Welcome to the Pediatric Section @ Chiro.Org! This section provides articles
and abstracts describing the benefits of chiropractic care for children.


Chiropractic Pediatrics

This section was compiled by Frank M. Painter, D.C.
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Alternative Care Chiropractic

If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary. If you want information about a specific disease, you can access the Merck Manual. You can also search Pub Med for more abstracts on this, or any other health topic.

Jump to: Pediatric References Articles of Interest Adverse Events

Attention Deficit Back & Neck Pain Breastfeeding Issues

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Chronic Neck Pain Low Back Pain Whiplash Section

Conditions That Respond Alternative Medicine Approaches to Disease


Helpful Pediatric References

Attention Deficit (ADD ~ ADHD) Page
A Chiro.Org article collection

Attention Deficit/Hyperactivity Disorder (ADD ~ ADHD) is the most commonly reported childhood behavioral disorder, affecting between between 3 and 7% of American children. The most common medical “treatment” for this controversial “disease” is prescriptions of Methylphenidate (Ritalin), a Class II controlled and addictive substance. The long-term effects of this drug on children is unknown, but the side-effects, including addiction, are becoming better understood. Learn more about how alternative approaches (chiropractic, nutrition) can help, without the reliance upon and social stigma of drugs.

Chiropractic and Spinal Pain
A Chiro.Org article collection

Review a collection of articles that focus on the effectiveness of chiropractic for reducing pain.

Chiropractic and Scoliosis
A Chiro.Org article collection

Review a collection of articles that focus on the effectiveness of chiropractic for scoliosis

Low Back Pain and Chiropractic
A Chiro.Org article collection

Review a collection of articles that focus on the effectiveness of chiropractic for reducing low back pain.

Our Pediatrics Book Shelf
A Chiro.Org book collection

Review the top texts on Chiropractic Pediatrics by our foremost authors. Your purchase of books from our partner Amazon helps to support our non commercial website.

Kids Need Chiropractic, Too!
A Chiro.Org article collection

This page is a collection of 137 different articles by various authors about the need for, safety, and the benefits of chiropractic care for children.   Updated 2-01-2016

Chiropractic Care for a Variety of Conditions
A Chiro.Org article collection

This page contains research articles demonstrating the benefits of chiropractic care for a variety of disorders, including asthma, colic, otitis media (middle ear infections), and several other childhood disorders.

Joint Pain in Children
A Dynamic Chiropractic article series

Joint pain is a common complaint in children but seldom a symptom of serious joint disease. How can you determine if a child with knee pain has just a strain/sprain or a more serious joint disease, such as Lyme disease, rheumatic fever, or juvenile rheumatoid arthritis? I'd like to review the more common joint disorders affecting children.

Pregnancy and Chiropractic: A Narrative Review of the Literature
J Chiropractic Medicine 2007 (Jun);   6 (2):   70–74 ~ FULL TEXT
Thirty-three references were used for this review. The current literature reports favorable results on the use of chiropractic care throughout pregnancy.   Chiropractic evaluation and treatment during pregnancy may be considered a safe and effective means of treating common musculoskeletal symptoms that affect pregnant patients. The scarcity of published literature warrants further research.

Infant and Child Chiropractic Care: An Assessment of the Research
Foundation for Chiropractic Education and Research ~ FULL TEXT
An assessment of pediatric research regarding chiropractic care for back pain, headaches, otitis media, infantile colic, constipation, nocturnal enuresis, asthma, retrolisthesis, scoliosis and neurological disorders including epilepsy, autism and ADD/ADHD. This monograph also includes a discussion of chiropractic theory, practice and safety issues.

Chiropractic Child Care
International Chiropractic Association
This is the 4th chapter of ICA's Recommended Clinical Protocols and Guidelines for the Practice of Chiropractic in Adobe Acrobat (PDF) format.

Adjusting the Pediatric Spine
Topics in Clinical Chiropractic 1997;   4 (4):   59–69 ~ FULL TEXT
The subject of chiropractic care of children must by necessity include a discussion of the various techniques chiropractors use to address a subluxation. [1–2] The act of introducing a force into a spinal joint in an effort to restore mobility or alignment is termed an adjustment.
This article discusses the technical aspects of adjusting the pediatric spine (ie, occiput to pelvis).

Other Topical Reference Pages:
Antibiotic Abuse Backpacks and Children Peds Book Shelf

Vaccine Information Vertebral Subluxation Women's Health


Pediatric Articles of Interest

Chiropractic Care for the Pregnant Body
Clinical Obstetrics and Gynecology 2021 (Sep 1);   64 (3):   602–610 ~ FULL TEXT

Chiropractic care is a commonly used treatment modality for musculoskeletal pain in pregnancy. Low back pain, pelvic pain, and other neuromuscular complaints are prevalent in pregnancy and contribute to significant maternal discomfort in many women. Nonpharmacologic therapies to relieve pain are increasingly important during pregnancy because of the opioid epidemic. Chiropractic treatment is one of the potential therapies that offers intervention without medications. This article provides an evidence-based review of the epidemiology of chiropractic use in obstetrics, commonly treated conditions, related physiology of pregnancy, and safety of spinal manipulation.

