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TRANSCRIPT
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Chiropractic Care In
Pediatrics
Series On Chiropractic Care
JASSIN M. JOURIA Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of
educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serve as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology.
ABSTRACT
Although modern medicine offers a wide array of pharmaceutical and
surgical treatments for pain, chiropractic care offers a natural, drug-free
treatment modality that can alleviate pain in many patients. Chiropractic
care has been shown to be successful in children, adults, and older adults,
and for a range of ailments. Although chiropractic care focuses on the spine,
correcting maladjustments can improve a patient’s overall health and
wellbeing and reduce or eliminate many seemingly unrelated conditions.
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Policy Statement
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policies of NurseCe4Less.com and the continuing nursing education
requirements of the American Nurses Credentialing Center's Commission on
Accreditation for registered nurses. It is the policy of NurseCe4Less.com to
ensure objectivity, transparency, and best practice in clinical education for
all continuing nursing education (CNE) activities.
Continuing Education Credit Designation
This educational activity is credited for 3 hours. Nurses may only claim credit
commensurate with the credit awarded for completion of this course activity.
Statement of Learning Need
Health clinicians will find that patients often tend to seek complementary
and alternative remedies or treatments along with or in lieu of conventional
medical care for prevention and healing. Chiropractic care is often sought as
an option for the treatment of certain medical conditions, and clinicians need
to be prepared to answer patients’ questions by understanding the general
chiropractic philosophy and methods of holistic care and healing. As greater
control over their healthcare needs are being sought, complementary and
alternative medicine may be selected by patients over invasive procedures
and prescription medications that may need to be incorporated into patient
treatment planning.
Course Purpose
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To provide clinicians with knowledge of chiropractic medicine as a
complementary and alternative approach to treat a medical condition, to
better understand patient preferences, and to educate patients on options
for treatment.
Target Audience
Advanced Practice Registered Nurses and Registered Nurses
(Interdisciplinary Health Team Members, including Vocational Nurses and
Medical Assistants may obtain a Certificate of Completion)
Course Author & Planning Team Conflict of Interest Disclosures
Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA,
Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures
Acknowledgement of Commercial Support
There is no commercial support for this course.
Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article.
Opportunity to complete a self-assessment of knowledge learned
will be provided at the end of the course. 1. True or False: Parents of children who receive chiropractic care
have reported several improvements in their children’s health and
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behavior as a result of chiropractic treatments, including a better overall behavior and attitude.
a. True b. False
2. Congenital spinal abnormalities are birth defects that affect the
spine
a. and the spinal cord. b. and that develop before a baby is born. c. and that can eventually affect other areas of the body. d. All of the above
3. During embryonic development, the spinal cord begins to form
____________________ after conception along with the initial growth of the neural tube.
a. within a couple of weeks b. during the second trimester c. a couple months d. during the third trimester
4. The ______________ eventually harden through ossification as
it/they become bones and the notochord ultimately forms the intervertebral discs.
a. cartilage b. neural tube c. annulus fibrosus d. somites
5. ______________ is a condition in which a portion of the spinal
cord protrudes through the vertebrae when the neural tube does not close properly during development.
a. Encephalocele b. Spina bifida c. Anencephaly d. Paresthesia
Introduction
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Children can certainly be candidates for chiropractic care and they often
respond well to many of the techniques used in chiropractic medicine.
Children often heal at a faster pace when compared to adults, and the
methods used in chiropractic care of some children have been shown to be
valuable in promoting health by supporting children’s bodies’ abilities to
heal. According to the International Chiropractic Pediatric Association (ICPA),
parents of children who receive chiropractic care have reported several
improvements in their children’s health and behavior as a result of
chiropractic treatments, including improved sleep habits, improved immune
system functioning, and better overall behavior and attitude.45 These results
are commonly reported by parents in addition to the positive support that
chiropractic care clinicians, including for pain relief and symptom control
when illness is present.
Spinal Problems In Utero
Congenital spinal abnormalities are types of birth defects that affect the
spine and that develop before a baby is born. These anomalies can impact
how the spine forms during gestation, which can influence the size and
shape of the vertebrae, their alignment, and the general function of the
spinal cord. Additionally, when spinal problems develop in utero, the person
can eventually have problems in other areas of the body, including the
kidneys or urinary tract, as well as difficulties performing routine activities of
daily living.
During embryonic development, the spinal cord begins to form within a
couple of weeks after conception with the initial growth of the neural tube.
This tube forms around the central structure called the notochord, which is
made up of cartilage and forms a shaft to support the growing embryo. The
neural tube is eventually what will become the central nervous system.
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Small segments called somites start to form on either side of the neural
tube, and these segments will eventually develop into the vertebrae of the
spine. The somites eventually harden through ossification as they become
bones and the notochord ultimately forms the intervertebral discs.
There are various reasons why the spine does not form normally during
development. Neural tube defects are some of the more commonly
understood congenital anomalies involving the spine and they include such
conditions as 1) spina bifida, in which a portion of the spinal cord protrudes
through the vertebrae when the neural tube does not close properly during
development, 2) anencephaly, which happens when a significant portion of
the brain and the skull do not form, and 3) encephalocele, which occurs
when the failed closure of the neural tube causes a sac that contains part of
the brain and the meninges to protrude through an opening at the base of
the skull. Neural tube defects are thought to be related to a combination of
environmental and genetic factors, but women who are pregnant or are even
thinking of becoming pregnant are advised to increase their intake of folic
acid, as it has been shown to reduce the risk of these specific kinds of birth
defects.
Many neural tube defects are severe and in some cases, such as with
anencephaly, are incompatible with life and the infant dies shortly after
birth. However, there are many children who are born with spina bifida who
survive and who thrive with proper care. Severe cases of spina bifida can
cause back deformities and difficulties with mobility; if the condition is
untreated and is serious, the child could suffer from poor mobility and/or
paralysis, and will often have difficulty with bladder control. Milder cases of
spina bifida can be managed through nonsurgical interventions that focus on
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stretching the muscles of the back, improving range of motion, and
supporting daily routines.
Spina bifida occulta is a type of spina bifida in which the neural tube closure
is not obvious; in many cases, the patient may be unaware that the
condition exists. Spina bifida occulta occurs most commonly in the lumbar
region of the spine and it could cause difficulties with walking or moving, as
well as back pain, vertebral disc herniation, and nerve dysfunction.44 This
particular type of spina bifida is often much more common than what is
diagnosed because physical examination does not always reveal the
condition. Some patients may have a hairy nevus on the back at the location
of the defect; however, a large percentage of cases display no signs of the
defect at all. The affected patient can still develop symptoms associated with
spina bifida whether the condition is readily recognized or not.
Although spina bifida occulta is the mildest form of the condition, it can still
cause muscular weakness and bladder dysfunction for some people. At
times, a person may seek medical help for another reason, such as low back
pain, and the spina bifida condition is identified on X-ray. A case report
published in the Journal of Chiropractic Medicine reviewed a case of a 10-
year-old boy who was taken to a chiropractor for care of low back pain after
falling. When the chiropractor performed radiological testing, it was noted
that the child had spina bifida occulta in the lumbar spine, as well as mild
scoliosis. Of note, the authors stated that approximately 20 percent of the
population has spina bifida occulta and most people are actually unaware of
it. Because the condition is so common, many chiropractors are likely to
come across it when treating patients. The child in the case report
underwent chiropractic treatment with instrument-assisted joint mobilization
in the lumbar spine, as well as high-velocity, low amplitude thrust
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manipulation in the same region near the deformity and for treatment of low
back pain. After six treatment sessions, the child’s pain was under control
and there were no unwanted effects on the spina bifida condition.44
To review, chiropractic care will not resolve spina bifida conditions, but when
a patient does seek help for circumstances that cause pain or deformity,
chiropractic care can be administered to control symptoms and to improve
functional abilities so that the patient is able to continue with less pain.
In addition to neural tube defects, other spinal deformities can include
1) abnormal curvature of the spine, such as through congenital scoliosis,
2) misshapen vertebrae, which includes the conditions of butterfly, wedge,
or hemi-shaped vertebrae, and 3) torticollis, or congenital lordosis or
kyphosis. All of these conditions can have significant impacts on an infant’s
ability to live a healthy life after birth, as the spinal abnormalities not only
affect the growth patterns of the infant’s body, but they can also affect other
organ systems and may be related to anomalies associated with organs such
as in the heart, lungs, kidneys, or brain.
Congenital scoliosis is described as the spine having a curvature to the side
instead of its usual vertical structure. It develops in utero when the bones of
the vertebrae fail to form normally in a regular pattern. Children with
congenital scoliosis may also have twisted vertebrae, or the spine may be
turned and bent upon itself, however, the condition is not always apparent
at birth and symptoms may not develop until childhood or adolescence. The
nearby structures of the ribs and the shoulder blades can also be affected.
The child can have problems with other organ systems as well, including
with the heart or kidney problems, or issues with the nerves or the urinary
system.
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With abnormal spinal growth, the child may not reach a full height and the
child’s posture could be stooped. This also puts pressure on the lungs and
respiratory system when the curvature of the spine prevents full lung
expansion; often, breathing difficulties due to decreased lung volume can
develop over time.
A consensus statement regarding early onset scoliosis given by the Growing
Spine Committee categorized congenital scoliosis as a type of early onset
scoliosis, which is considered to be the presentation of the spinal deformity
before the age of 10 years. The Committee also recommended that clinicians
working with children with congenital scoliosis should include radiology
testing of the spine, including X-ray and CT scans during diagnosis, as well
as further testing of the heart and kidneys.40 Treatment recommendations
include bracing, casting, or surgery on the spine, and while manual
manipulation therapies and stretching exercises were not recommended to
correct the condition, they could be used to control some other symptoms
associated with the disability.
Chiropractors who care for patients with congenital scoliosis do not
necessarily advise against braces or surgical treatment of the condition.
However, chiropractic care can be implemented in the time surrounding
these treatments to help the child. This may include spinal manipulations,
stretching, and range-of-motion exercises to strengthen muscle groups as
well as to diminish some of the effects of the condition. The chiropractic care
will not correct the spinal deformity but it could provide enough support that
it might decrease the time needed for braces or casting and it can help with
recovery after surgery.
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Kyphosis is a condition that causes an abnormal rounding of the spine that
produces a hump in the back; on appearance, the child may seem to have a
hunched back. It most often occurs in older adults after years of wear on the
spinal column that leads to compression of the intervertebral discs and
compression fractures. However, kyphosis can also develop in utero to cause
congenital kyphosis. During embryonic development when the spinal column
is coming together, at least one of the intervertebral discs or the vertebrae
themselves form abnormally, causing an irregular curve to the spinal
column, or a failure of the vertebrae to fully separate into distinct bones.
The spine is bowed forward at an angle and as the infant continues to
develop in utero, the angulation worsens with the growth of the spine.
Eventually, the baby is born with a lump on the back and there may be other
problems with different organ systems as well that are not as apparent.41
Lordosis is another spinal anomaly that can develop before birth. It
describes an abnormal curve in the lumbar region of the back, in which the
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lumbar spine curves inward toward the abdomen. In comparison to
kyphosis, which causes a hump on the back, lordosis causes the back to
appear concave as it curves inward. Congenital lordosis also develops during
spinal growth of the embryo when an abnormality in vertebral segmentation
causes the spinal column to grow forward in the lumbar region.42 The
condition may not be readily apparent at birth, or the infant may present
with an abnormal position of the back and hips and decreased movement. If
it is not treated, the child can grow to develop abdominal pain from the
pressure on the spine and can have difficulties walking and growing
normally.
The treatments for congenital kyphosis and lordosis can vary, depending on
the severity of the angle of the defects. In some cases, the physician may
closely observe the child as growth occurs to determine the most
appropriate timing of intervention. When the spinal angle is significant,
though, treatment through surgery is almost always necessary to prevent
further complications and to prevent problems with mobility and pain as the
child continues to develop. A chiropractor can also assist with some
treatments for kyphosis or lordosis.
Many studies have shown that helping patients with these conditions to work
on their posture and to stand up straight have had no impact on the
condition. Spinal adjustments made by chiropractors will not realign the
spine to correct the curvature, but these adjustments could help to control
some of the pain and inflammation of the condition. The chiropractor could
also work with an osteopathic physician to provide techniques that could
decrease some of the damage of the spinal curve as well as to help the
patient to achieve as much functional ability as possible while continuing to
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grow. As another option, chiropractic care could also help with healing
following surgical correction of the condition.
Congenital muscular torticollis is present at birth or can develop during
infancy. The condition is sometimes called wryneck and refers to a
tightening of the sternocleidomastoid muscle on the neck and side of the
head. As this muscle constricts, the infant’s head is drawn to one side in a
tilted position. The infant can also have difficulties with turning the head and
there may be spinal involvement or developmental hip dysplasia. It is
thought that congenital torticollis develops in utero when the infant is turned
or positioned abnormally as he grows in the womb. Prolonged anomalous
positioning causes aberrant muscle development in the neck, and scar tissue
eventually expands in the area, causing the muscle to be tight and
shortened.43
A child with congenital torticollis could eventually develop other problems
with poor range of motion in the head and neck. The child may be unable to
turn the head from side to side and consistently lives with a tilt of the head
in one direction. Infants with torticollis tend to sleep with their heads in the
same position, which can cause the affected side of the head to become
flattened and misshapen. If congenital hip dysplasia is also present, the child
will have difficulty moving the lower part of the body as well and will have
decreased mobility.
The main treatment for torticollis is a non-surgical approach through regular
stretching and positioning exercises. However, if the condition is significant
and the neck angle is severe, the torticollis may need to be treated with
surgery.
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Infants born with torticollis could receive treatment through chiropractic care
to improve flexibility and range of motion of the head and neck. Chiropractic
care of the condition can further prevent other mobility problems and
plagiocephaly if the baby continually sleeps on one side.
