Tetany: Are We Harming Our Children?

Ever since I was younger my sisters have always tried to convince me that I was adopted because I had so many ‘abnormalities’ as they would call it. I have an extremely short tongue that can barely extend over my teeth; two of my toes overlap, and to top it off I developed hand tremors a few weeks after I was born. There are various forms of tremors but the one that I have is called Tetany. Tetany is a condition that can be noted by severe muscle spasms.

My father is a pediatrician and when I was about twelve-years-old he took me to the hospital to have an assortment of tests done to see if these tremors were malignant. I don’t recall which tests were performed, but luckily all of them came back negative. My dad then tried to see if my tremors would get better by putting me on medication that he said would increase my calcium level. I referred to them as ‘horse tranquilizers’ because they were so big, and I had to swallow 5 of these pills everyday. Unfortunately, they proved to be ineffective: my tremors didn’t get better, nor did they get any worse. After weeks of taking the unresponsive pills, my dad finally told me that there was nothing left to do but just learn to control it myself, which is what I have been trying to do for the past few years. Sometimes you can hardly notice it, and other times I can barely lift a cup without spilling some of its contents, causing me to have to use my one hand to steady the other. Though, I have noticed that it is significantly worse if I am under a lot of stress or even if I drink coffee. However, I still don’t fully comprehend what exactly is causing these spasms, and why does it typically onset in newborns.

Tetany is a result of a mineral discrepancy noted by a deficient level of calcium in the body (1). The lack of calcium stimulates the nervous system to release nerves and, as a result, cause occasional spasms (1). These spasms don’t only occur in the hands; in certain mild forms they also affect the toes, and lips (1). Tetany can be lethal when seen in acute forms that are marked by cramps tremors and muscle spasms (1). Tetany can also be a product of Hypocalcemia, which is simply described as an extremely low level of calcium in the blood (3). Some people attribute the cause of tetany not only to the lack of calcium in blood but also to the lack of calcium ions in the fluid outside of cells (extracellular) and the fluid within cells (intracellular) (3).

Ok, so apparently I wasn’t given enough calcium as a baby. I guess this would relatively make sense for the fact that I have 4 older sisters, two of whom are twins, and we are all a year apart. We must have been all competing for that one main source of calcium that we all received – milk. Why is it that out of all five of us, I was the only daughter that developed a case of tetany? Was it my parent’s fault? Maybe I was just always the last one to receive milk and therefore, only got the remnants of what was left. Or maybe my body was rejecting the minerals found in calcium that was taken in by the milk. If this was the case I wonder if the specific type of milk affects the development of tetany, or if milk could even be considered a factor in causing tetany.

In 1996, there was a life-threatening case of hypocalcemia-hyperphosphatemia accompanied with spasms (5). Hyperphospatemia is a disorder resulting from an abnormally high level of phosphate in the blood (mednet4). The patient was only 14 weeks old and it was determined that the spasms had been a result of consuming a soy milk product that was low in calcium and very high in phosphate (5). The doctors believed that this error was due to the parent’s misconception that soy milk had the same amount of nutritional intake as breast milk and cow’s milk formulas (5).

I agree that one must be careful when choosing a certain type of formula, but can we honestly say that all forms of soy milk are incomparable to breast milk and cow’s milk? If this were true then how would we account for those infants who are unable to receive breast milk, or cow’s milk for that matter? With some evidence, scientists could determine which soy milk products could possibly contain just as many nutrients as breast or cow’s milk. The FDA states breast milk is better than formula products because it was produced for humans and it also has the perfect amount of proteins (2). However, they do confirm that infant formula is still a viable direction to choose (2). The FDA cautions what type of formula to choose since soy milk does not contain a sufficient enough protein source as does cow’s milk, and calcium is not obtained as proficiently from soy formulas (2).

