Andrea Anderson@aander1987
Anchoring bias nearly killed our son, whose initial diagnosis of reflux carried on through every specialist, each presuming the other had read his test results and therefor must have ruled out other causes. He was even scheduled for a fundoplication surgery to treat his reflux (which was internal and not projectile).
But his test results, a suck and swallow with Gi follow through, done at 3 weeks of age, reported his multiple cardiac defects. But the bottom line said “reflux was prevents and his doctor signed off and filed it in his chart (still paper at that time). He never read the multiple alarming internal report and thus missed by his first doctor, and each subsequent specialists I consulted, begging for help as he was dying in my arms, got worse and worse. The head of pediatric GI medicine at Hermann Hospital in Houston told me to take him off all reflux meds, give him rice cereal and for me to take Prozac.
All this time, our son was dying of a severe coarctation of the aorta, a patent ductus arteriosus, which was the only thing that kept a small supply of blood to his limbs, but it was closing off and dying. His lungs, liver, and abdomen were filled with blood, suffocating his heart from the inside, causing congestive heart failure. He could not eat and breathe at the same time.
It was only me, insisting on getting his entire chart faxed to my kitchen, so I could document his falling on the growth chart to the 3rd percentile, that allowed me to read the test results done with those first tests, which showed numerous cardiac abnormalities and cardiomegaly. His ejection fraction was less than 7, which is barely quivering. His BP to his head was over 200, where to his limbs it was zero.
When I read these reports, sitting at my kitchen table, 5 months later, we rushed him to the children’s hospital, where I was told to take him home and “bring him back if he turned blue or stopped breathing,” because there were no echo techs in the hospital at that time. I refused to leave. When he was finally seen at 7 am, suddenly tens of cardiologists rushed him to the PICU. He was so ill they tried to get the fluid off his body but could not, and surgery had to be undergone even though he was so ill.
His surgery had a 30 minute limit, they finished in 27. Dr. Debakey’s son in law, Dr. Charles Fraser, did the surgery. Our son is now a thriving adult.
But if I had not read his files, if I had given him the Propulsid medication for reflux that killed every baby who had underlying cardiac issues, he would have died within the previous 24 hours.
All this was due to anchoring bias - no one looked past his reflux diagnosis to guess “what else could this be?” Even though he was retracting, grunting on every expiration, sweating out of the top of his head, and various other signs of cardiac failure . If *anyone* had even taken pulses on all four limbs, or BP on each limb, the diagnosis would have been easily made.
Here’s what I learned: many children with underlying cardiac defects will present with reflux, because their G.I. system is not oxygenated.
I share this as a warning to any other clinicians to take reflux seriously and rule out all cardiac issues. We just saved a baby who was sent home with the same diagnosis, but actually had different, but equally severe, cardiac defects. We encouraged the family to pursue cardiac testing, which showed he was also dying of congenital heart defects.
