Pediatric Chiropractic

Dr-Mohsen-Khamessipour
The effects of Chiropractic Spinal Manipulation on Urinary Incontinence in patients with Low Back Pain and Radiculopathy: a retrospective case-series report  
September 25, 2017
Dr-Mohsen-Khamessipour
The Effects of Chiropractic Spinal
November 26, 2017

Pediatric Chiropractic

Pediatric Chiropractic

Wellness care involves education and implementation of specific lifestyle practices related to improvement of body function. In regards to chiropractic the focus is on correcting deficiencies in nervous system function. This is done by manual adjustment of the spine, pelvis, and cranium. The goal of chiropractic treatment is to raise the patient’s awareness of lifestyle factors, which can contribute to bodily stress. It is important to address the chiropractic role in reducing these nervous system stressors, for both the mother and baby.

If we discuss the benefits of chiropractic care for pediatric patients we can never ignore the benefits of this care for expecting mothers. A child’s health from the prenatal to perinatal stage is affected by its mother’s body, emotions and thoughts.

In regards to female sacroiliac joints are flatter, with wider retro articular space and longer interosseous ligaments, this creates ability for more mobility. If a motion segment is compensating for a lack of mobility at an adjacent level, then these segments may become hypermobile.

Pelvic misalignment is physiologically inherent to the last 3 months of pregnancy, hence it is imperative for the mother’s health and fetus’s better positioning to be provided by corrective treatments of chiropractic care.

Based on studies, prevalence of low back pain in pregnant women it about 50%. Most published articles indicate the efficacy of the adjustment for the resolution of low back pain to be 75% compared to those who have not received any corrective treatment for musculo-skeletal discomforts. During a study that evaluated the use of chiropractic treatment during pregnancy and birth compared to no treatment indicates. Women who received chiropractic adjustments experienced less pain during labor.

Weight gain, compensating postural changes, hormonally induced ligament laxity add to a woman’s predisposition toward pelvic misalignment/subluxation during pregnancy.  Based on Varney’s midwifery text: The potential for damage in pregnancy and the postpartum period to a woman’s neuromusculoskeletal structure is great. Shifts in the center of gravity forward and slightly upward destabilize her posture and realign the carriage of weights and forces through her joints, predisposing nerves, muscles, bones, and connective tissues to damage. Increased levels of relaxin and elastin further aggravate this situation.” The number one contributor to the biomechanical compromise of the lumbosacral spine is the maternal weight gain. Shift in center of gravity affects the musculoskeletal function of the pelvis, low back, and compensations in the thoracic and cervical. Hypertonicity and ligament laxity are of the biomechanical results of the aforementioned process.

The torsions and tensions present in the pelvic girdle joint system affects the uterine-ligament-musculature system. This leads to pelvic dysfunction from biomechanical perspective. This pelvic imbalance affects the fetus positioning.  Specifically, sacral rotation causes and anterior torqueing mechanism on the uterine ligaments and musculature, decreasing space and altering the environment for the fetus…when correction of the sacral subluxation occurs. The structure and function of uterine positioning is improved allowing the fetus to position itself properly.” Hence, abnormalities of presentation, position, or development may be caused due to pelvic dysfunction. The result of these processes can lead to dystocia. Based on the William’s Obstetrics: the three main reasons for dystocia are: Power, Passage, and Passenger. In regards to the Passage, abnormalities of the maternal bony pelvis are mentioned to affect the pelvic contractions.

Treatment of joint dysfunction in pregnant patient and pediatrics rely on the different techniques that are either osseous or non-osseous in nature.  These techniques are used to affect the joint complex, soft tissue, nervous system and immune system. Among these techniques a Webster certified chiropractor can help alleviate the sacral dysfunction, as well as ligamentous tension in all cases and specifically pregnant mothers. Research shows use of Webster technique has helped improve the pelvic dysfunction factors in a course of treatment, providing the better alignment and structure for the fetus to assume a more optimal positioning in the uterus. Also, studies show that benefits of spinal and cranial adjustments relevant to birth outcome may include decreases in: labor time, meconium staining of amniotic fluid, preterm delivery, umbilical cord prolapse, use of forceps, and C-sections.