The Effect of Chiropractic Care on Infantile Colic:
Results From a Single-blind Randomised Controlled Trial
Chiropractic & Manual Therapies 2021 (Apr 19);   29:   15 ~ FULL TEXT

In conclusion, we found that excessive crying was reduced by half an hour in favor of the group receiving chiropractic care compared with the control group, but not at a statistically significant level after adjustments. From a clinical perspective, the mean difference between the groups was small, but there were large individual differences, which emphasizes the need to investigate if subgroups of children, e.g. those with musculoskeletal problems, benefit more than others from chiropractic care.

Identifying Potential Treatment Effect Modifiers of the Effectiveness
of Chiropractic Care to Infants with Colic Through Prespecified
Secondary Analyses of a Randomized Controlled Trial
Chiropractic & Manual Therapies 2021 (Apr 19);   29:   16 ~ FULL TEXT

None of the preselected items or predefined indices were valuable for identification of infants with potentially larger gain from manual therapy than others. However, more hours of crying at baseline, short duration of symptoms and young age were all associated with an increased effect of chiropractic care; hours of crying at a statistically significant level. This may be a clinically relevant finding, suggesting that the most severely affected infants have the greatest potential for an advantage from manual therapy. This finding requires validation by further studies.

Why Aren’t Chiropractic Physicians Treating More Children with
Complex Diagnoses? A Commentary on Documenting P.A.R.T. for
Diagnosing and Treating Special Needs Children

Journal of Clinical Chiropractic Pediatrics 2019 (Nov);   18 (2) ~ FULL TEXT

It has been the clinical experience of chiropractic physicians and other health care professionals at Kentuckiana Children’s Center that many of the neuromusculoskeletal manifestations of the challenged child can be well managed and functional improvement attained when delivered in conjunction with many of the other rehabilitative services (occupational therapy, physical therapy, speech therapy, feeding therapies, etc). It is imperative that chiropractic physicians understand the value of their services to this population and seek the support and education to establish a comfort level with these patients and their care. Appropriate examination and documentation procedures will also assure appropriate reimbursement for services.

Manual Therapy for the Pediatric Population: A Systematic Review
BMC Complement Altern Med. 2019 (Mar 13);   19 (1):   60 ~ FULL TEXT

Fifty studies investigated the clinical effects of manual therapies for a wide variety of pediatric conditions. Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition's overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed.

Maternal Report of Outcomes of Chiropractic Care for Infants
J Manipulative Physiol Ther. 2019 (Mar);   42 (3):   167–176 ~ FULL TEXT

This was the first study of its kind to investigate prospectively collected data provided by mothers regarding presentation and outcomes from treatment from a large cohort of infants presented for chiropractic care. The infant’s care was reported by the mothers who completed follow-up as effective, safe, and cost-effective.

Can a Bothersome Course of Pelvic Pain From Mid-pregnancy to Birth
be Predicted? A Norwegian Prospective Longitudinal SMS-Track Study

BMJ Open. 2018 (Jul 25);   8 (7):   e021378 ~ FULL TEXT

If both active straight leg raise (ASLR) and P4 tests are positive at a clinical examination in mid-pregnancy, a course of persistent bothersome pelvic pain for more than 5 days per week throughout pregnancy may be predicted. The number of days per week with bothersome pelvic pain increases for every added pregnancy, but individual control over work situation and regular exercise may work as a PGP prophylactic since it invigorates a positive impact on optimal force closure of the pelvis, reduces risk of instability in the pelvic joints and enhances overall well-being.

The Effect of Chiropractic Treatment on Infantile Colic:
Study Protocol for a Single-blind Randomized Controlled Trial
Chiropractic & Manual Therapies 2018 (Jun 7);   26:   17 ~ FULL TEXT

In a single-blind randomized controlled design we will evaluate the effectiveness of chiropractic treatment on infantile colic. The study will contribute to determine the effect of chiropractic treatment on infantile colic in an area where limited evidence exists. Furthermore, the study aims to explore if subgroups of children with suspected musculoskeletal problems will benefit more from the intervention than others. If they obtain better results, this could imply the need for stratified care.

