Current Issue:  Vol. 16, Issue 1 (2017)

The Journal of Clinical Chiropractic Pediatrics (JCCP) is the official peer-reviewed journal of the ICA Council on Chiropractic Pediatrics. It is committed to publishing research, scientific and professional papers, literature reviews, case reports and clinical commentaries for chiropractors and other health care professionals interested in the treatment of the pregnant, postpartum and pediatric patient. Through the publication of these papers and the dissemination of this information, the JCCP seeks to encourage professional dialogue and awareness about chiropractic pediatric care to help enhance patient care and improve patient outcomes.

Editors: Sharon A. Vallone, DC, DICCP, FICCP, Cheryl Hawk, DC, PhD.

We are hopeful that this venue will provide field clinicians interested in maternal health and pediatric chiropractic with current research, case reports and clinical commentary that they will find both useful and informative.  We invite you to submit your own research or scientific writing for consideration for publication in this journal.


Is it about winning or losing? It’s all in the eye of the beholder

By Sharon Vallone, DC, DICCP, FICCP

As we all know, we are taught from an early age that there are winners and losers in every situation. Those of us in clinical practice might have that feeling when it comes to dealing with managed care, and those in research, each time we write a grant or race for the gold (publishing) with our data. But how does this apply to our young patients? When are they winners and when are they losers?

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The use of chiropractic care among 6-week-old babies in Bergen, Norway: a cross-sectional survey

By Veronica Pryme, DC and Joyce Miller, DC, PhD

Objectives: This study investigates the prevalence of six week-old babies in Bergen, Norway who present to a chiropractor, describes their demographics and documents their presenting complaints and referral patterns. Methods: This was an observational cross-sectional survey. Questionnaires were distributed by the health care visitor/midwife to the parents/guardians of infants attending the six-week control (health check up) in nine health care centres in Bergen, Norway. After collection, each form was coded with a number and data entered into the Statistical Package for the Social Sciences (SPSS). Results: In all, 123 surveys were collected. Among these, 12 (10%) had seen a chiropractor. Assisted deliveries were more frequent among the infants who had presented to a chiropractor versus the general population. The most common presenting complaints were colic and fussy baby (each reported by 6 participants). The most common mode of referral was by friends/family (N=5). Conclusion: The prevalence of six week-old babies in Bergen who have seen a chiropractor was 10%. This is the first study to have investigated the prevalence of all six week-old babies in the general population presented to a chiropractor at a snapshot in time. However, due to the small sample size, these results must be viewed with caution, and further, larger studies are warranted.

Keywords: prevalence, pediatrics, chiropractic

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Demographic profile of 266 mother-infant dyads presenting to a multidisciplinary breastfeeding clinic: a descriptive study

By Amy S. Miller, MSc, Joyce E. Miller, DC, PhD, Alison M. Taylor, PhD and Susan Way, PhD.

Worldwide, sustained breastfeeding rates are lower than optimal. Mothers and infants with suboptimal breastfeeding present to a wide variety of practitioners to assist their goal of total breastfeeding. To support these mother-infant dyads, a multi-disciplinary chiropractic and midwifery feeding clinic was opened alongside a chiropractic teaching clinic in England. To improve understanding of the presentation and clinical needs of these nursing dyads, a descriptive study was developed. This paper provides an overview of the cases that presented to this clinic over nine months, with a focus on feeding difficulties, birth and musculoskeletal problems in the infant. Mothers frequently reported more than one type of feeding problem, which most commonly included difficulty attaching, painful feeding, and a one sided feeding preference. Birth intervention was more common in this population than the national averages, particularly forceps deliveries. Musculoskeletal problems were prevalent in the babies presented to the feeding clinic, most commonly of the thoracic spine, cervical spine and sternocleidomastoid. Although causation cannot be established from this type of study, intervention at birth, feeding difficulties and musculoskeletal problems frequently coexisted in these infants. Therefore, including musculoskeletal care for infants as part of support for suboptimal breastfeeding may be appropriate.

