Pediatric cholelithiasis and breastfeeding difficulties: A chiropractic case report By Michelle A. Hubbard, MChiro

Objective: Through presenting the case of a 7-week-old the object of this report is (1) to create awareness of the increasing rate of cholelithiasis in the pediatric population, and (2) to outline how chiropractic care assisted in the resolution of breastfeeding difficulties. Design: A case report. Clinical Features: Following a chiropractic health history and physical examination it was identified that the breastfeeding difficulties were a consequence of a combination of issues. The infant was found to have limited left rotation of the neck, a result of upper cervical subluxations and cranial misalignments, and ankyloglossia (tongue-tie). Further investigation via stool analysis, abdominal ultrasound and blood testing led to the diagnosis of fetal cholelithiasis with an underactive gallbladder. Intervention & outcomes: Chiropractic adjustments were implemented to correct the cervical and cranial motion. Mother and child were also placed on daily probiotic supplementation. After one month of weekly chiropractic care the child was found to have normal cervical range of movement. A frenotomy was performed at 10 weeks old. The infant displayed complete resolution of the breastfeeding difficulties. At 11 weeks the infant was placed on 1.2ml Ursofalk ursodeoxycholic acid (bile acid) twice a day and 0.2ml colecalciferol (VitD) daily. This continued for one month. No further treatment was implemented for the cholelithiasis. Conclusion: As primary care practitioners it is essential that chiropractors recognize and understand the pathophysiology of gallbladder disease in the pediatric population. It is possible that the presenting symptoms may be misdiagnosed and therefore lead to inappropriate treatment. In this case a multidisciplinary approach was required to manage the various presentations. Chiropractic care resolved the biomechanical component of the breastfeeding difficulties which occurred concurrently with the cholelithiasis.