A case report published in the Journal of Chiropractic Medicine discussed a
case of a 23-month old child who was born with congenital torticollis and
who had developed abnormal fixation of one eye. The child had an abnormal
tilt of the head to one side, indicative of torticollis, as well as a slight
curvature of the spine, and adduction of the right eye when he was looking
straight ahead. The child underwent spinal manipulative therapy on the
cervical vertebrae, as well as routine massage and stretching exercises for a
period of four weeks. At the end of the sessions, the torticollis was almost
completely resolved and the deviated eye gaze was corrected.39 The
chiropractic care administered in this situation was able to provide enough
stretching to improve range of motion of the head and cervical spine to
resolve the torticollis. The abnormal eye gaze developed as a result of the
tilt of the head over time, but with resolution of the torticollis, the eye gaze
was also repaired.
The above case report is a useful example of a situation in which a child with
a spinal problem can be safely and effectively helped through chiropractic
care. When a health condition is present at birth because of abnormal
development in utero, the child may struggle with the condition for the rest
of his or her life. However, many treatments, including surgical and
pharmacological methods are available to help. Chiropractic care can be
used as part of standard treatment to significantly reduce the time of
healing, and in some cases, it may delay or even replace more invasive
methods of care.
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Spinal Problems During Birth
A birth injury, or birth trauma, is an
injury that harms the infant during the
birthing process. There are various types
of injuries and outcomes that occur as a
result of damage to the infant’s body, and
the extent of damage can range from
very mild circumstances such as head
molding or small abrasions on the scalp
to significant damage that can cause
lifelong disabilities, including intracranial
hemorrhage and nerve paralysis. Birth
trauma most often occurs when there is difficulty with the infant making the
transition through the birth canal, such as when the baby is large for
gestational age or if in the breech or side-lying positions in utero.46
The actual process of birth often involves a caregiver holding the baby’s
head during delivery and assisting with rotation of the body to deliver the
shoulders and the rest of the body. There may be times, though, that
delivery requires extended pulling or twisting to actually deliver the infant’s
body. Sometimes, physicians must use assistive devices through forceps or
vacuum extraction that help with the infant’s delivery; however, these
devices often cause tissue trauma, most often to the baby’s head and back.
A difficult delivery can also cause spinal damage to the infant, which could
cause lifelong health problems. There are some children who are
permanently disabled because of damage sustained during a particularly
difficult delivery. Infants who are positioned abnormally in utero – that is,
positioned in a manner other than the typical head-down position – are more
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likely to have a difficult delivery. Additionally, infants who are breech, face
up, or in any other position besides the standard presentation for delivery
are at highest risk of spinal damage during birth because the delivery
process is much more complicated.
The spine can be damaged when there is too much traction placed on the
baby’s body while emerging through the birth canal. For example, in the
case of a footling breech birth where the legs are first to emerge through the
birth canal, excess traction or pulling on the legs and the length of the body
could cause damage to the baby’s spine. At times, the infant’s head may
also be hyperextended during the birth transition; this position is sometimes
called the stargazer fetus because of the position of the infant’s head facing
up. Unfortunately, attempting to induce vaginal delivery with this form of
fetal presentation places the infant at risk of birth trauma, including spinal
cord injury.
One of the more significant injuries to occur due to birth trauma is spinal
cord injury, in which there is partial or complete split in the spinal cord,
often combined with bleeding. The condition most often occurs when the
infant’s back is stretched or pulled in a longitudinal fashion so that the cord
is stretched beyond its normal capacity. Trauma to the vertebrae which
results in fractures can also damage the cord, although it is rare that the
birth trauma is so extensive that the cord is completely severed.
As mentioned, hyperextension of the head during delivery can also cause
spinal cord damage if the infant’s head is pulled or rotated; this presentation
and subsequent extraction can cause the spinal cord to be damaged or
severed in the neck. Spinal injury due to birth trauma often occurs in the
cervical region of the neck, although it can happen anywhere along the
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spine.46 If the spinal cord is completely severed during delivery, the infant
will suffer paralysis and may have difficulty breathing. An infant with a
complete spinal cord separation can survive, but will live with paralysis and
have a lifelong disability.
An infant may also suffer damage to the vertebrae of the spine during birth,
which may not necessarily harm the spinal cord, but that could cause
misalignment of the spinal column. Traumatic birth syndrome describes a
condition in which an infant sustains damage to the head or spine, including
misalignment of the spinal column, because of the events that happened
during birth.47 Because of the sometimes traumatic nature of infant delivery,
which can involve pulling on the infant’s head, turning the body, or using
assistive devices when the birth is difficult, the infant is at risk of injuries to
the back, including the bones of the spine, the surrounding muscles and
intervertebral discs, and the associated nerves.
A baby may be born with spinal subluxation because of birth trauma, but the
effects may not be immediately seen. Problems with muscle weakness, poor
development, and difficulties with feeding and with sleeping can all develop
as a result of vertebral subluxations that occur during birth. There are some
chiropractors that specifically work with infants who are suffering from the
effects of traumatic birth syndrome, while other clinicians who work with
children may see older infants or children who have been struggling with the
ongoing effects of spinal misalignment that occurred during the birth
process.
A chiropractor who works with very young children and infants should
specialize in the unique needs and treatment of patients in this particular
population. Parents may take their infant to see a chiropractor for help with
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spinal adjustments to correct subluxations, which could potentially resolve
other problems the child may be having as well. Problems due to vertebral
subluxations in infants may manifest in a number of ways, such as through
colic, in which the infant cries inconsolably, sometimes for hours at a time.
Some parents have noted that their child suffers from reflux and excess
spitting up of milk or formula as a result of vertebral subluxations, as well. A
chiropractor who is trained to treat young children can perform spinal
adjustments on babies who have subluxations that occurred during
childbirth.48
A case series published in the Journal of Pediatric, Maternal & Family Health
reported an instance of twin boys, born prematurely, who had suffered birth
trauma that included plagiocephaly (a flattened part of the skull) and
scaphocephaly (a narrowed skull). By the age of seven months, the infants
were having difficulties with breastfeeding, and had long-term reflux and
chronic irritability. The babies underwent 16 weeks of spinal adjustments,
and at the end of the term, their mother reported a complete resolution of
reflux, few problems breastfeeding, a marked reduction in irritability, and
significant improvement in head shape following the plagiocephaly and
scaphocephaly.49
Birth trauma may cause damage to the nerves due to compression or nerve
stretching beyond its normal capacity. The damage can cause weakness and
paralysis of nearby structures. Brachial plexus nerve injury may occur from
excess stretching of the nerve in the upper arm and shoulder while the baby
is being delivered, such as in cases of shoulder dystocia, where there is
difficulty delivering the infant’s shoulders past the mother’s pubic bone after
the head has already been delivered. The brachial plexus is found in the
cervical regions of the neck and the upper portion of the thoracic spine;
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significant manipulation of the baby’s body during delivery can traumatize
this network of nerves. The injury can lead to various forms of palsy,
including Erb’s palsy, which can cause weakness or paralysis and paresthesia
in one arm; or Klumpke palsy, which causes paralysis in the wrist and the
hand.
Horner syndrome is a condition where there is such damage to the nerves
that the child has weakness, paralysis, and facial changes on one side of the
upper body, including small pupil size and ptosis on the affected side.46 The
condition can cause a lifelong disability for the affected child and often has
to be managed with ongoing therapy and rehabilitation to prevent
complications.
In some cases, chiropractic care may be utilized to improve range of motion,
function, and flexibility among infants with nerve damage due to birth
trauma. Adjustments and stretching exercises can improve symptoms and
may restore some strength in the affected areas. Chiropractic manipulation
may also be able to completely restore health and function to normal
capacity for some children. A case of Erb’s palsy that was resolved following
chiropractic manipulation was published in the Journal of Pediatric, Maternal
& Family Health, which referenced a case of a 5-month-old girl who suffered
from Erb’s palsy as a result of obstetric care. The girl had poor range of
motion and limited movement in the right arm. She underwent chiropractic
care for two months, which involved gentle stretching, adjustment, and
manipulation that was modified for her age. After two months, the infant
experienced significantly improved range of motion and resolution of the
palsy.50
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Chiropractic care of infants is specialized to this particular population in that
the chiropractor modifies his or her techniques when working with infants.
An infant’s body is much more fragile when compared to an older child or an
adult; the chiropractor must take into consideration the developmental stage
of the infant as well as the muscle and bone growth present. When making
an adjustment, the chiropractor is gentle and does not use much force at all
when aligning the spine and manipulating the tissues. Instead, tissue
manipulation or spinal adjustment is done by gently moving and stimulating
the muscles and joints.
The infant can also undergo range-of-motion exercises as the chiropractor
gently repositions and rotates the head, back, and extremities. Exercises to
increase flexibility and to stretch the muscles are performed similarly, while
considering the fragile state of the infant’s muscle and joint structures. Many
infants tolerate chiropractic procedures quite well and the experience can be
calming and soothing for them, sometimes promoting relaxation and sleep.
Related Disorders
In addition to the research performed on the benefits of chiropractic care in
utero and on newborn infants, there is evidence that chiropractic medicine
can be beneficial for care of some very common disorders that affect
children. While children often have more rapid healing outcomes when
compared to adults, they are also more likely to develop illnesses that can
be temporarily debilitating, which can weaken their health and prevent them
from going to school or daycare.
When illnesses occur in adults they are less likely to have as significant an
effect as in children. For example, an adult who develops a viral respiratory
infection that manifests as the common cold may feel under the weather and
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may suffer from a sore throat, cough, and nasal congestion. These
symptoms may also occur in a child with a similar illness, but the child may
also have a fever and such fatigue that a need may arise to stay home at
bedrest. The adult with a cold will often continue working and performing
routine activities. Whereas, the child who develops an illness or injury and
receives chiropractic care may shorten the time of illness symptoms and
return to normal activities faster.
Ear Infections
Ear infections are common illnesses seen in young children. They are often
short lived because they can be treated quickly, but there are some children
who have chronic ear infections. Parents of children who suffer from
frequent ear infections may seek alternative forms of treatment or therapy if
the condition is recurring and does not otherwise respond to conventional
treatment through medication. Acute otitis media, typically referred to
simply as an ear infection, occurs when there is an infection in the middle
part of the ear, the pressurized space beyond the tympanic membrane.
Children typically contract ear infections more often than adults; often,
children cannot describe what is wrong or why they are experiencing pain in
the ear. The infection is usually viral or bacterial in origin and may be
treated with antibiotics, although many physicians are now backing away
from frequent antibiotic use for otitis media treatment and are choosing a
wait-and-see approach to allow the infection to resolve on its own.
Ear infections can be very uncomfortable for children. They typically cause
pain in the ear, fever, and a feeling of pressure in the head. There may be
fluid draining from the ear as well. Very young children who develop ear
infections often have difficulties eating and sleeping and are frequently
irritable. Normally, the Eustachian tubes link the nasopharynx to the middle
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ear and are responsible for regulating the pressure in the middle ear and
ensuring that excess fluid does not build up in the space, which could
contribute to ear infections. The Eustachian tubes are very small and can be
easily blocked, particularly in children who suffer from frequent inflammation
or upper respiratory infections that can cause swelling and that can obstruct
the tubes. When the tubes do not drain fluid and air, increased pressure and
fluid in the middle ear increases the risk of infection.
Some children develop chronic ear infections because of consistent fluid
buildup behind the tympanic membrane, necessitating placement of
drainage tubes in the eardrum, which regulate the pressure behind the
membrane and drain fluid out of the middle ear, thereby decreasing the risk
of ear infections. Based on the potential causes of ear infections and
common reasons for their development, chiropractic care may not
necessarily be the first choice of treatment for this condition. However,
many parents take their children to see chiropractors for treatment of
frequent ear infections, and there seems to be a connection between
chiropractic medicine and the resolution of ear infections. As discussed,
chiropractic medicine provides holistic care, so if a child has suffered from
frequent ear infections, the chiropractor is more likely to try to find the root
cause of the condition, rather than prescribing medication right away.
The chiropractor can evaluate what factors in the child’s life may be
contributing to a tendency to develop ear infections, such as whether the
child has frequent upper respiratory infections or allergies, or if a structural
condition exists that would contribute to air or fluid buildup behind the
eardrum.
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Chiropractic medicine affirms that there is a link between subluxations,
particularly those in the cervical region of the neck, and frequent ear
infections in children. These subluxations may have developed very early in
life, even during birth. By managing the subluxations and aligning the spine,
the chiropractor may be able to treat an ear infection. The theory is that
when the cervical vertebrae are aligned properly, it takes pressure off of
some of the nerves in the neck that could be disrupting the work of the
Eustachian tube. By restoring normal nerve function, the Eustachian tube
may drain the fluid from the ear more efficiently and decrease the risk of
infection from fluid buildup.57
Often, when parents bring a child with an ear infection to a pediatrician, they
will receive a prescription for antibiotics for treatment. Unfortunately,
antibiotics are not always effective in treating ear infections; some bacteria
can become resistant to antibiotics over time and when the ear infection is
caused by a virus, antibiotics are not useful anyway. There are also many
children who suffer from chronic ear infections and who go through several
rounds of antibiotic treatments but who still continue to develop them. If
these infections are not well managed, they could lead to significant
complications for the affected child, including hearing loss, speech
difficulties, and the spread of the infection to other structures in the head
and face.
A review by Marom, et al., published in the journal Medicine (Baltimore)
considered the use of several different kinds of complementary and
alternative treatments specifically for otitis media in children. The review
stated that while many parents do seek conventional care for treatment of
ear infections in their children, there is also a growing number of parents
who consider additional treatments, often in conjunction with evidence-
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based medicine. The review looked at the use of spinal manipulation therapy
through chiropractic care on children as treatment for otitis media and
explained the hypothesis of why chiropractic care is often considered as a
treatment for this condition. The theory is that spinal manipulation therapy
produces certain biomechanical changes in the spine that ultimately affect
the sympathetic and parasympathetic nervous systems.
The use of spinal manipulation can have an effect on muscle tension to
decrease muscle rigidity and to promote excess fluid and lymphatic
drainage, thereby reducing fluid buildup in the inner ear. The review found
that chiropractic care could be helpful for some children with recurrent otitis
media and that this type of treatment generally causes few adverse effects
on children. Ultimately, more research about this specific form of treatment
is needed for clarity.58
Despite a lack of scientific research proving the benefits of chiropractic care
on the treatment of ear infections, there are many parents who count on this
method for their children. Just as chiropractic care can improve symptoms of
various conditions related to the musculoskeletal system, it could also be
beneficial in promoting fluid drainage through manipulation of the spine and
the muscles, making it an effective treatment option for some children.
