About Pediatric Chiropractic

From "Pediatric Chiropractic Care and Your Child"© (Pamphlet)
By:  Elise G. Hewitt, DC, CST, DICCP, Portland Chiropractic Group

 What kinds of pediatric conditions does a chiropractor address?

Colic Chronic ear infections Chronic constipation Headaches Poor sleep Nursing difficulties

Attention deficit disorder Asthma Growing pains Back and neck pain (of course) "Fussy" baby Bed wetting

This does not mean that every child with one of these conditions will respond to chiropractic care. Your chiropractor must first do an examination to determine if your child's condition is related to a spinal or cranial subluxation.

Questions and Answers Regarding Children and Chiropractic

How do I know when my child needs to see a chiropractor?

If your child has one of the conditions here, he or she should be seen by a chiropractor. If you are not sure, call. Your chiropractor will be happy to discuss your child's case on the phone and let you know if a chiropractic examination would be appropriate.

How much care will my child need?

Children respond very quickly to chiropractic care, much more quickly than adults. Often, a child's condition resolves after a couple of visits. Depending on your child's specific condition, he may need more or less care. Your chiropractor will examine your child on the first visit and let you know how much care to anticipate.

Why hasn't my pediatrician recommended chiropractic care?

Pediatricians are not usually taught about chiropractic care in medical school and generally aren't familiar with how chiropractic care works. Ideally, your child should have both a pediatrician and a pediatric chiropractor. Your pediatrician performs annual checkups, provides medications and is there for crisis care when necessary. Your pediatric chiropractor ensures that your child will have a healthy spine and thus a healthy nervous system. The two aspects of care are complementary. If needed, your chiropractor is available to answer your pediatrician's questions and to provide the latest research on pediatric chiropractic care.

Once my child sees a chiropractor, will she have to go for the rest of her life?

No and yes. No, because once your child's original condition is resolved, she is finished with care. Yes, because you may choose to continue with preventative care. Just as your child should see a dentist for the rest of her life to protect her smile, so too your child should see a chiropractor to protect her spine and nervous system.

How soon should my newborn be evaluated?

If your newborn is healthy, your chiropractor would like to examine your infant at age 2-3 weeks to allow mother andJ2...aby time to recover from childbirth. If, however, your child has a specific problem, or even if you "sense" something is wrong, bring your child in immediately. Newborns can be safely adjusted from the day they are born.

Is chiropractic care for children gentle? Is it safe?

Chiropractic care for children is both gentle and safe. The chiropractic profession's safety record is excellent - in over 100 years since chiropractic was founded, there has never been a malpractice case against a chiropractor for hurting a child with adjusting. Chiropractors have a 4-year degree with over 4500 hours of study in subjects including anatomy, physiology, neurology, orthopedics, pediatrics and nutrition. Chiropractic technique is so gentle that infants often fall asleep during their visit!

Articles on Pediatric Chiropractic Care (See below)

1. Adjusting the Newborn
2. The Safety of Chiropractic for Children
3. Chiropractic Care for the Child Athlete
4. Asthma— Gasping for Fresh Air
5. Carrying the Back Pack Issue into the School

Adjusting the Newborn
By: Armand Rossi D.C., F.I.C.P.A.
Originally Printed in: I.C.P.A. Newsletter November/December 1998

Adjusting a newborn infant may be one of the most significant and rewarding events that we get to perform in our offices. It is a shame that so many chiropractors take this event so lightly that they never convey the specialness to the parents or even to themselves. The new parent has given you the ultimate compliment, in allowing you to adjust their newborn. Remember that parents of newborns (especially first time parents) have a tremendous amount of fear involving the care for their child. Many good chiropractic patients will still hesitate to get their newborn adjusted because of the fear of hurting them. Do not blame the parent. This is a normal parental instinct. After all, wouldn't you do anything to protect your child?

Many times this fear is justified. Start thinking like a patient. If I went to a chiropractor who used high velocity osseous techniques on me, and I never got to witness first hand an adjustment on a child, I would be frightened that the adjustment could hurt the child. But, if the chiropractor took the time to give me a demonstration of how the child is adjusted, I would feel more at ease. Use a doll or use pinkie pressure on the arm of the adult to show the amount of force used on an infant. They'll them that the adjustment is so gentle that a sleeping child may not even wake up during the adjustment. If you are a parent, indicate to the patient that you adjust your own children and would not do something to their child that you have not already done to your own.