The family also maintained a strict vegetarian diet (5). The doctors also concluded that the vegetarian diet was the main cause of these critical spasms (5). I also agree that it would be very dangerous for a newborn to be kept on a vegetarian diet. If this is done the babies aren’t getting any of the other necessary proteins. After the baby’s calcium levels were increased and phosphate levels were lowered, the baby’s body began to stabilize (5). The Doctors made the conclusion that when determining the causes of hypocalcemia, one must also look to the fallacies of nutritional diets that many parents believe and malnutrition (5).

The article in the American Journal of Nursing titled “Cow Versus Mother” presented a likely cause of “unadapted” milk to neonatal tetany. A study was performed to determine if certain types of milk affect the levels of phosphate and calcium levels in comparison to breast milk (6). There were three test goups, each of which were given either breast milk, “unadapted” cow’s milk, or “adapted” cow’s milk (6). The article defines “unadapted” milk as “milk whose mineral composition has not been altered” and “adapted” milk as milk with “modified mineral content” (6). After a trial of six days the group that was breastfed was taken to be the normal rate of calcium intake (6). It was recorded that among the group that was given the “unadapted” milk, 16% had low levels of calcium and 28 % had high levels. All but one of the infants that were given “adapted” milk maintained a normal level of calcium in relation to breast milk (6).

The study then concluded that a probable cause of neonatal tetany is “unadapted” milk (6). They attribute their theory to the idea that “cow’s milk, in contrast to human, is high in phosphorus and thereby tends to produce a state of hyperphosphatemia and hypocalcemia” resulting in a case of tetany (6). The results of the study do prove to be consistent with their hypothesis. However, correlation does not necessarily mean causation. As a result, it would be unwise to state that “unadapted” milk would be the only cause of neonatal tetany. One must look at all the factors that are involved in the development of an infant.

My intentions before I researched the topic of tetany were simply to determine why I was so ‘fortunate’ to have developed it. Throughout my research I gained an insightful perspective. I learned that not only is tetany extremely bothersome, but different forms of it could possibly lead to death. My dad had previously informed me that some newborns remain in the intensive care for weeks and weeks. I have even visited the Intensive Care Unit at the hospital that my dad works at, and to actually see the little babies in the incubation units is truly devastating. I assumed that they must have had some serious desease, but looking back with hindsight I now realize that some of those babies could have had tetany as well as hypocalcemia or hyperphospatemia.

I also learned very important and life-threatening information – parents must be very well informed of nutritional hazards before having a baby in order to prevent disorders such as tetany. If I didn’t already know that calcium is a vital nutrient in our diet, I sure do now. I’m still unsure of what would be the best form of milk to obtain these nutrients. I know there are studies out there that praise the idea of soy milk and other milk for that matter, but how can they really be so sure? In that case, I’m sure with more research it will become much clearer. I have a lot of time before I, personally need this information, but until then, I plan on breastfeeding my future children J

Works Cited

1. “Columbia Encyclopedia” http://www.bartleby.com/65/te/tetany.html

2. U.S. Food and Drug Administration. “Breast Milk of Formula: Making the Right Choice for Your Baby” http://www.fda.gov/fdac/reprints/breastfed.html

3. Medical Definition of tetany http://www.medterms.com/script/main/art.asp?articlekey=13312

4. Medical Definition of hyperphosphatemia http://www.medterms.com/script/main/art.asp?articlekey=3843

5. PubMed. “Hypocalcemic tetany in ‘alternative’ soy milk in the first months of life” http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&db=pubmed&term=hypocalcemic+tetany+in+alternative+soy+milk&tool=fuzzy&ot=hypocalcemica+tetany+in+%27alternative%27+soy+milk

6. American Journal of Nursing. “Cow Versus Mother” http://www.jstor.org/view/0002936x/ap060824/06a00460/1?searchUrl=http%3a//www.jstor.org/search/BasicResults%3fhp%3d25%26si%3d1%26Query%3dtetany%2band%2bmilk&frame=noframe&currentResult=0002936x%2bap060824%2b06a00460%2b1%2c04&userID=a5528899@haverford.edu/01cce4406035a610f983b3ed2&dpi=3&config=jstor