Current Issue:  Vol. 21, Issue 1 (May 2022)

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 and Joyce Miller, 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.

Editorial

How do we measure up in 2022 caring for children as chiropractors?

By Sharon Vallone, DC, FICCP, Editor

Most chiropractors have heard from our patients about the breakdown in care under the current persisting constraints of telehealth visits. We also hear how the decrease in the healthcare provider workforce has presented a challenge to families seeking immediate or at times, specialized care, for their children. These challenges have brought many families to our doors because chiropractors have continued to provide safe and effective face to face and hands-on care under the guidelines of their individual state or country’s departments of health, and because our patients talk about the care we provide. Many of the new individuals you have met over the last year may not have called upon us had their familiar channels of care been open to them. However, they have chosen to seek our counsel on the direction of another satisfied parent or patient or because our offices are open and available to them.

 


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Articles

 

Commentary: Competencies and Standardization in Chiropractic Pediatric Education: An Opinion on Taking the Next Step

By Anna E.Papadopoulou, MChiro,D.C.,DACNB.,MSc (MSK health in Pediatrics), FRCC

Competencies and standardization for any profession are a sign of a well-established, healthy organization. Educational as well as professional competencies and standardizations are currently in place to ensure the safety and effectiveness of the chiropractic profession. Different versions of codes of ethics are globally available to guide clinicians and safeguard the public according to each country and region. The chiropractic profession has evolved and expanded to create several special interest groups over the years. These include sports, orthopedics, pediatrics, radiology, neurology and animal chiropractic. Unlike the global standardization of the chiropractic profession as a whole, there is a lack of guidelines in terms of special interest groups in general, as well as more specifically in the pediatric chiropractic arena.


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Breastfeeding and ASD: A spectrum of challenges

By Yolande Loftus, LLB

ABSTRACT
As their children are diagnosed with autism, many mothers are discovering their own neurodivergence. With the long-overdue acknowledgment of mothers’ position on the spectrum, pregnancy, parenting and breastfeeding issues of autistic women should become a priority for the scientific and healthcare community. Beyond the protective benefits of breastfeeding for reducing autism risk, the breastfeeding experience of autistic women also deserves a much closer look.


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Collaborative chiropractic management of breastfeeding difficulties in a neonate: A case study

By Catriona McNamara B.Sc; M.Chiro; DACCP; Gonstead Diplomate

ABSTRACT
Poor weight gain in the neonatal period is concerning. This paper outlines the management of care for a 3-week-old neonate that had significant weight loss and breastfeeding difficulty. Recognition of dysfunction in the mechanical aspects of breastfeeding by the International Board-Certified Lactation Consultant led to referral to a chiropractic clinic. This case study outlines the role that a chiropractor may play in encouraging the breastfeeding dyad with a collaborative approach. Chiropractic recognition of cervical, temporomandibular and shoulder dysfunction in the infant during the early crucial phase may assist this population in establishing good breastfeeding function. This paper describes the biomechanical, neurological, and clinical indicators, circumstances, and what role they may play in affecting the continuation of exclusive breastfeeding.


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Pediatric headache questionnaire, exam and history forms for the chiropractor

By Sue A. Weber DC, MSc Chiropractic Pediatrics

ABSTRACT
The academic arm of the European Chiropractic Union (ECU) is the European Academy of Chiropractic (EAC). Within the EAC are special interest groups (SIG) focusing on postgraduate education for chiropractors in the areas of pediatrics, neurology, clinical chiropractic and sports chiropractic. Children are one of the unique populations presenting to the chiropractor requiring a different skill set than that utilized to assess the adult patient. In recognition of this, the EAC’s SIG for pediatrics has developed history, examination and questionnaire forms for children with headache. The aim of these forms is to assist the chiropractor in identifying red flags and to skillfully differentially diagnose headaches as they present throughout growth and development. The process of development of these forms is outlined, and three forms are presented in this article.


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Using whole body vibration in the pediatric population: a primer for the chiropractor

By Tracy Barnes DC DICCP CKTI

ABSTRACT
Objective: To present a history of whole body vibration (WBV) and survey current literature as it relates to the use of this therapy with children. Clinical relevance for Doctors of Chiropractic who work in the pediatric realm will be noted. Methods: Primary source material came from a literature search of PubMed and google scholar. The search focused on whole body vibration therapy in use with children aged 0-18 years with keywords: ‘whole body vibration and pediatrics; whole body vibration and children, WBV and pediatrics, WBV and children, WBV contraindications.’ Results: Based on the results of this review, WBV appears to be safe and well tolerated in the pediatric population. Multiple effects have been found for WBV including decreasing muscle spasticity, improving muscle strength and balance and increasing bone density It has been studied in children diagnosed with a variety of disorders including cerebral palsy, Down syndrome, movement disorders, bone mineral density and more. Appropriate frequency levels for treatment are presented. Contraindications were minimal. Conclusion: WBV can safely be introduced to children and may provide positive therapeutic gains.