Perform the adjustment on the newborn with care, respect and love. move your hands slowly and only take the baby from the parent with permission and reverence. We will talk more about techniques in a future article. If the child is awake, look into the eyes of the child and contact the soul of the baby. Communicate on an innate to innate level. many a time I'll literally start to cry as I observe the beauty of this precious soul.

Take a picture of this first adjustment. After all it is a major event in the life of this family. Sending a thank-u-gram to the baby that evening is a way of acknowledging it as a real person. Something like, "Thank you for allowing me the honor of giving you your first chiropractic adjustment. you are special and have very special parents." This is usually one of the first items in the baby book.

Be especially careful to not frighten the child. Things that can frighten a child are: speaking too loudly, walking toward them too fast, moving your hands too quickly, speaking with too deep of a voice, having the parent's reflect their fear on the child, and of course, adjusting too roughly. Once you frighten a child it will take months to regain their trust.
I have observed many chiropractors ruin the relationship with the family by doing exactly what we preach not to do. Their actions tell the parents that we do not consider the baby a real person. We treat the infant cavalierly and with no more compassion than that of holding an inanimate object instead of a tiny piece of God. When the patients know that you care for their child as if it is your own, then you will not only have their loyalty and commitment, but the universe will send you countless numbers of babies. After all, God always protects and loves his children. And he always wants the best for them.

Armand Rossi is a former pediatric instructor at Life University and an instructor in the ICPA Pediatric Chiropractic Certification program. He is in private practice in Margate Florida and has been a member since 1994.

The Safety of Chiropractic for Children

A Researcher’s Perspective

By Dr. Joel Alcantara

Originally published I.C.P.A. Newsletter

March - April 2002

“As chiropractic care for children continues to develop within our profession; organizations with questionable interests continue to attack its safety and efficacy with baseless facts and half-truths.”

The Safety of Pediatric Chiropractic

A survey study examining the practice characteristics and pediatric care of chiropractors(1) in the Boston area estimated that approximately 420,000 pediatric chiropractic visits were made in the Boston metropolitan area alone for 1998. If extrapolated for the rest of the United States and Canada, the number of chiropractic visits to children in one year would be enormous numbering in several million visits. Given this high utilization rate of pediatric chiropractic services in the United States and Canada, statistics should indicate a great number of morbidity and mortality. On the contrary, there exists little evidence of harm to children from chiropractic.

When the Canadian Pediatric Society published their position statement on, “Chiropractic Care for Children: Controversies and Issues,” (2) they addressed the issue of “The Safety of Chiropractic in Paediatrics,” Only one case report of vertebrobasilar occlusion in a seven-year-old was cited. It occurred following gymnastics and repeated chiropractic manipulations of the cervical spine (3). They further readily admit that, “Reports of other paediatric complications are few.”

In Perspective:

Its been estimated that the annual cost of medication-related problems in the United States is approximately $84.6 billion (4,5)
The human impact of non-steroidal anti-inflammatory (i.e., aspirin)–related gastrointestinal deaths have been estimated at rates higher than that found from deaths due to cervical cancer, asthma or malignant melanoma (6)
Medication errors and adverse drug
events are three times higher in children and substantially higher still for neonates (7).
The list could go on...

Chiropractic for Children is Here to Stay.

Millions of children and their families will continue to experience the benefits of this safe and efficacious form of healthcare called chiropractic. Chiropractic researchers are looking into the salutary effects of chiropractic care in children with subluxations and concomitant conditions like ADHD, asthma, colic and others. When two forms of healthcare meet at the crossroads of patient care, there will be controversy.
As a researcher, all I ask is an honest and open dialog about the issues at hand so that all are informed. When a medical doctor questions the chiropractic care for children and not the growing use of stimulants, antidepressants and antipsychotic drugs in children as young as 2-4 years of age (9), then their motives come into question. In future articles, I will discuss the efficacy and safety of Chiropractic care for children in topics from A-Z (i.e., from ADHD to the use of x-rays in chiropractic practice) based on the scientific literature for the benefit of the readers to be informed.

