Prevalence of Musculoskeletal Dysfunction in Infants Presenting for Chiropractic Care in Norway: A Cross-sectional Study

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SOURCE:   J Clin Chiropractic Pediatrics 2017 (Sep); 16(1): 1355

Catherin Alvestad Slettebo, DC, MSc, Joyce E. Miller, DC, PhD

AECC University,
Bournemouth, UK

Background:   Musculoskeletal (MSK) injuries are common though considered under-recognized at birth. There are no gold standard routines for examination of the musculoskeletal system in infants, and very little research that investigates clinical examination and MSK findings in infants under the age of six months.

Objectives:   The objectives were to determine the prevalence of neck dysfunction, postural spine problems, and their possible association with parent reported behavioral problems such as suboptimal breastfeeding and supine sleeping in infants younger than six months of age. The aim of this study was to observe any associations between MSK problems of infancy and common behavioral and public health issues. Methods: This is a cross sectional questionnaire based observational study in a clinical population. Mothers of infants presented to chiropractic clinics in Norway filled in a questionnaire on the first visit, and this was followed by a clinical examination and questionnaire completed by the Doctors of Chiropractic on the same day.

Results:   In total, 90 infants enrolled in the study. A total of 56 infants (66%) had postural problems. Favorite side of cervical rotation (N=41; 75%) was the most common dysfunction in supine lying. Neck hyperextension was present in 21 infants (38%). The inability to rotate their head equally side to side was present in 49 children (54%). In total 22 (24%) of the infants did not have the ability to sleep or lie comfortably supine. Suboptimal breastfeeding was reported by 22 (25%) parents, and 10 (12%) of the mothers reported pain during feeding. TMJ imbalance was identified in 16 infants (19%). There were statistically significant associations between suboptimal breastfeeding and TMJ imbalance, suboptimal rooting/sucking reflexes, inability to turn head and neck equally and painful breastfeeding, respectively.

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Conclusion:   Parents reported several MSK problems in infants along with suboptimal breastfeeding and other ADLs, which were corroborated and specified by the clinical examination. More study is needed to determine a gold standard reference for infant musculoskeletal examinations along with the importance in improving activities of daily living and public health through balance of the MSK system.

Keywords:   cervical spine dysfunction, musculoskeletal injuries, musculoskeletal problems, musculoskeletal examination, breastfeeding problems, supine sleep, infants, pediatrics, chiropractic.

From the FULL TEXT Article:


Mild to moderate musculoskeletal injuries are common at birth, but frequently missed. [1] Although these injuries are common, their association with quality of life conditions like sleeping, feeding or excessive crying may not always be understood in professional practice. However, birth injuries are implicated in infant complaints. For example, a difficult birth has the highest association with infant colic (now known as excessive crying) than any other factor. [2]

Further, birth injury is implicated in suboptimal breastfeeding. [3–6] Breastfeeding is one of the key factors in improved health for the infant and mother, [7, 8] and although Initiation might be high, early discontinuation is a trend if the mothers experience problems, discomfort or pain with feeding. [9] A recent study in England on dyads with feeding problems showed that cessation of breastfeeding occurs early within three weeks of age. [10] It is suggested that the infant is the cause in 59% of feeding problems. [11] However, this has been disputed as being much higher (85%) in more current research. [12] It is therefore essential to assess biomechanical problems early in infants to detect any musculoskeletal problems that might influence breastfeeding. In addition to good sucking, rooting and swallowing reflexes, the infant needs appropriate and supportive posture and adequate cervical spine range of motion to establish sufficient breastfeeding. The newborn uses six cranial nerves, 22 bones connecting to 34 sutures, and 60 voluntary and involuntary muscles in order to suck swallow and breathe. [6] Doctors of chiropractic may contribute to this important task in light of the anatomy and biomechanical problems involved. [4, 13–22]

There is a need for more precise and early assessment of the newborn infant, with a full clinical examination including biomechanical features like examination of the infant’s neck and spine, cranium, and TMJ in addition to postural assessment, primitive reflexes (for example suck and rooting reflexes) and appropriate neurological examinations. These examinations are routine in chiropractic practice but the findings have not previously been documented in the research literature. This is key to further understanding of any association of observational findings with parent reports of behaviors.

This study was designed to specifically look at the prevalence of neck dysfunction, and other biomechanical problems in the infant that may be associated with suboptimal breastfeeding and other key ADLs. The chief goal of this study was to track routine clinical practice of infant care in chiropractic practices in Norway, by documenting and comparing parent report of infant problems and doctor of chiropractor’s clinical findings.

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