was noted that twenty-four hours after delivery, a Depo-Provera injection had been administered to the infant's mother. Chiropractic examination revealed decreased movement of the infant patient’s right atlanto-occipital joint, and a prominent transverse process on the right side of the atlas. Care in the form of a chiropractic adjustment was performed to the atlas vertebrae but with limited success. The patient history was reviewed for a second time. Nutritional supplementation was utilized, and adjustments were
CJA June 2012
CJA December 2012