References
1-Lee AC, Li DH, Kemper KJ. Chiropractic care for children. Arch Pediatr Adolesc Med 2000;154:401-407.
2-www.cps.ca/english/index.htm
3-Hondras MA, Linde K, Jones AP. Manual therapy for asthma (Cochrane Review). Cochrane Database Syst Rev 2001;1:CD001002.
4-Johnson JA, Bootman JL. Drug-related morbidity and mortality. A cost-of-illness model. Arch Intern Med 1995;155:1949-1956.
5-Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, Small SD, Sweitzer BJ, Leape LL. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA 1997;277:307-311.
6-Singh G.Gastrointestinal complications of prescription and over-the-counter nonsteroidal anti-inflammatory drugs: a view from the ARAMIS database. Arthritis, Rheumatism, and Aging Medical Information System.Am J Ther. 2000;7:115-121.
7-Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, Goldmann DA. Medication errors and adverse drug events in pediatric inpatients. JAMA 2001;285:2114-2120.
8-Zito JM, Safer DJ, dosReis S, Gardner JF, Boles M, Lynch F.Trends in the prescribing of psychotropic medications to preschoolers. JAMA 2000;23:1025-1030.

Dr. Joel Alcantara has published widely in scientific journals and in the popular chiropractic media and has co-authored several chapters in various chiropractic textbooks. Former instructor at two chiropractic colleges, Dr. Alcantara has accepted the position of Research Director of the Children’s Chiropractic Research Foundation the profession’s first full time organization of its kind. He can be reaced via e-mail at:drj_alcantara@yahoo.com. Read his bio

Chiropractic Care for the Child Athlete
By: Joel Miller D.C., F.I.C.P.A.
Originally Printed in: I.C.P.A. Newsletter September/October 1998

There are some negative opinions in chiropractic regarding contact sports like boxing and football. Some of our colleagues feel these sports should be avoided. Whatever your particular opinion, these sports (pee-wee football, boxing and the like) have been around for decades and are here to stay.

The sports chiropractor should not attempt to replace the medical staff already in place at any level of competition. However, it has been my experience that as chiropractors if we care for the athletes chiropractically and not attempt to interfere with or replace the trainers, medics or EMTS, our acceptance both on and off the field is much greater. Having been a team chiropractor for numerous athletic teams from professional baseball, wrestling, and boxing to the little league football and soccer levels, I'd like to share some information, as well as my experience, as such.

Almost all organized levels of childrens sports have age and weight limitations. In some sports, such as martial arts, events not only have an age and weight requirement but they also have the children categorized (or matched) according to their skill level. Team chiropractors' should be aware of the proper use of safety equipment and proper fit of protective gear like football helmets, pads and sparring gear used in contact sports.

Injuries to children's spines are not unique to contact sports like football or martial arts. They are also seen in non-contact sports like gymnastics and competitive cheerleading. Injuries to the pediatric spine vary according to the specific mechanism of injury. Therefore, the pediatric sports chiropractors knowledge of particular sports is helpful in assessing the care he or she will render.

Specific to the child athletes' spine one should have knowledge of the ossification centers. The primary centers at the vertebrae, or centrum, and the neural arch unite forming the vertebral arch. Fusion of the body with the posterior elements occurs as early as 3-6 years and as late as 16 years. The secondary centers of ossification, consisting of the two vertebral body end plates, the two transverse processes and the spinous process fuse between 14 and 25 years of age. Also the joints of Luschka are not fully formed until age 7. Additionally, some bones, such as the sacrum, do not fuse until well into the second decade of life, and thus may function as individual vertebrae depending on age.

Subluxations, fractures or failure of fusion of secondary ossification centers can result from head impacts as experienced in football or martial arts, or from falling on the child's feet or buttocks as in gymnastics or cheerleading. Development of the normal spinal curves will assist in dissipating compressive forces or loads. However, athletics may induce concussive forces the body cannot adapt to thus resulting in vertebral subluxation complexes.

The common area of injury from a head impact is the mid to lower cervical (C4-C6). The common area of injury from a forces from below, as in falling on the feet or buttocks, is T-9 - L2. Flexion injuries of the spine commonly affect the C4-C6, T5-6 and L1-L2. And one should always check the upper cervical spine.

T. K. Videman, M.D.1 from the University of Helsinki in 1987 found that the slightest hypomobility in diarthrodial joints (facet joints) would cause joint degeneration in 5-7 days, which becomes irreversible in 2-3 weeks. Following 5 weeks of joint fixation, 18 months of care was required for optimal healing which was almost always incomplete. The sooner we as chiropractors can care for the child athlete, and correct his or her subluxation, the less likely they are to have life long patterns of ill health and who better than the chiropractor to care for these little athletes.

Caring for the children during an event should be discussed next. The team chiropractor should be able to assess the athlete's specific needs. Never disregard the need for a comprehensive chiropractic evaluation. And please, no public display of adjusting. (P.D.A.)