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Evidence-Informed Milestones for Developmental Surveillance Tools
Jennifer M. Zubler, MD, Lisa D. Wiggins, PhD, Michelle M. Macias, MD, Toni M. Whitaker, MD, Judith S. Shaw, EdD, MPH, RN, Jane K. Squires, PhD, Julie A. Pajek, PhD, Rebecca B. Wolf, MA, Karnesha S. Slaughter, MPH, Amber S. Broughton, MPH, Krysta L. Gerndt, MPH, Bethany J. Mlodoch, Paul H. Lipkin, MD.
https://doi.org/10.1542/peds.2021-052138
The Centers for Disease Control and Prevention’s (CDC) Learn the Signs Act Early program, funded the American Academy of Pediatrics (AAP) to convene an expert working group to revise its developmental surveillance checklists. The goals of the group were to identify evidence-informed milestones to include in CDC checklists, clarify when most children can be expected to reach a milestone (to discourage a wait-and-see approach), and support clinical judgment regarding screening between recommended ages. Subject matter experts identified by the AAP established 11 criteria for CDC milestone checklists, including using milestones most children (≥75%) would be expected to achieve by specific health supervision visit ages and those that are easily observed in natural settings. A database of normative data for individual milestones, common screening and evaluation tools, and published clinical opinion was created to inform revisions. Application of the criteria established by the AAP working group and adding milestones for the 15- and 30-month health supervision visits resulted in a 26.4% reduction and 40.9% replacement of previous CDC milestones. One third of the retained milestones were transferred to different ages; 67.7% of those transferred were moved to older ages. Approximately 80% of the final milestones had normative data from ≥1 sources. Social-emotional and cognitive milestones had the least normative data. These criteria and revised checklists can be used to support developmental surveillance, clinical judgment regarding additional developmental screening, and research in developmental surveillance processes. Gaps in developmental data were identified particularly for socialemotional and cognitive milestones.

Comparison of Pelvic Floor Muscle Training With Connective Tissue Massage to Pelvic Floor Muscle Training Alone in Women With Overactive Bladder: A Randomized Controlled Study
Yasemin Karaaslan, Seyda Toprak Celenay, Faruk Kucukdurmaz
Journal of Manipulative and Physiological Therapeutics 2021, 44 (4): 295-306
DOI: http.//doi.org/10.1016/jmpt.2021.02.001
OBJECTIVE: The purpose of this study was to compare the effects of a 6-week program of pelvic floor muscle training (PFMT) plus connective tissue massage (CTM) to PFMT alone in women with overactive bladder (OAB) symptoms on those symptoms, pelvic floor muscle strength, and quality of life. RESULTS: In both groups, pelvic floor muscle strength increased, whereas OAB symptoms and PPIUS and KHQ scores decreased after treatment (P < .05). Although the OAB-V8, PPIUS, and KHQ scores decreased at week 3, frequency, OAB-V8, and PPIUS scores, in addition to some parameters of the KHQ, decreased after treatment in the PFMT+CTM group compared to the PFMT group (P < .05). CONCLUSION: Compared to PFMT alone, PFMT+CTM achieved superior outcomes in reducing OAB symptoms in the early and late periods.

Chiropractic Care for the Pregnant Body
Shayna N Conner, Amanda S Trudell, Craig A Conner
PMID: 33882524 DOI: 10.1097/GRF.0000000000000621
Chiropractic care is a commonly used treatment modality for musculoskeletal pain in pregnancy. Low back pain, pelvic pain, and other neuromuscular complaints are prevalent in pregnancy and contribute to significant maternal discomfort in many women. Nonpharmacologic therapies to relieve pain are increasingly important during pregnancy because of the opioid epidemic. Chiropractic treatment is one of the potential therapies that offers intervention without medications. This article provides an evidence-based review of the epidemiology of chiropractic use in obstetrics, commonly treated conditions, related physiology of pregnancy, and safety of spinal manipulation.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Identifying potential treatment effect modifiers of the effectiveness of chiropractic care to infants with colic through prespecified secondary analyses of a randomised controlled trial
Lise Vilstrup Holm, Werner Vach, Dorte Ejg Jarbøl, Henrik Wulff Christensen, Jens Søndergaard, Lise Hestbæk
Chiropractic & Manual Therapies 2021 April 19, 29 (1): 16
DOI: https://doi.org/10.1186/s12998-021-00373-6
A recent trial identified large variation in effect of chiropractic care for infantile colic. Thus, identification of possible effect modifiers could potentially enhance the clinical reasoning to select infants with excessive crying for chiropractic care. Therefore, the aim of this study is to identify potential treatment effect modifiers which might influence the effect of chiropractic care for excessive crying in infancy.