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Is tongue tie really the problem? Incidence of ankyloglossia in an infant population presented with suboptimal feeding: a cross-sectional survey

By Amy S. Miller, MSc Joyce E. Miller, DC, PhD

As the number of infants presenting to chiropractors with the problem of suboptimal breastfeeding is increasing, further questions about this population are raised. The incidence of ankyloglossia (tongue tie) diagnosis appears to be high in this population. However, there is little literature or clarity on the role of the ankyloglossia in the often complex clinical presentation of feeding difficulties, particularly on sustaining breastfeeding in the medium to long term. This study was designed to describe a population of infants presented to a chiropractic teaching clinic with the problem of suboptimal breastfeeding, and assess this population for diagnosis and management of ankyloglossia. This will be used as a starting point for further research into these common problems of ankyloglossia and suboptimal breastfeeding. Inclusion criteria were infants presenting to this clinic with the complaint of feeding difficulties, as reported by the mother. Data were collected using maternal questionnaires and a total of 131 infants were included over a period of five months. Ankyloglossia had been diagnosed prior to presentation to the chiropractor in 39% of infants, and of these, 77% had undergone frenulotomy (tongue tie cut) once or more. Given the high incidence of ankyloglossia diagnosis and frenulotomy in these infants with persistent feeding difficulties, both the diagnosis and management of this problem must be reflected upon and questioned. This study highlights a clinical need for a) clearer diagnostic criteria for ankyloglossia and, b) further research with a focus on sustained breastfeeding following frenulotomy and other treatments.

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Prevalence of musculoskeletal dysfunction in infants presenting for chiropractic care in Norway: A cross-sectional study

By Catherin Alvestad Slettebo, DC, MSc, Joyce E. Miller, DC, PhD

Background: Musculoskeletal (MSK) injuries are common though considered under-recognized at birth. There are no gold standard routines for examination of the musculoskeletal system in infants, and very little research that investigates clinical examination and MSK findings in infants under the age of six months. Objectives: The objectives were to determine the prevalence of neck dysfunction, postural spine problems, and their possible association with parent reported behavioral problems such as suboptimal breastfeeding and supine sleeping in infants younger than six months of age. The aim of this study was to observe any associations between MSK problems of infancy and common behavioral and public health issues. Methods: This is a cross sectional questionnaire based observational study in a clinical population. Mothers of infants presented to chiropractic clinics in Norway filled in a questionnaire on the first visit, and this was followed by a clinical examination and questionnaire completed by the Doctors of Chiropractic on the same day. Results: In total, 90 infants enrolled in the study. A total of 56 infants (66%) had postural problems. Favorite side of cervical rotation (N=41; 75%) was the most common dysfunction in supine lying. Neck hyperextension was present in 21 infants (38%). The inability to rotate their head equally side to side was present in 49 children (54%). In total 22 (24%) of the infants did not have the ability to sleep or lie comfortably supine. Suboptimal breastfeeding was reported by 22 (25%) parents, and 10 (12%) of the mothers reported pain during feeding. TMJ imbalance was identified in 16 infants (19%). There were statistically significant associations between suboptimal breastfeeding and TMJ imbalance, suboptimal rooting/sucking reflexes, inability to turn head and neck equally and painful breastfeeding, respectively. Conclusion: Parents reported several MSK problems in infants along with suboptimal breastfeeding and other ADLs, which were corroborated and specified by the clinical examination. More study is needed to determine a gold standard reference for infant musculoskeletal examinations along with the importance in improving activities of daily living and public health through balance of the MSK system. Keywords: cervical spine dysfunctions, musculoskeletal problems, musculoskeletal examination, breastfeeding problems, supine sleep, infants, pediatrics, chiropractic.

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Demographic profile of pediatric patients attending a Norwegian chiropractic practice

By Anne Helene Abusal Moksness, DC, MSc and Joyce E. Miller, DC, PhD

Background: The use of chiropractic care for the pediatric patient in Norway has been under investigated along with the demographic profile of the presenting patients. Chiropractic is considered one of the most popular complementary and alternative medicine (CAM) therapies for children worldwide and many chiropractors provide care to children. Doctors of chiropractic sometimes claim to treat a wide variety of pediatric health conditions. This has been considered a controversial area of chiropractic care, both within, and outside the profession. Routine presentations are not widely investigated. Objective: To investigate the demographic profile of pediatric patients aged 0-18 years of age presenting to a Norwegian chiropractor and their primary complaints. Methods: A retrospective cross sectional study of electronic patient files to locate patients presenting in the correct age group. The data were recorded anonymously. Two main software packages were used to analyze data; Microsoft Excel 2000 spreadsheet and SPSS V 21. Results: 258 pediatric patients were enrolled in the study. The most common age at presentation was one month (n=68). 49% were female; boys more commonly presented in infancy, girls more commonly in adolescence. On average there were three visits per patient. The patients had two or more presenting complaints (average 2.5). The most common presenting complaint was favored (asymmetrical) head position (n=84, 33%), followed by infant positioning/postural difficulties (n= 81; 31%) and inconsolable crying (n=79, 31%). No serious adverse events were reported; 5% reported an intermittent and self-limiting mild side effect lasting less than 24 hours. Approximately 13% of pediatric patients were referred from health care professionals. 85% of parents/children reported either full recovery or good improvement following a chiropractic treatment protocol. Conclusion: The infant was the most common age in pediatric presentations to a Norwegian chiropractic practice. The most common complaints were musculoskeletal in origin followed by excessive crying. On average pediatric patients had three treatment sessions, and most parents/patients reported full recovery or good improvement with no adverse events.

