May 3, 2009

Too Many Clean Diapers

As devices go, babies are pretty basic. They eat. They sleep. They poop.

New parents give so much, so fully. Shouldn't they expect something in return? So maybe it's natural that some parents ascribe to the baby's material productivity some kind of assessment of their parenting prowess.

Ellen was about 4 weeks old when her parents brought her in. They were generous enough to let me hold her and play with her while they told me why they were in my office. She hadn’t pooped in 4 days. Last week, she went 3 days, then several times a day for a few days, and now nothing for 4 days in a row. I was kind of listening to them, but I was having a lot of fun making Ellen smile, which she did easily. I asked them if she was this happy at home. She was happy, ate well, didn’t throw up, slept well, and was nursing like a champ. Her weight gain was perfect.

I told them what I knew at the time. Breastfed babies have unpredictable stooling patterns. Medically, I wouldn’t diagnose her as constipated unless she went at least 5 days. They were pretty amazed by this, and though they didn’t seem worried, I got the impression they weren’t fully satisfied, either.

There were many things that could be done to help the process along. An old remedy is to add sugar syrup (Karo syrup) to a baby’s bottle. Another is to sneak in a little pear juice. Taking advantage of the baby’s autonomic nervous system, a little direct anal stimulation will usually provide an effective reminder (that's why they usually go after getting their temperature taken).

They called me the following day, at 5 days. I tried to be reassuring.

They called me on the morning of day 6 to report that nothing productive had occurred. I called one of the very smart specialists in pediatric gastroenterology at Children’s Hospital Oakland. The specialist chuckled a little and said that he’s seen healthy breastfed babies go a long time.

I didn’t hear from them the next day, so I called to ask about the blessed event. I got a surprising response.

On the insistence of the baby’s grandmother, they reported being fortunate to get an urgent appointment with the grandmother’s chiropractor. He diagnosed the problem as a misalignment of the baby’s coccyx. In an additionally fortunate stroke, he was confident he could realign the baby’s lowermost spine to alleviate this problem. In order to reach the coccyx, which is deeply protected in the center of the pelvis, he put on a glove and pressed directly on the baby’s anal and perianal area.

Sure enough, said the parents, the baby went within an hour. They were told, however, that this alignment procedure was only temporary and the baby had a tendency to sacro-coccygeal subluxation. For this chronic problem, they would have to return once or twice a week for the foreseeable future. Each visit was $100.

They continued to see me for scheduled check-ups. Every few days, Ellen got a realignment. They never again had a problem with constipation.

The astute reader will notice that in the uppermost photograph of the felt-and-velcro skeleton which hangs in my office, a creative anatomist placed the pelvis and thorax upside-down. The sacrum and coccyx are oriented correctly, however. By giving medical experts of varying ages the opportunity to share their expertise, I have access to a valuable consulting resource. It could be argued that the implementation of a 21st-century perspective requires a voice born in the 21st-century. The occasional redesign of the human form is a small price to pay for this cutting-edge knowledge, especially from someone who has just learned to walk.

For the neuroanatomicially curious, the nerves controlling sphincter muscles and thus pooping emerge from the cauda equina tail of the spinal cord at the S3 and S4 segments of the sacrum, above the coccyx. For this reason,
one could live life with a subluxed, broken, deformed, or absent coccyx and poop like a champion. There are champions for this, aren't there? I'm not much of a sports fan so I don't know for sure.

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