Team chiropractors who will spend time working with children athlete should educate themselves regarding specialized training in the field of chiropractic pediatric adjusting techniques. That is not to say adjusting the child with bilateral supine, rotary breaks and lumbar roll both sides as is sometimes done on adults. Rather learn how to adjust children correctly through programs like ICPA's certification program, which Dr. Webster started and we are continuing to promote.

When evaluating a child either on or off the field before applying a chiropractic adjustment, one should be able to objectively evaluate as many components of the vertebral subluxation complex as possible. The sports chiropractor needs to be aware of the functional uniqueness of the child's spine when doing so. For example, the normal range of motion in a child's spine is greater than that of an adult. This is important to know when assessing a child's spine. Also, as a team chiropractor for any sport, and any level, there will come a point in time when you are the only attending health care provider. It would be a good idea to know when you should transport via EMT in emergency situations. My experience is that no one will belittle you if you play it safe. One of our chiropractic colleagues from an opposing team thought he could tape a knee and get the star player back into the game only to learn later that the child had suffered a fractured fibula.

As chiropractors, we must focus on the vertebral subluxations and the dangers of such especially those arising out of sports injuries. We should also educate the players, parents and coaches. Each year I hold a coach's clinic for all the area "Pop Warner" football coaches. This clinic is well attended because we bring in a certified athletic trainer to teach basic training and taping techniques. I also do a chiropractic health orientation and educate coaches and trainers on the cause and the harmful effects of subluxations.

In my presentation, I use the Emmett Smith quote "playing in a football game is like being in 30-40 care accidents" and then I multiply that by the 10 games the kids have each season. I also use this opportunity to show them the benefit of chiropractic care for the athletes, both pre and post game. This clinic is held in my office so the coaches, parents and players have the opportunity to see it first hand.

Whether the children are participating in contact or non-contact sports, a proper chiropractic evaluation by a qualified pediatric chiropractor can keep them in the game and help to minimize if not prevent injuries leading to vertebral subluxations.

Dr. Joel Miller is professor of pediatrics at Life University, School of Chiropractic. He has been an I.C.P.A. member since 1990. Dr. Miller has served as a team chiropractor for the Minnesota Twins, the Boston Red Sox, WWF Wrestling, Florida State University atheltic teams and numerous childrens sports organizations. Dr. Miller is also a member of the I.C.P.A.'s distinguished speakers bureau and conducts seminars for the I.C.P.A.
References:
1. Videman T. Connective tissue and immobilization. Key factors in musculoskeletal degeneration? Clin Orthop 1987 (221)26-32 / Medline ID 87274475

ASTHMA - GASPING FOR FRESH AIR
By: Jeanne Ohm, D.C., F.I.C.P.A.
Originally Printed in: I.C.P.A. Newsletter July/August 1998

According to the Better Health & Medical Network:

"Asthma is a chronic lung disease with inflammation and or obstruction of the airways from the nose and mouth to the lungs.
" 4 million children under the age of 18 suffer with asthma.
" Asthma has increased 46% from 1982-1993 with an 80% growth in children under 18.
" In the 5-17 age group, asthma causes an annual loss of more than 10 million school days per year.
" Asthma accounts for more childhood hospitalizations than any other childhood disease.
" Children with asthma spend approximately 7.3 million days per year restricted to bed rest.
" In 1990, there were 7.1 million physician visits for asthma.
" Health care costs for asthma were estimated to be $6.2 billion, which is almost 1% of the total US health care costs.
" More than 5,200 Americans died from asthma in 1991."

With the above statistics, we can see the seriousness of this condition, and the toll its taking on our children's lives If you have ever seen a child struggle for breath because of asthma, you can agree it is a frightening experience for both the child and observer. The helpless feeling causes parents to seek out treatments to relieve the symptoms and establish a somewhat normal lifestyle for their child. At some point, most parents become uneasy with the constant drug intake and are continuously looking for ways to regain normalcy for their child. As Doctors of Chiropractic our premise leads us to restoring optimal function of the nervous system, resulting in improved function for all body systems. We have all experienced the children coming into our offices who have suffered with chronic asthma for years. Children who then began the process of regeneration with the chiropractic adjustment and are living healthier, drug-free lives. We know what we know, and we live in a society that demands the proof, not just what we see day in and day out. This is what the ICPA is providing to you, its members: research and studies to objectively substantiate what we know to be so.

