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Pediatrics

Adverse Reactions of Medications in Children:The Need for Vigilance, A Case Study

By |July 19, 2014|Adverse Drug Reactions, Pediatrics|

Adverse Reactions of Medications in Children:
The Need for Vigilance, A Case Study

The Chiro.Org Blog


SOURCE:   J Clinical Chiropractic Pediatrics 2014 (Mar);   14 (2) ~ FULL TEXT


Edward Holmes [1], DC and Joyce Miller, BSc, DC, DABCO, FCC [2]

1 – Edward Homes, DC,
private practice,
Bournemouth, United Kingdom

2 – Joyce Miller, BSc, DC, DABCO, FCC,
Associate Professor,
Anglo-European College of Chiropractic,
Bournemouth, United Kingdom.
jmiller@aecc.ac.uk


Summary:   This study demonstrates that adverse drug reactions do potentially pose a public health risk within the pediatric population and all healthcare providers need to be mindful of this risk. Adverse events to medication within this population are prevalent particularly in children under the age of two. Chiropractors must therefore be aware of adverse drug reactions and recognize symptoms within their patient population.

Key terms:   off label use; non-prescription drugs, child, pediatrics, drug toxicity guidelines, adverse medication reactions in children


 

From the Full-Text Article:

Introduction

A 19-week-old premature infant presented to a chiropractic teaching clinic with a ‘poor feeding pattern, recent slowing in weight gain and increase in crying’ over a three week period. The mother stated that this had started following a respiratory infection which occurred two months ago, with an associated rash that spread from her abdomen to the back of her neck, face and head. At least six weeks previously her GP had prescribed a cold remedy for the day (Calcold®) and Calpol® Night for the evening for the respiratory infection, and cortisone cream when a rash developed two weeks later. The medications seemed to help the child sleep, in fact she seemed to sleep much more during the day and night, which was put down to illness. However this did not change in the ensuing weeks after the respiratory infection abated. The mother continued with the Calpol® Night at the recommendation of the GP along with a change to Calpol® (instead of Calcold®) in the day, since it seemed to have helped with sleep. We examined a lethargic infant with an erythematous rash covering the trunk, head and neck who had decreased almost two centiles on her growth chart in the previous several weeks, and although not losing weight, she was nevertheless not gaining weight. Without another obvious etiology, was there an association between the medication and the child’s signs and symptoms?

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An International Survey of Pain in Adolescents

By |June 11, 2014|Pediatrics|

An International Survey of Pain in Adolescents

The Chiro.Org Blog


SOURCE:   BMC Public Health. 2014 (May 13);   14 (1):   447


Michael Swain, Nicholas Henschke, Steven Kamper, Inese Gobina, Veronika Ottová-Jordan, Christopher Maher

Department of Chiropractic,
Faculty of Science,
Macquarie University,
Sydney 2109, Australia.
michael.swain@mq.edu.au


BACKGROUND:   A common belief is that pain is uncommon and short lived in adolescents. However, the burden of pain in adolescents is unclear because of limitations in previous research. The aim of this study is to estimate the prevalence of headache, stomach-ache and backache in adolescents and to explore the extent to which these three forms of pain coexist based upon a representative sample of adolescents from 28 countries.

METHODS:   Data were analysed from three consecutive waves (1997/98, 2001/02 and 2005/06) of the Health Behavior in School-aged Children: WHO Collaborative Cross-National survey (HBSC). Prevalence estimates are based upon adolescents who reported experiencing headache, stomach-ache or backache at least monthly for the last 6 months.

RESULTS:   There were a total of 404,206 participants with a mean (±SD) age of 13.6 (±1.7) years (range 9.8 to 17.3 years). The prevalence of headache was 54.1%, stomach-ache 49.8%, backache 37%, and at least one of the three pains 74.4%. Girls had a higher prevalence of the three pains than boys and the prevalence of pain increased with age. Headache, stomach-ache and backache frequently coexist, for example, of those with headache: 21.2% had headache alone, 31% suffered from both headache and stomach-ache, 12.1% suffered from backache and headache, and 35.7% had all three pains.

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Spinal Manipulation and Exercise for Low Back Painin Adolescents: Study Protocol for a Randomized Controlled Trial

By |June 1, 2014|Chiropractic Care, Low Back Pain, Pediatrics|

Spinal Manipulation and Exercise for Low Back Pain in Adolescents: Study Protocol for a Randomized Controlled Trial

The Chiro.Org Blog


SOURCE:   Chiropractic & Manual Therapies 2014 (May 23);   22:   21 ~ FULL TEXT


Craig Schulz, Brent Leininger, Roni Evans, Darcy Vavrek, Dave Peterson, Mitchell Haas

and Gert Bronfort

Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences
University, 2501 W 84th St, Bloomington, MN 55431, USA


Background   Low back pain is among the most common and costly chronic health care conditions. Recent research has highlighted the common occurrence of non-specific low back pain in adolescents, with prevalence estimates similar to adults. While multiple clinical trials have examined the effectiveness of commonly used therapies for the management of low back pain in adults, few trials have addressed the condition in adolescents. The purpose of this paper is to describe the methodology of a randomized clinical trial examining the effectiveness of exercise with and without spinal manipulative therapy for chronic or recurrent low back pain in adolescents.

Methods   This study is a randomized controlled trial comparing twelve weeks of exercise therapy combined with spinal manipulation to exercise therapy alone. Beginning in March 2010, a total of 184 participants, ages 12 to 18, with chronic or recurrent low back pain are enrolled across two sites. The primary outcome is self-reported low back pain intensity. Other outcomes include disability, quality of life, improvement, satisfaction, activity level, low back strength, endurance, and motion. Qualitative interviews are conducted to evaluate participants’ perceptions of treatment.

