Chiropractic Care In Pediatrics - NurseCe4Less.com · chiropractic care can be administered to...

nursece4less.com nursece4less.com nursece4less.com nursece4less.com

1

Chiropractic Care In

Pediatrics

Series On Chiropractic Care

JASSIN M. JOURIA Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of

educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serve as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology.

ABSTRACT

Although modern medicine offers a wide array of pharmaceutical and

surgical treatments for pain, chiropractic care offers a natural, drug-free

treatment modality that can alleviate pain in many patients. Chiropractic

care has been shown to be successful in children, adults, and older adults,

and for a range of ailments. Although chiropractic care focuses on the spine,

correcting maladjustments can improve a patient’s overall health and

wellbeing and reduce or eliminate many seemingly unrelated conditions.


2

Policy Statement

This activity has been planned and implemented in accordance with the

policies of NurseCe4Less.com and the continuing nursing education

requirements of the American Nurses Credentialing Center's Commission on

Accreditation for registered nurses. It is the policy of NurseCe4Less.com to

ensure objectivity, transparency, and best practice in clinical education for

all continuing nursing education (CNE) activities.

Continuing Education Credit Designation

This educational activity is credited for 3 hours. Nurses may only claim credit

commensurate with the credit awarded for completion of this course activity.

Statement of Learning Need

Health clinicians will find that patients often tend to seek complementary

and alternative remedies or treatments along with or in lieu of conventional

medical care for prevention and healing. Chiropractic care is often sought as

an option for the treatment of certain medical conditions, and clinicians need

to be prepared to answer patients’ questions by understanding the general

chiropractic philosophy and methods of holistic care and healing. As greater

control over their healthcare needs are being sought, complementary and

alternative medicine may be selected by patients over invasive procedures

and prescription medications that may need to be incorporated into patient

treatment planning.

Course Purpose


3

To provide clinicians with knowledge of chiropractic medicine as a

complementary and alternative approach to treat a medical condition, to

better understand patient preferences, and to educate patients on options

for treatment.

Target Audience

Advanced Practice Registered Nurses and Registered Nurses

(Interdisciplinary Health Team Members, including Vocational Nurses and

Medical Assistants may obtain a Certificate of Completion)

Course Author & Planning Team Conflict of Interest Disclosures

Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA,

Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures

Acknowledgement of Commercial Support

There is no commercial support for this course.

Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article.

Opportunity to complete a self-assessment of knowledge learned

will be provided at the end of the course. 1. True or False: Parents of children who receive chiropractic care

have reported several improvements in their children’s health and


4

behavior as a result of chiropractic treatments, including a better overall behavior and attitude.

a. True b. False

2. Congenital spinal abnormalities are birth defects that affect the

spine

a. and the spinal cord. b. and that develop before a baby is born. c. and that can eventually affect other areas of the body. d. All of the above

3. During embryonic development, the spinal cord begins to form

____________________ after conception along with the initial growth of the neural tube.

a. within a couple of weeks b. during the second trimester c. a couple months d. during the third trimester

4. The ______________ eventually harden through ossification as

it/they become bones and the notochord ultimately forms the intervertebral discs.

a. cartilage b. neural tube c. annulus fibrosus d. somites

5. ______________ is a condition in which a portion of the spinal

cord protrudes through the vertebrae when the neural tube does not close properly during development.

a. Encephalocele b. Spina bifida c. Anencephaly d. Paresthesia

Introduction


5

Children can certainly be candidates for chiropractic care and they often

respond well to many of the techniques used in chiropractic medicine.

Children often heal at a faster pace when compared to adults, and the

methods used in chiropractic care of some children have been shown to be

valuable in promoting health by supporting children’s bodies’ abilities to

heal. According to the International Chiropractic Pediatric Association (ICPA),

parents of children who receive chiropractic care have reported several

improvements in their children’s health and behavior as a result of

chiropractic treatments, including improved sleep habits, improved immune

system functioning, and better overall behavior and attitude.45 These results

are commonly reported by parents in addition to the positive support that

chiropractic care clinicians, including for pain relief and symptom control

when illness is present.

Spinal Problems In Utero

Congenital spinal abnormalities are types of birth defects that affect the

spine and that develop before a baby is born. These anomalies can impact

how the spine forms during gestation, which can influence the size and

shape of the vertebrae, their alignment, and the general function of the

spinal cord. Additionally, when spinal problems develop in utero, the person

can eventually have problems in other areas of the body, including the

kidneys or urinary tract, as well as difficulties performing routine activities of

daily living.

During embryonic development, the spinal cord begins to form within a

couple of weeks after conception with the initial growth of the neural tube.

This tube forms around the central structure called the notochord, which is

made up of cartilage and forms a shaft to support the growing embryo. The

neural tube is eventually what will become the central nervous system.


6

Small segments called somites start to form on either side of the neural

tube, and these segments will eventually develop into the vertebrae of the

spine. The somites eventually harden through ossification as they become

bones and the notochord ultimately forms the intervertebral discs.

There are various reasons why the spine does not form normally during

development. Neural tube defects are some of the more commonly

understood congenital anomalies involving the spine and they include such

conditions as 1) spina bifida, in which a portion of the spinal cord protrudes

through the vertebrae when the neural tube does not close properly during

development, 2) anencephaly, which happens when a significant portion of

the brain and the skull do not form, and 3) encephalocele, which occurs

when the failed closure of the neural tube causes a sac that contains part of

the brain and the meninges to protrude through an opening at the base of

the skull. Neural tube defects are thought to be related to a combination of

environmental and genetic factors, but women who are pregnant or are even

thinking of becoming pregnant are advised to increase their intake of folic

acid, as it has been shown to reduce the risk of these specific kinds of birth

defects.

Many neural tube defects are severe and in some cases, such as with

anencephaly, are incompatible with life and the infant dies shortly after

birth. However, there are many children who are born with spina bifida who

survive and who thrive with proper care. Severe cases of spina bifida can

cause back deformities and difficulties with mobility; if the condition is

untreated and is serious, the child could suffer from poor mobility and/or

paralysis, and will often have difficulty with bladder control. Milder cases of

spina bifida can be managed through nonsurgical interventions that focus on


7

stretching the muscles of the back, improving range of motion, and

supporting daily routines.

Spina bifida occulta is a type of spina bifida in which the neural tube closure

is not obvious; in many cases, the patient may be unaware that the

condition exists. Spina bifida occulta occurs most commonly in the lumbar

region of the spine and it could cause difficulties with walking or moving, as

well as back pain, vertebral disc herniation, and nerve dysfunction.44 This

particular type of spina bifida is often much more common than what is

diagnosed because physical examination does not always reveal the

condition. Some patients may have a hairy nevus on the back at the location

of the defect; however, a large percentage of cases display no signs of the

defect at all. The affected patient can still develop symptoms associated with

spina bifida whether the condition is readily recognized or not.

Although spina bifida occulta is the mildest form of the condition, it can still

cause muscular weakness and bladder dysfunction for some people. At

times, a person may seek medical help for another reason, such as low back

pain, and the spina bifida condition is identified on X-ray. A case report

published in the Journal of Chiropractic Medicine reviewed a case of a 10-

year-old boy who was taken to a chiropractor for care of low back pain after

falling. When the chiropractor performed radiological testing, it was noted

that the child had spina bifida occulta in the lumbar spine, as well as mild

scoliosis. Of note, the authors stated that approximately 20 percent of the

population has spina bifida occulta and most people are actually unaware of

it. Because the condition is so common, many chiropractors are likely to

come across it when treating patients. The child in the case report

underwent chiropractic treatment with instrument-assisted joint mobilization

in the lumbar spine, as well as high-velocity, low amplitude thrust


8

manipulation in the same region near the deformity and for treatment of low

back pain. After six treatment sessions, the child’s pain was under control

and there were no unwanted effects on the spina bifida condition.44

To review, chiropractic care will not resolve spina bifida conditions, but when

a patient does seek help for circumstances that cause pain or deformity,

chiropractic care can be administered to control symptoms and to improve

functional abilities so that the patient is able to continue with less pain.

In addition to neural tube defects, other spinal deformities can include

1) abnormal curvature of the spine, such as through congenital scoliosis,

2) misshapen vertebrae, which includes the conditions of butterfly, wedge,

or hemi-shaped vertebrae, and 3) torticollis, or congenital lordosis or

kyphosis. All of these conditions can have significant impacts on an infant’s

ability to live a healthy life after birth, as the spinal abnormalities not only

affect the growth patterns of the infant’s body, but they can also affect other

organ systems and may be related to anomalies associated with organs such

as in the heart, lungs, kidneys, or brain.

Congenital scoliosis is described as the spine having a curvature to the side

instead of its usual vertical structure. It develops in utero when the bones of

the vertebrae fail to form normally in a regular pattern. Children with

congenital scoliosis may also have twisted vertebrae, or the spine may be

turned and bent upon itself, however, the condition is not always apparent

at birth and symptoms may not develop until childhood or adolescence. The

nearby structures of the ribs and the shoulder blades can also be affected.

The child can have problems with other organ systems as well, including

with the heart or kidney problems, or issues with the nerves or the urinary

system.


9

With abnormal spinal growth, the child may not reach a full height and the

child’s posture could be stooped. This also puts pressure on the lungs and

respiratory system when the curvature of the spine prevents full lung

expansion; often, breathing difficulties due to decreased lung volume can

develop over time.

A consensus statement regarding early onset scoliosis given by the Growing

Spine Committee categorized congenital scoliosis as a type of early onset

scoliosis, which is considered to be the presentation of the spinal deformity

before the age of 10 years. The Committee also recommended that clinicians

working with children with congenital scoliosis should include radiology

testing of the spine, including X-ray and CT scans during diagnosis, as well

as further testing of the heart and kidneys.40 Treatment recommendations

include bracing, casting, or surgery on the spine, and while manual

manipulation therapies and stretching exercises were not recommended to

correct the condition, they could be used to control some other symptoms

associated with the disability.

Chiropractors who care for patients with congenital scoliosis do not

necessarily advise against braces or surgical treatment of the condition.

However, chiropractic care can be implemented in the time surrounding

these treatments to help the child. This may include spinal manipulations,

stretching, and range-of-motion exercises to strengthen muscle groups as

well as to diminish some of the effects of the condition. The chiropractic care

will not correct the spinal deformity but it could provide enough support that

it might decrease the time needed for braces or casting and it can help with

recovery after surgery.


10

Kyphosis is a condition that causes an abnormal rounding of the spine that

produces a hump in the back; on appearance, the child may seem to have a

hunched back. It most often occurs in older adults after years of wear on the

spinal column that leads to compression of the intervertebral discs and

compression fractures. However, kyphosis can also develop in utero to cause

congenital kyphosis. During embryonic development when the spinal column

is coming together, at least one of the intervertebral discs or the vertebrae

themselves form abnormally, causing an irregular curve to the spinal

column, or a failure of the vertebrae to fully separate into distinct bones.

The spine is bowed forward at an angle and as the infant continues to

develop in utero, the angulation worsens with the growth of the spine.

Eventually, the baby is born with a lump on the back and there may be other

problems with different organ systems as well that are not as apparent.41

Lordosis is another spinal anomaly that can develop before birth. It

describes an abnormal curve in the lumbar region of the back, in which the


11

lumbar spine curves inward toward the abdomen. In comparison to

kyphosis, which causes a hump on the back, lordosis causes the back to

appear concave as it curves inward. Congenital lordosis also develops during

spinal growth of the embryo when an abnormality in vertebral segmentation

causes the spinal column to grow forward in the lumbar region.42 The

condition may not be readily apparent at birth, or the infant may present

with an abnormal position of the back and hips and decreased movement. If

it is not treated, the child can grow to develop abdominal pain from the

pressure on the spine and can have difficulties walking and growing

normally.

The treatments for congenital kyphosis and lordosis can vary, depending on

the severity of the angle of the defects. In some cases, the physician may

closely observe the child as growth occurs to determine the most

appropriate timing of intervention. When the spinal angle is significant,

though, treatment through surgery is almost always necessary to prevent

further complications and to prevent problems with mobility and pain as the

child continues to develop. A chiropractor can also assist with some

treatments for kyphosis or lordosis.

Many studies have shown that helping patients with these conditions to work

on their posture and to stand up straight have had no impact on the

condition. Spinal adjustments made by chiropractors will not realign the

spine to correct the curvature, but these adjustments could help to control

some of the pain and inflammation of the condition. The chiropractor could

also work with an osteopathic physician to provide techniques that could

decrease some of the damage of the spinal curve as well as to help the

patient to achieve as much functional ability as possible while continuing to


12

grow. As another option, chiropractic care could also help with healing

following surgical correction of the condition.

Congenital muscular torticollis is present at birth or can develop during

infancy. The condition is sometimes called wryneck and refers to a

tightening of the sternocleidomastoid muscle on the neck and side of the

head. As this muscle constricts, the infant’s head is drawn to one side in a

tilted position. The infant can also have difficulties with turning the head and

there may be spinal involvement or developmental hip dysplasia. It is

thought that congenital torticollis develops in utero when the infant is turned

or positioned abnormally as he grows in the womb. Prolonged anomalous

positioning causes aberrant muscle development in the neck, and scar tissue

eventually expands in the area, causing the muscle to be tight and

shortened.43

A child with congenital torticollis could eventually develop other problems

with poor range of motion in the head and neck. The child may be unable to

turn the head from side to side and consistently lives with a tilt of the head

in one direction. Infants with torticollis tend to sleep with their heads in the

same position, which can cause the affected side of the head to become

flattened and misshapen. If congenital hip dysplasia is also present, the child

will have difficulty moving the lower part of the body as well and will have

decreased mobility.

The main treatment for torticollis is a non-surgical approach through regular

stretching and positioning exercises. However, if the condition is significant

and the neck angle is severe, the torticollis may need to be treated with

surgery.


13

Infants born with torticollis could receive treatment through chiropractic care

to improve flexibility and range of motion of the head and neck. Chiropractic

care of the condition can further prevent other mobility problems and

plagiocephaly if the baby continually sleeps on one side.