In the Journal of Vertebral Subluxation Research Vol. 1 No. 4, the ICPA in association with the Michigan Council of Chiropractors published one such study, demonstrating the positive effects of chiropractic care on 81 children with asthma.1 The results of the study concluded chiropractic care is a safe, drug free, health care approach where the patient perceived improved respiration, improved quality of life and less frequent asthma attacks. You would hope that "health care" providers would embrace this study with hope for this debilitating and seemingly non-relenting condition. Children's lives are at stake; this is the primary concern!

As experience has shown us, many medical studies (especially those evaluating new drugs) are often funded by drug manufacturers or other financially interested businesses. Needless to say, these multi-billion dollar pharmaceutical companies do not support research if it doesn't show drugs to be beneficial. This apparent conflict of interest has become so well known that the lead article in JAMA for the week of July 15, 1998 recommends that any financial interests of authors be clearly delineated for its readers. This will allow the readers to draw their own conclusions about conflict of interest in these studies.

So where does that lead us? Once again, folks, it is up to each and every one of us to do our part in our offices, communities and the profession at large, in getting the chiropractic message out to a sick and dying world. Please know, with your support, the ICPA is taking "what we as chiropractors have known all along" and producing the research to support it. Together, we will make it happen!

References:
1 Graham RL; Pistolese RA. An impairment rating analysis of asthmatic children under chiropractic care. J Vertebral Subluxation Res 1997; 1(4): 41-8
2 Krimsky S, Rothenberg LS. Financial interest and its disclosure in scientific publications. JAMA 1998; 280 (3): 225-226
Graham RL; Pistolese RA. An impairment rating analysis of asthmatic children under chiropractic care. J Vertebral Subluxation Res 1997; 1(4): 41-8
2 Krimsky S, Rothenberg LS. Financial interest and its disclosure in scientific publications. JAMA 1998; 280 (3): 225-226

Carrying the Back Pack Issue into the School
By: Jeanne Ohm, D.C., F.I.C.P.A.
Originally Printed in: I.C.P.A. Newsletter November/December 1999

As academic requirements are raised up, so are the amounts of books students are carrying to and from school. Parents, school officials and health care providers have growing concerns with the increased amount of weight being carried each day. According to a recent news article, the issue has taken on serious implications and pediatricians have said that school children should not carry more than 10 % of their own body weight. Dr. Wayne Yankus, of the American Academy of Pediatrics says, "There is a growing concern that youngsters may have long term back problems from trudging about with such heavy loads. It typically puts them off balance and gives them a posture that promotes low back pain. A lot of kids don't suffer it immediately, but over the long run they might."

David Pascoe, a professor and exercise physiologist at Auburn University researched the effects of backpacks on children between the ages of 11 and 13. Two-thirds of the children reported having muscle soreness. He discovered significant differences between the alignment of the spine in children who used both straps and those who carried the bags on one shoulder.

The Consumer Product Safety Commission estimated more than 3,300 children ages 5-14 had been treated in emergency rooms last year for injuries related to book bags. Visiting our local high school, the school nurse confirmed in that particular week alone, two students had visited her office for injuries related to backpacks. One student was complaining about lower back pain, the other had a swollen scaleneus anticus muscle on the side carrying the pack.

With permission from the principle, we went to the high school and randomly weighed students and their packs. We recorded gender, age, and whether or not they carried the packs on one or both shoulders. The ages of the students ranged from 14-17. Our first finding was that female cooperation was less than the males, as they did not want their weight revealed. The males, on the other hand did all they could to press harder onto the scale to increases their weight. Statistically, the female pack weight per body weight was significantly higher than the males, averaging at 16% compared with the male 13 %. This is because the females' packs weighed more than the males' packs (showing a higher level of homework compliance) and the females have a generally smaller body weight than the males . This also gave me the incentive to set up a similar survey in the middle school where the students have a more equalized interest in scholastics and the males' bodies are closer in size to the females.

The majority of the students suggested I come back at the beginning of the week stating that their packs were significantly heavier at the beginning of the week. Almost every student asked if this study would lead to less homework. Many also expressed their parents' concern for the heavy loads and it was apparent that follow-up in the schools with biomechanical safety tips is both necessary and appropriate for students. As chiropractors, we have the knowledge and ability to provide applicable information and solutions for these kids. My suggestion is for us to take the lead on this issue and make a significant difference in the spinal health of the children in your communities.

Jeanne Ohm, DC, FICPA Is in private practice in Media, PA and is Secretary of the ICPA, Inc. Board of Directors. Dr. Ohm is a member of the I.C.P.A.'s Distinguished Speakers Bureau and is available for speaking engagements through the ICPA.