Discussion   This is the first randomized clinical trial assessing the effectiveness of combining spinal manipulative therapy with exercise for adolescents with low back pain. The results of this study will provide important evidence on the role of these conservative treatments for the management of low back pain in adolescents.

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Chiropractic and Children: Is More Research Enough?

By |May 29, 2014|Chiropractic Care, Pediatrics|

Chiropractic and Children: Is More Research Enough?

The Chiro.Org Blog


SOURCE:   Chiropractic & Osteopathy 2010 (Jun 2);   18:   11 ~ FULL TEXT


Charlotte Leboeuf-Yde, and Lise Hestbæk

Nordic Institute of Chiropractic and Clinical Biomechanics,
Forskerparken 10, DK-5230 Odense M, Denmark. l.hestbaek@nikkb.dk


Many health science research and review articles end with the words: “More research is needed”. However, when it comes to research, it is not as much a question of quantity as of quality. There are a number of important prerequisites before research should be initiated. The three pillars, relevance, quality and ethics should be respected but for a project to be meaningful, it must also be based on plausible rationale.

In evidence-based (informed) practice, one takes into account not only research-based evidence but also clinical expertise and the patients’ perspectives. In this paper, we briefly discuss how this should be handled in clinical practice is briefly discussed, using the concept of “traffic lights” (red, yellow, green). We explain how the combination of evidence and plausibility can be used to reach a decision as to whether a treatment or diagnostic procedure is suitable, possible, or unsuitable.

In this thematic series of Chiropractic & Osteopathy a number of reviews are presented, in which the research status of pediatric chiropractic is scrutinized and found wanting. Two important aspects were studied in these reviews: the effect of treatment and safety issues. Two types of problems were identified: the lack of research in general and the lack of research using the appropriate study designs and methodology in particular. Therefore, we discuss the meager research noted in the areas of chiropractic care in children and the clinical consequences this should have. The prerequisites for “more research” are scrutinized and an example given of suitable research programs.

Finally, the important issue of implementation of research findings is covered, emphasizing the responsibility of all stakeholders involved at both the undergraduate and the postgraduate level, within professional associations, and on an individual level.


 

Introduction

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Possible Adverse Events in Children Treated By Manual Therapy: A Review

By |May 28, 2014|Adverse Events, Chiropractic Care, Pediatrics, Uncategorized|

Possible Adverse Events in Children Treated By Manual Therapy: A Review

The Chiro.Org Blog


SOURCE:   Chiropractic & Osteopathy 2010 (Jun 2); ;   18:   12 ~ FULL TEXT


B Kim Humphreys

Professor Chiropractic Medicine, University of Zürich and
University Orthopedic Hospital Balgrist,
Forchstrasse 340, 8008 Zürich, Switzerland.
kim.humphreys@balgrist.ch


Background   Pediatric manual therapy is controversial within the medical community particularly with respect to adverse events. Pediatric manual therapy (Ped MT) is commonly used by a number of professions such as chiropractors, osteopaths and naturopaths for a variety of treatments in children. Ped MT interventions range from advice, light touch, massage, through to mobilisation and high velocity spinal manipulation. However, current evidence related to adverse events associated with Ped MT is not well understood.

Objective   To update the clinical research literature from the 2007 report by Vohra, Johnston, Cramer and Humphreys on possible adverse events in children treated by spinal manipulation.

Methods   A review of the clinical research literature from June 2004 until January 2010 as reported in MEDLINE, PubMed and PubMed Central for adverse events specifically related to the treatment of pediatric cases by manual therapy.

Results   Only three new clinical studies, one systematic review with meta-analysis and one evidence report were identified. Two clinical studies reported on chiropractic care and one on osteopathic spinal manipulation in children. The systematic review investigated all studies of adverse events and manual therapy and was not specific for pediatric patients. The evidence review focused on effectiveness of spinal manipulation in a variety of musculoskeletal conditions. No serious or catastrophic adverse events were reported in the clinical studies or systematic review. However for adults, it has been estimated that between 0.003% and 0.13% of manual therapy treatments may result in a serious adverse event. Although mild to moderate adverse events are common in adults, an accurate estimate from high quality pediatric studies is currently not available.

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Chiropractic Approach to the Management of Children

By |May 18, 2014|Chiropractic Care, Education, Pediatrics|

Chiropractic Approach to the Management of Children

The Chiro.Org Blog


SOURCE:   Chiropractic & Osteopathy 2010 (Jun 2); 18: 16 ~ FULL TEXT


Sharon A Vallone, Joyce Miller, Annica Larsdotter, and Jennifer Barham-Floreani

Private Practice,
Connecticut, USA.
svallonedc@aol.com


Background   Chiropractic (Greek: done by hand) is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on joint subluxation (World Health Organization 2005) or mechanical lesion and restoring function. The chiropractor’s role in wellness care, prevention and treatment of injury or illness is based on education in anatomy and physiology, nutrition, exercise and healthy lifestyle counseling as well as referral to other health practitioners. Depending on education, geographic location, scope of practice, as well as consumer preference, chiropractors may assume the role of primary care for families who are pursuing a more natural and holistic approach to health care for their families.

Objective   To present a perspective on current management of the paediatric patient by members of the chiropractic profession and to make recommendations as to how the profession can safely and effectively manage the paediatric patient.

Discussion   The chiropractic profession holds the responsibility of ethical and safe practice and requires the cultivation and mastery of both an academic foundation and clinical expertise that distinguishes chiropractic from other disciplines.

Research into the effectiveness of chiropractic care for paediatric patients has lagged behind that of adult care, but this is being addressed through educational programs where research is now being incorporated into academic tracks to attain advanced chiropractic degrees.

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