Current Issue:  Vol. 18, Issue 2 ( 2019)

By Cheryl Hawk, DC, PhD, CHES, Editor and Sharon A. Vallone, DC, DICCP, FICCP, Editor

In August of 2018, the Minister of Health for the State of Victoria in Australia commissioned an independent review of spinal manipulation in children. This commission was the result of video footage of a chiropractor treating an infant that appeared in social media. The review, “Chiropractic Spinal Manipulation of Children under 12: Independent Review” was published in October 2019 and is available at http://bit.ly/SCVpaediatric. The World Federation of Chiropractic (WFC) published a report November 1, 2019, that summarized the review and is available at the WFC website.

By Mike Marinus MSc (Paeds) (M.Tech Chiro)

Objectives: Since the Back to Sleep campaign in 1992, the incidence of positional plagiocephaly continues to increase substantially. A body of work is emerging linking positional plagiocephaly to neurodevelopmental delay, including data that reveals a physical shift in brain parenchyma in response to skull asymmetry. This review assesses the nature of the relationship between these neurodevelopmental delays and positional plagiocephaly. Method: A literature search was required to answer the clinical question. Pubmed, Medline and The Cochrane Library were searched using the mesh terms: ‘plagiocephaly, nonsynostotic’ and ‘growth and development’ in conjunction with the terms: ‘neurodevelopmental delay’, development’ and ‘delay’. After the relevant inclusion and exclusion criteria were applied, 12 studies were reviewed. Results: Positional plagiocephaly has shown a defined link to neurodevelopmental delay in infants. The effect is seen more prominently in motor skills during infancy and the delay has been noted to extend into preschool age children. Plagiocephaly patients are more likely to have altered muscle tone. No correlation was seen between the severity of the skull asymmetry and the level of neurodevelopmental delay experienced by the child. Conclusion: The data suggest correlation but not necessarily causation. It is also possible that pre-existing neurodevelopmental delay may be the cause of positional plagiocephaly. In most cases it is likely to be a combination of the risk factors of supine sleep, lack of prone awake time, variable muscle tone, low activity levels, male gender and neck muscle dysfunction that attributes to the delays that have been recognized in these infants.

Key Words: Positional Plagiocephaly, neurodevelopmental delay, Chiropractic, Pediatric.

Resolution of unilateral breast-feeding preference and reflux in a 14-week-old infant with a preferred head position following chiropractic care: a case report

By Kayla Beardsley, DC

Introduction: Joint misalignment or hypomobility, termed subluxation in the chiropractic profession, can affect even the pediatric patient. Subluxations may present as a multitude of symptoms in this population such as breast-feeding dysfunction, reflux, and a preferred head position, among others. Presenting Concern: A 14-week-old infant presented to a chiropractic office with breast-feeding dysfunction, reflux, and a left lateral head tilt. Breast-feeding dysfunction began around four weeks of age and the onset of reflux was nine weeks of age, gradually worsening with time. The infant’s left lateral head tilt was noticed by mom, but she is uncertain of time of onset. Interventions: A course of chiropractic care was recommended: four visits over the course of three weeks. Modified chiropractic adjustments were administered to restriction of subluxation palpated in the pediatric spine. Outcomes: Complete resolution of breast-feeding dysfunction occurred following the first adjustment. Complete resolution of reflux and positional head preference occurred after the second adjustment. No outside referrals were warranted. Conclusions: Subluxation in the occipital cervical (C0C1) region which may present as a preferred head position is suggested to influence and produce symptoms such as breast-feeding dysfunction and reflux in the pediatric patient. As positive results were obtained in this case report, it is suggested that chiropractic care may be efficient and effective in evaluating and treating these complaints.

Key Words: breast-feeding dysfunction, reflux, preferred head position, head tilt, chiropractic, pediatric.