A case report published in the Journal of Chiropractic Medicine discussed a

case of a 23-month old child who was born with congenital torticollis and

who had developed abnormal fixation of one eye. The child had an abnormal

tilt of the head to one side, indicative of torticollis, as well as a slight

curvature of the spine, and adduction of the right eye when he was looking

straight ahead. The child underwent spinal manipulative therapy on the

cervical vertebrae, as well as routine massage and stretching exercises for a

period of four weeks. At the end of the sessions, the torticollis was almost

completely resolved and the deviated eye gaze was corrected.39 The

chiropractic care administered in this situation was able to provide enough

stretching to improve range of motion of the head and cervical spine to

resolve the torticollis. The abnormal eye gaze developed as a result of the

tilt of the head over time, but with resolution of the torticollis, the eye gaze

was also repaired.

The above case report is a useful example of a situation in which a child with

a spinal problem can be safely and effectively helped through chiropractic

care. When a health condition is present at birth because of abnormal

development in utero, the child may struggle with the condition for the rest

of his or her life. However, many treatments, including surgical and

pharmacological methods are available to help. Chiropractic care can be

used as part of standard treatment to significantly reduce the time of

healing, and in some cases, it may delay or even replace more invasive

methods of care.


14

Spinal Problems During Birth

A birth injury, or birth trauma, is an

injury that harms the infant during the

birthing process. There are various types

of injuries and outcomes that occur as a

result of damage to the infant’s body, and

the extent of damage can range from

very mild circumstances such as head

molding or small abrasions on the scalp

to significant damage that can cause

lifelong disabilities, including intracranial

hemorrhage and nerve paralysis. Birth

trauma most often occurs when there is difficulty with the infant making the

transition through the birth canal, such as when the baby is large for

gestational age or if in the breech or side-lying positions in utero.46

The actual process of birth often involves a caregiver holding the baby’s

head during delivery and assisting with rotation of the body to deliver the

shoulders and the rest of the body. There may be times, though, that

delivery requires extended pulling or twisting to actually deliver the infant’s

body. Sometimes, physicians must use assistive devices through forceps or

vacuum extraction that help with the infant’s delivery; however, these

devices often cause tissue trauma, most often to the baby’s head and back.

A difficult delivery can also cause spinal damage to the infant, which could

cause lifelong health problems. There are some children who are

permanently disabled because of damage sustained during a particularly

difficult delivery. Infants who are positioned abnormally in utero – that is,

positioned in a manner other than the typical head-down position – are more


15

likely to have a difficult delivery. Additionally, infants who are breech, face

up, or in any other position besides the standard presentation for delivery

are at highest risk of spinal damage during birth because the delivery

process is much more complicated.

The spine can be damaged when there is too much traction placed on the

baby’s body while emerging through the birth canal. For example, in the

case of a footling breech birth where the legs are first to emerge through the

birth canal, excess traction or pulling on the legs and the length of the body

could cause damage to the baby’s spine. At times, the infant’s head may

also be hyperextended during the birth transition; this position is sometimes

called the stargazer fetus because of the position of the infant’s head facing

up. Unfortunately, attempting to induce vaginal delivery with this form of

fetal presentation places the infant at risk of birth trauma, including spinal

cord injury.

One of the more significant injuries to occur due to birth trauma is spinal

cord injury, in which there is partial or complete split in the spinal cord,

often combined with bleeding. The condition most often occurs when the

infant’s back is stretched or pulled in a longitudinal fashion so that the cord

is stretched beyond its normal capacity. Trauma to the vertebrae which

results in fractures can also damage the cord, although it is rare that the

birth trauma is so extensive that the cord is completely severed.

As mentioned, hyperextension of the head during delivery can also cause

spinal cord damage if the infant’s head is pulled or rotated; this presentation

and subsequent extraction can cause the spinal cord to be damaged or

severed in the neck. Spinal injury due to birth trauma often occurs in the

cervical region of the neck, although it can happen anywhere along the


16

spine.46 If the spinal cord is completely severed during delivery, the infant

will suffer paralysis and may have difficulty breathing. An infant with a

complete spinal cord separation can survive, but will live with paralysis and

have a lifelong disability.

An infant may also suffer damage to the vertebrae of the spine during birth,

which may not necessarily harm the spinal cord, but that could cause

misalignment of the spinal column. Traumatic birth syndrome describes a

condition in which an infant sustains damage to the head or spine, including

misalignment of the spinal column, because of the events that happened

during birth.47 Because of the sometimes traumatic nature of infant delivery,

which can involve pulling on the infant’s head, turning the body, or using

assistive devices when the birth is difficult, the infant is at risk of injuries to

the back, including the bones of the spine, the surrounding muscles and

intervertebral discs, and the associated nerves.

A baby may be born with spinal subluxation because of birth trauma, but the

effects may not be immediately seen. Problems with muscle weakness, poor

development, and difficulties with feeding and with sleeping can all develop

as a result of vertebral subluxations that occur during birth. There are some

chiropractors that specifically work with infants who are suffering from the

effects of traumatic birth syndrome, while other clinicians who work with

children may see older infants or children who have been struggling with the

ongoing effects of spinal misalignment that occurred during the birth

process.

A chiropractor who works with very young children and infants should

specialize in the unique needs and treatment of patients in this particular

population. Parents may take their infant to see a chiropractor for help with


17

spinal adjustments to correct subluxations, which could potentially resolve

other problems the child may be having as well. Problems due to vertebral

subluxations in infants may manifest in a number of ways, such as through

colic, in which the infant cries inconsolably, sometimes for hours at a time.

Some parents have noted that their child suffers from reflux and excess

spitting up of milk or formula as a result of vertebral subluxations, as well. A

chiropractor who is trained to treat young children can perform spinal

adjustments on babies who have subluxations that occurred during

childbirth.48

A case series published in the Journal of Pediatric, Maternal & Family Health

reported an instance of twin boys, born prematurely, who had suffered birth

trauma that included plagiocephaly (a flattened part of the skull) and

scaphocephaly (a narrowed skull). By the age of seven months, the infants

were having difficulties with breastfeeding, and had long-term reflux and

chronic irritability. The babies underwent 16 weeks of spinal adjustments,

and at the end of the term, their mother reported a complete resolution of

reflux, few problems breastfeeding, a marked reduction in irritability, and

significant improvement in head shape following the plagiocephaly and

scaphocephaly.49

Birth trauma may cause damage to the nerves due to compression or nerve

stretching beyond its normal capacity. The damage can cause weakness and

paralysis of nearby structures. Brachial plexus nerve injury may occur from

excess stretching of the nerve in the upper arm and shoulder while the baby

is being delivered, such as in cases of shoulder dystocia, where there is

difficulty delivering the infant’s shoulders past the mother’s pubic bone after

the head has already been delivered. The brachial plexus is found in the

cervical regions of the neck and the upper portion of the thoracic spine;


18

significant manipulation of the baby’s body during delivery can traumatize

this network of nerves. The injury can lead to various forms of palsy,

including Erb’s palsy, which can cause weakness or paralysis and paresthesia

in one arm; or Klumpke palsy, which causes paralysis in the wrist and the

hand.

Horner syndrome is a condition where there is such damage to the nerves

that the child has weakness, paralysis, and facial changes on one side of the

upper body, including small pupil size and ptosis on the affected side.46 The

condition can cause a lifelong disability for the affected child and often has

to be managed with ongoing therapy and rehabilitation to prevent

complications.

In some cases, chiropractic care may be utilized to improve range of motion,

function, and flexibility among infants with nerve damage due to birth

trauma. Adjustments and stretching exercises can improve symptoms and

may restore some strength in the affected areas. Chiropractic manipulation

may also be able to completely restore health and function to normal

capacity for some children. A case of Erb’s palsy that was resolved following

chiropractic manipulation was published in the Journal of Pediatric, Maternal

& Family Health, which referenced a case of a 5-month-old girl who suffered

from Erb’s palsy as a result of obstetric care. The girl had poor range of

motion and limited movement in the right arm. She underwent chiropractic

care for two months, which involved gentle stretching, adjustment, and

manipulation that was modified for her age. After two months, the infant

experienced significantly improved range of motion and resolution of the

palsy.50


19

Chiropractic care of infants is specialized to this particular population in that

the chiropractor modifies his or her techniques when working with infants.

An infant’s body is much more fragile when compared to an older child or an

adult; the chiropractor must take into consideration the developmental stage

of the infant as well as the muscle and bone growth present. When making

an adjustment, the chiropractor is gentle and does not use much force at all

when aligning the spine and manipulating the tissues. Instead, tissue

manipulation or spinal adjustment is done by gently moving and stimulating

the muscles and joints.

The infant can also undergo range-of-motion exercises as the chiropractor

gently repositions and rotates the head, back, and extremities. Exercises to

increase flexibility and to stretch the muscles are performed similarly, while

considering the fragile state of the infant’s muscle and joint structures. Many

infants tolerate chiropractic procedures quite well and the experience can be

calming and soothing for them, sometimes promoting relaxation and sleep.

Related Disorders

In addition to the research performed on the benefits of chiropractic care in

utero and on newborn infants, there is evidence that chiropractic medicine

can be beneficial for care of some very common disorders that affect

children. While children often have more rapid healing outcomes when

compared to adults, they are also more likely to develop illnesses that can

be temporarily debilitating, which can weaken their health and prevent them

from going to school or daycare.

When illnesses occur in adults they are less likely to have as significant an

effect as in children. For example, an adult who develops a viral respiratory

infection that manifests as the common cold may feel under the weather and


20

may suffer from a sore throat, cough, and nasal congestion. These

symptoms may also occur in a child with a similar illness, but the child may

also have a fever and such fatigue that a need may arise to stay home at

bedrest. The adult with a cold will often continue working and performing

routine activities. Whereas, the child who develops an illness or injury and

receives chiropractic care may shorten the time of illness symptoms and

return to normal activities faster.

Ear Infections

Ear infections are common illnesses seen in young children. They are often

short lived because they can be treated quickly, but there are some children

who have chronic ear infections. Parents of children who suffer from

frequent ear infections may seek alternative forms of treatment or therapy if

the condition is recurring and does not otherwise respond to conventional

treatment through medication. Acute otitis media, typically referred to

simply as an ear infection, occurs when there is an infection in the middle

part of the ear, the pressurized space beyond the tympanic membrane.

Children typically contract ear infections more often than adults; often,

children cannot describe what is wrong or why they are experiencing pain in

the ear. The infection is usually viral or bacterial in origin and may be

treated with antibiotics, although many physicians are now backing away

from frequent antibiotic use for otitis media treatment and are choosing a

wait-and-see approach to allow the infection to resolve on its own.

Ear infections can be very uncomfortable for children. They typically cause

pain in the ear, fever, and a feeling of pressure in the head. There may be

fluid draining from the ear as well. Very young children who develop ear

infections often have difficulties eating and sleeping and are frequently

irritable. Normally, the Eustachian tubes link the nasopharynx to the middle


21

ear and are responsible for regulating the pressure in the middle ear and

ensuring that excess fluid does not build up in the space, which could

contribute to ear infections. The Eustachian tubes are very small and can be

easily blocked, particularly in children who suffer from frequent inflammation

or upper respiratory infections that can cause swelling and that can obstruct

the tubes. When the tubes do not drain fluid and air, increased pressure and

fluid in the middle ear increases the risk of infection.

Some children develop chronic ear infections because of consistent fluid

buildup behind the tympanic membrane, necessitating placement of

drainage tubes in the eardrum, which regulate the pressure behind the

membrane and drain fluid out of the middle ear, thereby decreasing the risk

of ear infections. Based on the potential causes of ear infections and

common reasons for their development, chiropractic care may not

necessarily be the first choice of treatment for this condition. However,

many parents take their children to see chiropractors for treatment of

frequent ear infections, and there seems to be a connection between

chiropractic medicine and the resolution of ear infections. As discussed,

chiropractic medicine provides holistic care, so if a child has suffered from

frequent ear infections, the chiropractor is more likely to try to find the root

cause of the condition, rather than prescribing medication right away.

The chiropractor can evaluate what factors in the child’s life may be

contributing to a tendency to develop ear infections, such as whether the

child has frequent upper respiratory infections or allergies, or if a structural

condition exists that would contribute to air or fluid buildup behind the

eardrum.


22

Chiropractic medicine affirms that there is a link between subluxations,

particularly those in the cervical region of the neck, and frequent ear

infections in children. These subluxations may have developed very early in

life, even during birth. By managing the subluxations and aligning the spine,

the chiropractor may be able to treat an ear infection. The theory is that

when the cervical vertebrae are aligned properly, it takes pressure off of

some of the nerves in the neck that could be disrupting the work of the

Eustachian tube. By restoring normal nerve function, the Eustachian tube

may drain the fluid from the ear more efficiently and decrease the risk of

infection from fluid buildup.57

Often, when parents bring a child with an ear infection to a pediatrician, they

will receive a prescription for antibiotics for treatment. Unfortunately,

antibiotics are not always effective in treating ear infections; some bacteria

can become resistant to antibiotics over time and when the ear infection is

caused by a virus, antibiotics are not useful anyway. There are also many

children who suffer from chronic ear infections and who go through several

rounds of antibiotic treatments but who still continue to develop them. If

these infections are not well managed, they could lead to significant

complications for the affected child, including hearing loss, speech

difficulties, and the spread of the infection to other structures in the head

and face.

A review by Marom, et al., published in the journal Medicine (Baltimore)

considered the use of several different kinds of complementary and

alternative treatments specifically for otitis media in children. The review

stated that while many parents do seek conventional care for treatment of

ear infections in their children, there is also a growing number of parents

who consider additional treatments, often in conjunction with evidence-


23

based medicine. The review looked at the use of spinal manipulation therapy

through chiropractic care on children as treatment for otitis media and

explained the hypothesis of why chiropractic care is often considered as a

treatment for this condition. The theory is that spinal manipulation therapy

produces certain biomechanical changes in the spine that ultimately affect

the sympathetic and parasympathetic nervous systems.

The use of spinal manipulation can have an effect on muscle tension to

decrease muscle rigidity and to promote excess fluid and lymphatic

drainage, thereby reducing fluid buildup in the inner ear. The review found

that chiropractic care could be helpful for some children with recurrent otitis

media and that this type of treatment generally causes few adverse effects

on children. Ultimately, more research about this specific form of treatment

is needed for clarity.58

Despite a lack of scientific research proving the benefits of chiropractic care

on the treatment of ear infections, there are many parents who count on this

method for their children. Just as chiropractic care can improve symptoms of

various conditions related to the musculoskeletal system, it could also be

beneficial in promoting fluid drainage through manipulation of the spine and

the muscles, making it an effective treatment option for some children.

