J Clinical Chiropractic Pediatrics 2022 (May); 21 (1): 1871–1876 ~ FULL TEXT
Sue A. Weber DC, MSc
Sue A. Weber DC, MSc Chiropractic Pediatrics
Chairperson EAC SIG Pediatrics, FEAC, FRCC
Practitioner Stockholm, Sweden
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.
Keywords: pediatric headache, chiropractic pediatric, pediatric history form, pediatric examination form, pediatric red flags, pediatric questionnaire.
From the Full-Text Article:
Chiropractic education typically includes a cursory level of education within pediatrics1 which varies from institution to institution. Chiropractors interested in pediatrics can pursue additional education through courses in continuing professional development (CPD), a diplomate, and/or a Master’s degree. These are available through a range of providers. Surveys from 2004 and 2014 assessing random samples of licensed Canadian Doctors of Chiropractic and Naturopaths have shown that the majority of practitioners questioned treated children of all ages, but felt they their education did not provide adequate skills in assessment and treatment. 
Triaging musculoskeletal (MSK) and non-MSK complaints is of the highest priority when assessing the pediatric patient with headache.  Some apparently benign headache presentations may have serious red flag causes, such as increased intracranial pressure, nocturnal epilepsy, possible brain tumor and/or cerebellar dysfunction.  Table 1 provides a check list for Red Flags.
Other conditions which present with headache at first glance may be due to potentially disabling pathology, including mitral valve disease,  hypothyroidism  and epilepsy.  Ability to triage is therefore a vital skill and knowledge base for practitioners to develop when seeing the pediatric patient with headache, as differential diagnosis and treatment vary significantly from the adult patient. 
The EAC is working to provide postgraduate education for practitioners. One focus of the EAC SIG pediatric group has been to work with the various European chiropractic educational institutions to standardize the level of education within pediatrics. Another primary goal is to raise the advance education around pediatric practice on an institutional and individual level.
The pediatric SIG is a team of four, each with advanced education within chiropractic and/or pediatrics (post-graduate Master’s degree or PhD), and each with expertise in clinical practice, research, and/or education.
Fungible pediatric headache questionnaires, history and examination forms specific to chiropractors and other manual therapists have not yet been made available. Consequently, a key initiative of the SIG over the past year has been to provide special history and examination forms particular to specific problems which present to chiropractors. The headache forms presented in this article have been designed to organize the history and examination for the pediatric headache.
Tables 2 and 3 provide history questions by age group. Table 4 provides an examination for ages 5-16, giving it form and consistency, aiding the practitioner in undertaking a thorough assessment.
These are intended as a screening tool for assessing the pediatric patient presenting with headache. The primary focus is on differential diagnosis of headaches throughout development. Two recent articles focus on headaches in children [8, 9] and are a good complement to these forms. One article focuses on differential diagnosis of common headaches in children presenting to the chiropractor  and the other details the changing phenotype of migraine headache through growth and development. 
By highlighting red flag presentations,  there is an emphasis on safety, particularly identifying and referring the ill child for medical assessment and care. These forms are helpful in reaching the goal of arriving at the correct diagnosis or diagnoses, in order that the proper management can be recommended.
The pediatric headache questionnaire, history, examination and red flag forms have been reviewed by all members of the SIG in an extensive, iterative process spanning nine months. Within the SIG an initial draft was created, multiple iterations were developed, and meetings were held to discuss and resolve disagreements by consensus. In total, three meetings were held between members of the SIG. This iteration was then shared with and reviewed by chiropractors with expertise in the pediatric patient, and their comments were reviewed by the author. The questionnaire was then translated into Swedish and used with a subset of patients to test its relevance.
Recommendations for chiropractors
The author recommend adopting these forms for clinical practice and to use them as an adjunct to the basic pediatric history and exam forms presented earlier.  Just as these forms reflect the fact that the child is growing and developing, treatment is also adjusted based on age and development.
Additional special exam forms to complement the history and examination forms for common complaints presenting to the chiropractor, such as the crying infant, growing pains, and scoliosis are currently being developed. A series of recorded lectures to accompany these forms are in progress, discussing key aspects of the history and examination of the pediatric patient. These will be soon available through the European Chiropractic Union home page, European Academy of Chiropractic (EAC) and the General Education Network for Chiropractic (GEN-C).
These forms represent a minimum standard for assessing pediatric headache in patients to ensure safe and effective management. The implementation of these forms should not only raise competence of practitioners, but with widespread use, enable data collection on a large scale for future research. The work to provide specific clinical exam forms is to elevate the safety and quality of musculoskeletal care provided by chiropractors to babies, children, and their families.
These forms were developed with significant contributions from Dr. Amy S. Miller (MSc, PhD) and Prof Lise Hestbaek (DC, PhD).
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Headaches in Children: Part 2. The Changing Phenotypes of
Migraine Headache in Infants, Children and Adolescents
J Clinical Chiropractic Pediatrics 2021 (Nov); 20 (2): 1802–1813
Headaches in Children: Part 1. The Changing Phenotypes of
Migraine Headache in nfants, Children and Adolescents
J Clinical Chiropractic Pediatrics 2022 (May); 20 (1): 1747–1756
Weber S, Miller AS.
Chiropractic history and examination forms for the infant,
pre-school, and school-aged child.
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