Pediatrics

Medical Management of Pediatric and Non-Musculoskeletal Conditions by Spinal Manipulation

By Frank M. Painter|January 23, 2014|Chiropractic Care, Non-Musculoskeletal Conditions, Pediatrics, Visceral Disease|

Medical Management of Pediatric and Non-Musculoskeletal Conditions by Spinal Manipulation

Chiropractic Journal of Australia 2013 (Dec); 43 (4): 131–136 ~ FULL TEXT

Peter L. Rome, D.C.

Melbourne, Australia

Thanks to Dr. Rolf Peters, editor of the Chiropractic Journal of Australia for permission to republish this Full Text article, exclusively at Chiro.Org!

Considering the unpleasant fallout from the Simon Singh Case, this article sheds a unique, new perspective on manipulative care for non-musculoskeletal conditions.

The Abstract: There is a well established precedent by medical doctors, particularly in Europe, of managing infant, paediatric and other patients for so-called organic conditions by spinal manipulation. There are also claims that chiropractic should not be involved with this form of management for so-called visceral disorders because it does not quite meet the current orthodox theories. This seems contradictory if not hypocritical when there is noted evidence in the medical literature itself of not only the rationale supporting these concepts, but evidence of medical doctors carrying out the same procedures for the same purpose on the same conditions.

Index terms: (MeSH): chiropractic; manipulation, chiropractic; manipulation, orthopedic; manipulation, musculoskeletal; manipulation, spinal; pediatrics; evidence based medicine. (other): medical manipulative therapy.

From the Full-Text Article:

Introduction

Some have questioned the hypotheses justifying chiropractic involvement in the management of paediatric patients, as well as those with so-called visceral conditions. [1-4] This topic was raised recently in a television program by Demasi. [5]

It is acknowledged that chiropractic constructs have been outside the traditional or orthodox models of understanding. However, there is a major contradiction regarding manipulative management of visceral and paediatric care due to the adoption of those very concepts by other areas of medicine – namely manipulative medicine. [6-9]

In particular, European medical doctors have published refereed papers on these very topics involving spinal manipulation in medical journals and medical textbooks for some decades. [10] (see Table 1) In an apparent contradictory development, it is primarily English language medical authors and other sources that seem to have attracted critics who direct their reservations at the principles espoused by chiropractors, but not to their European medical colleagues who are proponents of spinal manipulation. [11] It is also curious that osteopathic manipulative therapy does not appear to attract the same degree of debate and reservations despite the similarities.

There are at least three medical textbooks which include the topics of paediatric manipulative care and the manipulative management of visceral disorders. [6-8] One such medical text is totally devoted to paediatric manual therapy. [6]

INFANTS

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Children and Scoliosis

By Frank M. Painter|July 6, 2013|Pediatrics, Scoliosis|

Children and Scoliosis

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By Kim Christensen, DC, DACRB, CCSP, CSCS

Scoliosis is defined as “any lateral deviation of the spine from the mid-sagittal plane.” [1]

While there are many causes for scoliosis, children and adolescents with scoliosis who present to chiropractors usually fall into three categories.

Successful treatment is dependent upon differentiating the underlying cause of the spinal curvature. In most children, the scoliotic spine is not symptomatic; the spinal curvature is first noticed either by a parent who becomes concerned about a child’s posture, or during a screening examination, usually at school. The importance of a good evaluation and early treatment is to prevent progression and worsening of the curvature. Children with all three major causes of scoliosis should have a careful evaluation of the lower extremities as part of their spinal examination to determine associated or contributing components to the spinal deviation.

Structural vs. Nonstructural Scoliosis A structural scoliosis is defined as a spinal curvature that does not correct during recumbent, lateral flexion radiographs. The two most common causes of a structural scoliosis are congenital and idiopathic. A nonstructural scoliosis can be reduced when lying down, and will correct with recumbent lateral flexion. This type of spinal curvature is sometimes called a “functional curve,” and is often secondary to a leg length discrepancy.
Congenital Scoliosis Of the three major etiologies of scoliosis, this is the least common. Congenital scoliosis develops secondary to a bony anomaly of the sacrum, vertebrae or ribs. These are often defects of formation or segmentation, resulting in wedged, blocked, or hemi-vertebrae. In some cases, the abnormality will require corrective surgery. In many children, a heel lift or shoe buildup can provide sufficient structural support, and help to maintain a balanced spine.When a congenital spinal anomaly is discovered, it’s important to remember that there are usually multiple affected areas. For instance, it is more common to have multiple bony abnormalities than just a single level. Nonosseous and extraspinal deformities are also often present. These may include the cartilaginous and connective tissues, and even genitourinary or cardiovascular abnormalities. Clubfoot, a congenitally dislocated hip, or an anatomically short leg often will contribute to the spinal imbalance.
Idiopathic Scoliosis Idiopathic scoliosis can be progressive, worsening significantly during periods of rapid growth. In the more severe cases, bracing, or possibly surgery, may be necessary to prevent substantial deformity. [2] After skeletal maturity, most curvatures progress only slowly, if at all. Recent scientific research has focused on hormonal and neurological causes for idiopathic scoliosis, with some promising early results, but no definitive conclusions.

