Before a very small baby with an abdominal blockage such as pyloric stenosis is diagnosed and treated, it is actually starving to death. Doctors and emergency departments often take days or even weeks to take the problem seriously. Diagnostic tests may take another day or so. It usually takes at least yet another day to control the dehydration and correct the blood chemistry enough to withstand the drugs and often surgery necessary for a cure.
This is an understandable question which always adds to the immense pressures on the parents of such a desperately sick child. It will take several years for the baby to develop enough to reassure the parents that all is well – or is it? How can we really compare one child with another, even siblings? Surely there are too many variables for us ever to know for sure, even though we may have suspicions.
Having had such very early surgery after a period of total starvation as a newborn baby, it’s natural that I am very much interested in this matter. Research into the effects of early malnutrition on a very young child has been reported on for many years now. But from what I have been able to find, the results are rather unclear but somewhat troubling. They call for more work.
In a 1972 Swedish study over 203 patients treated for infant pyloric stenosis in Gothenburg between 1922 and 1942 were classified according to the severity of the exhaustion caused by their malnutrition. 180 of these people in later years registered for military service, when their height and intelligence test results were investigated, and 176 of these were contacted and interviewed for the study.
A significant relationship was found between the subjects’ adult height and their weight loss and degree of exhaustion during their illness. The difference in the intelligence and adaptability tests between the most severely undernourished patients compared with those of the same age when they entered military service was found to be a very small one, and not statistically significant.
Another finding was that under-nutrition in infancy seemed to be associated with a decreased fertility in men, especially in the siring of girls.
In the July 1975 issue of the Journal of Pediatrics Dr P S Klein reported on a smaller but more comprehensive study. It researched the effects of starvation in infancy on subsequent learning abilities, and because congenital hypertrophic pyloric stenosis (IPS) is relatively common, involves a relatively brief period of starvation in early infancy, is unrelated to socio-economic conditions and is easily correctable, babies diagnosed with this condition were chosen for the study!
A number of particular learning abilities together with the general growth of 50 subjects who had had IPS and were aged between 5 and 14 years, were studied and compared to 44 siblings and 50 matched controls. Learning ability was clearly affected by the degree of severity of the starvation. Starvation that resulted in a reduction of more than 10% of the expected body weight in infancy was found to be linked with poorer learning abilities, especially those involving short-term memory and attention span.
The following study is more reassuring:
From the available published information, the following inferences are warranted.
1. Severe Protein-Energy Malnutrition (PEM) occurring throughout most of the first two years of life in children living in populations where malnutrition is endemic generally results in severe cognitive deficits. In the absence of an appropriate rehabilitation programme or change to a stimulating home environment, this deficit will restrict the chances that the child has of taking advantage of the formal educational system.
2. Severe PEM resulting from a biological disorder (e.g., pyloric stenosis) during the first two years of life in children not exposed to poverty conditions may, but generally does not, leave cognitive deficits that interfere with school learning.
Ernesto Pollitt and Nita Lewis, Nutrition and educational achievement,
Human Nutrition Center, School of Public Health, University of Texas
I have written on this blogsite about my own story and the suspicions I have that malnutrition has affected my intellectual, motor and social development.
I’ll never know, I guess. Besides, there is really nothing that parents and often very little the medical world can do to prevent the short-term effects of a condition that develops to become life-threatening, but develops along a considerable variety of paths, some of them hard to spot at first.
Because I recognise that, I have got on with enjoying a life that despite its shaky start has been very happy and productive. But the facts about infant pyloric stenosis and its diagnosis, immediate and long-term effects and its treatment need to be more widely known! Hence this blogsite.
Finally this time, a test question: How would you answer these two worried mothers?
Question: What, if any, are the long term effects for an infant diagnosed with pyloric stenosis late?
My daughter had pyloric stenosis when she was 10 weeks old. Symptoms began at 2 weeks. She went 8 weeks before I finally took her to the ER. I took her to the doctor 3, even 4 times a week because of projectile vomiting, no bowel movements and her diapers were barely wet. The last visit to the doctor before going to the ER (which was on a Friday) he told me to give her diluted apple juice and that would help her have a bowel movement, and to call him on Tuesday. The surgeons at [the] Children’s Hospital told me that Sunday would have been too late. 2½ days later she was strong enough to have the pyloromyotomy. My daughter is now 13 years old but has learning disabilities in school. At home she doesn’t listen, cusses at dad and throws major tantrums. I’m not talking about the ‘normal’ unruliness of a teenager.
Could this be caused from being malnourished at a very critical developmental stage of life? Anyone ever heard of this condition causing problems later in life?
Question: My son had Pyloric Stenosis, could this hurt his brain development? When he was born, he weighed 6 pounds 4 oz. 5 weeks later he weighed 7 pounds 2 oz. They said that was low for his height. He started to projectile vomit most of his formula at 2½ weeks of age. How badly to you think this could have affected his brain? Do you think he will have to be in Special Education classes?
GreyDoc6 (“a retired paediatrician”) offered an answer that I have sadly come to recognise shows an all-too-common attitude problem of doctors –
I saw lots of patients with pyloric stenosis and most had normal intelligence except one who became dean of a school of law.
Pyloric stenosis affecting the brain may be a cause for mirth for some few, but parents and survivors would love the facts to be more clearly established by research. Parents also love doctors who are not dismissive of patients who have done some homework, especially when the doctors themselves are not “across” the area of that patient’s concern.