Retrospective Review of Case Records of School-aged Children Receiving Chiropractic Care

Background:   Chiropractic care is utilized in school aged children for a variety of health complaints, including headaches, postural issues, nocturnal enuresis, neurodevelopmental disorders, and back pain. Chiropractic care, with its ability to impact sensorimotor integration, motor control and the prefrontal cortex, could therefore potentially benefit school aged children.

Methods:   In this retrospective case series, records of patients presenting for chiropractic care at an onsite school chiropractic clinic were reviewed. Patients underwent 12 weeks of chiropractic care and completed three questionnaires and two sets of neurophysiological scans. The data from these questionnaires and scans were combined, averaged, and statistically analyzed.

Results:   One hundred and eighty records of children aged 5-18 years from nine schools were included in the overall analyses. Statistically significant improvements were noted in the ‘health and activities’ sub-section and overall score of the Pediatric Quality of Life Inventory™ and in the hyperactivity domain of the Strengths and Difficulties questionnaire.

Conclusion:   This retrospective review of case records from children attending an onsite school chiropractic clinic has demonstrated some changes in health-related quality of life following a period of 12 weeks of chiropractic care. Further research using a clinical trial design is needed to extrapolate the findings and to assess causation.

Keywords:   Chiropractic; Heart-rate variability; Neurodevelopmental disorders; Neurophysiology; Quality of life; School children; Surface electromyography; Thermography.

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Introduction

Childhood is a period of huge growth and development. The health and experiences of children during this critical time can have long-term impacts on disease rates, mental health, and overall well-being for the rest of their lives(Drozdz et al., 2021; Goodman et al., 2011; Middlebrooks., 2007; Marcus et al., 2022; Bellis et al., 2019). However, the health and wellbeing of children today is showing some alarming areas of decline and concern (Lebrun-Harris et al., 2022). Data from the National Survey of Children’s health in the US from 2016 to 2020 showed an increase in rates of anxiety, depression, behavioral disorders, and obesity (Lebrun-Harris et al., 2022)). The survey also showed declining rates of preventative medical visits, daily physical activity, and parents mental health (Lebrun-Harris et al., 2022). The decline in key areas of health is also evident from more historical data from the 2007 and 2011/2012 National Survey of Children’s Health (Initiative et al., 2024) which showed higher rates in many of the domains related to good health (preventative medical visits, physical activity) and lower rates of obesity, suggesting that the decline in key areas of children’s health has been evident for nearly two decades.

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PEDIATRICS Section

The US department of Health and Human services’ Healthy People 2030 campaign have numerous strategies related to children’s health, however many of these domains are also showing a decline in progress (Promotion et al., 2024). Concerningly, areas such as overall mortality rates in children, levels of physical activity and participation in sport, school performance in reading and math and death from child abuse are getting worse (Promotion et al., 2024). Only a few domains, such as oral health, are improving (Promotion et al., 2024).

There is also an increasing number of neurodevelopmental disorders (NDD’s) seen in school-aged children (Francé et al., 2022). Neurodevelopmental disorders (NDD’s) encompass conditions such as autism spectrum disorder (ASD), dyslexia, attention-deficit hyperactivity disorder (ADHD), dyspraxia, dyscalculia, dysphonia, Tourette syndrome, synesthesia, and other distinctions in behavior and neurobiology (Francé et al., 2022). Global prevalence of NDD’s can be difficult to ascertain due to varying capabilities in the detection and diagnosis of these conditions and the true prevalence is thought to be higher than the current detection rates. The current prevalence is estimated to be 15% of school-aged children, with ADHD having the highest prevalence at 5–11% (Francé et al., 2022). This prevalence is increasing with current data from the 2022–2023 National Survey of Children’s Health showing 10.5% of the population age 3–17 years in the US currently have ADD or ADHD, in 2011/2012 the prevalence was 8%(Initiative et al., 2024).