Sore Throats/Colds

Upper respiratory infections, often referred to as colds, are caused by

viruses that infect the upper airways, leading to cough, sore throat,

sneezing, and congestion. Millions of people suffer from colds each year and

because the infection can be caused by a number of different viruses, there

has yet to be a cure discovered for this very common condition. Most upper

respiratory infections are self-limiting, even in children, and they usually


24

resolve with rest and routine care. The majority of children who develop

colds have healthy enough immune systems that they are able to fight off

the viral infection and the symptoms tend to resolve in a short time.

There may be some people who are more likely to develop colds and upper

respiratory infections when compared to the general population. Additionally,

some symptoms that appear to be just a cold or minor illness can actually be

a sign of a much more serious situation. For example, a child with a sore

throat, fever, and swollen glands in the neck may have strep throat instead

of a viral respiratory infection. When a child’s sore throat or respiratory

symptoms are related to a bacterial infection or something more serious

than a virus, it typically needs to be managed with medication in addition to

home remedies.

There are many situations where a child with a sore throat or with cold

symptoms can be treated through chiropractic medicine. Chiropractic care

may also help to prevent the onset of some symptoms and related viral

infection. The goal of chiropractic care administered for the treatment of

colds or sore throat is to strengthen the patient’s immune system to better

fight off the viral infection. Chiropractic medicine asserts that this type of

care specifically improves the flow of lymph fluid through its channels, which

ultimately supports the immune system to allow a child to fight off a cold or

infection.

The lymphatic system plays a key role in immune system function. It

contains a system of channels that are somewhat similar to blood vessels in

the circulatory system; these channels transport lymph, which contains a

large number of white blood cells that are designed to fight infection. Lymph

is actually formed when interstitial fluids and blood plasma are emptied into


25

the lymph circulation. The fluid is circulated throughout the body and is

filtered when it passes through lymph nodes, which also contain large

numbers of immune system cells. Eventually, lymph enters blood circulation

when it flows into the subclavian vein. Lymph channels have an internal

structure that contains small valves that prevent the lymph fluid from

moving backward. The fluid is propelled through the lymph channels through

the force of smooth muscles as well as skeletal muscles.

The skeletal muscles apply pressure to the lymph channels when they

contract, which plays a key role in the transport of lymph fluid. Because a

significant amount of chiropractic care is focused on elements of the

musculoskeletal system, the adjustment of tissues that affect the skeletal

muscles could then further stimulate the flow of lymph through lymphatic

channels. By utilizing chiropractic care to stimulate muscle contractions, an

individual could potentially increase the flow of fluid through the lymphatic

system, increasing the rate at which the white blood cells within the lymph

fluid are able to respond to an infection or antigen.

It is through the stimulation of muscle contractions that chiropractic care is

thought to work as a technique that can manage cold symptoms or sore

throats in children. The body protects itself against infections by immune

system defenses, so if chiropractic care is able to stimulate the lymphatic

system to increase immune system response, it could potentially treat or

prevent viral infections.

Spinal adjustments made to the neck in children with cold symptoms and

sore throat could also decrease excess pressure on lymph channels and

swollen lymph nodes. By aligning the vertebrae in the neck, the lymph

channels may be unrestricted and free to allow proper lymph flow and an


26

appropriate response to support the immune system. A chiropractor may

also perform lymphatic massage, which may restore normal flow of lymph

fluid. Lymphatic massage may also be referred to as lymphatic drainage and

it is often employed in cases where a person has developed lymphedema,

such as following surgery when lymph channels are disrupted and there is

excess fluid accumulation.

Lymphatic massage is done to drain excess fluid and to restore normal

lymphatic flow. It can also be performed on occasion to support the normal

flow of lymph fluid through the lymphatic system, which ensures that the

body is receiving normal amounts of fluid and that the immune system is

functioning properly.

The holistic focus of chiropractic care means that a chiropractor who consults

with a patient suffering from a cold or sore throat may also have other

advice about what measures will treat or prevent future infections. For

example, dietary supplements and the intake of certain vitamins and

minerals is thought to impact the length of symptoms experienced from a

cold and taking herbal supplements may support immune system function to

prevent viral infections. Vitamin C supplementation, while it does not

necessarily prevent cold symptoms, may decrease the duration of cold

symptoms overall.59 A chiropractor may provide information to parents

about diet and lifestyle factors that they can implement with their child that

would help in the treatment or prevention of colds, in addition to performing

spinal adjustments on the child to support physical health.

Colic/Reflux

Some infants suffer from colic, which can be aggravating and upsetting to

parents who cannot otherwise understand how to calm their child. Colic is


27

described as a condition in which an infant will cry inconsolably, despite

being well fed and otherwise healthy. Technically, a baby is considered to

have colic when crying for longer than three hours a day, three or more days

a week, for a period of at least three weeks.60 Despite parents’ attempts to

soothe, feed or change the baby, or otherwise meet all of the baby’s needs,

the baby with colic will continue to cry for an unknown reason.

No one really knows what causes colic or why some infants develop the

condition. It is not related to illness or any type of physiological anomaly

that would cause pain or discomfort for the infant to trigger crying. Often,

the infant with colic cries in a way that is loud and distressing, almost as if in

pain, yet there is no source of discomfort. The infant with colic may draw the

legs up toward the body, but the colic is not necessarily associated with

gastrointestinal changes or excess gas buildup in the intestinal tract, except

if the infant swallows a lot of air because of excessive crying. Colic is

fortunately self-limiting and it resolves on its own, but often not before

weary and exhausted parents have tried different treatments or methods to

help their child stop crying.

Parents of infants with colic may be willing to try methods outside of

conventional medicine if it means that the colic resolves sooner. Some

complementary and alternative medicine techniques may play a role in

soothing colic and reducing the length of crying episodes. An article

published in the Italian Journal of Pediatrics considered possible new options

for the treatment of colic, including chiropractic care, as well as dietary

supplements, acupuncture, and behavioral interventions. The review showed

that certain herbal supplements, including lemon balm, fennel, and

chamomile could be reassuring and soothing for the infant and may aid in

reducing abdominal distention from swallowed air. Acupuncture was also


28

shown to be a safe and gentle method in reducing the duration of infant

crying episodes, although studies have not specifically shown significant

effects on infants who had acupuncture for crying due to colic. Chiropractic

treatment through spinal manipulation has been shown to reduce duration of

crying with colic, at least when administered on a short-term basis.61

A chiropractor may be able to help relieve some symptoms of colic by

performing a gentle spinal adjustment on the baby’s back. In some cases,

subluxations are present at different areas of the spine, and after

adjustment, the intensity and duration of crying because of colic is reduced

or even eliminated. Spinal disturbances can be present in infants for various

reasons; most often because of birth trauma, even if it is not immediately

apparent. An infant whose body has been pulled or manipulated during birth

could have subluxations in one or more areas of the spine, which could

potentially be related to colic that develops later.62 If a chiropractor performs

a gentle adjustment on these areas to correct the subluxations, the colic

symptoms can be helped.

Chiropractic care of colic is not an option for everyone; in fact, many parents

do not wish to have their child seen by a chiropractor if they do not

understand how the spinal manipulation can affect the baby’s health and

behavior. Many chiropractors do not even know how spinal adjustment to

correct subluxations can resolve colic symptoms, as it is difficult to establish

the cause of the colic itself. However, there have been enough cases of

spinal adjustments performed on babies with colic that clinicians have

discovered often works over time. The problems with colic could be related

to subluxations in the spine, and some children are more likely to have

subluxations in the cervical regions, which, when adjusted, corrects the

symptoms of colic. Subluxations related to colic symptoms are not only


29

found in the cervical region, but have also been noted in all areas of the

spine when performing these kinds of treatments.

An article published in Dynamic Chiropractic examined an early study that

evaluated the treatment of colic in infants using chiropractic techniques. The

study involved chiropractic treatment of over 300 infants with colic and

found that 90 percent of the babies showed improvement in colic symptoms

after only three chiropractic treatments.62 The exact mechanisms of why

spinal adjustment can affect colic and can reduce its symptoms remains to

be discovered, and more recent research is needed to support the results of

this early study. Until there is more scientific evidence about the causes of

colic and the connection between spinal adjustment and symptom

resolution, chiropractic care can still be an option for many parents who are

seeking to help their crying babies.

Reflux is another condition that may develop in infants and young children.

It involves food, fluid, and acid back up in the esophagus from the stomach.

In infants, reflux is often manifested as frequent spitting up. While it is

normal for babies to spit up sometimes after eating, reflux causes frequent

vomiting, as well as a cough, with an increased risk of aspiration of stomach

contents into the lungs. Babies who cannot explain their discomfort with

reflux often are irritable and may cry frequently; they may gag and spit

when trying to eat or they might refuse to eat much at all. In older children,

reflux causes pain after eating that is described as heartburn, as well as

frequent burping or vomiting.

Esophageal reflux is typically treated with medication to reduce stomach acid

secretions, although several lifestyle interventions may be included that can

reduce the risk of some episodes, including feeding an infant in an upright


30

position, avoiding lying down for a period of time after meals, and in older

children, avoiding foods that are more likely to cause an upset stomach,

such as citrus fruits, chocolate, tomatoes, and greasy or fried foods. Reflux

often occurs because of an issue with the lower esophageal sphincter (LES),

which separates the esophagus from the stomach. Normally, it is closed

tightly, opening briefly to allow swallowed food to pass into the stomach and

then closing again to prevent backflow of stomach acid. When the LES is

weakened, it may not close tightly and acid is therefore more likely to reflux

and cause heartburn and vomiting.

Gastroesophageal reflux disease (GERD) is a more severe form of chronic

reflux, in which the child experiences frequent reflux, coughing, vomiting,

wheezing, and problems with eating and sleeping. Children with GERD often

need medication to control the problem and sometimes, surgery is

warranted through fundoplication, which wraps part of the stomach around

the base of the esophagus to prevent further reflux and damage to the

esophageal tissue. Both acid reflux and GERD can lead to further problems in

children because they can affect growth and development and can cause

nutritional deficiencies.

Beyond standard treatments through medication, some parents may

consider chiropractic therapy as treatment of reflux and GERD. Chiropractic

care may be implemented in combination with other types of treatment, but

some parents turn to chiropractic medicine when other forms of treatment

have not helped. Chiropractic medicine techniques may reduce some

symptoms of reflux by decreasing backflow of stomach acid into the

esophagus and it could help to prevent future reflux episodes.


31

Because GERD and reflux are thought to be caused in part by problems with

the esophageal sphincter, chiropractic care often focuses on making spinal

adjustments that can affect this issue and provide better control. Spinal

manipulation therapy may reduce irritation on the nerves that affect the LES

and the muscles that control how the stomach churns and agitates food

during digestion. It is thought that when subluxations are present in the

spine, they can irritate the nerves connected to the stomach and esophagus,

which can decrease the transit of food through the stomach during digestion

and can affect stomach acid production. Resolution of these subluxations,

which are typically thought to occur in the thoracic area of the spinal

column, may reduce pressure on the nerves connected to the stomach and

esophagus and could therefore lead to partial or complete resolution of

reflux.67

A literature review by Angus, et al., in the Journal of the Canadian

Chiropractic Association found that chiropractic therapy through spinal

manipulation, craniosacral therapy, and soft tissue modalities has controlled

symptoms of GERD in pediatric patients as outlined in some clinical studies.

The effects of the chiropractic therapies on the patients with GERD resulted

in decreased severity and frequency of symptoms, as well as a decrease in

overall irritability and sleep difficulties.64 A further study published in the

International Journal of Medical Research & Health Sciences also showed a

reduction in GERD symptoms among patients who underwent chiropractic

care that involved kinesiology taping as well as certain exercises and the

addition of medications to control reflux.65 Kinesiology taping involves the

application of a type of tape to certain points on the body; the tape lifts the

skin slightly to promote lymphatic drainage, to decrease inflammation, and

to alleviate discomfort.66 The study evaluated the use of taping in a pediatric

patient with reflux and indigestion in order to improve and correct stomach


32

position and to stimulate a proprioceptive response in the skin of the

abdomen above where the reflux was occurring.65

Parents of children who suffer from reflux may try conventional forms of

treatment for this condition, but they have alternatives when they seek

chiropractic care. The chiropractor can not only perform adjustments that

can benefit the nerves in the stomach and esophagus that are contributing

to the reflux, but can offer many other practical recommendations that will

reduce symptoms as well. The chiropractic treatment of reflux is often

successful when used in combination with conventional treatment and may

reduce the amount of time that the child suffers from reflux symptoms.

Asthma

Asthma is a chronic disease that can develop in childhood or even infancy. It

affects the bronchioles so that they become inflamed and constricted, often

in response to environmental triggers. A child with asthma has airways that

are sensitive to certain elements that can be irritating to the tissue. When

coming into contact with these elements, the child’s airway becomes

inflamed and can swell, causing constriction and ultimately decreasing air

movement into and out of the lungs. There may be increased mucus

production as well, which can cause further difficulties with breathing

because of obstruction.

Asthma symptoms are typically not manifested on a continuous basis; rather

they occur in episodes or asthma attacks following a trigger. An asthma

attack causes significant coughing and difficulty breathing. The child may

wheeze while trying to breathe and may use accessory muscles of the chest.

Other symptoms include nasal flaring, activity intolerance, and fatigue.

Asthma is a very serious chronic condition of childhood. Although there are


33

adults with asthma, the condition seems to be prominent in children, with

approximately 6 million kids in the U.S. having been diagnosed.63 Asthma

can lead to further complications in which a child needs to be hospitalized

periodically for treatment, and it can also increase the risk of the child

developing pneumonia, pneumothorax from excessive coughing and

wheezing, and even respiratory failure.

Asthma is closely associated with allergies in children, and the condition

seems to run in families as well.63 Products in the environment that cause

allergy symptoms may also act as triggers for asthma attacks, including

pollen, hay, grass, dust mites, pet dander, or mold. Other stimulants, such

as cigarette smoke and air pollution can also act as triggers for asthma

attacks. Some children have exercise-induced asthma in which they develop

bronchospasm during or after exercising. Often, the condition occurs

because the individual must breathe harder and more rapidly when

exercising, which can lead to bronchospasm and constriction.