The effect of chiropractic care on infantile colic: results from a single-blind randomised controlled trial
Lise Vilstrup Holm, Dorte Ejg Jarbøl, Henrik Wulff Christensen, Jens Søndergaard, Lise Hestbæk
Chiropractic & Manual Therapies 2021 April 19, 29 (1): 15
https://chiromt.biomedcentral.com/track/pdf/10.1186/s12998-021-00371-8.pdf
This is a multicenter, single-blind randomized controlled trial conducted in four Danish chiropractic clinics, 2015-2019. Information was distributed in the maternity wards and by maternal and child health nurses. Children aged 2-14 weeks with unexplained excessive crying were recruited through home visits and randomized (1:1) to either chiropractic care or control group. Both groups attended the chiropractic clinic twice a week for 2 weeks. The intervention group received chiropractic care, while the control group was not treated. The parents were not present in the treatment room and unaware of their child’s allocation. The primary outcome was change in daily hours of crying before and after treatment. Secondary outcomes were changes in hours of sleep, hours being awake and content, gastrointestinal symptoms, colic status and satisfaction. All outcomes were based on parental diaries and a final questionnaire.

Is foot reflexology effective in reducing colic symptoms in infants: A randomized placebo-controlled trial
Nimet Karatas, Aysegul Isler Dalgic
Complementary Therapies in Medicine, Volume 59, 2021, 102732, ISSN 0965-2299
https://doi.org/10.1016/j.ctim.2021.102732.
Infantile colic and its accompanying crying represent a major source of stress and have negative physiological, emotional and psychological effects on infants and parents. The aim of this study was to examine the efficacy of foot reflexology for reducing symptoms of infantile colic. The study was conducted as a single-blind, randomized, placebo-controlled trial with a sample population of 45 infants diagnosed with infantile colic.

Dietary modifications for infantile colic
Morris Gordon, Elena Biagioli, Miriam Sorrenti, Carla Lingua, Lorenzo Moja, Shel Sc Banks, Simone Ceratto, Francesco Savino
Cochrane Database of Systematic Reviews 2018 October 10, 10: CD011029
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394439/pdf/CD011029.pdf
Infantile colic is typically defined as full-force crying for at least three hours per day, on at least three days per week, for at least three weeks. This condition appears to be more frequent in the first six weeks of life (prevalence range of 17% to 25%), depending on the specific location reported and definitions used, and it usually resolves by three months of age. The aetiopathogenesis of infantile colic is unclear but most likely multifactorial. A number of psychological, behavioural and biological components (food hypersensitivity, allergy or both; gut microflora and dysmotility) are thought to contribute to its manifestation. The role of diet as a component in infantile colic remains controversial. OBJECTIVES: To assess the effects of dietary modifications for reducing colic in infants less than four months of age.

Non-pharmacologic approach to pediatric constipation
Neha R Santucci, Ashish Chogle, Alycia Leiby, Maria Mascarenhas, Rachel E Borlack, Amanda Lee, Maria Perez, Alexandra Russell, Ann Ming Yeh
Complementary Therapies in Medicine 2021, 59: 102711
https://doi.org/10.1016/j.ctim.2021.102711
Functional constipation (FC) is a pervasive problem in pediatrics. Although pharmaceuticals are commonly used for FC, parents and patients show reluctance or find dissatisfaction with available medications at times. Further, patients often have interest in utilizing nutraceutical supplements and botanicals that are available over the counter. This literature review aims to summarize research studies performed on non-pharmacologic approaches to constipation and to evaluate the safety and efficacy of these modalities. Overall data on non-pharmacologic treatments for childhood constipation were sparse, and though some studies were available for adult populations, pediatrics studies were generally limited, lacking or flawed. Certain supplements, such as prebiotics, probiotics and fiber, are safe and are without significant side effects. Though fiber supplements such as glucomannan, green banana mass, cocao husk and various fiber blends have emerging evidence in children, evidence for psyllium, cellulose and flaxseed only have supportive studies in adults. Other than senna, studies of botanicals indicate significant safety concerns (in particular with Aloe vera with aloin and Cascara sagrada) and insufficient evidence. For patients with a significant behavioral or anxiety component to their FC and exhibit dyssynergia, mind-body interventions (e.g. diaphragmatic breathing, biofeedback, cognitive behavioral therapy, and behavioral modifications) are certainly safe and effective. Finally, movement and manipulative interventions such as abdominal massage, reflexology, acupuncture and transcutaneous nerve stimulation show promise in the field of pediatric constipation, and data is accumulating for efficacy. These modalities require further study to determine mechanisms of action and which populations may benefit the most from these therapies.