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The Prevalence and Progression of Neck and Back Pain in Children Over Time

By Frank M. Painter|July 3, 2013|Chiropractic Care, Neck Pain, Pediatrics|

The Prevalence and Progression of Neck and Back Pain in Children Over Time

The Chiro.Org Blog

SOURCE: Musculoskelet Disord. 2011 (May 16); 12: 98

Per Kjaer, Niels Wedderkopp, Lars Korsholm,
and Charlotte Leboeuf-Yde

Institute of Sports Science and Clinical Biomechanics,
Part of Clinical Locomotion Network,
University of Southern Denmark,
Campusvej 55, DK-5230, Odense, Denmark

The following article appears to be the first study to track and review the progression of back pain in the same group of children, over a prolonged period, to see how (or if) it is a contributor to those same complains in adulthood.

Of particular interest is Table 2, because it breaks down and tracks complaints of either neck, mid back, or low back pain in the same group of children at 3 different time periods: ages 9, 13 and 15 years old.

Table 2: Prevalence rates of different types of back pain in a cohort of Danish children/adolescents surveyed at three time points

Age Group	Age 9	Age 13	Age 15
Neck Pain
All children Boys Girls	10%9%11%	7%5%9%	15%13%18%
Mid Back Pain
All children Boys Girls	20%22%19%	13%13%13%	28%22%32%
Low Back Pain
All children Boys Girls	33%32%34%	28%26%30%	48%39%54%

The Abstract:

BACKGROUND: It is generally acknowledged that back pain (BP) is a common condition already in childhood. However, the development until early adulthood is not well understood and, in particular, not the individual tracking pattern. The objectives of this paper are to show the prevalence estimates of BP, low back pain (LBP), mid back pain (MBP), neck pain (NP), and care-seeking because of BP at three different ages (9, 13 and 15 years) and how the BP reporting tracks over these age groups over three consecutive surveys.

METHODS: A longitudinal cohort study was carried out from the years of 1997 till 2005, collecting interview data from children who were sampled to be representative of Danish schoolchildren. BP was defined overall and specifically in the three spinal regions as having reported pain within the past month. The prevalence estimates and the various patterns of BP reporting over time are presented as percentages.

RESULTS: Of the 771 children sampled, 62%, 57%, and 58% participated in the three back surveys and 34% participated in all three. The prevalence estimates for children at the ages of 9, 13, and 15, respectively, were for BP 33%, 28%, and 48%; for LBP 4%, 22%, and 36%; for MBP 20%, 13%, and 35%; and for NP 10%, 7%, and 15%. Seeking care for BP increased from 6% and 8% at the two youngest ages to 34% at the oldest. Only 7% of the children who participated in all three surveys reported BP each time and 30% of these always reported no pain. The patterns of development differed for the three spinal regions and between genders. Status at the previous survey predicted status at the next survey, so that those who had pain before were more likely to report pain again and vice versa. This was most pronounced for care-seeking.

CONCLUSION: It was confirmed that BP starts early in life, but the patterns of onset and development over time vary for different parts of the spine and between genders. Because of these differences, it is recommended to report on BP in youngsters separately for the three spinal regions, and to differentiate in the analyses between the genders and age groups. Although only a small minority reported BP at two or all three surveys, tracking of BP (particularly NP) and care seeking was noted from one survey to the other. On the positive side, individuals without BP at a previous survey were likely to remain pain free at the subsequent survey.

Background

It is well known that back pain (BP) is a common and costly problem in the general population. Previously, BP in children was considered rare and a sign of a potentially serious disorder [1,2]. Today, according to a recent systematic review, the general opinion would be that BP, including low back pain (LBP), mid back pain (MBP) and neck pain (NP), starts already early in life to accelerate during the early teens up till early adulthood [3] and that its presence in young age is a precursor for BP also in adulthood [4]. In order to approach the issues of prevention and treatment it is helpful to understand the extent and course of a disease, particularly around the time of its onset and that picture is, presently, far from clear. Methodological and definition issues can partly explain this [3]. However, this is also a question of the study objectives and design. It is therefore not surprising that the estimates from various studies vary and that often they make no sense. Also, there appears to be no credible data on the true incidence for each spinal region in young people.