Asthma must be managed carefully to prevent very severe complications

that could develop during an asthma attack. Often, the most successful

methods of controlling asthma are to learn what elements trigger symptoms

and avoid those items. For some children, though, avoidance of all triggers

is not possible, particularly when there are several items that can cause

reactions. In some cases, daily treatment with long-term control medication

can be used to prevent attacks from occurring in the first place, and a child

may then also use an asthma inhaler during times of an attack. The daily

control medication contains drugs that reduce the impact of environmental

triggers and that prevent asthma attacks from occurring; these drugs often

include theophylline or corticosteroids. The inhaler acts as an emergency

relief medication for when bronchospasm occurs, and it typically contains


34

medications that act on the beta receptors in the airways to prevent

constriction and to increase airflow to restore normal breathing.

Chiropractic treatments may also be utilized to manage asthma in some

children. A chiropractor may perform a spinal adjustment on a child with

asthma, as the effects of spinal manipulation can benefit the lung tissue and

the airways. If areas of the spine are compressing the nerves that innervate

the airways and the lungs, the adjustment of the spine to reduce pressure

on these nerves can then resolve some effects on the respiratory system.

For instance, the diaphragm plays a significant role in the respiratory system

and in support of breathing; when the diaphragm contracts, the lungs

expand to take in air in response. The phrenic nerve, which controls the

diaphragm, is located in the cervical region of the spine, at the levels of C3

to C5. If a child has subluxation in the cervical spine, it could put pressure

on these nerves and cause irritation, which might affect the work of the

diaphragm as well as how well the child is able to breathe. The nerves in and

around the spine also affect many other muscles that contribute to normal

breathing, including the intercostal muscles, as well as accessory muscles

such as the sternocleidomastoid, trapezius, and pectoralis muscles.

When the spine is aligned after the work of a chiropractor, the person is

more likely able to have fewer restrictions in the airway and a greater ability

to take full, deep breaths. Spinal alignment can support proper positioning of

the rest of the body so that even if the person develops breathing

difficulties, such as with an asthma attack, the back muscles and chest may

be stronger and may allow for full lung expansion and deeper breathing to

allow for better air flow.


35

A review by Lago, et al., in the Manual Therapy, Posturology, and

Rehabilitation Journal evaluated the literature related to chiropractic care

and osteopathic techniques in the treatment of asthma. The review stated

that manual manipulation techniques act on the nerves that innervate the

lung tissue and the diaphragm and that when spinal dysfunction is present,

it can irritate these nerves, causing a multitude of problems, including

decreased chest wall functioning, poor airway tone, and an increased risk of

airway inflammation. The review showed that in the literature, there have

been several published studies that have shown that spinal manipulation can

be successful as adjunct therapy in the treatment of asthma. While the

results have not shown that chiropractic spinal manipulation positively

improves lung function as demonstrated through lung function testing, the

use of chiropractic medicine is beneficial as a supplemental treatment and it

may reduce the need for other standard forms of treatment, such as by

decreased use of emergency inhalers or a reduced dose of daily control

medications for asthma.68

Because asthma is so commonly associated with allergies seen in children,

the two conditions may be treated simultaneously through chiropractic

medicine. Some parents of children with allergies may bring their children to

chiropractors for help in reducing allergic responses. Because of the impact

that chiropractic adjustments can have on both the immune system and the

muscles and nerves associated with the respiratory system, it is possible

that spinal manipulation and correction of subluxations could help some

children who also suffer from allergies. The adjustments made in the spine

and the manipulation of skeletal muscles that occur with chiropractic

treatments can improve lymph flow and subsequently support the immune

system, which could then be more effective in protecting a child from allergic

reactions.


36

Unfortunately, there is limited research about the established effects of

chiropractic care in the management and prevention of allergies in children,

but many parents believe in the success of chiropractic care as treatment for

this condition, in addition to the treatment of asthma and other illnesses

affecting the respiratory system.

Scoliosis

As previously discussed, scoliosis is a condition affecting the spine that

causes abnormal twisting or curvature of the vertebrae in the spinal column.

Scoliosis can be a congenital condition that is present at birth but the effects

of the condition often do not appear until the child grows and becomes more

mobile. Idiopathic scoliosis is more commonly seen during adolescence; it

often develops as a child’s spine grows and changes shape during adolescent

development. As the name implies, there is no particular reason why some

children develop idiopathic scoliosis and why the spine curves and bends as

it grows. The condition does seem to run in families and it tends to be more

common in girls.

Another form of scoliosis that may affect older adults is degenerative

scoliosis, which develops in adults who had scoliosis that was treated when

they were younger, or in some people who have abnormal amounts of spinal

deterioration with aging. Consequently, a child with scoliosis may also be at

greater risk of developing degenerative scoliosis later in life. As the bones of

the spine degenerate, some areas may collapse onto themselves in a

manner similar to compression fractures. The spine can become curved and

bowed outward, further increasing pressure on the intervertebral discs and

the bones of the spine. There are also other, rarer forms of scoliosis that are

often associated with chronic illness, such as neurodegenerative scoliosis,

which can occur with conditions such as cerebral palsy; and, syndromic


37

scoliosis, which is more likely to occur in people who were born with genetic

syndromes.

Scoliosis is often identified in children and teens when parents note a

problem with their child’s mobility or the appearance of the spine. Scoliosis

screenings are also often performed in schools and with routine well-child

checks in physician’s offices. The severity of the condition depends on the

area of the back that is involved and the extent of the curvature, however, if

it can be caught early, it may be treated through less-invasive measures to

prevent further curvature of the spine, such as through chiropractic

medicine. Chiropractic care uses non-invasive techniques through spinal

alignment and suggestions for lifestyle modifications that may help to

prevent the condition from worsening if it is caught early on.

Without appropriate treatment of scoliosis, it can worsen as the child grows,

causing deformity and difficulties with normal functioning. It is important to

correct the condition as soon as it is discovered in a child. Chiropractic

adjustments on the spine could help to control the curvature of the spine

and prevent it from worsening as the child grows. If a child is seen for

chiropractic care who already has advanced scoliosis, spinal adjustments will

not reset the vertebrae into normal alignment so that they grow correctly.

Spinal adjustments can, however, reduce some of the effects of scoliosis,

and can help the child to live well and function in spite of the deformity, and

as an adjunct to other types of treatment, including back braces or surgery.

Most of the time, scoliosis does not cause pain in affected children, but for

some, the curve in the spine can put pressure on nearby muscles and

ligaments; the intervertebral discs may also bear excess pressure from the

bones of the vertebrae. It may be possible that children who experience


38

back pain because of scoliosis can benefit from chiropractic care because of

the effects on the musculoskeletal system that this type of treatment offers.

For instance, if a person is suffering from muscle pain due to spine curvature

or deformity, manipulation of the spine will not reduce the curve but it could

take some pressure off of the back muscles that are contributing to the pain.

Spinal manipulation does not cure scoliosis and will not work in the same

method as a back brace or surgery. It can, however, realign the vertebrae

and correct subluxations that are otherwise irritating the nerves and

contributing to discomfort. Through this technique, the child may have less

pain from scoliosis and the process could reduce the amount of time the

child must spend undergoing conventional scoliosis treatments, such as by

decreasing time spent in a back brace or reducing the need for surgery.

A study by Morningstar, et al., in the journal Clinics and Practice looked at

the effects of chiropractic rehabilitation on patients who had been diagnosed

with adolescent idiopathic scoliosis. Because teens who have scoliosis are

still in stages of development to where their spines have not finished

growing, the authors of the study not only evaluated the subjects while they

went through cardiac rehabilitation, but they also continued to follow the

patients until they reached skeletal maturity. The study showed that 90

percent of the patients who had chiropractic care and idiopathic scoliosis

achieved some amount of spinal angle correction when they were later

evaluated at spinal maturity. The subjects in the study did not use spinal

braces to correct their scoliosis. The average amount of correction of spinal

angle was 12.75°.69 While more studies need to be conducted about the

effects of chiropractic manipulation to achieve even greater angle correction,

even some amount of spinal angle correction can be helpful for affected

patients and it prevents further progression of the spine into a scoliosis

curve. With this in mind, chiropractic care can be very beneficial in helping


39

children and teens diagnosed with scoliosis when used in addition to

conventional forms of treatment.

It should be noted that scoliosis treatment solely through chiropractic care is

controversial and that some patients have described adverse effects of

chiropractic care when they underwent treatment for their scoliosis,

including muscle pain and generally feeling worse after receiving treatment.

Chiropractic care is not necessarily the right choice for everyone, and many

people who utilize chiropractic medicine report only mild side effects. In

general, people should continue to use chiropractic care when they do

experience physical benefits from the techniques, particularly when it is in

combination with other standard forms of treatment.70

Headaches

Headaches are a common malady for most people, and they are no

exception for children. There are some children who suffer from headaches,

and in some cases, the pain may be common and recurring. Up to 51

percent of children under age 7 experience headaches, with the numbers

rising to 57 - 82 percent by the age of fifteen.73 Children can develop tension

headaches from stress and they may develop migraine headaches as well,

which can be very painful. Most headaches that develop in children are self-

limiting and are not related to a chronic condition; instead, they may

develop when an acute illness is present, such as with an upper respiratory

infection or influenza. They can also occur because of a variety of reasons

related to environmental stimuli or simply life stressors, including due to lack

of sleep, exposure to loud noises or strong scents, taking certain

medications, or eating particular foods.


40

Children feel the pain of headaches in ways that are similar to adults. They

may have pain in any area of the head, as well as in the face or neck. The

pain may be worsened by exposure to bright lights or loud noises and some

children feel better with rest and by limiting activity. The pain of a headache

can also be severe enough that it causes nausea and vomiting, nasal

congestion, and watery eyes; these symptoms are more closely associated

with migraines. Kids who get headaches can often report to their parents

many of their symptoms and explain how they are feeling, although very

young children who are not able to explain themselves may be fussy and

irritable because of the pain.

Chiropractic care of headaches involves an initial consultation to try to

determine the cause of the problem and if there is another issue present

that may be contributing. The chiropractor should speak with the parents

about the child’s regular activities and what changes, if any, that have

occurred that may be associated with the headaches. Other areas of

discussion related to the patient’s medical history and physical examination

might include talking about 1) the child’s diet, 2) how he or she relates to

other family members and friends, 3) if there are any particular life

stressors, 4) the level of sports or other activities that could cause head

trauma, 5) whether medications or supplements are taken, and 6) if there is

any family history of headaches. The chiropractor may also perform some

imaging studies to be certain that the headaches are not caused by a more

serious health issue.

Parents often treat their child’s headaches with over-the-counter

medications that are specified for pediatric use, such as acetaminophen or

ibuprofen. Other measures, such as lying down in a quiet and dark room or

putting a cool cloth on the forehead can also help to control some of the pain


41

of a headache. A child who struggles with recurring headaches to the point

that it affects activities and schoolwork should be seen by a physician. If a

parent seeks chiropractic care for help with a child’s headaches, it may be as

a sole treatment or it may be in conjunction with conventional treatment.

As with adults, chiropractors can manage headache pain in children through

gentle spinal adjustments and by promoting lifestyle modifications that can

prevent further headaches. Chiropractic care affirms that a significant

number of headaches in children are related to vertebral subluxations that

most commonly occur in the cervical spine. The subluxations could be

present unknowingly for years and could have developed because of birth

trauma or another injury for the child that did not immediately manifest

itself. Chronic stress could also be a cause of vertebral subluxations and the

child with significant life stressors may be more likely to develop

subluxations and consequent headaches.71

Some children may suffer from cervicogenic headaches, which are

headaches that occur as a result of pain or trauma to an area of the neck.

These headaches are often confused with migraines, as the pain and

symptoms can be similar. The cervical spine contains the cervical vertebrae

as well as cervical nerve roots that are connected to the spinal cord and that

extend away from it to control movement, sensation, and various other

activities in the upper body. For instance, the cervical root nerves extending

from C4 are important for controlling the diaphragm for breathing. The

spinal roots located in the upper cervical vertebrae (C1, C2, and C3) affect

the diaphragm to control breathing and they also control movement and

sensation of the head.


42

When the cervical nerve roots are irritated, it can send pain messages to the

brain that are manifested as a headache.72 It is thought that chiropractic

manipulation of the cervical vertebrae and treatment of subluxations in this

area can relieve some pressure on the cervical nerve roots, decrease

irritation, and relieve headache pain. A case report published in The Journal

of Headache and Pain reported that there is supportive evidence for the use

of spinal manipulation therapy in the treatment of cervicogenic headache

pain in children. The report described a situation of a 6-year-old child who

had suffered from chronic headaches for two years, but no physiological

cause had ever been identified. The child was treated with high velocity, low-

amplitude thrust spinal manipulation therapy for two months.73

The nerves in the neck and back are linked so intricately with the spinal

column that changes in movement or improper positioning can negatively

impact how they influence other body areas. The nerves are very sensitive

and so when they become irritated, they can cause significant pain and other

symptoms of muscle weakness or paresthesia. It is important to understand

that some headaches are truly caused by irritation of the nerve roots in the

spinal column and can be managed by aligning the vertebrae nearby.

Some children develop tension headaches, which often are manifested as

muscle spasms in the neck and at the base of the skull. The rectus capitis

posterior minor is a small muscle located at the base of the head, just under

the occipital region of the skull. It is attached to the C1 and C2 vertebrae at

the very top of the spinal column. This muscle plays a role in proprioception,

which is the awareness of the body’s position within a space; it also helps to

support the head and supports the movement of the neck. Although it is

small, when this muscle is injured or has spasms, it can cause pain and

disability in the affected person. If subluxations develop high in the spinal


43

column, in the C1 or C2 region of the cervical vertebrae, it not only irritates

the nerve roots found there, but the muscles in the region may also spasm,

including the rectus capitis posterior minor muscle. The muscle is also

connected to the dura mater, which acts as a covering to the brain and is

very sensitive to pain. Consequently, with the spasm of this muscle, the

affected person can feel headache pain.74 Correction of subluxations in the

cervical vertebrae may reduce muscle spasms that can contribute to this

type of headache pain.

Chiropractic care may also involve trigger point therapy for the reduction

and relief of headache pain. Trigger points are areas that, when stimulated,

can trigger pain in nearby regions in the body. For example, with a

cervicogenic headache, the neck contains areas that are trigger points in

that if they are irritated or aggravated in some manner, they can cause pain

in other areas, often the head. Trigger point therapy is a type of massage

that locates the areas that are irritated and that are causing pain and then

massages them to release them and loosen any constricted areas. A

chiropractor may identify trigger point areas when examining a child even

prior to starting actual therapeutic massage.