Sore Throats/Colds
Upper respiratory infections, often referred to as colds, are caused by
viruses that infect the upper airways, leading to cough, sore throat,
sneezing, and congestion. Millions of people suffer from colds each year and
because the infection can be caused by a number of different viruses, there
has yet to be a cure discovered for this very common condition. Most upper
respiratory infections are self-limiting, even in children, and they usually
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resolve with rest and routine care. The majority of children who develop
colds have healthy enough immune systems that they are able to fight off
the viral infection and the symptoms tend to resolve in a short time.
There may be some people who are more likely to develop colds and upper
respiratory infections when compared to the general population. Additionally,
some symptoms that appear to be just a cold or minor illness can actually be
a sign of a much more serious situation. For example, a child with a sore
throat, fever, and swollen glands in the neck may have strep throat instead
of a viral respiratory infection. When a child’s sore throat or respiratory
symptoms are related to a bacterial infection or something more serious
than a virus, it typically needs to be managed with medication in addition to
home remedies.
There are many situations where a child with a sore throat or with cold
symptoms can be treated through chiropractic medicine. Chiropractic care
may also help to prevent the onset of some symptoms and related viral
infection. The goal of chiropractic care administered for the treatment of
colds or sore throat is to strengthen the patient’s immune system to better
fight off the viral infection. Chiropractic medicine asserts that this type of
care specifically improves the flow of lymph fluid through its channels, which
ultimately supports the immune system to allow a child to fight off a cold or
infection.
The lymphatic system plays a key role in immune system function. It
contains a system of channels that are somewhat similar to blood vessels in
the circulatory system; these channels transport lymph, which contains a
large number of white blood cells that are designed to fight infection. Lymph
is actually formed when interstitial fluids and blood plasma are emptied into
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the lymph circulation. The fluid is circulated throughout the body and is
filtered when it passes through lymph nodes, which also contain large
numbers of immune system cells. Eventually, lymph enters blood circulation
when it flows into the subclavian vein. Lymph channels have an internal
structure that contains small valves that prevent the lymph fluid from
moving backward. The fluid is propelled through the lymph channels through
the force of smooth muscles as well as skeletal muscles.
The skeletal muscles apply pressure to the lymph channels when they
contract, which plays a key role in the transport of lymph fluid. Because a
significant amount of chiropractic care is focused on elements of the
musculoskeletal system, the adjustment of tissues that affect the skeletal
muscles could then further stimulate the flow of lymph through lymphatic
channels. By utilizing chiropractic care to stimulate muscle contractions, an
individual could potentially increase the flow of fluid through the lymphatic
system, increasing the rate at which the white blood cells within the lymph
fluid are able to respond to an infection or antigen.
It is through the stimulation of muscle contractions that chiropractic care is
thought to work as a technique that can manage cold symptoms or sore
throats in children. The body protects itself against infections by immune
system defenses, so if chiropractic care is able to stimulate the lymphatic
system to increase immune system response, it could potentially treat or
prevent viral infections.
Spinal adjustments made to the neck in children with cold symptoms and
sore throat could also decrease excess pressure on lymph channels and
swollen lymph nodes. By aligning the vertebrae in the neck, the lymph
channels may be unrestricted and free to allow proper lymph flow and an
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appropriate response to support the immune system. A chiropractor may
also perform lymphatic massage, which may restore normal flow of lymph
fluid. Lymphatic massage may also be referred to as lymphatic drainage and
it is often employed in cases where a person has developed lymphedema,
such as following surgery when lymph channels are disrupted and there is
excess fluid accumulation.
Lymphatic massage is done to drain excess fluid and to restore normal
lymphatic flow. It can also be performed on occasion to support the normal
flow of lymph fluid through the lymphatic system, which ensures that the
body is receiving normal amounts of fluid and that the immune system is
functioning properly.
The holistic focus of chiropractic care means that a chiropractor who consults
with a patient suffering from a cold or sore throat may also have other
advice about what measures will treat or prevent future infections. For
example, dietary supplements and the intake of certain vitamins and
minerals is thought to impact the length of symptoms experienced from a
cold and taking herbal supplements may support immune system function to
prevent viral infections. Vitamin C supplementation, while it does not
necessarily prevent cold symptoms, may decrease the duration of cold
symptoms overall.59 A chiropractor may provide information to parents
about diet and lifestyle factors that they can implement with their child that
would help in the treatment or prevention of colds, in addition to performing
spinal adjustments on the child to support physical health.
Colic/Reflux
Some infants suffer from colic, which can be aggravating and upsetting to
parents who cannot otherwise understand how to calm their child. Colic is
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described as a condition in which an infant will cry inconsolably, despite
being well fed and otherwise healthy. Technically, a baby is considered to
have colic when crying for longer than three hours a day, three or more days
a week, for a period of at least three weeks.60 Despite parents’ attempts to
soothe, feed or change the baby, or otherwise meet all of the baby’s needs,
the baby with colic will continue to cry for an unknown reason.
No one really knows what causes colic or why some infants develop the
condition. It is not related to illness or any type of physiological anomaly
that would cause pain or discomfort for the infant to trigger crying. Often,
the infant with colic cries in a way that is loud and distressing, almost as if in
pain, yet there is no source of discomfort. The infant with colic may draw the
legs up toward the body, but the colic is not necessarily associated with
gastrointestinal changes or excess gas buildup in the intestinal tract, except
if the infant swallows a lot of air because of excessive crying. Colic is
fortunately self-limiting and it resolves on its own, but often not before
weary and exhausted parents have tried different treatments or methods to
help their child stop crying.
Parents of infants with colic may be willing to try methods outside of
conventional medicine if it means that the colic resolves sooner. Some
complementary and alternative medicine techniques may play a role in
soothing colic and reducing the length of crying episodes. An article
published in the Italian Journal of Pediatrics considered possible new options
for the treatment of colic, including chiropractic care, as well as dietary
supplements, acupuncture, and behavioral interventions. The review showed
that certain herbal supplements, including lemon balm, fennel, and
chamomile could be reassuring and soothing for the infant and may aid in
reducing abdominal distention from swallowed air. Acupuncture was also
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shown to be a safe and gentle method in reducing the duration of infant
crying episodes, although studies have not specifically shown significant
effects on infants who had acupuncture for crying due to colic. Chiropractic
treatment through spinal manipulation has been shown to reduce duration of
crying with colic, at least when administered on a short-term basis.61
A chiropractor may be able to help relieve some symptoms of colic by
performing a gentle spinal adjustment on the baby’s back. In some cases,
subluxations are present at different areas of the spine, and after
adjustment, the intensity and duration of crying because of colic is reduced
or even eliminated. Spinal disturbances can be present in infants for various
reasons; most often because of birth trauma, even if it is not immediately
apparent. An infant whose body has been pulled or manipulated during birth
could have subluxations in one or more areas of the spine, which could
potentially be related to colic that develops later.62 If a chiropractor performs
a gentle adjustment on these areas to correct the subluxations, the colic
symptoms can be helped.
Chiropractic care of colic is not an option for everyone; in fact, many parents
do not wish to have their child seen by a chiropractor if they do not
understand how the spinal manipulation can affect the baby’s health and
behavior. Many chiropractors do not even know how spinal adjustment to
correct subluxations can resolve colic symptoms, as it is difficult to establish
the cause of the colic itself. However, there have been enough cases of
spinal adjustments performed on babies with colic that clinicians have
discovered often works over time. The problems with colic could be related
to subluxations in the spine, and some children are more likely to have
subluxations in the cervical regions, which, when adjusted, corrects the
symptoms of colic. Subluxations related to colic symptoms are not only
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found in the cervical region, but have also been noted in all areas of the
spine when performing these kinds of treatments.
An article published in Dynamic Chiropractic examined an early study that
evaluated the treatment of colic in infants using chiropractic techniques. The
study involved chiropractic treatment of over 300 infants with colic and
found that 90 percent of the babies showed improvement in colic symptoms
after only three chiropractic treatments.62 The exact mechanisms of why
spinal adjustment can affect colic and can reduce its symptoms remains to
be discovered, and more recent research is needed to support the results of
this early study. Until there is more scientific evidence about the causes of
colic and the connection between spinal adjustment and symptom
resolution, chiropractic care can still be an option for many parents who are
seeking to help their crying babies.
Reflux is another condition that may develop in infants and young children.
It involves food, fluid, and acid back up in the esophagus from the stomach.
In infants, reflux is often manifested as frequent spitting up. While it is
normal for babies to spit up sometimes after eating, reflux causes frequent
vomiting, as well as a cough, with an increased risk of aspiration of stomach
contents into the lungs. Babies who cannot explain their discomfort with
reflux often are irritable and may cry frequently; they may gag and spit
when trying to eat or they might refuse to eat much at all. In older children,
reflux causes pain after eating that is described as heartburn, as well as
frequent burping or vomiting.
Esophageal reflux is typically treated with medication to reduce stomach acid
secretions, although several lifestyle interventions may be included that can
reduce the risk of some episodes, including feeding an infant in an upright
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position, avoiding lying down for a period of time after meals, and in older
children, avoiding foods that are more likely to cause an upset stomach,
such as citrus fruits, chocolate, tomatoes, and greasy or fried foods. Reflux
often occurs because of an issue with the lower esophageal sphincter (LES),
which separates the esophagus from the stomach. Normally, it is closed
tightly, opening briefly to allow swallowed food to pass into the stomach and
then closing again to prevent backflow of stomach acid. When the LES is
weakened, it may not close tightly and acid is therefore more likely to reflux
and cause heartburn and vomiting.
Gastroesophageal reflux disease (GERD) is a more severe form of chronic
reflux, in which the child experiences frequent reflux, coughing, vomiting,
wheezing, and problems with eating and sleeping. Children with GERD often
need medication to control the problem and sometimes, surgery is
warranted through fundoplication, which wraps part of the stomach around
the base of the esophagus to prevent further reflux and damage to the
esophageal tissue. Both acid reflux and GERD can lead to further problems in
children because they can affect growth and development and can cause
nutritional deficiencies.
Beyond standard treatments through medication, some parents may
consider chiropractic therapy as treatment of reflux and GERD. Chiropractic
care may be implemented in combination with other types of treatment, but
some parents turn to chiropractic medicine when other forms of treatment
have not helped. Chiropractic medicine techniques may reduce some
symptoms of reflux by decreasing backflow of stomach acid into the
esophagus and it could help to prevent future reflux episodes.
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Because GERD and reflux are thought to be caused in part by problems with
the esophageal sphincter, chiropractic care often focuses on making spinal
adjustments that can affect this issue and provide better control. Spinal
manipulation therapy may reduce irritation on the nerves that affect the LES
and the muscles that control how the stomach churns and agitates food
during digestion. It is thought that when subluxations are present in the
spine, they can irritate the nerves connected to the stomach and esophagus,
which can decrease the transit of food through the stomach during digestion
and can affect stomach acid production. Resolution of these subluxations,
which are typically thought to occur in the thoracic area of the spinal
column, may reduce pressure on the nerves connected to the stomach and
esophagus and could therefore lead to partial or complete resolution of
reflux.67
A literature review by Angus, et al., in the Journal of the Canadian
Chiropractic Association found that chiropractic therapy through spinal
manipulation, craniosacral therapy, and soft tissue modalities has controlled
symptoms of GERD in pediatric patients as outlined in some clinical studies.
The effects of the chiropractic therapies on the patients with GERD resulted
in decreased severity and frequency of symptoms, as well as a decrease in
overall irritability and sleep difficulties.64 A further study published in the
International Journal of Medical Research & Health Sciences also showed a
reduction in GERD symptoms among patients who underwent chiropractic
care that involved kinesiology taping as well as certain exercises and the
addition of medications to control reflux.65 Kinesiology taping involves the
application of a type of tape to certain points on the body; the tape lifts the
skin slightly to promote lymphatic drainage, to decrease inflammation, and
to alleviate discomfort.66 The study evaluated the use of taping in a pediatric
patient with reflux and indigestion in order to improve and correct stomach
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position and to stimulate a proprioceptive response in the skin of the
abdomen above where the reflux was occurring.65
Parents of children who suffer from reflux may try conventional forms of
treatment for this condition, but they have alternatives when they seek
chiropractic care. The chiropractor can not only perform adjustments that
can benefit the nerves in the stomach and esophagus that are contributing
to the reflux, but can offer many other practical recommendations that will
reduce symptoms as well. The chiropractic treatment of reflux is often
successful when used in combination with conventional treatment and may
reduce the amount of time that the child suffers from reflux symptoms.
Asthma
Asthma is a chronic disease that can develop in childhood or even infancy. It
affects the bronchioles so that they become inflamed and constricted, often
in response to environmental triggers. A child with asthma has airways that
are sensitive to certain elements that can be irritating to the tissue. When
coming into contact with these elements, the child’s airway becomes
inflamed and can swell, causing constriction and ultimately decreasing air
movement into and out of the lungs. There may be increased mucus
production as well, which can cause further difficulties with breathing
because of obstruction.
Asthma symptoms are typically not manifested on a continuous basis; rather
they occur in episodes or asthma attacks following a trigger. An asthma
attack causes significant coughing and difficulty breathing. The child may
wheeze while trying to breathe and may use accessory muscles of the chest.
Other symptoms include nasal flaring, activity intolerance, and fatigue.
Asthma is a very serious chronic condition of childhood. Although there are
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adults with asthma, the condition seems to be prominent in children, with
approximately 6 million kids in the U.S. having been diagnosed.63 Asthma
can lead to further complications in which a child needs to be hospitalized
periodically for treatment, and it can also increase the risk of the child
developing pneumonia, pneumothorax from excessive coughing and
wheezing, and even respiratory failure.
Asthma is closely associated with allergies in children, and the condition
seems to run in families as well.63 Products in the environment that cause
allergy symptoms may also act as triggers for asthma attacks, including
pollen, hay, grass, dust mites, pet dander, or mold. Other stimulants, such
as cigarette smoke and air pollution can also act as triggers for asthma
attacks. Some children have exercise-induced asthma in which they develop
bronchospasm during or after exercising. Often, the condition occurs
because the individual must breathe harder and more rapidly when
exercising, which can lead to bronchospasm and constriction.
