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Referred Pain from Myofascial Trigger Points in Head and Neck-shoulder Muscles Reproduces Head Pain Features in Children With Chronic Tension type Headache

By |October 21, 2018|Headache, Myofascial Disorder, Pediatrics|

Referred Pain from Myofascial Trigger Points in Head and Neck-shoulder Muscles Reproduces Head Pain Features in Children With Chronic Tension type Headache

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SOURCE:   J Headache Pain. 2011 (Feb); 12 (1): 35–43

César Fernández-de-las-Peñas, Daniel M. Fernández-Mayoralas, Ricardo Ortega-Santiago, Silvia Ambite-Quesada, Domingo Palacios-Ceña and Juan A. Pareja

Department of Physical Therapy,
Occupational Therapy,
Rehabilitation and Physical Medicine,
Facultad de Ciencias de la Salud,
Universidad Rey Juan Carlos,
Avenida de Atenas s/n,
28922 Alcorcón, Madrid



Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children’s condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured.

The total number of TrPs was significantly greater in children with CTTH as compared to healthy children (P < 0.001). Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children.

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Chiropractic or Osteopathic Manipulation for Children in the United States

By |July 11, 2018|Pediatrics|

Chiropractic or Osteopathic Manipulation for Children in the United States: An Analysis of Data from the 2007 National Health Interview Survey

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SOURCE:   J Altern Complement Med. 2012 (Apr); 18 (4): 347–353

Harrison Ndetan, MSc, MPH, DrPH, Marion Willard Evans, Jr., DC, PhD, MCHES, Cheryl Hawk, DC, PhD, and Clark Walker, BS, MPH

Cheryl Hawk, DC, PhD
Logan College of Chiropractic
Chesterfield, MO 63017


OBJECTIVES:   The aim of this study was to describe use of chiropractic and/or osteopathic manipulation by children in the United States along with the specific health conditions for which they sought care.

METHODS:   The study was a secondary data analysis of the National Health Interview Survey 2007, Child Alternative Medicine file as well as the Child Core Sample. National population estimates were generated for reported use of chiropractic or osteopathic manipulation (C/OM) by children for specific health conditions. Odds ratios (OR) and 95% confidence intervals (CI) were generated from binary logistic regression models that assessed the likelihood that children of specific characteristics would use this therapy.

RESULTS:   National estimates indicated that 2.3 million children (2.3%) in the United States had used C/OM in 2007. C/OM was the most common complementary and alternative medicine procedure. Children aged 12–18 years were more likely to have seen these providers than were younger age groups (OR=3.4 [95% CI, 2.1–5.5]). Homeopathy (1.2%), massage (1.0), and naturopathy (0.3%) were the next most common procedures. The most common complaints were back and neck pain. Other conditions for which children were seen included other musculoskeletal conditions, sinusitis, allergies, and nonmigraine headaches. Racial categories did not differ significantly regarding use of manipulation, but those children with both mother and father in the household were more likely to have used this form of care (OR=1.7 [95% CI, 1.1–2.6]).

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Infant Demographic Profile and Parent Report of Treatment Outcomes at a Chiropractic Clinic in the UK

By |April 25, 2018|Pediatrics|

Infant Demographic Profile and Parent Report of Treatment Outcomes at a Chiropractic Clinic in the UK:
An Observational Study

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SOURCE:   J Clinical Chiropractic Pediatrics 2017 (Jan); 17 (1): 1398–1404

Johanna M. Jaskulski, MChiro and Joyce E. Miller, BS, DC, PhD

Private practice.
ProChiro Baesweiler,
Nordrhein-Westfalen, Deutschland


Background:   Children, particularly infants, commonly present to chiropractors. Few studies have concentrated on the demographic profile of infants as well as clinical changes reported by parents of infants under chiropractic care.

Objectives:   To identify the demographic profile of infants presenting to a chiropractic clinic and to investigate any change of infant symptoms and maternal feelings following an episode of chiropractic care.

Setting:   This health care observation study was performed at a chiropractic teaching clinic on the south coast of England.

