What is the presentation of irritable baby syndrome
- Abrupt onset of symptoms
- Cry is loud and more or less continuous, persistent for several hours at the same time each day, usually late afternoon or early in evening.
- Face sometime becomes flushed with circumoral pallor
- Feet are often cold and fisting of hands
How do babies gain relief from pain?
- Being fed (feeding every 2 hours is typically from pain) (sugar acts as an analgesic)
- Sucking - because of proprioception input
- Settles when held- coz of proprioception input -analgesic effect overriding pain pathway
- Settles with movement
Look for evidence of pain behaviour
Clinical management is finding cause of pain and removing it where possible
What is some advice we can give to mums with sleeping problems
It is important that we get on top of this as sleep problems can lead to complications in mental health and behaviour later in life.
- Work with sleep consultants (someone you can refer to)
- Ensure appropriate settling techniques are used
Consider:
- Appropriate room temp
- Appropriate level of noise- may benefit from continuous white noise
- Article of mothers clothing with infant
- appropriate room lighting
Use contingent music
-Calming music when infant is quiet and relaxed, turned off when infant is irritable or unsettled. May reduce unsettled behaviour by up to 40%. Form of positive feedback.
Avoid rapidly responding to a baby who wakes- or they don’t learn to self settle.
What are some signs and symptoms of a sympathetic dominant infant
What would exam findings be
What is our management?
-Needs to be held all the time
-Seperation anxiety with mother not near
Calms to movement and touch
Reduce sleep time
Wakes more often
Cold hands and feet
Maternal stress levels high during pregnancy >6/10 stress levels
Maternal type A personality
Examination findings:
Increased of spontaneous or persistent Moro reflex
Reduced peripheral circulation -increased capillary refill time of the hands and feet
Dilated poorly responsive pupillary reflexes
Management:
- Kangaroo carrying
- Baby massage
- Subluxation correction
- Increased auditory input (white noise)
What does research say about treating infantile colic?
Conclusion: Spinal manipulation is effective in relieving infantile colic
Strongest evidence for tx of colic was probiotics, particularly lactobacil-us, for breastfed infants.
- weaker but favourable evidence for manual therapy
- there is mixed but unfavourable evidence for use of simethicone
BEST EVIDENCE MANAGEMENT:
- Best available evidence indicates that SMT is the second more successful treatment of uncomplicated colic. (After probiotics)
- Cranio- sacral to ion its own has been shown by 2 trials to be significantly less successful and is not adequate as sole primary tx approach
- Primary to for uncomplicated colic should be SMT/ EMT (extremity manipulative therapy) with cranio-sacral therapy as secondary intervention.
Effects of crying on the infant and the family
Conclusion of studies
Colic and prolonged crying were associated with high maternal depression scores.
Most noteworthy, infantile colic at 2 months of age was associated with high maternal depression scores 4 months later.
What are the issues with early childhood sleeping issues?
Study findings suggest that early childhood sleep problems are differentially associated with later psychopathological symptoms.
Increased risk of emotional disorder, elevated anxiety, mental health difficulties.
EXAM QUESTION
What are the complicated causes of colic?
- Protein allergy
- Carbohydrate intolerance eg lactose
- Gastroesophageal reflux (GER)
- Pyloric Stenosis
- Intussusception
- Coeliac disease
- Urinary tract infection
Protein allergy in infants
Signs? Gastro, skin, respiratory, neurological
Signs:
Gastro: bloating, frequent passage of flats, crying with pulling up of the legs
Skin: Maculopapular rash most commonly on the gave, neck, trunk, buttocks,
Eczema.
Respiratory: Crackles/ wet sounds without obvious dysponea
Wheezing and rhinitis
Snuffly blocked nose
Neurological: disturbed sleep pattern, crying at night.
Exam Question?
What are the current classification of Reactions?
Immediate reactors (are described as reacting within 45 mins) Intermediate reactors (signs develop within 1-24 hours) Late reactors (have signs developing after 24-72 hours) Very late reactors (>72 hours)
Carbohydrate Intolerance (lactose) Clinical presentation
Response from ingestion of sugar lactose
Clinical presentation
-Onset of variability follows bout of gastroenteritis or is due to protein allergy
-presents as abdominal cramps, bloating, chronic diarrhoea (bubbly or frothy) excessive flatulence
-Explosive water diarrhoea is associated with abdominal distension, borborygmi, flatulence, amd am excoriated nappy area
-A syndrome of recurrent, vague, crampy abdominal distention
-school aged and pre-school aged children experience episodic mid- abdominal pain.
-Usually their general health is unaffected, and they may have no obvious temporal relationship of pain or diarrhoea with milk ingestion.
Treatment of Lactose Intolerance
Management
- Adjust subluxation complex
- continue breastfeeding unless there is deomstratable weight loss
- if formula fed change to lactos free formula (non soy lactose free)
- Can add lactase to formula or expressed milk to predigested lactose (takes 24 hours)
Gastro-esophageal reflux (GER)
What is it?
Is characterised by symptoms and complications such as
Physiological GER
-is clinically characterised by episodes of regurgitation and vomiting in an otherwise healthy and well- thriving individual.
- anemia
- esophagitis, with subsequent iron deficiency anemia
- failure to thrive
- apnea
- obstructive airway disease
- aspiration pneumonia, and other effects
What nerve inner ages esophageal motor function?
what clinical issues has been shown to affect the inner action of this nerve?
Vagus