Studies have shown that people who suffer from tension headaches have

increased incidences of tenderness in trigger points in the muscles around

the head and neck. A study by Moraska, et al., in the Clinical Journal of Pain

found that patients with tension-type headache pain who underwent trigger

point therapy reported greater improvement in pain. The study explained

that trigger point therapy is an important component of treatment for

tension headache pain.75 It is a non-invasive method of identifying those

areas that are significantly contributing to a patient’s pain and then releasing

the tension to improve the patient’s headache pain.


44

A chiropractor may perform trigger point therapy on a child with headaches

by addressing trigger points located in the neck and shoulders that could be

contributing to headache pain. Some major muscle groups in these areas,

including the sternocleidomastoid muscle and the trapezius muscles can

become tight and constricted, particularly with increased stress and tension.

The chiropractor may identify these or other muscles in the neck, shoulders,

and at the base of the head where the muscles are very tight and

constricted. This is done through gentle probing to avoid further irritation of

the muscle tissue. Once identified, the chiropractor may then lightly

massage the muscles and underlying connective tissue to reduce or

eliminate the referred pain. This trigger point therapy, when combined with

spinal adjustment or used independently as part of patient care, can make a

big difference in helping a child who struggles with frequent headaches.

Bedwetting And Constipation

Most children are able to control their urination through toilet training by the

time they are five years old, though some kids continue to have difficulty

with bedwetting at night while asleep. Nocturnal enuresis is the technical

term for bedwetting, which describes an involuntary release of urine at night

while asleep. The term is defined for those children who are otherwise able

to control urination while awake and who have been toilet trained. Normally,

while awake, a child can sense the feeling of a full bladder and then use the

bathroom to urinate. Nocturnal enuresis is present in up to 20 percent of 5-

year-old children, 5 percent of 10-year-old children, and approximately 1

percent of 15-year-old teens.78

For a child with nocturnal enuresis, there is an inability to control the release

of urine, either because the child is sleeping so deeply that he does not

perceive a full bladder, or due to other factors, such as decreased


45

vasopressin hormone, which normally decreases urine production, or chronic

illness, including diabetes or spinal cord injury.76 Bedwetting can be

embarrassing and problematic for affected children. Kids who struggle with

chronic bedwetting often need to manage their diet and fluid intake in the

evening before going to bed to reduce the chance of enuresis. Prescription

desmopressin increases anti-diuretic hormone levels, which then decrease

the amount of urine produced at night to reduce the chance of

unmanageable urine release. Some children benefit from using bedwetting

alarms as well, which react when bedding becomes damp to allow the child

to get up and use the bathroom.

Children who have difficulties with bedwetting can benefit from a physical

evaluation from a physician to determine if there is a structural problem that

is causing the issue. A chiropractor may also utilize imaging studies to check

the structure of the child’s genitourinary system, as well as perform a

laboratory analysis to check for hormones that may be deficient, such as

anti-diuretic hormone. Often, an older child with this issue may also feel

embarrassed and isolated when the bedwetting prevents overnight outings

or sleepovers. The child may feel stigmatized and self-conscious by being

required to routinely clean up soiled bedding or wear disposable

undergarments to bed at night. Discussion of the problem and its

consequences before and after chiropractic treatments can help the affected

child feel understood.

Problems with bedwetting could be related to subluxations that have

developed in the cervical spine or in the lumbar region of the spinal column.

When the vertebrae in the neck are out of alignment, it may affect the

phrenic nerve, which is located at levels C3 through C5. The phrenic reflex is

triggered when there is an increase in carbon dioxide in the bloodstream,


46

which could occur during a period of very deep sleep. Increased serum

carbon dioxide causes smooth muscles to relax, including the smooth

muscles that control bladder tone and that retain urine. The relaxation of

these muscles leads to an involuntary release of urine. Normally, this reflex

develops as kids mature and are able to control their urine, but some

children are slower than others. Subluxation in the cervical spine that

compresses or irritates the phrenic nerve could also affect this reflex,

leading to increased instances of bedwetting.77

Some children also develop subluxations in the lumbar or sacral regions of

the spine, which could also contribute to nocturnal enuresis. Several nerves

in the lower back, including the pelvic nerve, pudendal, and hypogastric

nerves, play roles in communicating with the brain the need to urinate as

well as controlling the sphincter muscle of the bladder to release urine.

When vertebral subluxations are present in the lower back, they could

irritate or place excess pressure on these nerves, which can impact how well

a child is able to control urination.77 It should be noted that some children

who are seen for chiropractic care of bedwetting do not necessarily respond

to spinal adjustments alone; the chiropractor may determine the child’s

phrenic nerve is still undeveloped and that spinal manipulation will not

necessarily correct this. However, there are some children who have

benefitted from chiropractic care of bedwetting, particularly when combined

with other strategies to reduce the instances of enuresis, such as by keeping

a voiding diary and controlling fluid intake before bed.

A case report published by Instebo, et al., in the Journal of Chiropractic

Medicine discussed a case of an 8-year-old girl who sought chiropractic

treatment for management of nighttime bedwetting that was unresolved

after instituting lifestyle changes as well as prescription desmopressin. The


47

patient had previously tried bedwetting alarms and restricting fluid intake

without success and her primary care physician had not identified any

physiological abnormality or reason why she continued to experience

nocturnal enuresis. The patient was examined by a chiropractor who found

no subluxations or abnormalities, but who did locate tenderness when

palpating the sacroiliac joint in the lower back. After one treatment of gentle

manipulation of this joint, the patient experienced one full week without any

bedwetting episodes, and after a total of three treatments, the patient’s

episodes of bedwetting had decreased significantly to the point where she

rarely had any more episodes and was able to spend more time with friends

with little fear of having urine accidents.78

Obviously, this is only one case of successful treatment of bedwetting

through chiropractic care, although there are many parents who also report

success in helping their children overcome enuresis by undergoing spinal

manipulation therapy. It should be noted that approximately 15 percent of

children with regular enuresis overcome the condition on their own without

any treatment.78 Nevertheless, when the problem is significant enough that

it is disruptive to a child’s social and personal success, parents may want to

consider chiropractic care for their child.

Another common issue that often affects toddlers, children, and teens and

that can cause embarrassment and shame is chronic constipation. The

condition can affect children of any age, including infants, and when it is

serious, it often requires treatment. Constipation is technically defined as the

passage of hard stools, passing stool with difficulty, or having less frequent

bowel movements. There is not one set number of bowel movements per

day or week that is thought to be normal in children; however, when parents

notice that their child is having infrequent bowel movements or is straining


48

to pass stool, constipation may be present, regardless of the total number of

stools passed in a particular time period.

Constipation causes more than an average amount of straining for a child to

pass stool. Parents should be aware of the average number and frequency of

stools their child has and note whether this amount has decreased. Some

children have a small amount of blood in their stool when they do have a

bowel movement if there is a rectal fissure present that causes minor

bleeding. At times, a child with constipation may have stool in the intestinal

tract that is impacted. When this happens, the child may actually have

diarrhea and can be incontinent of stool when runny stool passes around the

impacted area. The affected child may also experience abdominal pain, poor

appetite, lethargy, nausea, and restlessness.

Constipation can develop for a number of reasons; it is often classified as

being idiopathic, in which it is caused by dietary changes or holding in stool,

or as a result of another condition that affects gastrointestinal mobility,

including side effects of medications or due to neurological conditions.79 Most

children with chronic constipation can be treated by making changes in the

diet to include more fiber and to drink more fluids. In significant cases, a

child may need to take laxatives, many of which are formulated for pediatric

use.

In one case report published in the journal of The Academy of Chiropractic

Orthopedists, constipation caused by primary vesiculoureteral reflux disease

was treated successfully through chiropractic care of a pediatric patient.

Vesiculoureteral reflux occurs when urine flows backward toward the

kidneys. Children with this condition often have some degree of bowel

dysfunction as well and are likely to have some amount of constipation. The


49

child in the case study had undergone several tests to determine the extent

of the reflux as well as the degree of the constipation present; she also had

a manual examination by a chiropractor. She underwent manipulative

therapy by the chiropractor, utilizing both manual and instrument-guided

treatments and abdominal massage, and she was placed on probiotic

therapy. Following 13 weeks of care, in which the child had chiropractic

treatments as well as routine massage and probiotic therapy at home, her

parents reported that her constipation had resolved and she had regular

bowel movements.81

Chiropractic medicine may also resolve constipation in some children and it

may prevent further constipation from developing. Chiropractic care may

work through spinal manipulation or by promoting other lifestyle changes,

such as changes in diet, to relieve constipation in children. It is thought that

spinal adjustment may promote healthy bowel function to resolve

constipation and stimulate intestinal motility.

Chiropractic care is thought to treat constipation by promoting the work of

the autonomic nervous system, which unconsciously controls body systems.

Subluxations that occur along the spine, particularly within the lumbar

region of the back, can contribute to constipation because the misaligned

vertebrae affect the nerves that innervate the colon.80 As discussed, children

could develop subluxations for a number of reasons and the effects may not

be immediately apparent. Infants with lumbar subluxations that developed

during birth may have difficulties with constipation, even if they eat normal

amounts of milk or formula and are otherwise healthy. Children who are

engaged in strenuous activities, including sports, may have subluxations and

misalignments that can be corrected to improve chronic constipation and to

prevent future episodes.


50

If a parent takes a child to a

chiropractor for treatment of

constipation, an X-ray or imaging

studies may be done if the child has

not been examined through imaging

studies previously. A simple X-ray of

the abdomen can show if there are

large pockets of stool or excess air in

the bowel that contribute to

constipation and abdominal pain. The

X-ray can also show whether

impaction is present, which would

need further treatment to prevent some significant complications. Following

an X-ray, the chiropractor may also discuss the child’s diet and lifestyle

habits to determine if there are other factors that may be contributing to the

constipation, and may ask about other factors, such as the presence of

chronic disease, whether the child is taking medications, and how many

bowel movements normally occur.

Correction of constipation is often done manually through spinal adjustment

to correct nerve impingement and to promote the work of the nervous

system. Following manual treatment, the chiropractor may also discuss the

important elements of the child’s diet and may make recommendations

about what foods and nutrients to include each day. A child should have a

well-balanced diet with plenty of fiber, as fiber prevents excess uptake of

water in the colon, ensuring that stool does not become hard and dry and is

able to be passed easily. Foods with fiber are relatively easy to add into the

diet; they include many fruits and vegetables, as well as whole grains.


51

A previously discussed review by Angus, et al., in the Journal of the

Canadian Chiropractic Association showed that chiropractic medicine can

treat constipation in children and listed the results of several studies that

supported this. Included in the review were instances of several studies

where toddlers and school-age children were treated for constipation

through high-velocity low-amplitude thrust for spinal manipulation that was

appropriate for age. All of the studies listed supported the use of chiropractic

manipulation on children for the successful treatment of constipation.64

Additionally, chiropractic care will consider all elements that could be

contributing to a child’s constipation because chiropractic medicine maintains

a holistic focus on care.

Diet is one area to examine to determine if the child’s diet could be changed

to increase fiber intake and to add healthy foods to prevent further

constipation. The chiropractor may also institute other alternative and

complementary measures that would aid in controlling constipation. For

example, probiotics may be useful in preventing constipation and promoting

normal intestinal health. The chiropractor may make recommendations to

parents about how to incorporate more fermented foods or food items that

contain probiotics into the child’s diet. This advice, in combination with

physical therapies provided by the chiropractor, can support children who

struggle with problems of elimination, such as through bedwetting and

frequent constipation.

Growing Pains

Some children suffer from occasional aching or throbbing pain in the legs

that is unrelated to illness or chronic disease. Referred to as growing pains,

this type of pain can affect up to 40 percent of children; it most commonly

occurs during preschool and school-age years in children ages 3 to 5 years


52

and again in children ages 8 to 12 years.82 Growing pains are not just a

myth, but they can actually cause enough pain in affected children that they

require visits to a physician or hospital for diagnosis. Unfortunately, aside

from some home remedies and over-the-counter pain medication, there is

no treatment for growing pains.

Most children who suffer from growing pains develop pain in the legs,

typically focused behind the knee, in the calf, or in the front of the thigh.

The pain is muscular in origin and usually does not affect the joints or the

bones. Many children with growing pains complain of the pain most often at

night, which can interrupt sleep. There is no particular cause of the pain and

it is not related to another chronic illness or acute disease. It is believed that

children who are active and athletic tend to be more likely to experience

growing pains, as the pain seems to be related to increased muscle use.

Typically, parents can help their children who experience growing pains by

promoting rest and massaging the affected muscles.

Over-the-counter pain medications such as acetaminophen may also be

helpful, as well as warm packs applied to the affected areas. Growing pains

are self-limiting and they tend to resolve on their own. Fortunately, they also

do not seem to occur on a daily basis and are usually only sporadic in nature

when they do happen.

Although growing pains are temporary, not related to other chronic diseases,

nor a sign of a serious health problem, some parents may want to seek

further medical advice for help in controlling the painful symptoms. Parents

who take their child to a physician because of growing pains may learn that

there is not a problem with the muscles in the child’s legs and there are no

structural problems in the extremities that could be contributing to the pain.


53

An X-ray of the legs can point out if there is an issue with the joints or bones

that is causing the pain and that it is not growing pains. A chiropractor can

also help with diagnosis and management of growing pains, and treatment

through chiropractic care may be a worthwhile option for some kids who

have enough pain that it affects sleep or other activities.

Chiropractic care of growing pains involves an assessment of the child’s

pain, including its location in the legs and its intensity, as well as the child’s

activity levels and whether other medical problems are present that could

also be contributing to pain. For instance, pain in the legs that is manifested

as growing pains could actually be the result of another condition, such as a

muscle strain or joint inflammation, and an examination of the legs and the

spine is necessary to rule out other causes.

A child who is very active could develop subluxations in areas of the spine

that can affect the nerves innervating the muscles in the legs to contribute

to growing pains. Additionally, a child may have an orthopedic issue

associated with the joints, such as a small injury that has gone unnoticed

but that later manifests itself as muscular pain of growing pains. The fact

that active children are more likely to experience growing pains seems to be

related to the stress or wear and tear on the muscles and joints that can

eventually cause pain in the legs.