Subjects/Patients:   The study included all mother-infant dyads who presented to the clinic between August 2011 and June 2015 and could read and write English and who consented to complete the forms. Exclusion criteria were mothers of infants older than one year of age at presentation.

Methods:   All mothers were asked to complete two questionnaires at the initial visit and two follow-up questionnaires at discharge. Data collected were sociodemographic characteristics along with questions asking for graded responses regarding the daily amount of irritable behavior in their child, level of distress the mother feels with her child’s behavior, restfulness of infant sleep during the week and difficulty to console the child when crying as well as to the clinical experience provided. Additionally, the validated Edinburgh Postnatal Depression Scale (EPDS) was used as a report of the mother’s feelings.

Results:   413 mothers completed the intake questionnaires. 197 (48%) mothers completed the discharge questionnaires. At intake, 50.3% (n=182) of the patients were four weeks of age or younger. The presenting complaint appeared before the age of two weeks in 79.1% (n=161) of the cases. 30.2% (n=160) presented with colic/crying and 22.9% (n=121) with a feeding related complaint. The modal length of an episode of care was two weeks. Over the course of treatment, average maternal distress levels reduced by 48%. Mean amount of irritability reduced by 31%; mean restfulness of sleep improved by 27% and mean difficulty to console reduced by 38% in the infant. The median EPDS score dropped by 50% over the time of care. 96.3% of parents rated 8–10 satisfaction with care on a scale of 1–10.

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Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood

By |April 3, 2018|Pediatrics|

Association Between Use of Acid-Suppressive Medications and Antibiotics During Infancy and Allergic Diseases in Early Childhood

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SOURCE:   JAMA Pediatrics 2018 (Apr 2) [Epub]

Edward Mitre, MD; Apryl Susi, MS; Laura E. Kropp, MPH

Department of Microbiology and Immunology,
F. Edward Hébert School of Medicine,
Uniformed Services University of the Health Sciences,
Bethesda, Maryland


A new Study reports:
Infants who are given antacids like Zantac or Pepcid
are more likely to develop childhood allergies


FROM:   TIME Magazine ~ April 2, 2018 ~ FULL TEXT

Infants who are given antacids like Zantac or Pepcid are more likely to develop childhood allergies, perhaps because these drugs may alter their gut bacteria, a new large study suggests.

Early use of antibiotics also raised the chances of allergies in the study of nearly 800,000 children.

Researchers combed the health records of kids born between 2001 and 2013 and covered by Tricare, an insurance program for active duty and retired military personnel and their families. A surprising 9 percent of the babies received antacids, reflecting the popularity of treating reflux in infancy.

Over four years, more than half of all the children developed allergies to foods or medications, rashes, asthma, hay fever or other allergic diseases. The study couldn’t prove causes, but the connection with antacids and antibiotics was striking.

For children who received an antacid during their first six months, the chances of developing a food allergy doubled; the chances of developing a severe allergic reaction called anaphylaxis or hay fever were about 50 percent higher. For babies who received antibiotics, the chances doubled for asthma and were at least 50 percent higher for hay fever and anaphylaxis.

The results were published Monday in JAMA Pediatrics.

      The Abstract:

Importance   Allergic diseases are prevalent in childhood. Early exposure to medications that can alter the microbiome, including acid-suppressive medications and antibiotics, may influence the likelihood of allergy.

Objective   To determine whether there is an association between the use of acid-suppressive medications or antibiotics in the first 6 months of infancy and development of allergic diseases in early childhood.

Design, Setting, and Participants   A retrospective cohort study was conducted in 792,130 children who were Department of Defense TRICARE beneficiaries with a birth medical record in the Military Health System database between October 1, 2001, and September 30, 2013, with continued enrollment from within 35 days of birth until at least age 1 year. Children who had an initial birth stay of greater than 7 days or were diagnosed with any of the outcome allergic conditions within the first 6 months of life were excluded from the study. Data analysis was performed from April 15, 2015, to January 4, 2018.