Association Between Use of Acid-Suppressive Medications and
Antibiotics uring Infancy and Allergic Diseases in Early Childhood

JAMA Pediatrics 2018 (Jun 4);   172 (6):   e180315 ~ FULL TEXT

Infants who are given antacids like Zantac or Pepcid are more likely to develop childhood allergies. Early use of antibiotics also raised the chances of allergies in the study of nearly 800,000 children. Researchers combed the health records of kids born between 2001 and 2013 and covered by Tricare, an insurance program for active duty and retired military personnel and their families. A surprising 9 percent of the babies received antacids, reflecting the popularity of treating reflux in infancy. Over four years, more than half of all the children developed allergies to foods or medications, rashes, asthma, hay fever or other allergic diseases. The study couldn’t prove causes, but the connection with antacids and antibiotics was striking.

Chiropractic Management of a Patient with Asthma: Case Report
and Follow-Up of a 12-Year-old Female

Chiropractic Journal of Australia 2018 (Mar 13);   46 (1):   48–78 ~ FULL TEXT

The management of this case was centred on spinal adjustments of spinal subluxations. The significance of this complex is its influence upon neurological elements – both physical and physiological. Other supportive measures were considered important but adjunctive to the management of this patient. It should be noted that chiropractic case management is not necessarily limited to manual spinal care alone. In view of the published chiropractic, medical, and osteopathic published evidence, it would be imprudent and even unprincipled to deny that there is some evidence to support the observation of a spine-related influence in some asthmatics. Without that evidence identified in case reports, there would not be grounds for further research on the topic or involvement in management of asthmatics. However, positive outcomes and patient demand continues to drive and justifies that involvement. As reported in Australian Doctor, 1/3rd of asthmatic patients are already seeking care outside the conventional model. This cited Canadian research study found that more than one-third of asthma patients use complementary and alternative medicines to try to control their symptoms. [222]

Prevalence and Incidence of Musculoskeletal Extremity Complaints
in Children and Adolescents. A Systematic Eeview

BMC Musculoskelet Disord. 2017 (Oct 18);   18 (1):   418 ~ FULL TEXT

In general, ankle/ft and knee were the most frequent sites of musculoskeletal extremity complaints regardless of age and type of population. However, in the general population studies, there were relatively more non-traumatic complaints of the lower extremities than in the clinical population studies, indicating a large amount of non-traumatic low intensity complaints in the general population that do not reach threshold for consultation. We intended to describe the prevalence and incidence of musculoskeletal extremity complaints in children and adolescents, but a meta-analysis, or even a simple overall description of prevalence and incidence, was not feasible, due to study heterogeneity, primarily related to outcome. Future research should use standardised and validated outcome measures and investigate the possible consequences of the low intensity complaints in large longitudinal cohorts to establish if there is a potential for prevention of long-term sequelae through early detection and intervention.

Pediatric Patients in Swiss Chiropractic Clinics: A Questionnaire Survey
J Manipulative Physiol Ther. 2017 (Sep);   40 (7):   477–485 ~ FULL TEXT

The sample consisted of 144 chiropractors, which represented a 53% response rate, and 98% of the responding practitioners treated patients younger than age 18. The proportion of pediatric patients treated was 8.7%. The most common pediatric age groups were schoolchildren and adolescents, with infants younger than 6 months being the third most common. Musculoskeletal complaints were the most common conditions treated in all age groups. In children younger than 2 years old, nonmusculoskeletal conditions were well represented. Prophylactic examination was common among children 6 years and younger. A total of 61% of responding chiropractors received direct referrals from medical doctors and 56% received direct referrals from pediatricians. The most common age groups for referrals from pediatricians were schoolchildren and adolescents. Only 15% of the chiropractors wrote reports about their pediatric patients to their pediatrician often or regularly; 90% of the responding chiropractors stated they rarely or never refer to a pediatric specialist, and 80% of the chiropractors have never or have rarely been invited to attend medical congresses or to teach the pediatric health care community about chiropractic care for children.

Pediatric Integrative Medicine
Pediatrics. 2017 (Sep);   140 (3):   e20171961 ~ FULL TEXT

The American Academy of Pediatrics is dedicated to optimizing the well-being of children and advancing family-centered health care. Related to this mission, the American Academy of Pediatrics recognizes the increasing use of complementary and integrative therapies for children and the subsequent need to provide reliable information and high-quality clinical resources to support pediatricians. This Clinical Report serves as an update to the original 2008 statement on complementary medicine. The range of complementary therapies is both extensive and diverse. Therefore, in-depth discussion of each therapy or product is beyond the scope of this report. Instead, our intentions are to define terms; describe epidemiology of use; outline common types of complementary therapies; review medicolegal, ethical, and research implications; review education and training for select providers of complementary therapies; provide educational resources; and suggest communication strategies for discussing complementary therapies with patients and families.