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Journal Abstracts

The Human Intestinal Microbiome in Health and Disease.

Susan V. Lynch, Ph.D., and Oluf Pedersen, M.D., D.M.Sc.

N Engl J Med 2016; 375:2369-2379December 15, 2016DOI: 10.1056/NEJMra1600266

The large majority of studies on the role of the microbiome in the pathogenesis of disease are correlative and preclinical; several have influenced clinical practice.

The Use of Probiotics in Pediatric Gastroenterology: A Review of the Literature and Recommendations by Latin-American Experts.

Sylvia Cruchet, Raquel Furnes, Aldo Maruy, Eduardo Hebel, Jorge Palacios, Fernando Medina, Nelson Ramirez, Marina Orsi, Lysette Rondon, Vera Sdepanian, Luis Xo chihua, Manuel Ybarra, Roberto Arturo Zablah

Pediatr Drugs (2015) 17:199–216 DOI 10.1007/s40272-015-0124-6

Published online: 24 March 2015 Ó The Author(s) 2015. This article is published with open access at

Aerophagia Induced Reflux in Breastfeeding Infants with Ankyloglossia and Shortened Maxillary Labial Frenula (Tongue and Lip Tie).

Scott A. Siegel

Int J Clin Pediatr 2016;5(1):6-8

Suck-Swallow-Breathe Dynamics in Breastfed Infants.

Vanessa S. Sakalidis, BHlth Sc (Hons), PhD, Donna T. Geddes, DMU, Post Grad Dip (Sc), PhD

Journal of Human Lactation, Vol 32, Issue 2, 2016

Manipulation Peak Forces Across Spinal Regions for Children Using Mannequin Simulators.

John J. Triano, DC, PhD, Steven Lester, DC, MSc, David Starmer, DC, MHS, and Elise G. Hewitt, DC

Journal of Manipulative and Physiological Therapeutics March/April 2017

Impact of physical activity during pregnancy on obstetric outcomes in obese women.

Tinius RA, Cahill AG, Cade WT.

J Sports Med Phys Fitness. 2017 May;57(5):652-659. doi: 10.23736/S0022-4707.17.06222-3. Epub 2015 Nov 12.

Musculoskeletal Effects of Pregnancy on the Lower Extremity: A Literature Review.

Anselmo DS, Love E, Tango DN, Robinson L.

J Am Podiatr Med Assoc. 2017 Jan;107(1):60-64. doi: 10.7547/15-061.

Medicinal Plants for Management of Gastroesophageal Reflux Disease: A Review of Animal and Human Studies.

Salehi M, Karegar-Borzi H, Karimi M, Rahimi R.

J Altern Complement Med.
2017 Feb;23(2):82-95. doi: 10.1089/acm.2016.0233. Epub 2016 Dec 20.

Herbal medicines in children with attention deficit hyperactivity disorder (ADHD): A systematic review.

Anheyer D, Lauche R, Schumann D, Dobos G, Cramer H.

Complement Ther Med. 2017 Feb;30:14-23. doi: 10.1016/j.ctim.2016.11.004. Epub 2016 Nov 18.

Complementary and alternative medicine among hospitalized pediatric patients.

Oren-Amit A, Berkovitch M, Bahat H, Goldman M, Kozer E, Ziv-Baran T, Abu-Kishk I.

Complement Ther Med. 2017 Apr;31:49-52. doi: 10.1016/j.ctim.2017.02.002. Epub 2017 Feb 7.

High-Protein and High-Dietary Fiber Breakfasts Result in Equal Feelings of Fullness and Better Diet Quality in Low-Income Preschoolers Compared with Their Usual Breakfast.