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Early Adolescent Lumbar Intervertebral Disc Injury: A Case Study

By Frank M. Painter|June 20, 2013|Chiropractic Care, Disc Injury, Pediatrics|

Early Adolescent Lumbar Intervertebral Disc Injury: A Case Study

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2013 (Apr 26); 21: 13

Chris T Carter, Lyndon G Amorin-Woods and Arockia Doss

School of Health Professions,
Murdoch University,
Murdoch, Western Australia, Australia

This article describes and discusses the case of an adolescent male with lumbar intervertebral disc injury characterized by chronic low back pain (LBP) and antalgia. A 13-year-old boy presented for care with a complaint of chronic LBP and subsequent loss of quality of life. The patient was examined and diagnosed by means of history, clinical testing and use of imaging. He had showed failure in natural history and conservative management relief in both symptomatic and functional improvement, due to injury to the intervertebral joints of his lower lumbar spine. Discogenic LBP in the young adolescent population must be considered, particularly in cases involving even trivial minor trauma, and in those in which LBP becomes chronic. More research is needed regarding long-term implications of such disc injuries in young people, and how to best conservatively manage these patients. A discussion of discogenic LBP pertaining to adolescent disc injury is included.

The Full-Text Article:

Background

LBP in children and adolescence is an important and increasing problem, and prevalence increases with age [1]. Systematic review and meta-analysis studies of LBP in adolescence found mean LBP point prevalence and one-year prevalence for adolescents to be around 12%, and 33% respectively [2,3]. Watson et al. [4] reported a one month period prevalence of 24% in schoolchildren aged 11–14 years in northwest England. Historically considered as trivial and non-limiting, LBP in this age-group may have both immediate and long-term consequences for an important proportion of those affected [4]. Risk factors have been debated, although ergonomics of school furniture, school bag weight and mechanics, trauma, history of scoliosis, and involvement of strenuous physical activity may be associative or causative factors in young persons with LBP [5]. There is also increasing evidence that psychological and psychosocial factors may play a significant influence in the aetiology of LBP in this age group [6, 7].

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Get the Lead Out!

By Frank M. Painter|May 13, 2013|Iatrogenic Injury, Pediatrics, Pregnancy, Supplementation|

Get the Lead Out!

The Chiro.Org Blog

SOURCE: MedPage Today ~ May 13, 2013

By Nancy Walsh, Staff Writer, MedPage Today

When the FDA finally got around to testing 324 multivitamin-mineral products that target children and pregnant women, they found that only 4 of them were lead-free. [1]

Now, new research published in the Pediatrics Journal suggests that even low levels of lead in a supplement can have adverse effects on your children. [2] Why not use a supplement made correctly, so you can protect your family?

Here’s the Bad news from MedPage Today:

Even Low Lead Exposure Hinders Kids’ Reading

Young children exposed to lead — even at low levels — are at risk for not meeting reading readiness benchmarks in kindergarten, a large study of urban children found.

On tests of reading readiness, children with blood lead levels between 5 and 9 µg/dL scored 4.5 points (95% CI −2.9 to −6.2) lower than those with levels below 5 µg/dL, according to Pat McLaine, DPH, of the University of Maryland in Baltimore, and colleagues.

And those with lead levels of 10 µg/dL and higher had scores 10.1 points (95% CI −7 to −13.3) lower, the researchers reported online in Pediatrics. [2] (more…)

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Too Sweet to Be Good? The Potential Health Hazards of Artificial Sweeteners

By Frank M. Painter|December 27, 2012|Artificial Sweeteners, Attention Deficit, Chemical Sensitivity, Environmental Sensitivity, Food Sensitivity, Headache, Obesity, Pediatrics|

Too Sweet to Be Good? The Potential Health Hazards of Artificial Sweeteners

The Chiro.Org Blog

SOURCE: Dynamic Chiropractic

By Claudia Anrig, DC

With worldwide obesity rates doubling in the past three decades, is it any surprise that artificial sweeteners have been gaining popularity? Beginning with the creation of saccharin, “sugar substitutes” have become the supposed answer to a dieter’s prayer – and part of the daily diet of many of our children.

Let’s review the various sugar substitutes on the market today to appreciate what they are and why they may not be the best option in terms of your patients’ – and your – health.

Aspartame: NutraSweet or Equal

This sugar substitute was discovered in 1965 by accident while chemist James Schlatter was testing an anti-ulcer drug. [1] Aspartame gained FDA approval in 1981 and was approved in 1983 for use in carbonated beverages, where it is most commonly found now as the primary sweetener for most diet sodas. [2]

Aspartame accounts for over 75 percent of the adverse reactions to food additives reported to the FDA and has been linked to serious medical reactions. [3, 4] Researchers and physicians studying these reactions have concluded that the following chronic illnesses can worsen when ingesting aspartame: brain tumors, multiple sclerosis, epilepsy, chronic fatigue syndrome, Parkinson’s disease, Alzheimer’s, mental retardation, lymphoma, birth defects, fibromyalgia, and diabetes. [4] (more…)

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