Current Issue:  Vol. 17, Issue 2 ( 2018)

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.


Remembering Maxine McMullen, RN, DC, FICCP

By Sharon Vallone, DC, DICCP, FICCP

There are people who come into our lives who gently nudge (or in some cases, firmly bump!) us off the path we thought we were following with keen focus. They broaden our horizon and challenge us to excel by raising the bar. Whether inspired by awe (or “fear,”) beguiled by humor, instilled with confidence, embraced with love or a kaleidoscope of all those experiences, we follow their lead which soon becomes the way of our own hearts as we begin to embrace the gifts they confidently declare that we have and must own so that we can be of the greatest service to the children who need our care and advocacy. One such very special and awesome woman crossed my path in 1992 and irrevocably changed the course of the years to follow. It was with deep sorrow that the International Chiropractors Association and chiropractors around the world heard of the passing of Dr. Maxine McMullen, one of the icons of chiropractic and a pioneer of chiropractic pediatrics.

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Benign joint hypermobility — developing clinical significance

By Peter N. Fysh, DC, FICCP

The aim of this paper is to examine the clinical significance of joint hypermobility, and to suggest some diagnostic and management protocols which might be used in a chiropractic practice. Joint hypermobility is a largely unrecognized condition that is little understood, little talked about and often misdiagnosed. Clinicians may encounter patients with joint hypermobility but fail to appreciate the significance in terms of overall morbidity. The clinical significance of joint hypermobility is examined from many aspects. Considerations include the effect of joint hypermobility on different body structures as well as during pregnancy, on newborn, school-aged and adolescent conditions and the effect of different sports on the hypermobile child. Finally, the effects of joint hypermobility on spinal adjusting, and the modifications thereof, are discussed.

Key words: joint hypermobility, newborn, infant, child, pregnancy, sport, chiropractic, spinal adjusting, motor development, disc degeneration, scoliosis, attention deficit hyperactivity disorder.

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Portable pad or pen and paper? Preference of mothers completing an outcomes instrument: a cross-sectional survey

By Mandy Hiew, MSc, Derek Shawn Lo Tiap Kwong, MSc, Zicheng Mok, MSc,Yun Han Tee, MScand Joyce Miller, BS, DC, PhD

Background: The objective of this study was to investigate the preferred method of data collection, paper or electronic, for mothers completing a validated infant outcomes instrument, the United Kingdom Infant Questionnaire. Methods: Mothers of children aged 0-12 months were asked to complete the questionnaire in both paper and electronic formats. The mother was then given another form to select her preferred type of survey. Results: In all, 51 mothers participated; 35 (69%) preferred the electronic questionnaire, 11 (21%) preferred the paper version and 5 (10%) felt neither one was better. Comments included that electronic form was easier and it was better to save the trees. Conclusion: Although the number was small, this study showed that electronic-based questionnaires were preferred by mothers of infants. With the progression of technology, electronic questionnaires could be considered a more efficient method for collecting important data, without loss due to patient or parent preferences.

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Early intervention: Improvement in motor developmental speech delay in a 2-year-old male following chiropractic care: a case report

By Andrew Dorough DC

Objective: To chronical the improvements in a non-verbal 2-year-old male presenting without the age appropriate receptive language. At the time he presented, he was unable to pronounce simple vowel sounds. Methods: Online review of the literature on motor development delay, speech delay and chiropractic were performed using the index to chiropractic literature, PubMed and Google Scholar. Search terms “motor developmental delay”, “speech delay”, “child apraxia”, “speech delay and chiropractic”, “speech and language delay” and “spinal manipulation” were used. Clinical Features: A 2-year-old male with apparent motor speech delay reported to the office for chiropractic care. This child was almost completely non-verbal and unable and or unwilling to articulate simple vowel sounds, simple words or word sounds. His expressive vocabulary consisted of 5-8 words that were poorly pronounced. His main form of communication was crying or using bodily gestures. The child had seen no other professional for this complaint nor had he received any treatment by another professional for this complaint. Intervention and outcome: The child received cervical and cranial chiropractic care for 7 visits over 8 weeks using digital vibration with hands (Gonstead technique) and Sigma-Instrument (instrument assisted) technique to correct cervical vertebral and atlanto-occipital segmental dysfunction. Throughout chiropractic care, the child showed steady progress in articulating vowel sounds, word sounds and simple words including pronunciation attempts upon reading words. Parents also report, subjectively, that child has become more “affectionate” and “loving”. Conclusion: An early intervening course of chiropractic care using modified Gonstead Technique and Sigma Instrument assisted adjusting technique for the correction of cervical vertebral and atlanto-occipital bone subluxation were associated with improvement in the child’s presenting motor developmental speech delay.

Keywords: motor developmental delay, speech delay, child apraxia, speech delay and chiropractic, speech and language delay.