Exposures   Exposures were defined as having any dispensed prescription for a histamine-2 receptor antagonist (H2RA), proton pump inhibitor (PPI), or antibiotic.

Main Outcomes and Measures   The main outcome was allergic disease, defined as the presence of food allergy, anaphylaxis, asthma, atopic dermatitis, allergic rhinitis, allergic conjunctivitis, urticaria, contact dermatitis, medication allergy, or other allergy.

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The Quality of Life of Children Under Chiropractic Care Using PROMIS-25

By |January 2, 2018|Pediatrics|

The Quality of Life of Children Under Chiropractic Care Using PROMIS-25: Results from a Practice-Based Research Network

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SOURCE:   J Altern Complement Med. 2017 (Dec 20) [Epub]

Joel Alcantara, DC, Andrea E. Lamont, PhD,
Jeanne Ohm, DC, and Junjoe Alcantara, DC

The International Chiropractic Pediatric Association,
327N Middletown Road
Media, PA 610-565-2360


OBJECTIVES:   To characterize pediatric chiropractic and assess pediatric quality of life (QoL).

DESIGN:   A prospective cohort. Setting/Locations: Individual offices within a practice-based research network located throughout the United States.

SUBJECTS:   A convenience sample of children (8-17 years) under chiropractic care and their parents.

EXPOSURE:   Chiropractic spinal adjustments and adjunctive therapies.

OUTCOME MEASURES:   Survey instrument measuring sociodemographic information and correlates from the clinical encounter along with the Patient Reported Outcomes Measurement Information System (PROMIS)-25 to measure QoL (i.e., depression, anxiety, and pain interference). Sociodemographic and clinical correlates were analyzed using descriptive statistics (i.e., frequencies/percentages, means, and standard deviations). The PROMIS-25 data were analyzed using scoring manuals, converting raw scores to T score metric (mean = 50; SD = 10). A generalized linear mixed model was utilized to examine covariates (i.e., sex, number of visits, and motivation for care) that may have played an important role on the PROMIS outcome.

RESULTS:   The original data set consisted of 915 parent-child dyads. After data cleaning, a total of 881 parents (747 females, 134 males; mean age = 42.03 years) and 881 children (467 females and 414 males; mean age = 12.49 years) comprised this study population. The parents were highly educated and presented their child for mainly wellness care. The mean number of days and patient visits from baseline to comparative QoL measures was 38.12 days and 2.74 (SD = 2.61), respectively. After controlling for the effects of motivation for care, patient visits, duration of complaint, sex, and pain rating, significant differences were observed in the probability of experiencing problems (vs. no reported problems) across all QoL domains (Wald = 82.897, df = 4, p < 0.05). Post hoc comparisons demonstrated the children were less likely to report any symptoms of depression (Wald = 6.1474, df = 1, p < 0.05), anxiety (Wald = 20.603, df = 1, p < 0.05), fatigue (Wald = 22.191, df = 1, p < 0.05), and pain interference (Wald = 47.422, df = 1, p < 0.05) after a trial of chiropractic care.

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The Use of the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients

By |December 25, 2017|Pediatrics|

The Use of the Patient Reported Outcomes Measurement Information System and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing the Webster Technique

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SOURCE:   J Altern Complement Med. 2017 (Dec 20) [Epub]

Joel Alcantara, Andrea Lamont Nazarenko,
Jeanne Ohm, and Junjoe Alcantara

The International Chiropractic Pediatric Association,
Media, PA.


OBJECTIVE:   To quantify the quality of life (QoL) and visit-specific satisfaction of pregnant women.

DESIGN:   A prospective cohort within a practice-based research network (PBRN). Setting/locations: Individual chiropractic offices.

SUBJECTS:   Pregnant women (age ≥18 years) attending chiropractic care.

INTERVENTION(S):   Chiropractic care (i.e., The Webster Technique, spinal adjustments, and adjunctive therapies).

MAIN OUTCOME MEASURES:   The RAND VSQ9 to measure visit-specific satisfaction and the Patient Reported Outcomes Measurement Information System (PROMIS®)-29 to measure QoL.

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