Asthma must be managed carefully to prevent very severe complications
that could develop during an asthma attack. Often, the most successful
methods of controlling asthma are to learn what elements trigger symptoms
and avoid those items. For some children, though, avoidance of all triggers
is not possible, particularly when there are several items that can cause
reactions. In some cases, daily treatment with long-term control medication
can be used to prevent attacks from occurring in the first place, and a child
may then also use an asthma inhaler during times of an attack. The daily
control medication contains drugs that reduce the impact of environmental
triggers and that prevent asthma attacks from occurring; these drugs often
include theophylline or corticosteroids. The inhaler acts as an emergency
relief medication for when bronchospasm occurs, and it typically contains
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medications that act on the beta receptors in the airways to prevent
constriction and to increase airflow to restore normal breathing.
Chiropractic treatments may also be utilized to manage asthma in some
children. A chiropractor may perform a spinal adjustment on a child with
asthma, as the effects of spinal manipulation can benefit the lung tissue and
the airways. If areas of the spine are compressing the nerves that innervate
the airways and the lungs, the adjustment of the spine to reduce pressure
on these nerves can then resolve some effects on the respiratory system.
For instance, the diaphragm plays a significant role in the respiratory system
and in support of breathing; when the diaphragm contracts, the lungs
expand to take in air in response. The phrenic nerve, which controls the
diaphragm, is located in the cervical region of the spine, at the levels of C3
to C5. If a child has subluxation in the cervical spine, it could put pressure
on these nerves and cause irritation, which might affect the work of the
diaphragm as well as how well the child is able to breathe. The nerves in and
around the spine also affect many other muscles that contribute to normal
breathing, including the intercostal muscles, as well as accessory muscles
such as the sternocleidomastoid, trapezius, and pectoralis muscles.
When the spine is aligned after the work of a chiropractor, the person is
more likely able to have fewer restrictions in the airway and a greater ability
to take full, deep breaths. Spinal alignment can support proper positioning of
the rest of the body so that even if the person develops breathing
difficulties, such as with an asthma attack, the back muscles and chest may
be stronger and may allow for full lung expansion and deeper breathing to
allow for better air flow.
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A review by Lago, et al., in the Manual Therapy, Posturology, and
Rehabilitation Journal evaluated the literature related to chiropractic care
and osteopathic techniques in the treatment of asthma. The review stated
that manual manipulation techniques act on the nerves that innervate the
lung tissue and the diaphragm and that when spinal dysfunction is present,
it can irritate these nerves, causing a multitude of problems, including
decreased chest wall functioning, poor airway tone, and an increased risk of
airway inflammation. The review showed that in the literature, there have
been several published studies that have shown that spinal manipulation can
be successful as adjunct therapy in the treatment of asthma. While the
results have not shown that chiropractic spinal manipulation positively
improves lung function as demonstrated through lung function testing, the
use of chiropractic medicine is beneficial as a supplemental treatment and it
may reduce the need for other standard forms of treatment, such as by
decreased use of emergency inhalers or a reduced dose of daily control
medications for asthma.68
Because asthma is so commonly associated with allergies seen in children,
the two conditions may be treated simultaneously through chiropractic
medicine. Some parents of children with allergies may bring their children to
chiropractors for help in reducing allergic responses. Because of the impact
that chiropractic adjustments can have on both the immune system and the
muscles and nerves associated with the respiratory system, it is possible
that spinal manipulation and correction of subluxations could help some
children who also suffer from allergies. The adjustments made in the spine
and the manipulation of skeletal muscles that occur with chiropractic
treatments can improve lymph flow and subsequently support the immune
system, which could then be more effective in protecting a child from allergic
reactions.
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Unfortunately, there is limited research about the established effects of
chiropractic care in the management and prevention of allergies in children,
but many parents believe in the success of chiropractic care as treatment for
this condition, in addition to the treatment of asthma and other illnesses
affecting the respiratory system.
Scoliosis
As previously discussed, scoliosis is a condition affecting the spine that
causes abnormal twisting or curvature of the vertebrae in the spinal column.
Scoliosis can be a congenital condition that is present at birth but the effects
of the condition often do not appear until the child grows and becomes more
mobile. Idiopathic scoliosis is more commonly seen during adolescence; it
often develops as a child’s spine grows and changes shape during adolescent
development. As the name implies, there is no particular reason why some
children develop idiopathic scoliosis and why the spine curves and bends as
it grows. The condition does seem to run in families and it tends to be more
common in girls.
Another form of scoliosis that may affect older adults is degenerative
scoliosis, which develops in adults who had scoliosis that was treated when
they were younger, or in some people who have abnormal amounts of spinal
deterioration with aging. Consequently, a child with scoliosis may also be at
greater risk of developing degenerative scoliosis later in life. As the bones of
the spine degenerate, some areas may collapse onto themselves in a
manner similar to compression fractures. The spine can become curved and
bowed outward, further increasing pressure on the intervertebral discs and
the bones of the spine. There are also other, rarer forms of scoliosis that are
often associated with chronic illness, such as neurodegenerative scoliosis,
which can occur with conditions such as cerebral palsy; and, syndromic
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scoliosis, which is more likely to occur in people who were born with genetic
syndromes.
Scoliosis is often identified in children and teens when parents note a
problem with their child’s mobility or the appearance of the spine. Scoliosis
screenings are also often performed in schools and with routine well-child
checks in physician’s offices. The severity of the condition depends on the
area of the back that is involved and the extent of the curvature, however, if
it can be caught early, it may be treated through less-invasive measures to
prevent further curvature of the spine, such as through chiropractic
medicine. Chiropractic care uses non-invasive techniques through spinal
alignment and suggestions for lifestyle modifications that may help to
prevent the condition from worsening if it is caught early on.
Without appropriate treatment of scoliosis, it can worsen as the child grows,
causing deformity and difficulties with normal functioning. It is important to
correct the condition as soon as it is discovered in a child. Chiropractic
adjustments on the spine could help to control the curvature of the spine
and prevent it from worsening as the child grows. If a child is seen for
chiropractic care who already has advanced scoliosis, spinal adjustments will
not reset the vertebrae into normal alignment so that they grow correctly.
Spinal adjustments can, however, reduce some of the effects of scoliosis,
and can help the child to live well and function in spite of the deformity, and
as an adjunct to other types of treatment, including back braces or surgery.
Most of the time, scoliosis does not cause pain in affected children, but for
some, the curve in the spine can put pressure on nearby muscles and
ligaments; the intervertebral discs may also bear excess pressure from the
bones of the vertebrae. It may be possible that children who experience
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back pain because of scoliosis can benefit from chiropractic care because of
the effects on the musculoskeletal system that this type of treatment offers.
For instance, if a person is suffering from muscle pain due to spine curvature
or deformity, manipulation of the spine will not reduce the curve but it could
take some pressure off of the back muscles that are contributing to the pain.
Spinal manipulation does not cure scoliosis and will not work in the same
method as a back brace or surgery. It can, however, realign the vertebrae
and correct subluxations that are otherwise irritating the nerves and
contributing to discomfort. Through this technique, the child may have less
pain from scoliosis and the process could reduce the amount of time the
child must spend undergoing conventional scoliosis treatments, such as by
decreasing time spent in a back brace or reducing the need for surgery.
A study by Morningstar, et al., in the journal Clinics and Practice looked at
the effects of chiropractic rehabilitation on patients who had been diagnosed
with adolescent idiopathic scoliosis. Because teens who have scoliosis are
still in stages of development to where their spines have not finished
growing, the authors of the study not only evaluated the subjects while they
went through cardiac rehabilitation, but they also continued to follow the
patients until they reached skeletal maturity. The study showed that 90
percent of the patients who had chiropractic care and idiopathic scoliosis
achieved some amount of spinal angle correction when they were later
evaluated at spinal maturity. The subjects in the study did not use spinal
braces to correct their scoliosis. The average amount of correction of spinal
angle was 12.75°.69 While more studies need to be conducted about the
effects of chiropractic manipulation to achieve even greater angle correction,
even some amount of spinal angle correction can be helpful for affected
patients and it prevents further progression of the spine into a scoliosis
curve. With this in mind, chiropractic care can be very beneficial in helping
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children and teens diagnosed with scoliosis when used in addition to
conventional forms of treatment.
It should be noted that scoliosis treatment solely through chiropractic care is
controversial and that some patients have described adverse effects of
chiropractic care when they underwent treatment for their scoliosis,
including muscle pain and generally feeling worse after receiving treatment.
Chiropractic care is not necessarily the right choice for everyone, and many
people who utilize chiropractic medicine report only mild side effects. In
general, people should continue to use chiropractic care when they do
experience physical benefits from the techniques, particularly when it is in
combination with other standard forms of treatment.70
Headaches
Headaches are a common malady for most people, and they are no
exception for children. There are some children who suffer from headaches,
and in some cases, the pain may be common and recurring. Up to 51
percent of children under age 7 experience headaches, with the numbers
rising to 57 - 82 percent by the age of fifteen.73 Children can develop tension
headaches from stress and they may develop migraine headaches as well,
which can be very painful. Most headaches that develop in children are self-
limiting and are not related to a chronic condition; instead, they may
develop when an acute illness is present, such as with an upper respiratory
infection or influenza. They can also occur because of a variety of reasons
related to environmental stimuli or simply life stressors, including due to lack
of sleep, exposure to loud noises or strong scents, taking certain
medications, or eating particular foods.
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Children feel the pain of headaches in ways that are similar to adults. They
may have pain in any area of the head, as well as in the face or neck. The
pain may be worsened by exposure to bright lights or loud noises and some
children feel better with rest and by limiting activity. The pain of a headache
can also be severe enough that it causes nausea and vomiting, nasal
congestion, and watery eyes; these symptoms are more closely associated
with migraines. Kids who get headaches can often report to their parents
many of their symptoms and explain how they are feeling, although very
young children who are not able to explain themselves may be fussy and
irritable because of the pain.
Chiropractic care of headaches involves an initial consultation to try to
determine the cause of the problem and if there is another issue present
that may be contributing. The chiropractor should speak with the parents
about the child’s regular activities and what changes, if any, that have
occurred that may be associated with the headaches. Other areas of
discussion related to the patient’s medical history and physical examination
might include talking about 1) the child’s diet, 2) how he or she relates to
other family members and friends, 3) if there are any particular life
stressors, 4) the level of sports or other activities that could cause head
trauma, 5) whether medications or supplements are taken, and 6) if there is
any family history of headaches. The chiropractor may also perform some
imaging studies to be certain that the headaches are not caused by a more
serious health issue.
Parents often treat their child’s headaches with over-the-counter
medications that are specified for pediatric use, such as acetaminophen or
ibuprofen. Other measures, such as lying down in a quiet and dark room or
putting a cool cloth on the forehead can also help to control some of the pain
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of a headache. A child who struggles with recurring headaches to the point
that it affects activities and schoolwork should be seen by a physician. If a
parent seeks chiropractic care for help with a child’s headaches, it may be as
a sole treatment or it may be in conjunction with conventional treatment.
As with adults, chiropractors can manage headache pain in children through
gentle spinal adjustments and by promoting lifestyle modifications that can
prevent further headaches. Chiropractic care affirms that a significant
number of headaches in children are related to vertebral subluxations that
most commonly occur in the cervical spine. The subluxations could be
present unknowingly for years and could have developed because of birth
trauma or another injury for the child that did not immediately manifest
itself. Chronic stress could also be a cause of vertebral subluxations and the
child with significant life stressors may be more likely to develop
subluxations and consequent headaches.71
Some children may suffer from cervicogenic headaches, which are
headaches that occur as a result of pain or trauma to an area of the neck.
These headaches are often confused with migraines, as the pain and
symptoms can be similar. The cervical spine contains the cervical vertebrae
as well as cervical nerve roots that are connected to the spinal cord and that
extend away from it to control movement, sensation, and various other
activities in the upper body. For instance, the cervical root nerves extending
from C4 are important for controlling the diaphragm for breathing. The
spinal roots located in the upper cervical vertebrae (C1, C2, and C3) affect
the diaphragm to control breathing and they also control movement and
sensation of the head.
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When the cervical nerve roots are irritated, it can send pain messages to the
brain that are manifested as a headache.72 It is thought that chiropractic
manipulation of the cervical vertebrae and treatment of subluxations in this
area can relieve some pressure on the cervical nerve roots, decrease
irritation, and relieve headache pain. A case report published in The Journal
of Headache and Pain reported that there is supportive evidence for the use
of spinal manipulation therapy in the treatment of cervicogenic headache
pain in children. The report described a situation of a 6-year-old child who
had suffered from chronic headaches for two years, but no physiological
cause had ever been identified. The child was treated with high velocity, low-
amplitude thrust spinal manipulation therapy for two months.73
The nerves in the neck and back are linked so intricately with the spinal
column that changes in movement or improper positioning can negatively
impact how they influence other body areas. The nerves are very sensitive
and so when they become irritated, they can cause significant pain and other
symptoms of muscle weakness or paresthesia. It is important to understand
that some headaches are truly caused by irritation of the nerve roots in the
spinal column and can be managed by aligning the vertebrae nearby.
Some children develop tension headaches, which often are manifested as
muscle spasms in the neck and at the base of the skull. The rectus capitis
posterior minor is a small muscle located at the base of the head, just under
the occipital region of the skull. It is attached to the C1 and C2 vertebrae at
the very top of the spinal column. This muscle plays a role in proprioception,
which is the awareness of the body’s position within a space; it also helps to
support the head and supports the movement of the neck. Although it is
small, when this muscle is injured or has spasms, it can cause pain and
disability in the affected person. If subluxations develop high in the spinal
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column, in the C1 or C2 region of the cervical vertebrae, it not only irritates
the nerve roots found there, but the muscles in the region may also spasm,
including the rectus capitis posterior minor muscle. The muscle is also
connected to the dura mater, which acts as a covering to the brain and is
very sensitive to pain. Consequently, with the spasm of this muscle, the
affected person can feel headache pain.74 Correction of subluxations in the
cervical vertebrae may reduce muscle spasms that can contribute to this
type of headache pain.
