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Chiropractic Care For Children

Chiropractic Care For Children

The Chiro.Org Blog


Seven new articles (a Thematic Series) titled “Chiropractic Care for Children” has just been released by the peer-reviewed journal Chiropractic & Osteopathy.

This is a direct quote from the Introduction to these articles:


“In commissioning this series of articles the Editors aimed to bring the busy clinician up to date with the current best evidence in key aspects of evaluation and management of chiropractic care for children.”

Individual articles address a chiropractic approach to the management of children, chiropractic care of musculoskeletal conditions in children and adolescents, chiropractic care of nonmusculoskeletal conditions in children and adolescents, chiropractic care for attention-deficit/hyperactivity disorder and possible adverse effects from chiropractic management of children.

The final article by Charlotte Leboeuf-Yde and Lise Hestbæk is an overview of the current state of the evidence and future research opportunities for chiropractic care for children.

We conclude this editorial discussing the strengths and weaknesses of contemporary research relevant to chiropractic care of children and the implications for chiropractic practice.” (End quote)


This Blog has reviewed previous commentary on the supposedly controversial topic of chiropractic care for children on 12-03-2009, in a review titled:

Government Support and the Research Challenges of Chiropractic Pediatrics.

For your added interest, we also have a very in-depth review of the pediatric literature by Anthony L. Rosner, Ph.D titled:

Infant and Child Chiropractic Care: An Assessment of the Research.

These are just a few of the materials that are available in our:

Chiropractic Pediatrics Section.


Two Tables follow from “Chiropractic Approach to the Management of Children” because they contain recommendations culled from the leading chiropractic pediatric educators. [1]


TABLE 1:   Serious Signs and Symptoms of Children That Require Immediate Medical Referral

Symptom/Sign Explanation/Implication
Neonate Since the health status of a neonate can change rapidly, any signs of illness require immediate referral.
Lethargy Absence of interaction, hypotonia and/or crying
High Respiratory Rate Rapid or difficult respirations not related to activity; respiration rate > 60 breaths/minute with rib recession
Blue Lips or Tongue May indicate reduced blood oxygen level
Dehydration Common sequel to diarrhea or vomiting. Dry mouth, sunken fontanelle, tenting skin, < 4 wet nappies/diapers (60-90 mL/4-6 TBS). Urine should be pale and mild smelling.
Pain and Tenderness Child screams when touched or being moved; avoids being held. Sudden onset of groin pain in a boy may be a sign of testicular torsion; episodic screaming in young children may be a sign of intussusception
Tender Abdomen Inability to tolerate 2 cm abdominal impression; bloated or rigid abdomen
Inability to Walk Refusal or inability to walk in child who previously was walking (or crawling); development of a limp requires attention
Bulging Fontanelle Evident bulge and rigidity in anterior fontanelle in a quiet child in an upright position
Stiff or Rigid Neck Refusal/inability to look toward their toes or at a toe placed on their chest may be an early sign of meningitis; very young infants may have meningitis with no obvious signs of neck stiffness
Petechiae Purple or blood-red spots on the skin that do not blanch with pressure may be a sign of bloodstream infection. Exclude bruises that have an explanation
High Fever Referral for consult: Neonates (<28days): > 38 C (100F); 28-90 days > 38 C with signs of toxicity or incessant crying; 91-36 months: > 39 C (102.2F) and signs of toxicity. [58]
Drooling Sudden onset of drooling not associated with teething, especially when associated with difficult swallowing, may be a sign of epiglottal or pharyngeal infections



TABLE 2: Absolute and Relative Contraindications to Manual Therapy

ABSOLUTE CONTRAINDICATIONS
Indication Explanation
Withdrawal of consent by the parent or child Potential for litigation
Hypermobility of the joints of the child Increased flexibility of joint structures and less muscular resistance than the adult
Long-lever and high force manual procedures Anatomically immature: no joint “lockup.”
Occipito-atlantal & Atlanto-axial instability Common in children with Down Syndrome, Juvenile Rheumatoid Arthritis, Marquio’s, Klippel-Feil Syndrome
Brain or spinal tumors Potential of neurologic damage or vascular compromise by the introduction of specific or non-specific force due to the pathophysiology or anatomical position of the tumor; immediate referral to appropriate healthcare provider
Active metaphyseal growth tissue Zone of provisional calcification- the transitional region between cartilage and newly formed metaphyseal bone is subject to separation and avascular necrosis when subject to force
RELATIVE CONTRAINDICATIONS/ Need for caution
Cervical Spine adjustments Reduce the incidence of potential adverse event by refraining from over treating the sensitive structures of the cervical spine
Down Syndrome or other congenital anomalies If you see an anomaly in one region, be suspicious of anomalies elsewhere.
Recent upper respiratory tract virus Potential for inflammatory disruption to the atlanto-axial joint
Symptoms and signs incongruous with palpatory findings. Diagnosis requires corroboration of signs and symptoms with exam findings (including palpatory findings). When they are incongruous, further diagnostic studies should be ordered to rule out any potentially serious underlying pathology.
History of sleep-disorder in infants < 12 weeks of age Watchful waiting first 12 weeks (rule out Arnold Chiari Syndrome)
Inversion of neonate or young infant Relative contraindication secondary to neonatal circulation and clotting factors, respiratory distress, cranial and cervical birth trauma, undiagnosed perinatal or postnatal stroke, undiagnosed hip dysplasia.


I highly recommend these articles for any DC who provides cares for children.

REFERENCES:

  1. Chiropractic Approach to the Management of Children
    Chiropractic & Osteopathy 2010 (Jun 2); 18: 16

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