I’ll never know for sure… but

At school I was typically 2nd in my class or subject.  Right through: very gifted but not a born academic.

I disappeared during phys ed classes if I could.  I never felt safe (let alone comfortable) and sport teams never wanted me on their side.  I am dreamy, slow and uncoordinated.  I love walking and swimming for leisure – in my own way and at my own pace.  My Germanic (or is it Nordic?) genes have made me lanky but no Samson.

I am loved and respected for lots of fine character qualities but my levels of personal and social confidence are not strong.

So far – so good.  We all have our strengths and weaknesses.  Life wasn’t meant to be easy. Every family has a runt (even if I was the first-born).

What I think may be significant about all this is that my four siblings seem to rate more highly in each of academic ability and memory, physical prowess and motor coordination, and social confidence… and that studies have shown that each of these areas is affected by starvation and surgery in early infancy.  Except social confidence, but that’s a story on its own… anxiety.

The physical and mental development of infants who have survived Infantile Hypertrophic Pyloric Stenosis (IHPS) was investigated in an interesting long-term follow-up study reported on back in 1973.

Just over 200 patients treated for IHPS at the Children’s Hospital in Gothenburg between 1922 and 1942 were classified according to the severity of their under-nourishment during their illness.  180 of these former patients later registered for military service, and their height and the intelligence test results were then investigated, and almost all of these were later interviewed.

A significant correlation was found between the adult height and the weight loss and the duration of their starvation in infancy at a constant birth weight.  A numerical but not statistically significant difference was evident in the intelligence adaptability tests between the patients with more severe under-nutrition and those of the same age at the time they entered military service.

The full Report of this study was included in the March 1973 issue of Acta Paediatrica (pp. 125-129).

This Ethiopian baby boy starved for too long before being diagnosed and treated for pyloric stenosis at 3 months

The Abstract of a report in the July 1975  Journal of Pediatrics (pp. 8-15) on the effect of starvation in early infancy on later development is rather brief but nevertheless very revealing.  It states that the researchers chose the starvation resulting from IHPS as their model in this study as it involves a period of brief starvation in early infancy, is unrelated to socio-economic conditions, and is correctable.

A number of specific learning abilities together with the general adjustment of 50 subjects, 5 to 14 years old, who had PS were studied and compared to those of 44 siblings and 50 matched controls.

Learning ability was negatively correlated with the degree of severity of the starvation. Starvation resulting in a reduction of more than 10% of the expected body weight in infancy was associated with poorer learning abilities, especially those involving short-term memory and attention.

My pyloric  stenosis caused a far greater weight loss than 10%, as it often does:  IHPS babies are small and frail, and delay before diagnosis and treatment is to be expected.

The most recent report I have read (again, sadly, only in abstract form) was on the work of four researchers in Sydney (Australia) over a two year period during 2006-2008.  43 infants who had had surgery for IHPS had developmental assessments at 12 months of age and were compared with a control group of 211.

This study found lower than expected developmental scores for infants after surgery for IHPS than for healthy control infants.  The infants with pyloric stenosis scored significantly lower on the cognitive, receptive language, fine motor, and gross motor subscales compared to the control infants.

This team found that their findings raise concerns over the potential impact of IHPS and its surgical treatment.  The Abstract does not mention whether their findings might be caused by the malnutrition and dehydration that accompanies IHPS, by the following surgery or by both.  They recommended further studies should be performed, including continuing developmental review, to determine whether these differences persist and their functional importance.

The full study report may be found in the Journal of Pediatric Surgery, December 2010, pp. 2369-2372.

Comparing my abilities with those of my brother and sisters is of course anecdotal evidence and thus of little or no scientific value.

There are any number of anxious parents on the web looking for explanations of their child’s learning disabilities, physical challenges and social difficulties after starting life with IHPS and early surgery.

While it is impossible to make direct connections, there are some well established correlations.

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One thought on “I’ll never know for sure… but

  1. Pingback: Pyloromyotomy has made progress « Stories from the Survivors of early Surgery

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