Chiropractic care may also involve trigger point therapy for the reduction
and relief of headache pain. Trigger points are areas that, when stimulated,
can trigger pain in nearby regions in the body. For example, with a
cervicogenic headache, the neck contains areas that are trigger points in
that if they are irritated or aggravated in some manner, they can cause pain
in other areas, often the head. Trigger point therapy is a type of massage
that locates the areas that are irritated and that are causing pain and then
massages them to release them and loosen any constricted areas. A
chiropractor may identify trigger point areas when examining a child even
prior to starting actual therapeutic massage.
Studies have shown that people who suffer from tension headaches have
increased incidences of tenderness in trigger points in the muscles around
the head and neck. A study by Moraska, et al., in the Clinical Journal of Pain
found that patients with tension-type headache pain who underwent trigger
point therapy reported greater improvement in pain. The study explained
that trigger point therapy is an important component of treatment for
tension headache pain.75 It is a non-invasive method of identifying those
areas that are significantly contributing to a patient’s pain and then releasing
the tension to improve the patient’s headache pain.
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A chiropractor may perform trigger point therapy on a child with headaches
by addressing trigger points located in the neck and shoulders that could be
contributing to headache pain. Some major muscle groups in these areas,
including the sternocleidomastoid muscle and the trapezius muscles can
become tight and constricted, particularly with increased stress and tension.
The chiropractor may identify these or other muscles in the neck, shoulders,
and at the base of the head where the muscles are very tight and
constricted. This is done through gentle probing to avoid further irritation of
the muscle tissue. Once identified, the chiropractor may then lightly
massage the muscles and underlying connective tissue to reduce or
eliminate the referred pain. This trigger point therapy, when combined with
spinal adjustment or used independently as part of patient care, can make a
big difference in helping a child who struggles with frequent headaches.
Bedwetting And Constipation
Most children are able to control their urination through toilet training by the
time they are five years old, though some kids continue to have difficulty
with bedwetting at night while asleep. Nocturnal enuresis is the technical
term for bedwetting, which describes an involuntary release of urine at night
while asleep. The term is defined for those children who are otherwise able
to control urination while awake and who have been toilet trained. Normally,
while awake, a child can sense the feeling of a full bladder and then use the
bathroom to urinate. Nocturnal enuresis is present in up to 20 percent of 5-
year-old children, 5 percent of 10-year-old children, and approximately 1
percent of 15-year-old teens.78
For a child with nocturnal enuresis, there is an inability to control the release
of urine, either because the child is sleeping so deeply that he does not
perceive a full bladder, or due to other factors, such as decreased
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vasopressin hormone, which normally decreases urine production, or chronic
illness, including diabetes or spinal cord injury.76 Bedwetting can be
embarrassing and problematic for affected children. Kids who struggle with
chronic bedwetting often need to manage their diet and fluid intake in the
evening before going to bed to reduce the chance of enuresis. Prescription
desmopressin increases anti-diuretic hormone levels, which then decrease
the amount of urine produced at night to reduce the chance of
unmanageable urine release. Some children benefit from using bedwetting
alarms as well, which react when bedding becomes damp to allow the child
to get up and use the bathroom.
Children who have difficulties with bedwetting can benefit from a physical
evaluation from a physician to determine if there is a structural problem that
is causing the issue. A chiropractor may also utilize imaging studies to check
the structure of the child’s genitourinary system, as well as perform a
laboratory analysis to check for hormones that may be deficient, such as
anti-diuretic hormone. Often, an older child with this issue may also feel
embarrassed and isolated when the bedwetting prevents overnight outings
or sleepovers. The child may feel stigmatized and self-conscious by being
required to routinely clean up soiled bedding or wear disposable
undergarments to bed at night. Discussion of the problem and its
consequences before and after chiropractic treatments can help the affected
child feel understood.
Problems with bedwetting could be related to subluxations that have
developed in the cervical spine or in the lumbar region of the spinal column.
When the vertebrae in the neck are out of alignment, it may affect the
phrenic nerve, which is located at levels C3 through C5. The phrenic reflex is
triggered when there is an increase in carbon dioxide in the bloodstream,
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which could occur during a period of very deep sleep. Increased serum
carbon dioxide causes smooth muscles to relax, including the smooth
muscles that control bladder tone and that retain urine. The relaxation of
these muscles leads to an involuntary release of urine. Normally, this reflex
develops as kids mature and are able to control their urine, but some
children are slower than others. Subluxation in the cervical spine that
compresses or irritates the phrenic nerve could also affect this reflex,
leading to increased instances of bedwetting.77
Some children also develop subluxations in the lumbar or sacral regions of
the spine, which could also contribute to nocturnal enuresis. Several nerves
in the lower back, including the pelvic nerve, pudendal, and hypogastric
nerves, play roles in communicating with the brain the need to urinate as
well as controlling the sphincter muscle of the bladder to release urine.
When vertebral subluxations are present in the lower back, they could
irritate or place excess pressure on these nerves, which can impact how well
a child is able to control urination.77 It should be noted that some children
who are seen for chiropractic care of bedwetting do not necessarily respond
to spinal adjustments alone; the chiropractor may determine the child’s
phrenic nerve is still undeveloped and that spinal manipulation will not
necessarily correct this. However, there are some children who have
benefitted from chiropractic care of bedwetting, particularly when combined
with other strategies to reduce the instances of enuresis, such as by keeping
a voiding diary and controlling fluid intake before bed.
A case report published by Instebo, et al., in the Journal of Chiropractic
Medicine discussed a case of an 8-year-old girl who sought chiropractic
treatment for management of nighttime bedwetting that was unresolved
after instituting lifestyle changes as well as prescription desmopressin. The
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patient had previously tried bedwetting alarms and restricting fluid intake
without success and her primary care physician had not identified any
physiological abnormality or reason why she continued to experience
nocturnal enuresis. The patient was examined by a chiropractor who found
no subluxations or abnormalities, but who did locate tenderness when
palpating the sacroiliac joint in the lower back. After one treatment of gentle
manipulation of this joint, the patient experienced one full week without any
bedwetting episodes, and after a total of three treatments, the patient’s
episodes of bedwetting had decreased significantly to the point where she
rarely had any more episodes and was able to spend more time with friends
with little fear of having urine accidents.78
Obviously, this is only one case of successful treatment of bedwetting
through chiropractic care, although there are many parents who also report
success in helping their children overcome enuresis by undergoing spinal
manipulation therapy. It should be noted that approximately 15 percent of
children with regular enuresis overcome the condition on their own without
any treatment.78 Nevertheless, when the problem is significant enough that
it is disruptive to a child’s social and personal success, parents may want to
consider chiropractic care for their child.
Another common issue that often affects toddlers, children, and teens and
that can cause embarrassment and shame is chronic constipation. The
condition can affect children of any age, including infants, and when it is
serious, it often requires treatment. Constipation is technically defined as the
passage of hard stools, passing stool with difficulty, or having less frequent
bowel movements. There is not one set number of bowel movements per
day or week that is thought to be normal in children; however, when parents
notice that their child is having infrequent bowel movements or is straining
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to pass stool, constipation may be present, regardless of the total number of
stools passed in a particular time period.
Constipation causes more than an average amount of straining for a child to
pass stool. Parents should be aware of the average number and frequency of
stools their child has and note whether this amount has decreased. Some
children have a small amount of blood in their stool when they do have a
bowel movement if there is a rectal fissure present that causes minor
bleeding. At times, a child with constipation may have stool in the intestinal
tract that is impacted. When this happens, the child may actually have
diarrhea and can be incontinent of stool when runny stool passes around the
impacted area. The affected child may also experience abdominal pain, poor
appetite, lethargy, nausea, and restlessness.
Constipation can develop for a number of reasons; it is often classified as
being idiopathic, in which it is caused by dietary changes or holding in stool,
or as a result of another condition that affects gastrointestinal mobility,
including side effects of medications or due to neurological conditions.79 Most
children with chronic constipation can be treated by making changes in the
diet to include more fiber and to drink more fluids. In significant cases, a
child may need to take laxatives, many of which are formulated for pediatric
use.
In one case report published in the journal of The Academy of Chiropractic
Orthopedists, constipation caused by primary vesiculoureteral reflux disease
was treated successfully through chiropractic care of a pediatric patient.
Vesiculoureteral reflux occurs when urine flows backward toward the
kidneys. Children with this condition often have some degree of bowel
dysfunction as well and are likely to have some amount of constipation. The
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child in the case study had undergone several tests to determine the extent
of the reflux as well as the degree of the constipation present; she also had
a manual examination by a chiropractor. She underwent manipulative
therapy by the chiropractor, utilizing both manual and instrument-guided
treatments and abdominal massage, and she was placed on probiotic
therapy. Following 13 weeks of care, in which the child had chiropractic
treatments as well as routine massage and probiotic therapy at home, her
parents reported that her constipation had resolved and she had regular
bowel movements.81
Chiropractic medicine may also resolve constipation in some children and it
may prevent further constipation from developing. Chiropractic care may
work through spinal manipulation or by promoting other lifestyle changes,
such as changes in diet, to relieve constipation in children. It is thought that
spinal adjustment may promote healthy bowel function to resolve
constipation and stimulate intestinal motility.
Chiropractic care is thought to treat constipation by promoting the work of
the autonomic nervous system, which unconsciously controls body systems.
Subluxations that occur along the spine, particularly within the lumbar
region of the back, can contribute to constipation because the misaligned
vertebrae affect the nerves that innervate the colon.80 As discussed, children
could develop subluxations for a number of reasons and the effects may not
be immediately apparent. Infants with lumbar subluxations that developed
during birth may have difficulties with constipation, even if they eat normal
amounts of milk or formula and are otherwise healthy. Children who are
engaged in strenuous activities, including sports, may have subluxations and
misalignments that can be corrected to improve chronic constipation and to
prevent future episodes.
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If a parent takes a child to a
chiropractor for treatment of
constipation, an X-ray or imaging
studies may be done if the child has
not been examined through imaging
studies previously. A simple X-ray of
the abdomen can show if there are
large pockets of stool or excess air in
the bowel that contribute to
constipation and abdominal pain. The
X-ray can also show whether
impaction is present, which would
need further treatment to prevent some significant complications. Following
an X-ray, the chiropractor may also discuss the child’s diet and lifestyle
habits to determine if there are other factors that may be contributing to the
constipation, and may ask about other factors, such as the presence of
chronic disease, whether the child is taking medications, and how many
bowel movements normally occur.
Correction of constipation is often done manually through spinal adjustment
to correct nerve impingement and to promote the work of the nervous
system. Following manual treatment, the chiropractor may also discuss the
important elements of the child’s diet and may make recommendations
about what foods and nutrients to include each day. A child should have a
well-balanced diet with plenty of fiber, as fiber prevents excess uptake of
water in the colon, ensuring that stool does not become hard and dry and is
able to be passed easily. Foods with fiber are relatively easy to add into the
diet; they include many fruits and vegetables, as well as whole grains.
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A previously discussed review by Angus, et al., in the Journal of the
Canadian Chiropractic Association showed that chiropractic medicine can
treat constipation in children and listed the results of several studies that
supported this. Included in the review were instances of several studies
where toddlers and school-age children were treated for constipation
through high-velocity low-amplitude thrust for spinal manipulation that was
appropriate for age. All of the studies listed supported the use of chiropractic
manipulation on children for the successful treatment of constipation.64
Additionally, chiropractic care will consider all elements that could be
contributing to a child’s constipation because chiropractic medicine maintains
a holistic focus on care.
Diet is one area to examine to determine if the child’s diet could be changed
to increase fiber intake and to add healthy foods to prevent further
constipation. The chiropractor may also institute other alternative and
complementary measures that would aid in controlling constipation. For
example, probiotics may be useful in preventing constipation and promoting
normal intestinal health. The chiropractor may make recommendations to
parents about how to incorporate more fermented foods or food items that
contain probiotics into the child’s diet. This advice, in combination with
physical therapies provided by the chiropractor, can support children who
struggle with problems of elimination, such as through bedwetting and
frequent constipation.
Growing Pains
Some children suffer from occasional aching or throbbing pain in the legs
that is unrelated to illness or chronic disease. Referred to as growing pains,
this type of pain can affect up to 40 percent of children; it most commonly
occurs during preschool and school-age years in children ages 3 to 5 years
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and again in children ages 8 to 12 years.82 Growing pains are not just a
myth, but they can actually cause enough pain in affected children that they
require visits to a physician or hospital for diagnosis. Unfortunately, aside
from some home remedies and over-the-counter pain medication, there is
no treatment for growing pains.
Most children who suffer from growing pains develop pain in the legs,
typically focused behind the knee, in the calf, or in the front of the thigh.
The pain is muscular in origin and usually does not affect the joints or the
bones. Many children with growing pains complain of the pain most often at
night, which can interrupt sleep. There is no particular cause of the pain and
it is not related to another chronic illness or acute disease. It is believed that
children who are active and athletic tend to be more likely to experience
growing pains, as the pain seems to be related to increased muscle use.
Typically, parents can help their children who experience growing pains by
promoting rest and massaging the affected muscles.
Over-the-counter pain medications such as acetaminophen may also be
helpful, as well as warm packs applied to the affected areas. Growing pains
are self-limiting and they tend to resolve on their own. Fortunately, they also
do not seem to occur on a daily basis and are usually only sporadic in nature
when they do happen.
Although growing pains are temporary, not related to other chronic diseases,
nor a sign of a serious health problem, some parents may want to seek
further medical advice for help in controlling the painful symptoms. Parents
who take their child to a physician because of growing pains may learn that
there is not a problem with the muscles in the child’s legs and there are no
structural problems in the extremities that could be contributing to the pain.
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An X-ray of the legs can point out if there is an issue with the joints or bones
that is causing the pain and that it is not growing pains. A chiropractor can
also help with diagnosis and management of growing pains, and treatment
through chiropractic care may be a worthwhile option for some kids who
have enough pain that it affects sleep or other activities.
Chiropractic care of growing pains involves an assessment of the child’s
pain, including its location in the legs and its intensity, as well as the child’s
activity levels and whether other medical problems are present that could
also be contributing to pain. For instance, pain in the legs that is manifested
as growing pains could actually be the result of another condition, such as a
muscle strain or joint inflammation, and an examination of the legs and the
spine is necessary to rule out other causes.