Having said the above reasons for the need of prenatal and perinatal chiropractic care for mothers, the care for the pediatric patient is unquestionable. Invasive procedures including manual rotation, pulling of fetal head, forceps, vacuum extraction, and C-sections, lead to these procedures: macrosomia, cephalopelvic disproportion, dystocia, failure to progress, breech and fetal distress and prolonged second stage. In addition, the abnormal positioning in the uterus, pelvic dysfunction and its effects on spinal structures during delivery can lead to subluxations/ joint dysfunction and malpresentations that can be alleviated by spinal adjustments. Based article by Gottlieb birth trauma is poorly publicized and undertreated. There is a great need for treatment of birth trauma injuries to the neuromusckeletal system of the new born in the fields of chiropractic and manual medicine. Another study by Guttman reports that a study of 1000 infants show 80% of newborns to suffer from some form of nerve dysfunction. He suggests that many health problems can arise from the first vertebral misalignment for the fact that its anatomy can dictate many target organ’s functions. Such problems are: lowered resistance to infections in the ear, nose, and throat. Nerve dysfunction associated with birth trauma can lead to breathing weaknesses, mood irritability, digestive disorders, difficulty with feeding and attachment, sleeping problems, immunity deficits, and neurological impairment for instance. Biedermann has studies significant improvements in the health of infants who received specific upper cervical adjustments after birth. He has studies cases series in which upper cervical misalignment in the newborn is due to prolonged labor and the use of extraction methods.

There are no known contraindications to chiropractic spinal and pelvic adjustments through pregnancy other than those documented for non-gravid individuals. Pediatric patients are also receiving chiropractic treatments worldwide by the qualified chiropractor. As for pediatric patients it is essential for the parents to be assured of their practitioners qualifications on working with pediatrics.

Chiropractic techniques have been evaluated and utilized in many studies to document their efficacy for pregnancy and pediatrics. ICPA has formed a practice-based research network through PBRN requirements. These research have so far shown no reported harm except slight soreness after the first adjustment for the adult patients. This was also resolved within the second visit.

Conditions that refer to chiropractic offices in the cases of pediatric population are: structural, systemic, functional. Among the structural cases are scoliosis, torticollis, Erb’s Palsy, neck pain, low back pain, and so forth. Among the systemic cases are ear infection, GERD, sleeplessness, irritability, constipation, bed wetting and so forth. Among the functional cases are coordination, delayed developmental milestones for infants, weakness of using limbs and eye coordination.

Pediatric patients can be divided into different populations: Newborns

(0- 18 months), toddlers (18-36ys), Preschoolers (3-5 ys), Preadolescent (6-10ys), adolescent (10-16ys) and young adults (16-18ys). Depending on the developmental milestones for each age group, due to hormonal changes, musculoskeletal and mental developments, they require careful examination, diagnosis and treatment plan. A skilled chiropractor will help the parents and the patient to find the correct treatment in chiropractic office, otherwise will refer to a skilled medical provider for further follow up on their case.

It is the hope of this article to bring to your attention the importance of spine, musculoskeletal and systems review examination by a chiropractor for pediatric patients to avoid long term effects of undiagnosed conditions in these population. \Just as a dental checkup is essential at any age, a monthly check up is optimal for any individual young and old.

It is essential to realize that chiropractic is not a treatment of any medical condition. The purpose of chiropractic is to find and reduce stress and interference to nervous system, allowing the person to experience greater function and an overall improved quality of life. Hence, in our health care system there is a great potential for collaboration of treatment modalities in order to reduce sick days, improve body function and enhance quality of life for our patients.

Bibliography

Alcantara J, Hamel I. The chiropractic care of a gravid patient with a history of multiple cesarean births and sacral subluxation. J Vert Sublux Res 2008 (March 11).
Alcantrara J, Mullin L, Ohm J, et al. The chiropractic care of pregnant patients: a practice-based observational study. Poster Presentation at the Association of Chiropractic Colleges/ Research Agenda Conference, Las Vegas, NV, March 12-14, 2009.
Alcantra J, Ohm J. Chiropractic care of a patient with dystocia: a case report. J Pediatr Maternal Fam Health 2009: 1: 1-5.
Alcantra J, Renaud C. Evidence-based integrative approach to patients with dystocia: a case series. Poster presentation at the American College of Nurse-Midwives Annual Meeting, Boston, MA, May 2008.
Barbin L, Verhoeff F, Barbin BJ. Maternal height, birth weight and cephalo pelvic disproportion in urban Nigeria and rural Malawi. Acta Obstet Gynecol Scand 2002; 81 (6) : 502-507.
Biederman H. Kinematic imbalances due to suboocipital strain in newborns. J Manual Med 1992; 6: 151-156.
Biederman H. Manual therapy in children: proposal for an etiologic model. J Manipulative physiol ther 2005; 28 (3): el- e 15.