According to de Beer, et al., in the Journal of Interdisciplinary Health

Sciences, growing pains are thought to occur as a result of one of three

theoretical circumstances. The anatomical cause of the growing pains

reveals that the child suffers from pain because of poor posture or

orthopedic problems in the bones, joints, or muscles that have been

previously unrecognized. The fatigability theory states that the child feels


54

pain after increased activity when there is a greater likelihood of increased

metabolic waste accumulating in the muscle tissue, which may more likely

explain why some children experience growing pains more often after being

active. The third theory states that growing pains occur because affected

children have psychological predispositions toward experiencing the pain and

if a family history is present, they may be more susceptible to pain from

family tendencies.83

The same authors also performed a study that was published in the journal

that evaluated the effects of chiropractic care on children suffering from

growing pains. In the study, part of the children recruited underwent lumbar

spinal manipulation therapy for treatment, while the other group had no

chiropractic treatment but did have help from parents in the home for the

pain, such as through massage. The study found that spinal manipulation

therapy was beneficial as treatment, based on subjective responses from the

parents.83 While other measures, such as massage and home remedies may

also be helpful, spinal manipulation could reduce the amount of time that an

affected child suffers from growing pains.

The chiropractic standpoint of the treatment of growing pains is based on a

physiological mechanism that is contributing to the pain, whether it is from

orthopedic trauma or damage to the joints and muscles, or whether the child

feels pain specifically because of increased activity levels.84 Chiropractic

treatment can relieve some of the pain of growing pains by relieving

pressure on the nerve roots in the spine when subluxations are present, as

well as by assisting the child with stress reduction that can negatively impact

the nervous system. Increased stress can affect posture and movement,

which in turn could affect how the vertebrae influence the nerve roots in the

spinal column. Additionally, when trauma to the spine has occurred, such as


55

during birth or because of significant activity, the child’s spinal vertebrae

may be putting excess pressure on the nerve roots and causing irritation to

the nerves.

The leg pain that the child feels because of growing pains can come from

vertebral impingement on nerve roots in the lumbar region that innervate

the hamstrings, calf muscles, and quadriceps. Misalignment in the pelvic

region can affect how the child is able to distribute weight on the legs,

carries the body when ambulating, and the child’s overall stance, which

could cause pain in the lower legs and feet as well.84

Chiropractic correction of growing pains often involves spinal manipulation

therapy to align the spinal column and take pressure off of the nerves

innervating the legs. It also includes assessment of the joints in the back,

the pelvis, hips, and legs to look for problems that could be contributing to

pain and then making adjustments when necessary. Other exercises may

include stretching the leg muscles and performing range-of-motion exercises

in the legs and hips to improve muscle strength and flexibility.

An article published in Pathways to Family Wellness that evaluated the

chiropractic care of children with growing pains also provided

recommendations that the chiropractor may give to parents to help their

child at home in addition to undergoing chiropractic techniques.

Recommendations from the chiropractor included having the child drink

plenty of water and other fluids to avoid dehydration, which can impact

muscle tissue, taking a vitamin supplement that contains adequate calcium

and magnesium, performing stretching exercises for the back, thighs, knees,

and lower legs, and monitoring stress levels in the child to avoid postural or


56

activity changes that could place excess stress on the child’s frame, possibly

contributing to the pain.84

Growing pains are a real phenomenon, with some children routinely

struggling with pain and discomfort when they occur. As with other

conditions that cause pain, parents may want to consider chiropractic care

for relief of this common complaint.

Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is not entirely limited to

children, but it is commonly diagnosed and managed during childhood. The

condition is a brain disorder that causes difficulties with concentration and

impulsive behaviors. Some children may be hyperactive and have difficulties

with settling down; they may be constantly moving and may talk excessively

without much purposeful interaction with others through conversation. ADHD

also leads to inattention, in that the affected child is frequently distracted

and has trouble focusing on the topic at hand. The child may be very

disorganized and often have trouble completing any work. Impulsivity is also

often associated with ADHD in that the affected child seems to lack the

ability to control reactions to situations and does not stop to think before

acting. The child may have difficulty with social relationships because his or

her actions can be harmful to others and the child cannot think about

behavioral consequences.

Not all children with ADHD will exhibit impulsivity, hyperactivity, and

inattention, but these three traits are common elements that are associated

with the definition and diagnosis of the disorder. Children affected by ADHD

may have trouble with one or more of these components, at varying levels

of severity.85 ADHD is challenging for both the affected child and the child’s


57

family. The child often is unable to complete routine tasks because of

problems with focus and concentration, consequently, there are often issues

with school work or chores that are rarely completed.

The child with ADHD may feel isolated and lonely, having difficulties making

or sustaining friendships because other children often do not understand the

behavior or do not want to put up with it. The child may even be

unintentionally hurtful toward others because of impulsivity, which alienates

the child with ADHD from other children who do not understand.

For parents, having a child with ADHD can be particularly trying. They may

struggle with helping their child to complete normal activities and to stay

engaged in events and work for school or hobbies. It can be frustrating to

watch a child struggle to make friends and to be alone because of having

trouble controlling behavior. The parents may have problems disciplining the

child because he or she may have trouble listening and does not respond to

structure. Parents may have difficulties with staying calm and not becoming

angry when their child repeatedly breaks the rules. It is important to

understand that when a child has ADHD, he or she is often not trying to be

difficult and hurtful, but simply is unable to adequately process a situation.

Importantly, parents need to realize that the condition has not developed

because of overstimulation or faulty parenting. Of note, adults also can have

ADHD and it is often a lifelong condition that the affected person must cope

with once diagnosed, whether diagnosed as a child or whether the condition

was later discovered during adulthood.

Most children diagnosed with ADHD are treated with prescription

medications to control many of their behaviors. Prescription stimulants

paradoxically seem to work well for children with ADHD to help them to slow


58

down and focus by affecting brain neurotransmitters. Some children also

require counseling and psychotherapy to better learn how to recognize when

their behaviors are off and they need to get back on track. Psychotherapy

can aid with helping children to learn to finish tasks and follow through with

activities to completion. Counseling is also quite helpful for the parents of

children with ADHD to better enable them to learn to manage their child’s

behaviors, to respond appropriately to negative behaviors, and to instill

discipline properly.

In addition to the medications, counseling, and support groups available for

ADHD, children may also benefit from chiropractic care. It may seem

surprising that chiropractic medicine can positively affect a brain disorder

such as ADHD, since the practice is often associated mostly with

management of musculoskeletal-related conditions. However, more parents

are looking into complementary and alternative treatments as adjunct

treatment for ADHD when their child needs further help. In fact, some

parents choose chiropractic care as a natural form of ADHD treatment

instead of trying to force their child to take medications.

As discussed, chiropractic medicine is focused on holistic care of the patient.

The chiropractor who sees a child for treatment of ADHD will not just focus

on the child’s activities or behavior, but will also consider and ask the

parents about other factors that can be affecting how well the child is able to

relate to others and to perform in school. For example, the chiropractor may

perform a physical assessment on the child, but will also be interested in

finding out about the child’s sleeping patterns, diet, social activities,

allergies, exposure to environmental stimulants, stress levels, and

relationships with friends and family.


59

Chiropractic medicine is focused on treatment and management of

conditions that affect the neurological system, which can include ADHD.

Chiropractors attest that when subluxations are present in the cervical

region of the spine, they can affect the nerves that innervate the brainstem

and can cause some of the behavioral issues associated with ADHD. The

areas of C1 through C3 vertebrae are particularly vulnerable for these

problems. When the chiropractor corrects the subluxations found in these

areas, it is thought that this correction may resolve some of the behaviors

seen with the disorder.86

The overall goal of chiropractic care for ADHD management is not to cure

the ADHD, but instead to improve nervous system function by identifying

subluxations and other issues that may be contributing to nervous

dysfunction.87 Chiropractic care may also work to help a child who is

struggling with processing of sensory input, which may contribute to

symptoms of ADHD. For example, if a child is unable to process information

through sensory means – what is heard, seen, or tasted – or if the child’s

brain has difficulty with proprioception, which is the recognition of the

positioning of the body within a space, this may relate to difficulties with

ADHD symptoms. Sensory processing can be affected by subluxations in the

cervical spine if misaligned vertebrae affect nerve roots that innervate the

parts of the brain that affect the vestibular or proprioceptive systems. It is

possible that by correcting vertebral subluxations in the cervical spine, as

well as in other regions of the spine that are connected to sensory

processing, the child’s neurosensory system may function more efficiently

and the child with ADHD may be able to function better.88

In addition to performing physical treatments of ADHD, the chiropractor may

also make some suggestions to families about interventions they can


60

incorporate at home to better help their child with behavior and activity. The

chiropractor may make suggestions about helping the child and family to

deal with stress and can help them learn to incorporate stress relief

measures. The chiropractor may also make suggestions about dietary

changes to ensure that the child gets enough vitamins and minerals in the

diet; this may include taking an herbal supplement or also avoiding fast food

and foods with high amounts of sugar, additives, and fat. While there is no

evidence that sugar intake is related to ADHD symptoms, the child can

benefit from reducing sugar intake in order to eat foods that are healthier

instead.

Summary

Children can certainly be candidates for chiropractic care and they often

respond well to many of the techniques used in chiropractic medicine.

Children often heal at a faster pace when compared to adults, and the

methods used in chiropractic care of some children have been shown to be

valuable in promoting health by supporting the ability of children’s bodies to

heal. According to the International Chiropractic Pediatric Association (ICPA),

parents of children who receive chiropractic care have reported several

improvements in their children’s health and behavior as a result of

chiropractic treatments, including improved sleep habits, improved immune

system functioning, and better overall behavior and attitude. These results

are commonly reported by parents in addition to the positive support that

chiropractic care clinicians provide, including pain relief and symptom control

when illness is present.

Unfortunately, there is a lack of research about the effectiveness of spinal

manipulation on newborns and the effects of adjustments on controlling

symptoms of colic, reflux, or sleeping difficulties in babies. However,


61

pediatric chiropractors who work with infants have suggested that these

gentle adjustments to the spine to correct misalignment are safe and can

help these and many other health problems in infants, in a manner similar to

problems treated by chiropractic care in older children and adults. The long-

term effects of chiropractic care of newborns will need more study and

further clinical research to demonstrate that this type of therapy is safe and

effective for infants.

Chiropractic care that is directed specifically toward children has several

benefits. A mother may seek chiropractic care for some issues even before

her child is born, as chiropractic techniques can be performed on pregnant

women and are considered to be safe and effective. Sometimes the effects

of birth trauma can be remedied with gentle chiropractic care. Some infants

are born with health conditions that affect their abilities to grow and develop

normally or that even put them at risk of acquiring other conditions that can

impact their general health or that could cause illness. Many studies have

shown that chiropractic care delivered to children with health conditions,

whether they occurred before birth or they developed during infancy and

childhood, is beneficial and therapeutic.

Please take time to help NurseCe4Less.com course planners evaluate the nursing knowledge needs met by completing the self-assessment of Knowledge Questions after reading the article, and providing feedback in the online course evaluation. Completing the study questions is optional and is NOT a course requirement.


62

1. True or False: Parents of children who receive chiropractic care have reported several improvements in their children’s health and behavior as a result of chiropractic treatments, including a better overall behavior and attitude.

a. True b. False


spine

a. and the spinal cord. b. and that develop before a baby is born. c. and that can eventually affect other areas of the body. d. All of the above



a. within a couple of weeks b. during the second trimester c. a couple months d. during the third trimester

4. The ______________ eventually harden through ossification as

it/they become bones and the notochord ultimately forms the intervertebral discs.

a. cartilage b. neural tube c. annulus fibrosus d. somites



a. Encephalocele b. Spina bifida c. Anencephaly d. Paresthesia


63

6. When the neural tube fails to close during fetal development, the child can develop encephalocele if

a. a significant portion of the brain and the skull do not form. b. a sac containing part of the brain and the meninges protrudes

through an opening at the base of the skull. c. a portion of the spinal cord protrudes through the vertebrae. d. vertebral disc herniation and nerve dysfunction are present.

7. Women who are pregnant or are even thinking of becoming

pregnant are advised to increase their intake of ___________, as it has been shown to reduce the risk of neural tube defects such as spina bifida.

a. iron b. Vitamin D c. zinc d. folic acid

8. True or False: Many neural tube defects are severe and in some

cases, such as with anencephaly, are incompatible with life and the infant dies shortly after birth.

a. True b. False

9. Spina bifida occulta is a type of spina bifida that

a. is severe, causing back deformities and poor mobility. b. not obvious and a patient may be unaware of the condition. c. is so severe it causes paralysis. d. is nonexistent but the patient exhibits some of its symptoms.

10. Which of the following statement(s) is/are true regarding spina

bifida occulta?

a. It can cause muscular weakness and bladder dysfunction. b. It affects less than 1% of the population. c. It cannot be treated by a chiropractor. d. All of the above


64

11. Congenital scoliosis is described as the spine having

a. an abnormal rounding, “hump,” on the back of the spine. b. the lumbar spine curve inward toward the abdomen. c. a nevus in the lumbar region of the spine. d. a curvature to the side instead of its usual vertical structure.

12. True or False: The Growing Spine Committee recommends

manual manipulation therapies and stretching exercises to treat and manage congenital scoliosis.

a. True b. False

13. _____________ is a condition that causes an abnormal

rounding of the spine that produces a hump in the back; on appearance, the child may seem to have a hunched back.

a. Lordosis b. Kyphosis c. Congenital muscular torticollis d. Scoliosis

14. Lordosis is a spinal anomaly that is described as an abnormal

curve in the lumbar region of the back, in which the lumbar spine

a. curves to the side instead of its usual vertical structure. b. rounds in the shape of a hump. c. curves inward toward the abdomen. d. is bowed forward at an angle.

15. Kyphosis is a spinal condition

a. that most often develop in utero. b. in which the vertebrae fully separate into distinct bones. c. that most often occurs in older adults. d. in which the spinal curve is normal but the vertebrae do not full

separate.


65

16. Chiropractic spinal adjustments to treat kyphosis or lordosis

a. will realign the spine to correct the curvature. b. is not recommended. c. could help control associated pain and inflammation. d. will exacerbate the condition.

17. A baby may be born with spinal subluxation because of birth

trauma, which may lead to

a. muscle weakness. b. poor development. c. difficulties with feeding and sleeping. d. All of the above

18. True or False: Chiropractic care may be utilized to improve range

of motion, function, and flexibility among infants with nerve damage due to birth trauma.

a. True b. False

19. Chiropractic care may help to prevent the onset of some

symptoms of sore throat, a cold or related viral infection, by specifically improving

a. the flow of lymph fluid. b. posture and mobility. c. feeding and sleeping patterns. d. muscular tone and strength.