Parent proxy report and pre-adolescent self-report of pain and trauma: A cross-sectional observational study in Sweden

By Sue A. Weber BSc, DC, MSc Chiropractic Pediatrics

Background: The prevalence of musculoskeletal pain changes significantly between pre-adolescence and adolescence. It is unclear whether parent proxy reports and child report of pain and trauma are concordant. This study investigated the respective agreement between pre-adolescents and their parents in reporting head and/or neck trauma and recurrent neck pain and/or headache. Methods: This cross-sectional observational study formed part of a study carried out to ascertain the prevalence of non-specific neck pain and/or headache in 131 Swedish pre-adolescents. Information was gathered from a questionnaire completed in school, and an informed consent with additional questions for the parents. Results: All of the students (n=131) who were approached to participate in the study agreed to complete the questionnaire. Of these, 40% (n=52) reported that they experienced neck pain and/or headaches with 31% (n=41) reporting the frequency was “often.” The parental report differed with 6% (n=8) of parents acknowledging that their child often had neck pain and/or headache. Similarly, 61% (n=80) of children reported trauma to the head/neck while 20% (n= 26) of the parents reported that their child had experienced trauma to the head and/or neck region. Conclusion: Neck pain and/or headache in this group of Swedish pre-adolescents were common, as was previous trauma to the head or neck. Most of the parents were unaware that their child often had neck pain and/or headache or had suffered head or neck trauma. This discordance should be further explored to better understand the change in reporting pain from pre-adolescence to adolescence.

Giving birth: a systematic review of the value of skin to skin contact in a medicalized birth

By Kiara Defrancq, MChiro, MSc APP (Pediatrics) DC

Purpose: The musculoskeletal system sets the foundation of the infant’s future growth and development. Skin-to-skin care (SSC), also referred to as kangaroo mother care, should be employed as a routine postnatal practice to enhance optimal growth and health of the newborn. Unfortunately, the benefits of this practice are underestimated by many healthcare professionals and parents are not always made aware of this beneficial alternative to conventional neonatal care. Therefore, the aim of this review is to evaluate the impact of medical interventions as well as reduced or no skin-to-skin contact on the newborn’s physiology on a long-term basis. Methods: The literature search was conducted using Pubmed, Medline, CINAHL, Cochrane Library and Alt Health Watch to review the current evidence using the keywords skin-to-skin, breastfeeding, newborn and outcomes. In total, 31 articles met the inclusion and exclusion criteria and were eligible for this review. Results: The literature search concluded that skin-to-skin care (SSC) between mother and child is beneficial for the infant’s tactile, auditory, sensory, motor, vestibular, parasympathetic and sympathetic development as well as their mental state. Currently, conservative healthcare professionals continue to employ conventional protocols and underestimate the importance of encouraging early mother kangaroo care. Also, more investigation should be encouraged focusing on the impact medical interventions, such as intravenous lines, extraction, etc. have on the infant’s physiology and the child-mother bonding. C-section, prematurity and low birth weight may contribute to the complexity of the neonate’s situation, however, with appropriate surveillance, SSC is not impossible. There is disagreement about the optimal timing and the duration that SSC should be employed. Conclusion: The research states that (early) skin-to-skin contact is the most simple, cost-effective and life-saving ‘intervention’ a child can get. There is enough supporting material showing its benefits on the child’s mental and musculoskeletal health. More research is warranted to establish the most beneficial timing and duration for maternal-infant skin-to-skin care.

Why aren’t chiropractic physicians treating more children with complex diagnoses? A commentary on documenting P.A.R.T. for diagnosing and treating special needs children

By Eric Epstein, DC, Jean Elizabeth Grabowski and Richard Duenas, DC, DABCN

According to the Centers for Medicare and Medicaid Services (CMS) guidelines, chiropractors are deemed physicians in the Medicare system and for consistency throughout the term chiropractic physician will encompass chiropractor, chiropractic doctor, doctor of chiropractic and chiropractic physician. Chiropractic physicians must document subluxation of the spine through x-ray or physical examination. The documentation of subluxation of the spine through physical examination includes the identification of two out of four criteria including: Pain/tenderness, Asymmetry/misalignment, Range of motion abnormality, Tissue tone, texture, and temperature abnormality (P.A.R.T.) with at least one of the two criteria being either A or R. Since special needs children often have difficulty expressing pain, and/or experiencing pain the way a typical child can, it is necessary to understand approaches to the special needs child that allow the doctor to evaluate and treat the child, as well as comply with insurance mandates to establish medical necessity. The purpose of this paper is to help the doctor understand approaches to document the diagnosis/diagnoses and procedures utilized for the medically necessary care of special needs children to while remaining in compliance with the billing to 3rd party payers. A case report follows to illustrate these challenges.

Keywords: Special needs children, autism, Down syndrome, insurance compliance, Medicare, medical necessity, pediatrics, chiropractic, chiropractic physician, chiropractor.