Cowlin A. Women and exercise. In: Varney H, Kriebs J, Gegor C (eds). Varneys Midwifery (4th ed). Boston, MA: Jones and Bartlett; 2003; p. 199.
Cunningham G, et al. Anatomy of the reproductive tract. In: Cunningham FG, Gant NF, Leveno KJ, et al. (eds). Williams Obstetrics (21st ed). New York, NY: Mc Graw-Hill Publishing, 2001; p.43

Cunningham G, et al. Dystocia: abnormal labor and fetopelvic disproportion. In: Cunningham FG, Gant NF,Levenot KJ, et al (eds). Williams Obstetrics (21st ed). New York, NY: Mc Grawp Hill Publishing, 2001; p. 426.
Descarreux M, Bloun JS, Drolet M, et al. Efficacy of preventive spinal manipulation for chronic low back pain and related disabilities: a preliminary study. J manipulative physiol Ther 2004; 27(8): 509-514
Fallon JM. The effect of chiropractic treatment on pregnancy and labor: a comprehensive study. Proceedings of the Scientific Symposium World Federation of Chiropractic, 1991: 24-25.

Forrester J, Anrig CA. The prenatal and perinatal Period. In: Anrig C, Plaugher G (eds). Pediatric Chiropractic. Baltimore, MD: Williams and Wilkins, 2011; p.370.

Gitlin RS, Wolf DL. Uterine contractions following osteopathic cranial manipulation: a pilot study. J Am Osteopath Assoc 1992; 92: 1183

Gottlieb MS. Neglected spinal cord, brain stem and musculoskeletal inuries stemming from birth trauma. J manipulative physiol Ther 1993; 16 (8): 537-543.
Gutmann G. Blocked atlantal nerve syndrome in babies and infants. Manuelle Medizin 1987; 25:5-10.
International Chiropractic Pediatric Association. For Parents: Chiropractic Research. < http://icpa4kids.org/Chiropractic-Research> , 2017/06/17.

Haram K, Pirhonen J, Bergsjo P. Suspected big baby: a difficult clinical problem in obstetrics. Acta Obstet Gynecol Scand 2002; 81: 185-194.
Janni w, Schiessl B, Peschers U, et al. The prognostic impact of a prolonged second stage of labor on maternal and fetal outcome. Acta Obstet Gynecol Scand 2002; 81 (3): 214- 221.
Keirse M. Evidence- based childbirth only for breech babies? Birth 2002; 29 (1): 55-59.
King H, Osteopathic manipulation treatment I prenatal care: evidence supporting improved outcome and health policy implications. AAO Journal 2000; 10: 25-33.
King H, Tettambel MA, Lockwood MD, et al. Osteopathic manipulative treatment in prenatal care: a retrospective case study control design study. J Am Osteopath Assoc 2003; 103 (12): 577-582.
Mullin L, Dever L , Barton D. Midwifery views on Chiropractic: A survey of North American midwives, J Chiro Ed2009; 23: 52.

Neil J. Davies, foreword by Dana Lawrence, Chiropractic Pediatrics (2nd ed). 2010.
Parry S, Severs CP, Sehdev HM, et al. Ultrasonographic prediction of the fetal macrosomia: association with cesarean delivery. J Reprod Med 2000; 45: 17-22.

Ruch W. Atlas of common subluxations of the Human Spine and Pelvis. Boca Raton, FL: CRC Press, L.L.C., 1997; p.180.

Sandmire HF, Woolley HF, Robert J. Macrosomia: can we prevent big problems with big bbies? Birth 1998; 25 (4): 263-267.

Usta IM, Nassar AH, Khabbaz AY, Abu Musa AA. Undiagnosed term breech: Impact on mode of delivery and neonatal outcome. Acta obstet Gynecol Scand 2003; 82 (9): 841-844.

Whiting LM. Can the length of labor be shortened by osteopathic treatment? J Am Osteopath Assoc 1911; 19:17-21

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>