A child who is very active could develop subluxations in areas of the spine
that can affect the nerves innervating the muscles in the legs to contribute
to growing pains. Additionally, a child may have an orthopedic issue
associated with the joints, such as a small injury that has gone unnoticed
but that later manifests itself as muscular pain of growing pains. The fact
that active children are more likely to experience growing pains seems to be
related to the stress or wear and tear on the muscles and joints that can
eventually cause pain in the legs.
According to de Beer, et al., in the Journal of Interdisciplinary Health
Sciences, growing pains are thought to occur as a result of one of three
theoretical circumstances. The anatomical cause of the growing pains
reveals that the child suffers from pain because of poor posture or
orthopedic problems in the bones, joints, or muscles that have been
previously unrecognized. The fatigability theory states that the child feels
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pain after increased activity when there is a greater likelihood of increased
metabolic waste accumulating in the muscle tissue, which may more likely
explain why some children experience growing pains more often after being
active. The third theory states that growing pains occur because affected
children have psychological predispositions toward experiencing the pain and
if a family history is present, they may be more susceptible to pain from
family tendencies.83
The same authors also performed a study that was published in the journal
that evaluated the effects of chiropractic care on children suffering from
growing pains. In the study, part of the children recruited underwent lumbar
spinal manipulation therapy for treatment, while the other group had no
chiropractic treatment but did have help from parents in the home for the
pain, such as through massage. The study found that spinal manipulation
therapy was beneficial as treatment, based on subjective responses from the
parents.83 While other measures, such as massage and home remedies may
also be helpful, spinal manipulation could reduce the amount of time that an
affected child suffers from growing pains.
The chiropractic standpoint of the treatment of growing pains is based on a
physiological mechanism that is contributing to the pain, whether it is from
orthopedic trauma or damage to the joints and muscles, or whether the child
feels pain specifically because of increased activity levels.84 Chiropractic
treatment can relieve some of the pain of growing pains by relieving
pressure on the nerve roots in the spine when subluxations are present, as
well as by assisting the child with stress reduction that can negatively impact
the nervous system. Increased stress can affect posture and movement,
which in turn could affect how the vertebrae influence the nerve roots in the
spinal column. Additionally, when trauma to the spine has occurred, such as
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during birth or because of significant activity, the child’s spinal vertebrae
may be putting excess pressure on the nerve roots and causing irritation to
the nerves.
The leg pain that the child feels because of growing pains can come from
vertebral impingement on nerve roots in the lumbar region that innervate
the hamstrings, calf muscles, and quadriceps. Misalignment in the pelvic
region can affect how the child is able to distribute weight on the legs,
carries the body when ambulating, and the child’s overall stance, which
could cause pain in the lower legs and feet as well.84
Chiropractic correction of growing pains often involves spinal manipulation
therapy to align the spinal column and take pressure off of the nerves
innervating the legs. It also includes assessment of the joints in the back,
the pelvis, hips, and legs to look for problems that could be contributing to
pain and then making adjustments when necessary. Other exercises may
include stretching the leg muscles and performing range-of-motion exercises
in the legs and hips to improve muscle strength and flexibility.
An article published in Pathways to Family Wellness that evaluated the
chiropractic care of children with growing pains also provided
recommendations that the chiropractor may give to parents to help their
child at home in addition to undergoing chiropractic techniques.
Recommendations from the chiropractor included having the child drink
plenty of water and other fluids to avoid dehydration, which can impact
muscle tissue, taking a vitamin supplement that contains adequate calcium
and magnesium, performing stretching exercises for the back, thighs, knees,
and lower legs, and monitoring stress levels in the child to avoid postural or
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activity changes that could place excess stress on the child’s frame, possibly
contributing to the pain.84
Growing pains are a real phenomenon, with some children routinely
struggling with pain and discomfort when they occur. As with other
conditions that cause pain, parents may want to consider chiropractic care
for relief of this common complaint.
Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) is not entirely limited to
children, but it is commonly diagnosed and managed during childhood. The
condition is a brain disorder that causes difficulties with concentration and
impulsive behaviors. Some children may be hyperactive and have difficulties
with settling down; they may be constantly moving and may talk excessively
without much purposeful interaction with others through conversation. ADHD
also leads to inattention, in that the affected child is frequently distracted
and has trouble focusing on the topic at hand. The child may be very
disorganized and often have trouble completing any work. Impulsivity is also
often associated with ADHD in that the affected child seems to lack the
ability to control reactions to situations and does not stop to think before
acting. The child may have difficulty with social relationships because his or
her actions can be harmful to others and the child cannot think about
behavioral consequences.
Not all children with ADHD will exhibit impulsivity, hyperactivity, and
inattention, but these three traits are common elements that are associated
with the definition and diagnosis of the disorder. Children affected by ADHD
may have trouble with one or more of these components, at varying levels
of severity.85 ADHD is challenging for both the affected child and the child’s
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family. The child often is unable to complete routine tasks because of
problems with focus and concentration, consequently, there are often issues
with school work or chores that are rarely completed.
The child with ADHD may feel isolated and lonely, having difficulties making
or sustaining friendships because other children often do not understand the
behavior or do not want to put up with it. The child may even be
unintentionally hurtful toward others because of impulsivity, which alienates
the child with ADHD from other children who do not understand.
For parents, having a child with ADHD can be particularly trying. They may
struggle with helping their child to complete normal activities and to stay
engaged in events and work for school or hobbies. It can be frustrating to
watch a child struggle to make friends and to be alone because of having
trouble controlling behavior. The parents may have problems disciplining the
child because he or she may have trouble listening and does not respond to
structure. Parents may have difficulties with staying calm and not becoming
angry when their child repeatedly breaks the rules. It is important to
understand that when a child has ADHD, he or she is often not trying to be
difficult and hurtful, but simply is unable to adequately process a situation.
Importantly, parents need to realize that the condition has not developed
because of overstimulation or faulty parenting. Of note, adults also can have
ADHD and it is often a lifelong condition that the affected person must cope
with once diagnosed, whether diagnosed as a child or whether the condition
was later discovered during adulthood.
Most children diagnosed with ADHD are treated with prescription
medications to control many of their behaviors. Prescription stimulants
paradoxically seem to work well for children with ADHD to help them to slow
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down and focus by affecting brain neurotransmitters. Some children also
require counseling and psychotherapy to better learn how to recognize when
their behaviors are off and they need to get back on track. Psychotherapy
can aid with helping children to learn to finish tasks and follow through with
activities to completion. Counseling is also quite helpful for the parents of
children with ADHD to better enable them to learn to manage their child’s
behaviors, to respond appropriately to negative behaviors, and to instill
discipline properly.
In addition to the medications, counseling, and support groups available for
ADHD, children may also benefit from chiropractic care. It may seem
surprising that chiropractic medicine can positively affect a brain disorder
such as ADHD, since the practice is often associated mostly with
management of musculoskeletal-related conditions. However, more parents
are looking into complementary and alternative treatments as adjunct
treatment for ADHD when their child needs further help. In fact, some
parents choose chiropractic care as a natural form of ADHD treatment
instead of trying to force their child to take medications.
As discussed, chiropractic medicine is focused on holistic care of the patient.
The chiropractor who sees a child for treatment of ADHD will not just focus
on the child’s activities or behavior, but will also consider and ask the
parents about other factors that can be affecting how well the child is able to
relate to others and to perform in school. For example, the chiropractor may
perform a physical assessment on the child, but will also be interested in
finding out about the child’s sleeping patterns, diet, social activities,
allergies, exposure to environmental stimulants, stress levels, and
relationships with friends and family.
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Chiropractic medicine is focused on treatment and management of
conditions that affect the neurological system, which can include ADHD.
Chiropractors attest that when subluxations are present in the cervical
region of the spine, they can affect the nerves that innervate the brainstem
and can cause some of the behavioral issues associated with ADHD. The
areas of C1 through C3 vertebrae are particularly vulnerable for these
problems. When the chiropractor corrects the subluxations found in these
areas, it is thought that this correction may resolve some of the behaviors
seen with the disorder.86
The overall goal of chiropractic care for ADHD management is not to cure
the ADHD, but instead to improve nervous system function by identifying
subluxations and other issues that may be contributing to nervous
dysfunction.87 Chiropractic care may also work to help a child who is
struggling with processing of sensory input, which may contribute to
symptoms of ADHD. For example, if a child is unable to process information
through sensory means – what is heard, seen, or tasted – or if the child’s
brain has difficulty with proprioception, which is the recognition of the
positioning of the body within a space, this may relate to difficulties with
ADHD symptoms. Sensory processing can be affected by subluxations in the
cervical spine if misaligned vertebrae affect nerve roots that innervate the
parts of the brain that affect the vestibular or proprioceptive systems. It is
possible that by correcting vertebral subluxations in the cervical spine, as
well as in other regions of the spine that are connected to sensory
processing, the child’s neurosensory system may function more efficiently
and the child with ADHD may be able to function better.88
In addition to performing physical treatments of ADHD, the chiropractor may
also make some suggestions to families about interventions they can
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incorporate at home to better help their child with behavior and activity. The
chiropractor may make suggestions about helping the child and family to
deal with stress and can help them learn to incorporate stress relief
measures. The chiropractor may also make suggestions about dietary
changes to ensure that the child gets enough vitamins and minerals in the
diet; this may include taking an herbal supplement or also avoiding fast food
and foods with high amounts of sugar, additives, and fat. While there is no
evidence that sugar intake is related to ADHD symptoms, the child can
benefit from reducing sugar intake in order to eat foods that are healthier
instead.
Summary
Children can certainly be candidates for chiropractic care and they often
respond well to many of the techniques used in chiropractic medicine.
Children often heal at a faster pace when compared to adults, and the
methods used in chiropractic care of some children have been shown to be
valuable in promoting health by supporting the ability of children’s bodies to
heal. According to the International Chiropractic Pediatric Association (ICPA),
parents of children who receive chiropractic care have reported several
improvements in their children’s health and behavior as a result of
chiropractic treatments, including improved sleep habits, improved immune
system functioning, and better overall behavior and attitude. These results
are commonly reported by parents in addition to the positive support that
chiropractic care clinicians provide, including pain relief and symptom control
when illness is present.
Unfortunately, there is a lack of research about the effectiveness of spinal
manipulation on newborns and the effects of adjustments on controlling
symptoms of colic, reflux, or sleeping difficulties in babies. However,
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pediatric chiropractors who work with infants have suggested that these
gentle adjustments to the spine to correct misalignment are safe and can
help these and many other health problems in infants, in a manner similar to
problems treated by chiropractic care in older children and adults. The long-
term effects of chiropractic care of newborns will need more study and
further clinical research to demonstrate that this type of therapy is safe and
effective for infants.
Chiropractic care that is directed specifically toward children has several
benefits. A mother may seek chiropractic care for some issues even before
her child is born, as chiropractic techniques can be performed on pregnant
women and are considered to be safe and effective. Sometimes the effects
of birth trauma can be remedied with gentle chiropractic care. Some infants
are born with health conditions that affect their abilities to grow and develop
normally or that even put them at risk of acquiring other conditions that can
impact their general health or that could cause illness. Many studies have
shown that chiropractic care delivered to children with health conditions,
whether they occurred before birth or they developed during infancy and
childhood, is beneficial and therapeutic.
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1. True or False: Parents of children who receive chiropractic care have reported several improvements in their children’s health and behavior as a result of chiropractic treatments, including a better overall behavior and attitude.
a. True b. False
2. Congenital spinal abnormalities are birth defects that affect the
spine
a. and the spinal cord. b. and that develop before a baby is born. c. and that can eventually affect other areas of the body. d. All of the above
3. During embryonic development, the spinal cord begins to form
____________________ after conception along with the initial growth of the neural tube.
a. within a couple of weeks b. during the second trimester c. a couple months d. during the third trimester
4. The ______________ eventually harden through ossification as
it/they become bones and the notochord ultimately forms the intervertebral discs.
a. cartilage b. neural tube c. annulus fibrosus d. somites
5. ______________ is a condition in which a portion of the spinal
cord protrudes through the vertebrae when the neural tube does not close properly during development.
a. Encephalocele b. Spina bifida c. Anencephaly d. Paresthesia
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6. When the neural tube fails to close during fetal development, the child can develop encephalocele if
a. a significant portion of the brain and the skull do not form. b. a sac containing part of the brain and the meninges protrudes
through an opening at the base of the skull. c. a portion of the spinal cord protrudes through the vertebrae. d. vertebral disc herniation and nerve dysfunction are present.
7. Women who are pregnant or are even thinking of becoming
pregnant are advised to increase their intake of ___________, as it has been shown to reduce the risk of neural tube defects such as spina bifida.
a. iron b. Vitamin D c. zinc d. folic acid
8. True or False: Many neural tube defects are severe and in some
cases, such as with anencephaly, are incompatible with life and the infant dies shortly after birth.
a. True b. False
9. Spina bifida occulta is a type of spina bifida that
a. is severe, causing back deformities and poor mobility. b. not obvious and a patient may be unaware of the condition. c. is so severe it causes paralysis. d. is nonexistent but the patient exhibits some of its symptoms.
10. Which of the following statement(s) is/are true regarding spina
bifida occulta?
a. It can cause muscular weakness and bladder dysfunction. b. It affects less than 1% of the population. c. It cannot be treated by a chiropractor. d. All of the above
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11. Congenital scoliosis is described as the spine having
a. an abnormal rounding, “hump,” on the back of the spine. b. the lumbar spine curve inward toward the abdomen. c. a nevus in the lumbar region of the spine. d. a curvature to the side instead of its usual vertical structure.
12. True or False: The Growing Spine Committee recommends
manual manipulation therapies and stretching exercises to treat and manage congenital scoliosis.
a. True b. False
13. _____________ is a condition that causes an abnormal
rounding of the spine that produces a hump in the back; on appearance, the child may seem to have a hunched back.
a. Lordosis b. Kyphosis c. Congenital muscular torticollis d. Scoliosis
14. Lordosis is a spinal anomaly that is described as an abnormal
curve in the lumbar region of the back, in which the lumbar spine
a. curves to the side instead of its usual vertical structure. b. rounds in the shape of a hump. c. curves inward toward the abdomen. d. is bowed forward at an angle.