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Chiropractic management of musculoskeletal disorders associated with a neonatal clavicle fracture: a case report

By Amelie Bourque, DC

Objective: To present chiropractic management of a 5-month-old patient with multiple complaints related to a neonatal clavicle fracture and the resolution of all symptoms after 4 treatments. Case presentation: A 5-month-old male presenting with history of a fractured left clavicle, fussing, irritability, crying, grunting, rigidity, abnormal positioning of his left arm at rest, breastfeeding difficulties on the right side and apparent discomfort lying on his stomach. He presented to a chiropractic office after consulting various health professionals without improvement. Interventions, and outcomes: Various techniques, including touch and hold, sacro-occipital, light vibration and mobilization were used to treat the 5-month-old male infant during the 4 visits complimented by home exercises. Objective findings of subluxations of the left clavicle, left 1st rib, T2, T5, occiput, left scapula and left gleno-humeral joint were confirmed with static palpation, motion palpation of the spine and the upper limb. Following 4 visits, grunting and crying ceased, the left arm was in normal position at rest with complete active and passive range of motion, breastfeeding successfully bilaterally without nipple pain for the mother. The child also demonstrated improvement in motor development. Conclusion: Chiropractic management should be considered collaboratively with medical follow-up in cases of birth trauma such as clavicle fracture. Further research is warranted to asses the long-term musculoskeletal sequelae with similar cases of neonatal birth trauma.

Key Words: case report, chiropractic, subluxation, neonatal clavicle fracture, footling breech presentation, birth trauma, Caesarean section, breastfeeding difficulties, irritability, sleep disorder.

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The chiropractor’s role in the interdisciplinary care of the infant with faltering growth: two case reports

By Linda Alida Bernadette Anna Overschie, BSc, MSc Chiropractic, DC

1. AECC University College, Bournemouth, United Kingdom

Background: this case report identifies chiropractic care as one component in the diversified approach to faltering growth in the infant. Methods: A literature search was conducted in October 2017 using the journal databases PubMed, Medline, Cochrane Library, Index to chiropractic literature, CINAHL and the AECC library. Case presentations: Two infants presented separately for care, having not been able to regain their birthweight at three and eight weeks of age, respectively. Intervention and outcomes: The chiropractic approach was used to address the biomechanical and musculoskeletal problems in the infants. Other professionals were consulted for other aspects of their care. Discussion: An interdisciplinary team approach was needed to address all of the issues of the faltering growth. Chiropractic care was key to improve the baby’s use of muscles of mastication and to allow for comfort in supine sleep.

Key Words: pediatrics, faltering growth, failure to thrive, chiropractic, case series.

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Cervical Proprioception in a Young Population Who Spend Long Periods on Mobile Devices: A 2-Group Comparative Observational Study.
Journal of Manipulative and Physiologic Therapeutics February 2018 Volume 41, Issue 2, Pages 123–128
Andrew Portelli, BPhysiotherapy(Hons); Susan A. Reid, PhD, MMedSc(Phty), GradDip(Manip.Phty)
School of Physiotherapy, Australian Catholic University, North Sydney, New South Wales, Australia

Breastfeeding and early white matter development: A cross-sectional study.
Neurolmage Volume 82-Novv 12, 2013
Sean C, Deoni, Douglas Dean III, Irene Piryatinsky, Jonathan O’Muircheartaigh, et al.

Association of Combined Patterns of Tobacco and Cannabis Use in Adolescence with Psychotic Experiences.
JAMA Psychiatry 2018;75(3):240-246.
Hannah J. Jones, PhD; Suzanne H. Gage, PhD; Jon Heron, PhD; et al.
Key Points — Question: Are patterns of adolescent cigarette and cannabis use differentially associated with subsequent onset of psychotic experiences? Findings: In this longitudinal cohort study of 3328 adolescents, there is evidence that both cannabis and cigarette use are associated with subsequent psychotic experiences prior to adjusting for confounders. However, after adjusting, the associations for cigarette-only use attenuated substantially, whereas those for cannabis use remained consistent. Meaning: While individuals who use either cannabis or cigarettes during adolescence appear to be at increased risk of psychotic experiences, the association of psychotic experiences is greater with cannabis than with tobacco smoking.

Rebellious Behaviors in Adolescents with Epilepsy.
J Pediatr Psychol 2018;43(1):52-60.
Aimee W. Smith, PhD; Constance Mara, PhD; Shannon Ollier, Psy.D; et al.

Association of Sex with Recurrence of Autism Spectrum Disorder Among Siblings.
JAMA Pediatr 2017;171(11):1107-1112.
Nathan Palmer, PhD; Andrew Beam, PhD; Denis Agniel, PhD; et al
Key Points — Question: What are the sex-specific recurrence rates of autism spectrum disorder among siblings? Findings: In this population analysis of 1 583 271 families with 2 children, a significantly increased risk of recurrence of autism spectrum disorder was found among males than among females. Meaning: An older female sibling diagnosed with autism spectrum disorder is associated with greater risk of recurrence in the younger sibling compared with an older diagnosed male sibling, and male siblings are more likely to experience recurrence than female siblings regardless of the sex of the diagnosed sibling.

