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The Informed Parent

What’s Up Doc

by John H. Samson, M.D., F.A.A.P.
Published on Mar. 15, 2010
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This is the third report on medical literature review to appear in The Informed Parent. I have been encouraged to do so based on reader response.

I.  COLIC: ALTERED FECAL MICROFLORA AND INCREASED FECAL CALPROTECTIN IN INFANTS WITH COLIC
by J. Marc Rhoads, M.D., et.al.  Journal of Pediatrics, December 2009; V. 155; pg.823-828

The authors looked at the age-old problem of colic and found alteration in the bacterial flora of the intestine which might explain some cases.

COMMENT:   I’m glad to see researchers looking for the diagnosis of this common vexing problem. I’ve never agreed with COLIC as a diagnosis. It is a statement of a symptom complex. To be a diagnosis there must be an etiology. 

The common causes of colic are:

  • Hunger, underfeeding. The infant simply needs more to eat.
  • Aerophagia, air swallowing; i.e., inadequate burping.
  • Lactose intolerance.
  • Cow milk allergy.
  • Soy allergy.
  • Gastro esophageal reflex, with or without observed vomiting,  due to peristaltic dysfunction or intestinal tract malformation.
  • Irritable bowel syndrome.
  • As these authors suggest, altered intestinal flora.

As an involved parent, do not accept the diagnosis of colic unless you are also told the cause of it. These authors may be right, but I’m sure there are multi-causes.

II.  LOW-RISK LUMBAR SKIN STIGMATA IN INFANTS
            THE ROLE OF ULTRASOUND SCREENING
by Liat Ben-Siras, M.D., et.al. Journal of Pediatrics, December 2009; V. 155; pg.864-869

Skin abnormalities in the sacral area of newborns. The authors clearly point out that an ultrasound of the lumbo-sacral area (lower spine) to evaluate for spinal cord abnormalities in infants with simple dimples, asymmetrical buttocks crease or deviation of gluteal fold is sufficient. An MRI is not needed unless a high risk abnormality is seen.

COMMENT:   As an informed parent, if your newborn’s pediatrician tells you imaging of the lower spine is needed because of a finding on the examination, ask if an ultrasound is sufficient or if an MRI is needed. The ultrasound is not only less expensive but does not require the sedation that the MRI might.

The pictures in the article are very helpful (pg. 865). Remember, high risk physical findings in the area mandate an MRI. Your pediatrician can clearly advise you on this.

Next week we will continue with the report on medical literature with an article on whooping cough and another on vitamins.




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