15. Kyphosis is a spinal condition
a. that most often develop in utero. b. in which the vertebrae fully separate into distinct bones. c. that most often occurs in older adults. d. in which the spinal curve is normal but the vertebrae do not full
separate.
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16. Chiropractic spinal adjustments to treat kyphosis or lordosis
a. will realign the spine to correct the curvature. b. is not recommended. c. could help control associated pain and inflammation. d. will exacerbate the condition.
17. A baby may be born with spinal subluxation because of birth
trauma, which may lead to
a. muscle weakness. b. poor development. c. difficulties with feeding and sleeping. d. All of the above
18. True or False: Chiropractic care may be utilized to improve range
of motion, function, and flexibility among infants with nerve damage due to birth trauma.
a. True b. False
19. Chiropractic care may help to prevent the onset of some
symptoms of sore throat, a cold or related viral infection, by specifically improving
a. the flow of lymph fluid. b. posture and mobility. c. feeding and sleeping patterns. d. muscular tone and strength.
20. In children, occasional aching or throbbing pain in the legs that
is unrelated to illness or chronic disease, referred to as growing pains,
a. is a myth, not a physical condition. b. is most common after age 12. c. can affect up to 40 percent of children. d. All of the above
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CORRECT ANSWERS 1. True or False: Parents of children who receive chiropractic care
have reported several improvements in their children’s health and behavior as a result of chiropractic treatments, including a better overall behavior and attitude.
a. True “According to the International Chiropractic Pediatric Association (ICPA), parents of children who receive chiropractic care have reported several improvements in their children’s health and behavior as a result of chiropractic treatments, including improved sleep habits, improved immune system functioning, and better overall behavior and attitude.”
2. Congenital spinal abnormalities are birth defects that affect the
spine
a. and the spinal cord. b. and that develop before a baby is born. c. and that can eventually affect other areas of the body. d. All of the above [correct answer]
“Congenital spinal abnormalities are types of birth defects that affect the spine and that develop before a baby is born. These anomalies can impact how the spine forms during gestation, which can influence the size and shape of the vertebrae, their alignment, and the general function of the spinal cord. Additionally, when spinal problems develop in utero, the person can eventually have problems in other areas of the body, including the kidneys or urinary tract, as well as difficulties performing routine activities of daily living.”
3. During embryonic development, the spinal cord begins to form
____________________ after conception along with the initial growth of the neural tube.
a. within a couple of weeks “During embryonic development, the spinal cord begins to form within a couple of weeks after conception with the initial growth of the neural tube.”
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4. The ______________ eventually harden through ossification as it/they become bones and the notochord ultimately forms the intervertebral discs.
d. somites “The somites eventually harden through ossification as they become bones and the notochord ultimately forms the intervertebral discs.”
5. ______________ is a condition in which a portion of the spinal
cord protrudes through the vertebrae when the neural tube does not close properly during development.
b. Spina bifida “… spina bifida, in which a portion of the spinal cord protrudes through the vertebrae when the neural tube does not close properly during development;....”
6. When the neural tube fails to close during fetal development, the
child can develop an encephalocele if
b. a sac containing part of the brain and the meninges protrudes through an opening at the base of the skull. “Neural tube defects are some of the more commonly understood congenital anomalies involving the spine … and an encephalocele, which occurs when the failed closure of the neural tube causes a sac that contains part of the brain and the meninges to protrude through an opening at the base of the skull.”
7. Women who are pregnant or are even thinking of becoming pregnant are advised to increase their intake of ___________, as it has been shown to reduce the risk of neural tube defects such as spina bifida.
d. folic acid “Neural tube defects are thought to be related to a combination of environmental and genetic factors, but women who are pregnant or are even thinking of becoming pregnant are advised to increase their intake of folic acid, as it has been shown to reduce the risk of these specific kinds of birth defects.”
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8. True or False: Many neural tube defects are severe and in some cases, such as with anencephaly, are incompatible with life and the infant dies shortly after birth.
a. True “Many neural tube defects are severe and in some cases, such as with anencephaly, are incompatible with life and the infant dies shortly after birth.”
9. Spina bifida occulta is a type of spina bifida that
b. not obvious and a patient may be unaware of the condition. “Spina bifida occulta is a type of spina bifida in which the neural tube closure is not obvious; in many cases, the patient may be unaware that the condition exists. Spina bifida occulta occurs most commonly in the lumbar region of the spine and it could cause difficulties with walking or moving, as well as back pain, vertebral disc herniation, and nerve dysfunction.”
10. Which of the following statement(s) is/are true regarding spina
bifida occulta?
a. It can cause muscular weakness and bladder dysfunction. “Although spina bifida occulta is the mildest form of the condition, it can still cause muscular weakness and bladder dysfunction for some people...”
11. Congenital scoliosis is described as the spine having
d. a curvature to the side instead of its usual vertical structure. “Congenital scoliosis is described as the spine having a curvature to the side instead of its usual vertical structure.”
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12. True or False: The Growing Spine Committee recommends manual manipulation therapies and stretching exercises to treat and manage congenital scoliosis.
d. False “A consensus statement regarding early onset scoliosis given by the Growing Spine Committee categorized congenital scoliosis as a type of early onset scoliosis, which is considered to be the presentation of the spinal deformity before the age of 10 years.... Treatment recommendations include bracing, casting, or surgery on the spine, and while manual manipulation therapies and stretching exercises were not recommended to correct the condition, they could be used to control some other symptoms associated with the disability.”
13. _____________ is a condition that causes an abnormal
rounding of the spine that produces a hump in the back; on appearance, the child may seem to have a hunched back.
b. Kyphosis “Kyphosis is a condition that causes an abnormal rounding of the spine that produces a hump in the back; on appearance, the child may seem to have a hunched back.”
14. Lordosis is a spinal anomaly that is described as an abnormal
curve in the lumbar region of the back, in which the lumbar spine
c. curves inward toward the abdomen. “Lordosis is a spinal anomaly that is described as an abnormal curve in the lumbar region of the back, in which the lumbar spine curves inward toward the abdomen.”
15. Kyphosis is a spinal condition
c. that most often occurs in older adults. “Kyphosis ... most often occurs in older adults after years of wear on the spinal column that leads to compression of the intervertebral discs and compression fractures.”
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16. Chiropractic spinal adjustments to treat kyphosis or lordosis
c. could help control associated pain and inflammation. “The treatments for congenital kyphosis and lordosis can vary, depending on the severity of the angle of the defects.... A chiropractor can also assist with some treatments for kyphosis or lordosis. Many studies have shown that helping patients with these conditions to work on their posture and to stand up straight have had no impact on the condition. Spinal adjustments made by chiropractors will not realign the spine to correct the curvature, but these adjustments could help to control some of the pain and inflammation of the condition.”
17. A baby may be born with spinal subluxation because of birth
trauma, which may lead to
a. muscle weakness. b. poor development. c. difficulties with feeding and sleeping. d. All of the above [correct answer]
“A baby may be born with spinal subluxation because of birth trauma, but the effects may not be immediately seen. Problems with muscle weakness, poor development, and difficulties with feeding and with sleeping can all develop as a result of vertebral subluxations that occur during birth.”
18. True or False: Chiropractic care may be utilized to improve range
of motion, function, and flexibility among infants with nerve damage due to birth trauma.
a. True “In some cases, chiropractic care may be utilized to improve range of motion, function, and flexibility among infants with nerve damage due to birth trauma.”
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19. Chiropractic care may help to prevent the onset of some symptoms of sore throat, a cold or related viral infection, by specifically improving
a. the flow of lymph fluid. “There are many situations where a child with a sore throat or with cold symptoms can be treated through chiropractic medicine. Chiropractic care may also help to prevent the onset of some symptoms and related viral infection. The goal of chiropractic care administered for treatment of colds or sore throat is to strengthen the patient’s immune system to better fight off the viral infection. Chiropractic medicine asserts that this type of care specifically improves the flow of lymph fluid through its channels, which ultimately supports the immune system to allow a child to fight off a cold or infection.”
20. In children, occasional aching or throbbing pain in the legs that
is unrelated to illness or chronic disease, referred to as growing pains,
c. can affect up to 40 percent of children. “Some children suffer from occasional aching or throbbing pain in the legs that is unrelated to illness or chronic disease. Referred to as growing pains, this type of pain can affect up to 40 percent of children; it most commonly occurs during preschool and school-age years in children ages 3 to 5 years and again in children ages 8 to 12 years. Growing pains are not just a myth, but they can actually cause enough pain in affected children that they require visits to the doctor or hospital for diagnosis.... A chiropractor can also help with diagnosis and management of growing pains, and treatment through chiropractic care may be a worthwhile option for some kids who have enough pain that it affects sleep or other activities.”
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Reference Section
The reference section of in-text citations includes published works intended as helpful material for further reading. [References are for a multi-part series on Chiropractic Care].
1. Adams, J., et al. (2017). The prevalence, patterns, and predictors of chiropractic use among US adults: Results from the 2012 National Health Interview Survey. Spine. 2017 Apr 28.
2. Gerstenkorn Family Chiropractic. (n.d.). Gonstead care. Retrieved from http://www.gerstenkornchiropractic.com/gonstead-technique
3. Herbst, R. (2014). Gonstead Chiropractic Science and Art. (2014). SCI-CHI Pulications.
4. Kemper, K. (2017). Complementary and alternative medicine in pediatrics. UpToDate. Retrieved online at https://www.uptodate.com/contents/complementary-and-alternative-medicine-in-pediatrics?source=search_result&search=chiropractic&selectedTitle=7~42.
5. Young, K. (2017). Historical influence on the practice of chiropractic radiology: part II - thematic analysis on the opinions of diplomates of the American Chiropractic College of Radiology about the future. UpToDate. Chiropr Man Therap. 2017 May 8;25:15. Retrieved online at https://www.ncbi.nlm.nih.gov/pubmed/28503293.
6. The Pettibon System. (2015). How the Pettibon system works. Retrieved from https://pettibonsystem.com/about/how-pettibon-works
7. Xia, T., et al. (2017). Association of lumbar spine stiffness and flexion-relaxation phenomenon with patient-reported outcomes in adults with chronic low back pain - a single-arm clinical trial investigating the effects of thrust spinal manipulation. BMC Complement Altern Med. 2017 Jun 9;17(1). Retrieved online at https://www.ncbi.nlm.nih.gov/pubmed/28599647.
8. Muller, A., Murphy, E. Brownstein, S., Boyles, R. (2015). Effectiveness of spinal manipulation in the treatment of non-musculoskeletal disorders: a systematic review. Physical Therapy Research Symposium, Paper 8.
9. Physiopedia. (n.d.). Manual therapy techniques for the lumbar spine. Retrieved from http://www.physio-pedia.com/Manual_Therapy_Techniques_For_The_Lumbar_Spine
10. Seo, Y., Lee, J., Han, D. (2014). The effects of spinal mobilization with arm movements on shoulder muscle strengthening. J Phys Ther Sci. 27(11-13).
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11. Russell, D. Kimura, M., Cowie, H., de Groot, C., McMinn, E., Sherson, M. (2016). Changes in quality of life in 7 older adult patients receiving activator methods chiropractic technique. J Chiropr Med. 15(1): 59-66.
12. Maiers, M., et al. (2014). Spinal manipulative therapy and exercise for seniors with chronic neck pain. The Spine Journal 14(9): 1879-1889.
13. Dougherty, P., Karuza, J., Dunn, A., Savino, D., Katz, P. (2014). Spinal manipulation therapy for chronic lower back pain in older veterans. Geriatr Orthop Surg Rehabil. 5(4): 154-164.
14. Galicia-Castillo, M.C. and Weiner, D.K. (2017). Treatment of persistent pain in older adults. UpToDate. Retrieved online at https://www.uptodate.com/contents/treatment-of-persistent-pain-in-older-adults?source=search_result&search=hip%20pain%20and%20chiropractic&selectedTitle=2~150.
15. Mayo Clinic. (2017). Stretching: focus on flexibility. Retrieved from http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931
16. Taylor, F.R. (2017). Tension-type headache in adults: Preventive treatment. UpToDate. Retrieved online at https://www.uptodate.com/contents/tension-type-headache-in-adults-preventive-treatment?source=search_result&search=headache%20and%20chiropractic&selectedTitle=3~150.
17. Moore, C., Sibbritt, D., Adams, J. (2017). A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness. BMC Neurology 17(61). Retrieved from https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-017-0835-0
18. Mckay, T., Jenkins, K. (2016). Headaches. Retrieved from http://www.spineguys.com/health_conditions/headaches.asp
19. Silberstein, S. (2016). Migraine. Merck Manual. Retrieved from http://www.merckmanuals.com/professional/neurologic-disorders/headache/migraine
20. Chaibi, A., Benth, J., Tuchin, P., Russell, M. (2016). Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. European Journal of Neurology 24(1): 143-153.
21. Knight, C., et al. (2017). Treatment of acute low back pain. UpToDate. Retrieved online at https://www.uptodate.com/contents/treatment-of-acute-low-back-pain?source=search_result&search=low%20back%20strain%20and%20chiropractic&selectedTitle=2~150.
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22. Schneider, M., Haas, M., Glick, R., Stevans, J., Landsittel, D. (2015). A comparison of spinal manipulation methods and usual medical care for acute and sub-acute low back pain: a randomized clinical trial. Spine 40(4): 209-217.
23. Wheeler, S., et al. (2017). Evaluation of low back pain in adults. UpToDate. Retrieved online at https://www.uptodate.com/contents/evaluation-of-low-back-pain-in-adults?source=search_result&search=ruptured%20disc&selectedTitle=6~96.