20. In children, occasional aching or throbbing pain in the legs that

is unrelated to illness or chronic disease, referred to as growing pains,

a. is a myth, not a physical condition. b. is most common after age 12. c. can affect up to 40 percent of children. d. All of the above


66

CORRECT ANSWERS 1. True or False: Parents of children who receive chiropractic care

have reported several improvements in their children’s health and behavior as a result of chiropractic treatments, including a better overall behavior and attitude.

a. True “According to the International Chiropractic Pediatric Association (ICPA), parents of children who receive chiropractic care have reported several improvements in their children’s health and behavior as a result of chiropractic treatments, including improved sleep habits, improved immune system functioning, and better overall behavior and attitude.”


spine

a. and the spinal cord. b. and that develop before a baby is born. c. and that can eventually affect other areas of the body. d. All of the above [correct answer]

“Congenital spinal abnormalities are types of birth defects that affect the spine and that develop before a baby is born. These anomalies can impact how the spine forms during gestation, which can influence the size and shape of the vertebrae, their alignment, and the general function of the spinal cord. Additionally, when spinal problems develop in utero, the person can eventually have problems in other areas of the body, including the kidneys or urinary tract, as well as difficulties performing routine activities of daily living.”



a. within a couple of weeks “During embryonic development, the spinal cord begins to form within a couple of weeks after conception with the initial growth of the neural tube.”


67

4. The ______________ eventually harden through ossification as it/they become bones and the notochord ultimately forms the intervertebral discs.

d. somites “The somites eventually harden through ossification as they become bones and the notochord ultimately forms the intervertebral discs.”



b. Spina bifida “… spina bifida, in which a portion of the spinal cord protrudes through the vertebrae when the neural tube does not close properly during development;....”

6. When the neural tube fails to close during fetal development, the

child can develop an encephalocele if

b. a sac containing part of the brain and the meninges protrudes through an opening at the base of the skull. “Neural tube defects are some of the more commonly understood congenital anomalies involving the spine … and an encephalocele, which occurs when the failed closure of the neural tube causes a sac that contains part of the brain and the meninges to protrude through an opening at the base of the skull.”

7. Women who are pregnant or are even thinking of becoming pregnant are advised to increase their intake of ___________, as it has been shown to reduce the risk of neural tube defects such as spina bifida.

d. folic acid “Neural tube defects are thought to be related to a combination of environmental and genetic factors, but women who are pregnant or are even thinking of becoming pregnant are advised to increase their intake of folic acid, as it has been shown to reduce the risk of these specific kinds of birth defects.”


68

8. True or False: Many neural tube defects are severe and in some cases, such as with anencephaly, are incompatible with life and the infant dies shortly after birth.

a. True “Many neural tube defects are severe and in some cases, such as with anencephaly, are incompatible with life and the infant dies shortly after birth.”

9. Spina bifida occulta is a type of spina bifida that

b. not obvious and a patient may be unaware of the condition. “Spina bifida occulta is a type of spina bifida in which the neural tube closure is not obvious; in many cases, the patient may be unaware that the condition exists. Spina bifida occulta occurs most commonly in the lumbar region of the spine and it could cause difficulties with walking or moving, as well as back pain, vertebral disc herniation, and nerve dysfunction.”

10. Which of the following statement(s) is/are true regarding spina

bifida occulta?

a. It can cause muscular weakness and bladder dysfunction. “Although spina bifida occulta is the mildest form of the condition, it can still cause muscular weakness and bladder dysfunction for some people...”

11. Congenital scoliosis is described as the spine having

d. a curvature to the side instead of its usual vertical structure. “Congenital scoliosis is described as the spine having a curvature to the side instead of its usual vertical structure.”


69

12. True or False: The Growing Spine Committee recommends manual manipulation therapies and stretching exercises to treat and manage congenital scoliosis.

d. False “A consensus statement regarding early onset scoliosis given by the Growing Spine Committee categorized congenital scoliosis as a type of early onset scoliosis, which is considered to be the presentation of the spinal deformity before the age of 10 years.... Treatment recommendations include bracing, casting, or surgery on the spine, and while manual manipulation therapies and stretching exercises were not recommended to correct the condition, they could be used to control some other symptoms associated with the disability.”

13. _____________ is a condition that causes an abnormal

rounding of the spine that produces a hump in the back; on appearance, the child may seem to have a hunched back.

b. Kyphosis “Kyphosis is a condition that causes an abnormal rounding of the spine that produces a hump in the back; on appearance, the child may seem to have a hunched back.”

14. Lordosis is a spinal anomaly that is described as an abnormal

curve in the lumbar region of the back, in which the lumbar spine

c. curves inward toward the abdomen. “Lordosis is a spinal anomaly that is described as an abnormal curve in the lumbar region of the back, in which the lumbar spine curves inward toward the abdomen.”

15. Kyphosis is a spinal condition

c. that most often occurs in older adults. “Kyphosis ... most often occurs in older adults after years of wear on the spinal column that leads to compression of the intervertebral discs and compression fractures.”


70

16. Chiropractic spinal adjustments to treat kyphosis or lordosis

c. could help control associated pain and inflammation. “The treatments for congenital kyphosis and lordosis can vary, depending on the severity of the angle of the defects.... A chiropractor can also assist with some treatments for kyphosis or lordosis. Many studies have shown that helping patients with these conditions to work on their posture and to stand up straight have had no impact on the condition. Spinal adjustments made by chiropractors will not realign the spine to correct the curvature, but these adjustments could help to control some of the pain and inflammation of the condition.”

17. A baby may be born with spinal subluxation because of birth

trauma, which may lead to

a. muscle weakness. b. poor development. c. difficulties with feeding and sleeping. d. All of the above [correct answer]

“A baby may be born with spinal subluxation because of birth trauma, but the effects may not be immediately seen. Problems with muscle weakness, poor development, and difficulties with feeding and with sleeping can all develop as a result of vertebral subluxations that occur during birth.”

18. True or False: Chiropractic care may be utilized to improve range

of motion, function, and flexibility among infants with nerve damage due to birth trauma.

a. True “In some cases, chiropractic care may be utilized to improve range of motion, function, and flexibility among infants with nerve damage due to birth trauma.”


71

19. Chiropractic care may help to prevent the onset of some symptoms of sore throat, a cold or related viral infection, by specifically improving

a. the flow of lymph fluid. “There are many situations where a child with a sore throat or with cold symptoms can be treated through chiropractic medicine. Chiropractic care may also help to prevent the onset of some symptoms and related viral infection. The goal of chiropractic care administered for treatment of colds or sore throat is to strengthen the patient’s immune system to better fight off the viral infection. Chiropractic medicine asserts that this type of care specifically improves the flow of lymph fluid through its channels, which ultimately supports the immune system to allow a child to fight off a cold or infection.”

20. In children, occasional aching or throbbing pain in the legs that

is unrelated to illness or chronic disease, referred to as growing pains,

c. can affect up to 40 percent of children. “Some children suffer from occasional aching or throbbing pain in the legs that is unrelated to illness or chronic disease. Referred to as growing pains, this type of pain can affect up to 40 percent of children; it most commonly occurs during preschool and school-age years in children ages 3 to 5 years and again in children ages 8 to 12 years. Growing pains are not just a myth, but they can actually cause enough pain in affected children that they require visits to the doctor or hospital for diagnosis.... A chiropractor can also help with diagnosis and management of growing pains, and treatment through chiropractic care may be a worthwhile option for some kids who have enough pain that it affects sleep or other activities.”


72

Reference Section

The reference section of in-text citations includes published works intended as helpful material for further reading. [References are for a multi-part series on Chiropractic Care].

1. Adams, J., et al. (2017). The prevalence, patterns, and predictors of chiropractic use among US adults: Results from the 2012 National Health Interview Survey. Spine. 2017 Apr 28.

2. Gerstenkorn Family Chiropractic. (n.d.). Gonstead care. Retrieved from http://www.gerstenkornchiropractic.com/gonstead-technique

3. Herbst, R. (2014). Gonstead Chiropractic Science and Art. (2014). SCI-CHI Pulications.

4. Kemper, K. (2017). Complementary and alternative medicine in pediatrics. UpToDate. Retrieved online at https://www.uptodate.com/contents/complementary-and-alternative-medicine-in-pediatrics?source=search_result&search=chiropractic&selectedTitle=7~42.

5. Young, K. (2017). Historical influence on the practice of chiropractic radiology: part II - thematic analysis on the opinions of diplomates of the American Chiropractic College of Radiology about the future. UpToDate. Chiropr Man Therap. 2017 May 8;25:15. Retrieved online at https://www.ncbi.nlm.nih.gov/pubmed/28503293.

6. The Pettibon System. (2015). How the Pettibon system works. Retrieved from https://pettibonsystem.com/about/how-pettibon-works

7. Xia, T., et al. (2017). Association of lumbar spine stiffness and flexion-relaxation phenomenon with patient-reported outcomes in adults with chronic low back pain - a single-arm clinical trial investigating the effects of thrust spinal manipulation. BMC Complement Altern Med. 2017 Jun 9;17(1). Retrieved online at https://www.ncbi.nlm.nih.gov/pubmed/28599647.

8. Muller, A., Murphy, E. Brownstein, S., Boyles, R. (2015). Effectiveness of spinal manipulation in the treatment of non-musculoskeletal disorders: a systematic review. Physical Therapy Research Symposium, Paper 8.

9. Physiopedia. (n.d.). Manual therapy techniques for the lumbar spine. Retrieved from http://www.physio-pedia.com/Manual_Therapy_Techniques_For_The_Lumbar_Spine

10. Seo, Y., Lee, J., Han, D. (2014). The effects of spinal mobilization with arm movements on shoulder muscle strengthening. J Phys Ther Sci. 27(11-13).


73

11. Russell, D. Kimura, M., Cowie, H., de Groot, C., McMinn, E., Sherson, M. (2016). Changes in quality of life in 7 older adult patients receiving activator methods chiropractic technique. J Chiropr Med. 15(1): 59-66.

12. Maiers, M., et al. (2014). Spinal manipulative therapy and exercise for seniors with chronic neck pain. The Spine Journal 14(9): 1879-1889.

13. Dougherty, P., Karuza, J., Dunn, A., Savino, D., Katz, P. (2014). Spinal manipulation therapy for chronic lower back pain in older veterans. Geriatr Orthop Surg Rehabil. 5(4): 154-164.

14. Galicia-Castillo, M.C. and Weiner, D.K. (2017). Treatment of persistent pain in older adults. UpToDate. Retrieved online at https://www.uptodate.com/contents/treatment-of-persistent-pain-in-older-adults?source=search_result&search=hip%20pain%20and%20chiropractic&selectedTitle=2~150.

15. Mayo Clinic. (2017). Stretching: focus on flexibility. Retrieved from http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931

16. Taylor, F.R. (2017). Tension-type headache in adults: Preventive treatment. UpToDate. Retrieved online at https://www.uptodate.com/contents/tension-type-headache-in-adults-preventive-treatment?source=search_result&search=headache%20and%20chiropractic&selectedTitle=3~150.

17. Moore, C., Sibbritt, D., Adams, J. (2017). A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness. BMC Neurology 17(61). Retrieved from https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-017-0835-0

18. Mckay, T., Jenkins, K. (2016). Headaches. Retrieved from http://www.spineguys.com/health_conditions/headaches.asp

19. Silberstein, S. (2016). Migraine. Merck Manual. Retrieved from http://www.merckmanuals.com/professional/neurologic-disorders/headache/migraine

20. Chaibi, A., Benth, J., Tuchin, P., Russell, M. (2016). Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. European Journal of Neurology 24(1): 143-153.

21. Knight, C., et al. (2017). Treatment of acute low back pain. UpToDate. Retrieved online at https://www.uptodate.com/contents/treatment-of-acute-low-back-pain?source=search_result&search=low%20back%20strain%20and%20chiropractic&selectedTitle=2~150.


74

22. Schneider, M., Haas, M., Glick, R., Stevans, J., Landsittel, D. (2015). A comparison of spinal manipulation methods and usual medical care for acute and sub-acute low back pain: a randomized clinical trial. Spine 40(4): 209-217.

23. Wheeler, S., et al. (2017). Evaluation of low back pain in adults. UpToDate. Retrieved online at https://www.uptodate.com/contents/evaluation-of-low-back-pain-in-adults?source=search_result&search=ruptured%20disc&selectedTitle=6~96.

24. Bridwell, K. (2017). Intervertebral discs. Retrieved from https://www.spineuniverse.com/anatomy/intervertebral-discs

25. Ehrler, M., Peterson, C., Leemann, S., Schmid, C., Anklin, B., Humphreys, B. (2016). Symptomatic, MRI confirmed, lumbar disc herniations: a comparison of outcomes depending on the type and anatomical axial location of the hernia in patients treated with high-velocity, low-amplitude spinal manipulation. Journal of Manipulative and Physiological Therapeutics 39(3): 192-199. Retrieved from http://www.jmptonline.org/article/S0161-4754(16)00060-9/fulltext

26. Horst Chiropractic. (2012). Chiropractic treatment for fractures. Retrieved from http://www.horst-chiropractic.com/chiropractic-treatment-for-fractures/

27. Cedars-Sinai. (2017). Back pain during pregnancy. Retrieved from https://www.cedars-sinai.edu/Patients/Health-Conditions/Back-Pain-During-Pregnancy.aspx

28. Peterson, C., Muhlemann, D., Humphreys, B. (2014). Outcomes of pregnant patients with low back pain undergoing chiropractic treatment: a prospective cohort study with short term, medium term and 1-year follow-up. Chiropractic & Manual Therapies 22(15).

29. Shekelle, P., et al. (2017). Spinal manipulation in the treatment of musculoskeletal pain. UpToDate. Retrieved online at https://www.uptodate.com/contents/spinal-manipulation-in-the-treatment-of-musculoskeletal-pain?source=search_result&search=headache%20and%20chiropractic&selectedTitle=1~150.