Chiropractic management of dominating one-sided pelvic girdle pain in pregnant women; a randomized controlled trial.
BMC Pregnancy Childbirth 2017 Sep 29;17(1):331.
Gausel AM, Kjærmann I, Malmqvist S, Andersen K, Dalen I, Larsen JP, Økland I.

Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood.
JAMA Pediatr Published online April 2, 2018.
Edward Mitre, MD; Apryl Susi, MS; Laura E. Kropp, MPH; et al
Key Points — Question: Does use of medications that disturb the microbiome in infancy increase subsequent risk of developing allergic diseases? Findings: In this cohort study of 792 130 children, the hazard of developing an allergic disease was significantly increased in those who had received acid-suppressive medications or antibiotics during the first 6 months of life. Meaning: Exposure to acidsuppressive medications or antibiotics in the first 6 months of life may increase risk of allergic disease development.

Revision Lingual Frenotomy Improves Patient-Reported Breastfeeding Outcomes: A Prospective Cohort Study.
Journal of Human Lactation May 2018
Bobak A. Ghaheri, MD, Melissa Cole, IBCLC, Jess C. Mace, MPH, CCRP
First Published May 22, 2018 Research Article

Schroth physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis: how many patients require treatment to prevent one deterioration? - results from a randomized controlled trial - “SOSORT 2017 Award Winner.”
Scoliosis Spinal Disord. 2017 Nov 14;12:26.
Schreiber S, Parent EC, Hill DL, Hedden DM, Moreau MJ, Southon SC.

Breastfeeding and Maternal Hypertension.
American Journal of Hypertension, Vol 31 (13), May 2018
Article published: 30 January 2018
Sangshin Park, Nam-Kyong Choi

Associations Between Brain Structure and Connectivity in Infants and Exposure to Selective Serotonin Reuptake Inhibitors During Pregnancy.
JAMA Pediatr. Published online April 9, 2018.
Claudia Lugo-Candelas, PhD1,2; Jiook Cha, PhD1,2; Susie Hong, BS1,2; et al

Breastfeeding and motor development in term and preterm infants in a longitudinal US cohort.
Am J Clin Nutr. 2017 Dec;106(6):1456-1462. Epub 2017 Nov 1.
Michels KA, Ghassabian A, Mumford SL, Sundaram R, Bell EM, et al.

Low back pain and causative movements in pregnancy: a prospective cohort study.
BMC Musculoskelet Disord. 2017;18: 416.
Saori Morino, Mika Ishihara, Fumiko Umezaki, Hiroko Hatanaka, et al.
Published online 2017 Oct 16.
PMCID: PMC5644197 PMID: 29037184

Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: A systematic review and meta-analysis.
J Bodyw Mov Ther 2017 Oct;21(4):752-762. doi: 10.
Franke H, Franke JD, Belz S, Fryer G. Epub 2017 May 31.

Risk for Autism Spectrum Disorders According to Period of Prenatal Antidepressant ExposureA Systematic Review and Meta-analysis.
JAMA Pediatr 2017;171(6):555-563.
Antonia Mezzacappa, MD; Pierre-Alexandre Lasica; Francesco Gianfagna, MD, PhD; et al.
Key Points — Question: Does prenatal antidepressant exposure increase the risk for autism spectrum disorders? Findings: This systematic review and meta-analysis suggests an association between increased autism spectrum disorder risk and maternal use of antidepressants during pregnancy; however, it appears to be more consistent during the preconception period than during each trimester. The association was weaker when controlled for past maternal mental illness. Meaning: Maternal psychiatric disorders in treatment before pregnancy rather than antenatal exposure to antidepressants could have a major role in the risk for autism spectrum disorders.

Pregnancy and Pelvic Girdle Pain.
Journal of the American Podiatric Medical Association, July 2017, Vol. 107, No. 4, pp. 299-306
Floriane Kerbourc’h, Jeanne Bertuit, Véronique Feipel and Marcel Rooze

Effect of Foot Manipulation on Pregnancy-Related Pelvic Girdle Pain: A Feasibility Study.
J Chiropr Med. 2017 Sep;16(3):211-219.
Melkersson C, Nasic S, Starzmann K, Bengtsson Boström K.

Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses.
BMJ Journals/Open Volume 8, Issue 1
Dawn Carnes, Austin Plunkett, Julie Ellwood, Clare Miles

Association of Prenatal Ultrasonography and Autism Spectrum Disorder.
JAMA Pediatr 2018;172(4):336-344.
N. Paul Rosman, MD; Rachel Vassar, MD; Gheorghe Doros, PhD; et al
Key Points — Question: Is prenatal ultrasonography frequency, timing, duration, or strength associated with later diagnosis of autism spectrum disorder? Findings: In this case-control study of 420 children, those with autism spectrum disorder were exposed to greater mean depth of ultrasonographic penetration during the first and second trimesters compared with typically developing children and during the first trimester compared with developmentally delayed children. No association between the number of scans or duration of ultrasound exposure and later autism spectrum disorder was found. Meaning: Increased depth of prenatal ultrasonographic penetration may be associated with perturbations in fetal neuronal cortical migration and later autism spectrum disorder; this correlation deserves further study.

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