Kranz S, Brauchla M, Campbell WW, Mattes RD, Schwichtenberg AJ.

J Nutr. 2017 Mar;147(3):445-452. doi: 10.3945/jn.116.234153. Epub 2017 Jan 11.

Musculoskeletal Traumatic Injuries in Children: Characteristic Imaging Findings and Mimickers.

Ho-Fung VM, Zapala MA, Lee EY.

Radiol Clin North Am. 2017 Jul;55(4):785-802. doi: 10.1016/j.rcl.2017.02.011. Epub 2017 Mar 27.

Beverage Consumption Patterns at Age 13 to 17 Years Are Associated with Weight, Height, and Body Mass Index at Age 17 Years.

Marshall TA, Van Buren JM, Warren JJ, Cavanaugh JE, Levy SM.

J Acad Nutr Diet. 2017 May;117(5):698-706. doi: 10.1016/j.jand.2017.01.010. Epub 2017 Mar 2.

Association between maternal intake of n-6 to n-3 fatty acid ratio during pregnancy and infant neurodevelopment at 6 months of age: results of the MOCEH cohort study.

Kim H, Kim H, Lee E, Kim Y, Ha EH, Chang N.

Nutr J. 2017 Apr 18;16(1):23. doi: 10.1186/s12937-017-0242-9.

Prospective associations of meat consumption during childhood with measures of body composition during adolescence: results from the GINIplus and LISAplus birth cohorts.

Harris C, Buyken A, von Berg A, Berdel D, Lehmann I, Hoffmann B, Koletzko S, Koletzko B, Heinrich J, Standl M.

Nutr J. 2016 Dec 5;15(1):101.

A Systematic Review of the Soft-Tissue Connections Between Neck Muscles and Dura Mater: The Myodural Bridge.

Palomeque-Del-Cerro L, Arráez-Aybar LA, Rodríguez-Blanco C, Guzmán-García R, Menendez-Aparicio M, Oliva-Pascual- Vaca Á.

Spine (Phila Pa 1976). 2017 Jan 1;42(1):49-54. doi: 10.1097/BRS.0000000000001655.

Impact of imposed exercise on energy intake in children at risk for overweight.

Fearnbach SN, Masterson TD, Schlechter HA, Ross AJ, Rykaczewski MJ, Loken E, Downs DS, Thivel D, Keller KL.

Nutr J. 2016 Oct 21;15(1):92.

Application of Kinesio Taping method for newborn swallowing difficultly: A case report and literature review.

Chien-Lin Lin, MD, BS, Wei-Ting Wu, MD, Ke-Vin Chang, MD, PhD, Hong-Yi Lin, MD, Li-Wei Chou, MD, PhD

Medicine (2016) 95:31

Association between sports type and overuse injuries of extremities in children and adolescents: a systematic review.

Chéron C, Le Scanff C, Leboeuf-Yde C.

Chiropr Man Therap. 2016 Nov 15;24:41. eCollection 2016.

Case Report: Severe Breast Pain Resolved with Pectoral Muscle Massage.

Edith Kernerman, IBCLC and Eileen Park, MSc, IBCLC, ND

Journal of Human Lactation 2014, Vol. 30(3) 287–291 © The Author(s) 2014 Reprints and permissions:
nav DOI: 10.1177/0890334414535842

Primary Care Interventions to Support Breastfeeding: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Patnode CD, Henninger ML, Senger CA, Perdue LA, Whitlock EP.

JAMA. 2016 Oct 25;316(16):1694-1705. doi: 10.1001/jama.2016.8882.Erratum in

Breastfeeding Improvement Following Tongue-Tie and Lip-Tie Release: A Prospective Cohort Study.

Bobak A. Ghaheri, MD; Melissa Cole, IBCLC; Sarah C. Fausel, BA; Maria Chuop, BS; Jess C. Mace, MPH, CCRP

The Laryngoscope VC 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Dietary Inflammatory Potential during Pregnancy Is Associated with Lower Fetal Growth and Breastfeeding Failure: Results from Project Viva

Sarbattama Sen, Sheryl L Rifas-Shiman, Nitin Shivappa, Michael D Wirth, James R Hebert, Diane R Gold, Matthew W Gillman, and Emily Oken

The Journal of Nutrition Nutrition and Disease 2016 American Society for Nutrition.
First published online March 2, 2016; doi:10.3945/jn.115.225581.

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