These conditions are associated with several health and wellbeing difficulties, including poor sleep, poor school performance, gross motor function deficits, musculoskeletal pain, headaches, digestive issues, and other physical health complaints (Abdelgadir et al., 2018; Donaghy et al., 2023; Alabaf et al., 2019; Blackmer et al., 2016; Boivin et al., 2015; Gnanavel et al., 2019; King-Dowling et al., 2019; Landgren et al., 2023). The pathophysiology of many neurodivergent and neurodevelopmental conditions are often unknown, and specific diagnoses are based on clinical observations using criteria from The Diagnostic and Statistical Manual of Mental Disorders (Association., 2013).

It is clear from recent evidence that there is an increasing incidence of certain health complaints and disorders in school-age children. There are numerous campaigns and strategies that are being employed by the US department for Health and Human Services. However, there is also a growing interest in the use of complementary and alternative health medicine (CAM) in the paediatric population. Utilization of CAM was recorded at approximately 12% in 4–17-year-old children in the 2012 National Health Interview Survey in the US (Black et al., 2015). The most frequently used modality is dietary supplements (nonvitamin, nonmineral), followed by chiropractic or osteopathic manipulation (Black et al., 2015).

Chiropractic, a health care modality focusing on spine function and motion to improve central neural function, suggests that areas of joint dysfunction, or vertebral subluxations, may negatively alter sensory input to the brain, impacting the central nervous system’s (CNS) ability to self-regulate, self-organize, adapt, repair and heal (Haavik et al., 2012, 2021; Lelic et al., 2016; Taylor et al., 2010). When not corrected, over time these changes can lead to symptoms of dysfunction and pain and lessen the ability of the CNS to adapt and respond to internal and external environmental cues (Haavik et al., 2021).

Chiropractic adjustments, also known as spinal manipulation, target joints with altered alignment and/or mobility that result in aberrant afferent feedback to the CNS (Haavik et al., 2021). Over the past two decades, growing evidence has indicated that chiropractic care can influence sensorimotor and multimodal integration, enhancing the accuracy of brain schemas related to the inner body and external environment in neurotypical populations (Haavik et al., 2011, 2012, 2016, 2021; Lelic et al., 2016; Taylor et al., 2010; Baarb et al., 2018; Christiansen et al., 2018; Holt et al., 2016, 2019; Niazi et al., 2015). It is now known that chiropractic adjustments in adults have a neural plastic effect on the brain and have been shown to have a particular influence on the prefrontal cortex, an area of the brain that is responsible for executive functions, such as memory, goal planning and focus (Haavik et al., 2021; Lelic et al., 2016; Taylor et al., 2010).

Chiropractic care is a frequently utilized health care modality amongst the paediatric population around the world (Gotlib et al., 2008; Marchand, 2012). Parents and caregivers seek alternative therapies for their children for a variety of reasons but often it is related to back or neck pain, concerns over medication side effects, a lack of improvement with traditional therapies or wanting to seek a natural approach (Blackmer et al., 2016; Guinchat et al., 2020). The most common reason for seeking chiropractic care in the paediatric population is musculoskeletal complaints (Marchand, 2012; Ndetan et al., 2012; Peng et al., 2021). Previous research on chiropractic care in the paediatric population has also shown improvements in quality of life and a high satisfaction of care (Alcantara et al., 2020). Chiropractic care for children has been used in the clinical setting to help co-manage individuals with NDD’s, particularly autism spectrum disorders, ADHD, and other behavioral disorders (Alcantara et al., 2010, 2011; Strand et al., 2019; Fairest et al., 2019; Shaw et al., 2021; Parnell Prevost et al., 2019).

There are numerous case reports and some basic science studies that have investigated the effects of chiropractic care on various NDD’s (Alcantara et al., 2010, 2011; Strand et al., 2019; Fairest et al., 2019; Shaw et al., 2021; Parnell Prevost et al., 2019). The current available literature suggests that some individual children with NDD’s appear to show improvement following chiropractic care. Changes reported, that may be due to chiropractic care, include improved concentration, motor control, reading, sleep, and behavior (Gotlib et al., 2008; Alcantara et al., 2010, 2011; Strand et al., 2019; Fairest et al., 2019; Shaw et al., 2021). However, larger clinical studies are lacking, thus further research is needed to understand causality and to confirm these individual observations.

The purpose of this study is to review the case records of children receiving chiropractic care in a school setting and to investigate possible neurophysiological and health-related quality of life (HRQOL) changes.

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