Clinical efficacy and safety of acupuncture treatment of TIC disorder in children: A systematic review and meta-analysis of 22 randomized controlled trials
Chen Lu, Li-qun Wu, Hongwen Hao, Xinting Kimberly Leow, Fang-wei Xu, Pan-pan Li, Dong-sheng Wang,
Complementary Therapies in Medicine, Volume 59, 2021, 102734, ISSN 0965-2299,
https://doi.org/10.1016/j.ctim.2021.102734.
To systematically evaluate the clinical efficacy and safety of acupuncture in the treatment of Tic Disorders (TD) in children, and to clarify the current evidence regarding the clinical application of acupuncture in the treatment of TD. Randomized controlled trials (RCTs) comparing acupuncture treatment with pharmaceutical treatment for TD were included in this review. Conclusion: Acupuncture treatment alone is more effective in the treatment of TD than pharmaceutical treatment, as seen in the reduction of YGTSS scores, fewer adverse effects and lower recurrence rates.

Effectiveness of chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7-14 years - a randomised clinical trial
Susanne Lynge, Kristina Boe Dissing, Werner Vach, Henrik Wulff Christensen, Lise Hestbaek
Chiropractic & Manual Therapies 2021 January 7, 29 (1): 1
DOI: https://doi.org/10.1186/s12998-020-00360-3
To investigate the effectiveness of chiropractic spinal manipulation versus sham manipulation in children aged 7-14 with recurrent headaches. RESULTS: Chiropractic spinal manipulation resulted in significantly fewer days with headaches (reduction of 0.81 vs. 0.41, p=0.019, NNT=7 for 20% improvement) and better global perceived effect (dichotomized into improved/not improved, OR=2.8 (95% CI: 1.5-5.3), NNT=5) compared with a sham manipulation procedure. There was no difference between groups for pain intensity during headache episodes. Due to methodological shortcomings, no conclusions could be drawn about medication use.

Physical activity and low back pain in children and adolescents: a systematic review
Agnieszka Kedra, Magdalena Plandowska, Przemyslaw Kedra, Dariusz Czaprowski
European Spine Journal 2021, 30 (4): 946-956
https://link.springer.com/content/pdf/10.1007/s00586-020-06575-5.pdf
Due to a high prevalence of low back pain (LBP) among children and adolescents, it is significant to seek effective prevention and therapeutic procedures. One idea for the programmes is a potential relation between the occurrence of LBP and the level of physical activity. The aim of this review was to analyse the current knowledge regarding the association between physical activity and LBP among children and adolescents. CONCLUSION: There is moderate evidence for the association between physical activity and LBP in children and adolescents. The results highlight the need for continued research. It seems that for clear evaluation of the analysed association the prospective cohort studies should be conducted.

Diagnosis and Management of Hypermobility Spectrum Disorders in Primary Care
Karina Atwell, William Michael, Jared Dubey, Sarah James, Andrea Martonffy, Scott Anderson, Nathan Rudin, Sarina Schrager
PMID: 34312277 DOI: 10.3122/jabfm.2021.04.200374
Hypermobility spectrum disorders (HSDs) encompass an array of connective tissue disorders characterized by joint instability and chronic pain. Fatigue and other systemic symptoms that affect daily functioning may occur, as well. Accurate data on incidence and prevalence of HSDs is hampered by lack of awareness of these conditions and the wide heterogeneity of their clinical presentation. Identifying which type of HSD is present is important in guiding appropriate care. In particular, making the diagnosis of hypermobile Ehlers-Danlos syndrome (hEDS) is important, as individuals with hEDS may be at risk for more significant multisystem involvement. Diagnostic criteria for hEDS include measures of joint hypermobility, skin and other connective tissue findings, and lack of evidence of a different type of Ehlers-Danlos syndrome. Beyond accurate diagnosis, HSDs pose many challenges for primary care providers, as ongoing patient education, patient empowerment, and coordination of a multidisciplinary treatment team are integral to proper care. This article describes the incidence and prevalence, pathophysiology, diagnosis, and management of HSDs, including clinical cases exemplifying how joint hypermobility might present within a primary care setting.

The safety of spinal manipulative therapy in children under 10 years: a rapid review
Melissa Corso, Carol Cancelliere, Silvano Mior, Anne Taylor-Vaisey, Pierre Côté
PMID: 32093727 PMCID: PMC7041232 DOI: 10.1186/s12998-020-0299-y
The safety of spinal manipulative therapy (SMT) in children is controversial. We were mandated by the College of Chiropractors of British Columbia to review the evidence on this issue. We conducted a rapid review of the safety of SMT in children (< 10 years). We aimed to: 1) describe adverse events; 2) report the incidence of adverse events; and 3) determine whether SMT increases the risk of adverse events compared to other interventions. Conclusion: The risk of moderate and severe adverse events is unknown in children treated with SMT. It is unclear whether SMT increases the risk of adverse events in children < 10 years.

 

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