30. The Joint Chiropractic. (2017). Chiropractic care 101: whiplash! Retrieved from https://www.thejoint.com/california/encinitas/encinitas-31006/chiropractic-care-101-whiplash

31. Rodway, I. (2015). Cervical radiculopathy (pinched nerve). Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00332

32. Aquaroli, R., Camacho, E., Marchi, L., Pimenta, L. (2016). Manual therapy and segmental stabilization in the treatment of cervical radiculopathy. Fisioterapia em Movimento 29(1). Retrieved from


75

http://www.scielo.br/scielo.php?pid=S0103-51502016000100045&script=sci_arttext

33. Isaac, Z. (2017). Evaluation of the patient with neck pain and cervical spine disorders. UpToDate. Retrieved online at https://www.uptodate.com/contents/evaluation-of-the-patient-with-neck-pain-and-cervical-spine-disorders?source=search_result&search=cervical%20degenerative%20disc&selectedTitle=1~150.

34. Gentile, J. (2016). Chiropractic care for degenerative disc disease. Retrieved from https://www.spineuniverse.com/conditions/degenerative-disc/chiropractic-care-degenerative-disc-disease

35. Bryans, R., et al. (2014). Evidence-based guidelines for the chiropractic treatment of adults with neck pain. Journal of Manipulative and Physiological Therapeutics 37(1): 42-63.

36. Amendolia, C., et al. (2017). The physical and psychological impact of neurogenic claudication: the patients’ perspectives. J Can Chiropr Assoc. 2017 Mar; 61(1): 18–31.

37. Adriano Rodrigues de Oliveira (2017). What is the ideal dose and power output of low-level laser therapy (810 nm) on muscle performance and post-exercise recovery? Study protocol for a double-blind, randomized, placebo-controlled trial. Trials. 2014; 15: 69.

38. Panton, L., et al. (2013). Effects of Class IV laser therapy on fibromyalgia impact and function in women with fibromyalgia. The Journal of Alternative and Complementary Medicine 19(5): 445-452.

39. Baker, A. (2016). The link between toxicity and chronic pain. Retrieved from http://nourishholisticnutrition.com/the-link-between-toxicity-and-chronic-pain/

40. Siegenthaler, M. (2015, Mar.). Chiropractic management of infantile torticollis with associated abnormal fixation of one eye: a case report. J Chiropr Med. 14(1): 51-56.

41. Skaggs, et al. (2015). Early onset scoliosis consensus statement, SRS Growing Spine Committee, 2015. Spine Deformity, 3.

42. Scoliosis Research Society. (2017). Congenital kyphosis. Retrieved from http://www.srs.org/professionals/online-education-and-resources/conditions-and-treatments/congenital-kyphosis

43. Nationwide Children’s Hospital. (n.d.). Lordosis. Retrieved from http://www.nationwidechildrens.org/lordosis

44. American Academy of Orthopaedic Surgeons. (2013). Congenital muscular torticollis (twisted neck). Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00054

45. Cofano, G., Anderson, B., Stumpff, E. (2014). Chiropractic care of acute low back pain and incidental spina bifida occulta: a case report. J Chiropr Med. 13(4): 273-277.


76

46. Weissman, L. and Bridgemohan, C. (2017) Autism spectrum disorder in children and adolescents: Complementary and alternative therapies. UpToDate. Retrieved online at https://www.uptodate.com/contents/autism-spectrum-disorder-in-children-and-adolescents-complementary-and-alternative-therapies?source=see_link.

47. Gibson, E. (2015). Birth injuries. Retrieved from http://www.merckmanuals.com/professional/pediatrics/perinatal-problems/birth-injuries

48. Tatano Beck, C. (2017). Middle Range Theory of Traumatic Childbirth. Glob Qual Nurs Res. 2015 Jan-Dec; 2. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342633/.

49. Lee Turner, T. and Palamountain, S. (2017). Infantile colic: Management and outcome. UpToDate. Retrieved online at https://www.uptodate.com/contents/infantile-colic-management-and-outcome?source=search_result&search=infant%20and%20chiropractic&selectedTitle=2~42.

50. Collins, K., Alcantara, J., Holt, K. (2015). Resolution of breastfeeding and gastrointestinal complaints in infant twins with plagiocephaly and scaphocephaly following birth trauma: a case series. Journal of Pediatric, Maternal & Family Health – Chiropractic, Issue 1: 34-41. Retrieved from https://chiropracticpediatrics.sharepoint.com/Pages/2015_1360_twins_reflux_plagio.aspx

51. Ferrero, F., Smith, M., Alcantara, J., Russell, D. (2016). Resolution of Erb-Duchenne palsy in a 5-month-old female following subluxation based chiropractic care. Journal of Pediatric, Maternal & Family Health – Chiropractic, Issue 1: 9-13. Retrieved from https://chiropracticpediatrics.sharepoint.com/Pages/2016_1413_erbpalsy.aspx

52. American Academy of Orthopaedic Surgeons. (2014). Hip bursitis. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00409

53. National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2017). Questions and answers about bursitis and tendinitis. Retrieved from https://www.niams.nih.gov/health_info/bursitis/

54. Houston Methodist. (2017). A patient’s guide to de Quervain’s tenosynovitis. Retrieved from http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/wrist/de-quervains-tenosynovitis/

55. Carr, D. (2015). How can a chiropractor help with carpal tunnel syndrome. Retrieved from http://www.stanfordchiropractic.com/blogs/rethink/can-a-chiropractor-help-with-carpal-tunnel-syndrome.html


77

56. Gliedt, J., Daniels, C. (2014). Chiropractic treatment of lateral epicondylitis: a case report utilizing active release techniques. J Chiropr Med. 13(2): 104-109.

57. Page, M., O’Connor, D., Pitt, V., Massy-Westropp, N. (2012). Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD009601.

58. Pohlman, K. and Holton-Brown, M. (2012). Otitis media and spinal manipulative therapy: a literature review. J Chiropr Med. 2012 Sep; 11(3): 160–169. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437347/.

59. Marom, T., Marchisio, P., Tamir, S., Torretta, S., Gavriel, H., Esposito, S. (2016). Complementary and alternative medicine treatment options for otitis media. Medicine (Baltimore). 96(6): e2695.

60. Hemila, H., Chalker, E. (2013). Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD000980.

61. Mayo Clinic. (2014, May). Colic. Retrieved from http://www.mayoclinic.org/diseases-conditions/colic/basics/definition/con-20019091

62. Savino, F., Ceratto, S., De Marco, A., Cordero di Montezemolo, L. (2014). Looking for new treatments of infantile colic. Italian Journal of Pediatrics 40(53). Retrieved from https://ijponline.biomedcentral.com/articles/10.1186/1824-7288-40-53

63. Savino, F. (2014). Looking for new treatments of Infantile Colic. Ital J Pediatr. 2014; 40: 53. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050441/.

64. Children’s National Health System. (2017). Pediatric asthma. Retrieved from https://childrensnational.org/choose-childrens/conditions-and-treatments/airway-lungs/asthma

65. Angus, K., Asgharifar, S., Gleberzon, B. (2015). What effect does chiropractic treatment have on gastrointestinal (GI) disorders: a narrative review of the literature. J Can Chiropr Assoc. 59(2): 122-133.

66. Padwal, T., Gurudut, P., Hajare, S. (2016). Effect of shakers exercise with kinesio taping in subjects with gastroesophageal reflux disease: a randomized controlled trial. International Journal of Medical Research & Health Sciences 5(10): 170-178.

67. Kinesio Holding Corporation. (2016). What is kinesio tape? Retrieved from https://kinesiotaping.com/about/what-is-kinesio-tape/

68. Angus, K., et al (2015). What effect does chiropractic treatment have on gastrointestinal (GI) disorders: a narrative review of the literature. J Can Chiropr Assoc. 2015 Jun; 59(2): 122–133. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486990/.


78

69. Vasconcelos Lago, R., Figueiredo da Silva Filho, M., Nery dos Santos, A. (2015). Effect of osteopathic maneuvers in the treatment of asthma: review of literature. Manual Therapy, Posturology & Rehabilitation Journal 13: 262.

70. Morningstar, M., Dovorany, B., Stitzel, C., Siddiqui, A. (2017). Chiropractic rehabilitation for adolescent idiopathic scoliosis: end-of-growth and skeletal results. Clin Pract. 7(11): 911.

71. Woggon, A., Woggon, D. (2015). Patient-reported side effects immediately after chiropractic scoliosis treatment: a cross-sectional survey utilizing a practice-based research network. Scoliosis and Spinal Disorders 10(29).

72. Woodfield, H.C., et al (2015). Craniocervical chiropractic procedures – a précis of upper cervical chiropractic. J Can Chiropr Assoc. 2015 Jun; 59(2): 173–192. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486989/.

73. Kamhi, L. (2010). Neck pain and headaches. Retrieved from https://www.spineuniverse.com/blogs/kamhi/neck-pain-headaches

74. Alcantara, J., Olsen, R. (2014). Spinal manipulation for a child with chronic cervicogenic headaches: a case report. The Journal of Headache and Pain 15(Suppl 1): C2.

75. Dwyer, D. (2017). Chiropractic for treating headaches. Retrieved from http://www.tollgatechiropractic.com/conditions/headaches.html

76. Moraska, A., Stenerson, L., Butryn, N., Krutsch, J., Schmiege, S., Mann, J. (2015). Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial. Clin J Pain 31(2): 159-168.

77. Drutz, J., Tu, N. (2017). Patient education: bedwetting in children (beyond the basics). Retrieved from https://www.uptodate.com/contents/bedwetting-in-children-beyond-the-basics

78. Donohoe Chiropractic. (2014). Nocturnal enuresis (bedwetting). Retrieved from http://www.donohoechiropractic.com/blog/2014/2/28/nocturnal-enuresis-bedwetting

79. Instebo, E., Lystad, R. (2016). Chiropractic care of an 8-year-old girl with nonorganic, primary nocturnal enuresis: a case report. Journal of Chiropractic Medicine (2016) 15: 47-52.

80. Kenny, T. (2016). Constipation in children. Retrieved from https://patient.info/health/constipation-in-children-leaflet

81. Gleberzon, B. (2011). A narrative review of the published chiropractic literature regarding older patients from 2001–2010. J Can Chiropr Assoc. 2011 Jun; 55(2): 76–95. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095583/.


79

82. Barber, V., Carfora, J., Wicks, T. (2016). Improvement in functional constipation while under chiropractic care in a pediatric patient with primary vesicoureteral reflux: a case report. The Academy of Chiropractic Orthopedists 13(2).

83. Dowshen, S. (Ed.). (2015). Growing pains. Retrieved from http://kidshealth.org/en/parents/growing-pains.html

84. de Beer, D., Bester, C. (2015). The effect of lumbosacral manipulation on growing pains. Health SA Gesondheid 20(1): 75-82.

85. Arndt, T. (2007, Mar.). “Growing pains” and chiropractic care – how does chiropractic help? Retrieved from http://icpa4kids.org/Wellness-Articles/growing-pains-and-chiropractic-care/How-Does-Chiropractic-Help.html

86. National Institute of Mental Health. (2016). Attention deficit hyperactivity disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

87. Bimie, K., et al. (2014). A practical guide and perspectives on the use of experimental pain modalities with children and adolescents. Pain Manag. 2014 Mar; 4(2): 97–111. Retrieved online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110966/.

88. Prentice, S. (2012). ADHD from treatment to function. Pathways to Family Wellness, Issue 35. Retrieved from http://pathwaystofamilywellness.org/Chiropractic/adhd-from-treatment-to-function.html

89. Healthy Start Chiropractic. (2017). Neurosensory integration. Retrieved from http://healthystartchiro.com/neurosensory-integration/

90. University Park Chiropractic. (2015). What is a subluxation? Retrieved from http://www.upchiro.com/what-is-a-subluxation.html

91. Hart, J. (2016). Analysis and adjustment of vertebral subluxation as a separate and distinct identity for the chiropractic profession: a commentary. Journal of Chiropractic Humanities 23(1): 46-52.

92. Atlas Orthogonal Chiropractic. (2015). Our techniques. Retrieved from http://www.atlasorthogonalchiro.com/About-Us/Our-Techniques.aspx

93. Francio, V. (2014). Chiropractic care for foot drop due to peroneal nerve neuropathy. Journal of Bodywork & Movement Therapies 18(2): 200-203.

94. Wong, K. (2013). Treating sprained ankles with chiropractic care. Dynamic Chiropractic 31(15). Retrieved from http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56624

95. Morgan, W. Morgan, C. (2014). Chiropractic care of a patient with neurogenic heterotopic ossification of the anterior longitudinal ligament after traumatic brain injury: a case report. J Chiropr Med 13(4): 260-265.


80

96. Hawk, C. (Ed.). (2017). The Praeger handbook of chiropractic health care: evidence-based practices. Santa Barbara, CA: Praeger

97. Dougherty, P., Hawk, C., Weiner, D., Gleberzon, B., Andrew, K., Killinger, L. (2012). The role of chiropractic care in older adults. Chiropr Man Therap. 20(3).

98. Holt, K., Haavik, H., Lee, A., Murphy, B., Elley, C. (2016). Effectiveness of chiropractic care to improve sensorimotor function associated with falls risk in older people: a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics 39(4): 267-278.

Theinformationpresentedinthiscourseisintendedsolelyfortheuseofhealthcareprofessionalstakingthiscourse,forcredit,fromNurseCe4Less.com.Theinformationisdesignedtoassisthealthcareprofessionals,includingnurses,inaddressingissuesassociatedwithhealthcare.Theinformationprovidedinthiscourseisgeneralinnature,andisnotdesignedtoaddressanyspecificsituation.Thispublicationinnowayabsolvesfacilitiesoftheirresponsibilityfortheappropriateorientationofhealthcareprofessionals.Hospitalsorotherorganizationsusingthispublicationasapartoftheirownorientationprocessesshouldreviewthecontentsofthispublicationtoensureaccuracyandcompliancebeforeusingthispublication.Hospitalsandfacilitiesthatusethispublicationagreetodefendandindemnify,andshallholdNurseCe4Less.com,includingitsparent(s),subsidiaries,affiliates,officers/directors,andemployeesfromliabilityresultingfromtheuseofthispublication.ThecontentsofthispublicationmaynotbereproducedwithoutwrittenpermissionfromNurseCe4Less.com.

Chiropractic Care In Pediatrics - NurseCe4Less.com · chiropractic care can be administered to...

Documents

Transcript of Chiropractic Care In Pediatrics - NurseCe4Less.com · chiropractic care can be administered to...