24. Bridwell, K. (2017). Intervertebral discs. Retrieved from https://www.spineuniverse.com/anatomy/intervertebral-discs
25. Ehrler, M., Peterson, C., Leemann, S., Schmid, C., Anklin, B., Humphreys, B. (2016). Symptomatic, MRI confirmed, lumbar disc herniations: a comparison of outcomes depending on the type and anatomical axial location of the hernia in patients treated with high-velocity, low-amplitude spinal manipulation. Journal of Manipulative and Physiological Therapeutics 39(3): 192-199. Retrieved from http://www.jmptonline.org/article/S0161-4754(16)00060-9/fulltext
26. Horst Chiropractic. (2012). Chiropractic treatment for fractures. Retrieved from http://www.horst-chiropractic.com/chiropractic-treatment-for-fractures/
27. Cedars-Sinai. (2017). Back pain during pregnancy. Retrieved from https://www.cedars-sinai.edu/Patients/Health-Conditions/Back-Pain-During-Pregnancy.aspx
28. Peterson, C., Muhlemann, D., Humphreys, B. (2014). Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1-year follow-up. Chiropractic & Manual Therapies 22(15).
29. Shekelle, P., et al. (2017). Spinal manipulation in the treatment of musculoskeletal pain. UpToDate. Retrieved online at https://www.uptodate.com/contents/spinal-manipulation-in-the-treatment-of-musculoskeletal-pain?source=search_result&search=headache%20and%20chiropractic&selectedTitle=1~150.
30. The Joint Chiropractic. (2017). Chiropractic care 101: whiplash! Retrieved from https://www.thejoint.com/california/encinitas/encinitas-31006/chiropractic-care-101-whiplash
31. Rodway, I. (2015). Cervical radiculopathy (pinched nerve). Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00332
32. Aquaroli, R., Camacho, E., Marchi, L., Pimenta, L. (2016). Manual therapy and segmental stabilization in the treatment of cervical radiculopathy. Fisioterapia em Movimento 29(1). Retrieved from
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http://www.scielo.br/scielo.php?pid=S0103-51502016000100045&script=sci_arttext
33. Isaac, Z. (2017). Evaluation of the patient with neck pain and cervical spine disorders. UpToDate. Retrieved online at https://www.uptodate.com/contents/evaluation-of-the-patient-with-neck-pain-and-cervical-spine-disorders?source=search_result&search=cervical%20degenerative%20disc&selectedTitle=1~150.
34. Gentile, J. (2016). Chiropractic care for degenerative disc disease. Retrieved from https://www.spineuniverse.com/conditions/degenerative-disc/chiropractic-care-degenerative-disc-disease
35. Bryans, R., et al. (2014). Evidence-based guidelines for the chiropractic treatment of adults with neck pain. Journal of Manipulative and Physiological Therapeutics 37(1): 42-63.
36. Amendolia, C., et al. (2017). The physical and psychological impact of neurogenic claudication: the patients’ perspectives. J Can Chiropr Assoc. 2017 Mar; 61(1): 18–31.
37. Adriano Rodrigues de Oliveira (2017). What is the ideal dose and power output of low-level laser therapy (810 nm) on muscle performance and post-exercise recovery? Study protocol for a double-blind, randomized, placebo-controlled trial. Trials. 2014; 15: 69.
38. Panton, L., et al. (2013). Effects of Class IV laser therapy on fibromyalgia impact and function in women with fibromyalgia. The Journal of Alternative and Complementary Medicine 19(5): 445-452.
39. Baker, A. (2016). The link between toxicity and chronic pain. Retrieved from http://nourishholisticnutrition.com/the-link-between-toxicity-and-chronic-pain/
40. Siegenthaler, M. (2015, Mar.). Chiropractic management of infantile torticollis with associated abnormal fixation of one eye: a case report. J Chiropr Med. 14(1): 51-56.
41. Skaggs, et al. (2015). Early onset scoliosis consensus statement, SRS Growing Spine Committee, 2015. Spine Deformity, 3.
42. Scoliosis Research Society. (2017). Congenital kyphosis. Retrieved from http://www.srs.org/professionals/online-education-and-resources/conditions-and-treatments/congenital-kyphosis
43. Nationwide Children’s Hospital. (n.d.). Lordosis. Retrieved from http://www.nationwidechildrens.org/lordosis
44. American Academy of Orthopaedic Surgeons. (2013). Congenital muscular torticollis (twisted neck). Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00054
45. Cofano, G., Anderson, B., Stumpff, E. (2014). Chiropractic care of acute low back pain and incidental spina bifida occulta: a case report. J Chiropr Med. 13(4): 273-277.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
76
46. Weissman, L. and Bridgemohan, C. (2017) Autism spectrum disorder in children and adolescents: Complementary and alternative therapies. UpToDate. Retrieved online at https://www.uptodate.com/contents/autism-spectrum-disorder-in-children-and-adolescents-complementary-and-alternative-therapies?source=see_link.
47. Gibson, E. (2015). Birth injuries. Retrieved from http://www.merckmanuals.com/professional/pediatrics/perinatal-problems/birth-injuries
48. Tatano Beck, C. (2017). Middle Range Theory of Traumatic Childbirth. Glob Qual Nurs Res. 2015 Jan-Dec; 2. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342633/.
49. Lee Turner, T. and Palamountain, S. (2017). Infantile colic: Management and outcome. UpToDate. Retrieved online at https://www.uptodate.com/contents/infantile-colic-management-and-outcome?source=search_result&search=infant%20and%20chiropractic&selectedTitle=2~42.
50. Collins, K., Alcantara, J., Holt, K. (2015). Resolution of breastfeeding and gastrointestinal complaints in infant twins with plagiocephaly and scaphocephaly following birth trauma: a case series. Journal of Pediatric, Maternal & Family Health – Chiropractic, Issue 1: 34-41. Retrieved from https://chiropracticpediatrics.sharepoint.com/Pages/2015_1360_twins_reflux_plagio.aspx
51. Ferrero, F., Smith, M., Alcantara, J., Russell, D. (2016). Resolution of Erb-Duchenne palsy in a 5-month-old female following subluxation based chiropractic care. Journal of Pediatric, Maternal & Family Health – Chiropractic, Issue 1: 9-13. Retrieved from https://chiropracticpediatrics.sharepoint.com/Pages/2016_1413_erbpalsy.aspx
52. American Academy of Orthopaedic Surgeons. (2014). Hip bursitis. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00409
53. National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2017). Questions and answers about bursitis and tendinitis. Retrieved from https://www.niams.nih.gov/health_info/bursitis/
54. Houston Methodist. (2017). A patient’s guide to de Quervain’s tenosynovitis. Retrieved from http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/wrist/de-quervains-tenosynovitis/
55. Carr, D. (2015). How can a chiropractor help with carpal tunnel syndrome. Retrieved from http://www.stanfordchiropractic.com/blogs/rethink/can-a-chiropractor-help-with-carpal-tunnel-syndrome.html
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
77
56. Gliedt, J., Daniels, C. (2014). Chiropractic treatment of lateral epicondylitis: a case report utilizing active release techniques. J Chiropr Med. 13(2): 104-109.
57. Page, M., O’Connor, D., Pitt, V., Massy-Westropp, N. (2012). Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD009601.
58. Pohlman, K. and Holton-Brown, M. (2012). Otitis media and spinal manipulative therapy: a literature review. J Chiropr Med. 2012 Sep; 11(3): 160–169. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437347/.
59. Marom, T., Marchisio, P., Tamir, S., Torretta, S., Gavriel, H., Esposito, S. (2016). Complementary and alternative medicine treatment options for otitis media. Medicine (Baltimore). 96(6): e2695.
60. Hemila, H., Chalker, E. (2013). Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD000980.
61. Mayo Clinic. (2014, May). Colic. Retrieved from http://www.mayoclinic.org/diseases-conditions/colic/basics/definition/con-20019091
62. Savino, F., Ceratto, S., De Marco, A., Cordero di Montezemolo, L. (2014). Looking for new treatments of infantile colic. Italian Journal of Pediatrics 40(53). Retrieved from https://ijponline.biomedcentral.com/articles/10.1186/1824-7288-40-53
63. Savino, F. (2014). Looking for new treatments of Infantile Colic. Ital J Pediatr. 2014; 40: 53. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050441/.
64. Children’s National Health System. (2017). Pediatric asthma. Retrieved from https://childrensnational.org/choose-childrens/conditions-and-treatments/airway-lungs/asthma
65. Angus, K., Asgharifar, S., Gleberzon, B. (2015). What effect does chiropractic treatment have on gastrointestinal (GI) disorders: a narrative review of the literature. J Can Chiropr Assoc. 59(2): 122-133.
66. Padwal, T., Gurudut, P., Hajare, S. (2016). Effect of shakers exercise with kinesio taping in subjects with gastroesophageal reflux disease: a randomized controlled trial. International Journal of Medical Research & Health Sciences 5(10): 170-178.
67. Kinesio Holding Corporation. (2016). What is kinesio tape? Retrieved from https://kinesiotaping.com/about/what-is-kinesio-tape/
68. Angus, K., et al (2015). What effect does chiropractic treatment have on gastrointestinal (GI) disorders: a narrative review of the literature. J Can Chiropr Assoc. 2015 Jun; 59(2): 122–133. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486990/.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
78
69. Vasconcelos Lago, R., Figueiredo da Silva Filho, M., Nery dos Santos, A. (2015). Effect of osteopathic maneuvers in the treatment of asthma: review of literature. Manual Therapy, Posturology & Rehabilitation Journal 13: 262.
70. Morningstar, M., Dovorany, B., Stitzel, C., Siddiqui, A. (2017). Chiropractic rehabilitation for adolescent idiopathic scoliosis: end-of-growth and skeletal results. Clin Pract. 7(11): 911.
71. Woggon, A., Woggon, D. (2015). Patient-reported side effects immediately after chiropractic scoliosis treatment: a cross-sectional survey utilizing a practice-based research network. Scoliosis and Spinal Disorders 10(29).
72. Woodfield, H.C., et al (2015). Craniocervical chiropractic procedures – a précis of upper cervical chiropractic. J Can Chiropr Assoc. 2015 Jun; 59(2): 173–192. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486989/.
73. Kamhi, L. (2010). Neck pain and headaches. Retrieved from https://www.spineuniverse.com/blogs/kamhi/neck-pain-headaches
74. Alcantara, J., Olsen, R. (2014). Spinal manipulation for a child with chronic cervicogenic headaches: a case report. The Journal of Headache and Pain 15(Suppl 1): C2.
75. Dwyer, D. (2017). Chiropractic for treating headaches. Retrieved from http://www.tollgatechiropractic.com/conditions/headaches.html
76. Moraska, A., Stenerson, L., Butryn, N., Krutsch, J., Schmiege, S., Mann, J. (2015). Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clin J Pain 31(2): 159-168.
77. Drutz, J., Tu, N. (2017). Patient education: bedwetting in children (beyond the basics). Retrieved from https://www.uptodate.com/contents/bedwetting-in-children-beyond-the-basics
78. Donohoe Chiropractic. (2014). Nocturnal enuresis (bedwetting). Retrieved from http://www.donohoechiropractic.com/blog/2014/2/28/nocturnal-enuresis-bedwetting
79. Instebo, E., Lystad, R. (2016). Chiropractic care of an 8-year-old girl with nonorganic, primary nocturnal enuresis: a case report. Journal of Chiropractic Medicine (2016) 15: 47-52.
80. Kenny, T. (2016). Constipation in children. Retrieved from https://patient.info/health/constipation-in-children-leaflet
81. Gleberzon, B. (2011). A narrative review of the published chiropractic literature regarding older patients from 2001–2010. J Can Chiropr Assoc. 2011 Jun; 55(2): 76–95. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095583/.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
79
82. Barber, V., Carfora, J., Wicks, T. (2016). Improvement in functional constipation while under chiropractic care in a pediatric patient with primary vesicoureteral reflux: a case report. The Academy of Chiropractic Orthopedists 13(2).
83. Dowshen, S. (Ed.). (2015). Growing pains. Retrieved from http://kidshealth.org/en/parents/growing-pains.html
84. de Beer, D., Bester, C. (2015). The effect of lumbosacral manipulation on growing pains. Health SA Gesondheid 20(1): 75-82.
85. Arndt, T. (2007, Mar.). “Growing pains” and chiropractic care – how does chiropractic help? Retrieved from http://icpa4kids.org/Wellness-Articles/growing-pains-and-chiropractic-care/How-Does-Chiropractic-Help.html
86. National Institute of Mental Health. (2016). Attention deficit hyperactivity disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
87. Bimie, K., et al. (2014). A practical guide and perspectives on the use of experimental pain modalities with children and adolescents. Pain Manag. 2014 Mar; 4(2): 97–111. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110966/.
88. Prentice, S. (2012). ADHD from treatment to function. Pathways to Family Wellness, Issue 35. Retrieved from http://pathwaystofamilywellness.org/Chiropractic/adhd-from-treatment-to-function.html
89. Healthy Start Chiropractic. (2017). Neurosensory integration. Retrieved from http://healthystartchiro.com/neurosensory-integration/
90. University Park Chiropractic. (2015). What is a subluxation? Retrieved from http://www.upchiro.com/what-is-a-subluxation.html
91. Hart, J. (2016). Analysis and adjustment of vertebral subluxation as a separate and distinct identity for the chiropractic profession: a commentary. Journal of Chiropractic Humanities 23(1): 46-52.
92. Atlas Orthogonal Chiropractic. (2015). Our techniques. Retrieved from http://www.atlasorthogonalchiro.com/About-Us/Our-Techniques.aspx
93. Francio, V. (2014). Chiropractic care for foot drop due to peroneal nerve neuropathy. Journal of Bodywork & Movement Therapies 18(2): 200-203.
94. Wong, K. (2013). Treating sprained ankles with chiropractic care. Dynamic Chiropractic 31(15). Retrieved from http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56624
95. Morgan, W. Morgan, C. (2014). Chiropractic care of a patient with neurogenic heterotopic ossification of the anterior longitudinal ligament after traumatic brain injury: a case report. J Chiropr Med 13(4): 260-265.
nursece4less.com nursece4less.com nursece4less.com nursece4less.com
80
96. Hawk, C. (Ed.). (2017). The Praeger handbook of chiropractic health care: evidence-based practices. Santa Barbara, CA: Praeger
97. Dougherty, P., Hawk, C., Weiner, D., Gleberzon, B., Andrew, K., Killinger, L. (2012). The role of chiropractic care in older adults. Chiropr Man Therap. 20(3).
98. Holt, K., Haavik, H., Lee, A., Murphy, B., Elley, C. (2016). Effectiveness of chiropractic care to improve sensorimotor function associated with falls risk in older people: a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics 39(4): 267-278.
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