Pediatrics

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

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.

(more…)

0

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].

There are many more articles like this in our:

Chiropractic Pediatrics Section

You will also enjoy our:

Disc Herniation and Chiropractic Page

(more…)

0

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…)

6

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…)

3

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial

By Frank M. Painter|November 25, 2012|Chiropractic Care, Colic, Pediatrics|

Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2012 (Oct); 35 (8): 600–607

Joyce E. Miller, BS, DC, David Newell, PhD, and
Jennifer E. Bolton, PhD

Associate Professor,
Anglo-European College of Chiropractic,
Bournemouth, UK.
jmiller@aecc.ac.uk.

Dr. Miller wrote a follow-up to this study, a cost comparison of the medical and chiropractic care provided in her earlier RTC study, titled:

Costs of Routine Care For Infant Colic in the UK and Costs of Chiropractic Manual Therapy as a Management Strategy Alongside a RCT For This Condition
J Clinical Chiropractic Peds 2013 (Jun); 14 (1): 1063–1069

This RTC cast new and significant insights into previous colic trials:

Chiropractic care lowered overall costs more than 400% compared with medical management
The current study revealed that excessively crying infants were 5 times less likely to cry significantly, if they were treated with chiropractic manual therapy, and that chiropractic care reduced their crying times by about 50%, compared with those infants provided solely medical management.

OBJECTIVE: The purpose of this study was to determine the efficacy of chiropractic manual therapy for infants with unexplained crying behavior and if there was any effect of parental reporting bias.

METHODS: Infants with unexplained persistent crying (infant colic) were recruited between October 2007 and November 2009 at a chiropractic teaching clinic in the United Kingdom. Infants younger than 8 weeks were randomized to 1 of 3 groups: (i) infant treated, parent aware; (ii) infant treated, parent unaware; and (iii) infant not treated, parent unaware. The primary outcome was a daily crying diary completed by parents over a period of 10 days. Treatments were pragmatic, individualized to examination findings, and consisted of chiropractic manual therapy of the spine. Analysis of covariance was used to investigate differences between groups.

RESULTS: One hundred four patients were randomized. In parents blinded to treatment allocation, using 2 or less hours of crying per day to determine a clinically significant improvement in crying time, the increased odds of improvement in treated infants compared with those not receiving treatment were statistically significant at day 8 (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 1.4-45.0) and at day 10 (adjusted OR, 11.8; 95% CI, 2.1-68.3). The number needed to treat was 3. In contrast, the odds of improvement in treated infants were not significantly different in blinded compared with nonblinded parents (adjusted ORs, 0.7 [95% CI, 0.2-2.0] and 0.5 [95% CI, 0.1-1.6] at days 8 and 10, respectively).

CONCLUSIONS: In this study, chiropractic manual therapy improved crying behavior in infants with colic. The findings showed that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects in this study. Thus, it is unlikely that observed treatment effect is due to bias on the part of the reporting parent.

Introduction

Excessive infant crying in otherwise healthy infants, traditionally called infant colic, continues to be an enigmatic condition with no known cause and no known cure. [1-3] Afflicting between 10% to 30% of all infants and consuming significant health care resources, [2] infant colic is a problem for parents and clinicians, both of whom try a wide range of therapies with often disappointing results.

You may review the earlier Colic studies at:

The Infantile Colic and Chiropractic Page

and you may also enjoy our

Chiropractic Pediatrics Page

Despite decades of research, a clear pathogenesis has not been elucidated. Notwithstanding, what is clear is that underlying disease is rare in the excessively crying baby [4] and that half of those affected recover by 6 months of age, [5] with a small proportion at risk of injury [6] or long-term developmental problems. [7-9] In an effort to help their child with what appears to be a painful condition, some parents choose complementary and alternative medicine (CAM), including chiropractic manual therapy. [9-12] To date, several randomized trials have been reported, [13-19] and although these trials demonstrate some reduction in crying, weaknesses in study methodologies have compromised their contribution to the evidence base. [20-23]

(more…)

1

What Is the Role Of Chiropractic Care in Prevention or Reduction of Musculoskeletal Injuries in Children?

By Frank M. Painter|November 19, 2012|Chiropractic Care, Pediatrics|

What Is the Role Of Chiropractic Care in Prevention or Reduction of Musculoskeletal Injuries in Children?

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2012 (Sep); 35 (7): 493–513

Chiropractic Care and Public Health: Answering Difficult Questions About Safety, Care Through the Lifespan, and Community Action

Lise Hestbaek, DC, PhD

Back and neck pain are common ailments in school age children with prevalence rates ranging from 5% to 74%. [38, 39] The prevalence of low back pain increases from preadolescence to early adulthood, [38, 40] but after that, the prevalence rates change surprisingly little. [41] A similar pattern is seen for neck pain, [41] but less is known about the course of other musculoskeletal disorders throughout life. However, extremity complaints are found frequently in children. [42]

It has been demonstrated that children and adolescents with musculoskeletal complaints have a higher risk of having these problems as adults. [43-45] Pain and aberrant musculoskeletal function are known to have other consequences with regard to health. Long-lasting pain conditions, including back pain, have been associated with a generally decreased pain threshold, [46-48] which seems to develop alongside pain, because patients did not have a higher pain threshold than asymptomatic subjects before the onset of back pain. [49] If this process is initiated in childhood, it is likely to increase the impact of minor trauma or overuse in everyday life and thus may induce a lifelong cascade of negative health events, resulting in poorer general health and lower quality of life.

Another possible consequence of musculoskeletal disorders in childhood is pain becoming a barrier to physical activity. Children who are injured while performing sport activities [42, 50] may avoid or stop the activity that caused the original injury. It is also plausible that continued pain or discomfort may reduce motivation to participate and enjoy physical activities. Reduction in activity can have serious health implications over time. It is established that physical activity is one of the most important factors relating to several lifestyle disorders such as diabetes and cardiovascular disease, [51, 52] and it has been shown that increased physical activity in youth can reduce the risk of these disorders in adulthood. [53, 54] Moreover, health habits throughout the lifespan are established in youth, [55, 56] and therefore, promoting and maintaining a healthy level of physical activity in children and adolescence are essential to improve public health. Thus, an important element to reach lifelong health is to optimize musculoskeletal health.

You may also enjoy our:

Chiropractic Pediatrics Page

(more…)

4