Infant Demographic Profile and Parent Report of Treatment Outcomes
at a Chiropractic Clinic in the UK: An Observational Study

J Clinical Chiropractic Pediatrics 2017 (Jan);   17 (1):   1398–1404 ~ FULL TEXT

413 mothers completed the intake questionnaires. 197 (48%) mothers completed the discharge questionnaires. At intake, 50.3% (n=182) of the patients were four weeks of age or younger. The presenting complaint appeared before the age of two weeks in 79.1% (n=161) of the cases. 30.2% (n=160) presented with colic/crying and 22.9% (n=121) with a feeding related complaint. The modal length of an episode of care was two weeks. Over the course of treatment, average maternal distress levels reduced by 48%. Mean amount of irritability reduced by 31%; mean restfulness of sleep improved by 27% and mean difficulty to console reduced by 38% in the infant. The median EPDS score dropped by 50% over the time of care. 96.3% of parents rated 8–10 satisfaction with care on a scale of 1–10.

Clinical Effects of Spinal Manipulation in the Management of Children
and Young Adults Diagnosed With Autism Spectrum Disorder –
A Systematic Review of the Literature

Journal of Clinical Chiropractic Pediatrics 2016 (Dec);   15 (3):   1280–1291 ~ FULL TEXT

The results of this systematic review confirm a general lack of good quality, high level of evidence studies on the topic, as well as no existing experimental studies that have been published in the last 10 years. This review indicates that the literature on the effects of chiropractic interventions to the musculoskeletal system of autistic children and young adults appears to be favourable with respect to the severity of their symptoms. However, the results of this review have to be interpreted with great caution, as the majority of identified studies were case reports. Further feasibility and pilot research is needed to lay the foundation for good quality clinical trials of spinal manipulation in the autistic child population.

Children and Adolescents Presenting to Chiropractors in Norway:
National Health Insurance Data and a Detailed Survey

Chiropractic & Manual Therapies 2016 (Aug 1);   24:   29 ~ FULL TEXT

The youngest children constituted the largest pediatric group in Norwegian chiropractic practice. Musculoskeletal problems were the most common reason for children visiting a chiropractor in all of the age categories, according to NHI data. Part two of the study found that one-third of young school children and adolescents reported pain lasting longer than 1-year. Eleven percent of children found that their complaint had severely affected their mood and 22% felt their activities were very limited by their condition. Referrals from healthcare professionals were uncommon. The survey's results were based on 161 completed questionnaires, received from 15% of the Norwegian chiropractors.

Forces of Commonly Used Chiropractic Techniques for Children:
A Review of the Literature

J Manipulative Physiol Ther. 2016 (Jul);   39 (6):   401–410 ~ FULL TEXT

This review found that technique selection and application by chiropractors treating infants and young children are typically modified in force and speed to suit the age and development of the child.

Effect of Spinal Manipulation on Pelvic Floor Functional Changes in Pregnant
and Nonpregnant Women: A Preliminary Study

J Manipulative Physiol Ther. 2016 (Jun);   39 (5):   339–347 ~ FULL TEXT

Spinal manipulation of pregnant women in their second trimester increased the levator hiatal area at rest and thus appears to relax the pelvic floor muscles. This did not occur in the nonpregnant control participants, suggesting that it may be pregnancy related.

Chiropractic Management of Pregnancy-Related Lumbopelvic Pain: A Case Study
Journal of Chiropractic Medicine 2016 (Jun);   15 (2):   129–133 ~ FULL TEXT

There are discrepancies to defining lumbopelvic pain in the pregnant population. [1, 2] Current terminology, pain topography, functional disabilities, and positive correlation of clinical testing have demarcated the classification of pregnancy-related lumbopelvic pain (PR LPP) into subgroups:   Pregnancy- related low back pain (PR LBP) has been defined [2] as pain between the 12th rib and the gluteal fold throughout the course of the pregnancy. Pregnancy-related back pain shares clinical symptoms to nonpregnancy nonspecific low back pain, [2–4] including dull pain exacerbated by forward flexion, associated erector spinae pain upon palpation, and associated restriction in lower spinal movement.   Pregnancy-related pelvic girdle pain (PR PGP) is defined as pain located from the level of the posterior iliac crest, the gluteal fold, and over the anterior and posterior elements of the pelvis during the course of the pregnancy. Pregnancy-related pelvic girdle pain also includes symphysis pubis pain syndrome and leg disturbances. The pain may radiate across the hip joint and femur, [7] lacking a typical nerve root distribution. [4] In PR PGP, functional abilities are compromised including endurance capacity for standing, walking, and sitting.

Chiropractic Care For Infants And Children – There Is No Evidence For It
and It Is Dangerous? A Selective Review of The Literature and Commentary

Chiropractic Journal of Australia 2016;   44 (3):   222–233 ~ FULL TEXT

This selective review of the literature was conducted to examine the accuracy of claims reported in Australia in the popular press relating to chiropractic care of infants and children. These were specifically that there is no evidence to support the practice, and that it is dangerous. The reviewed literature reveals several important points. Aspects of medical care were reviewed to contextualize the relative risk of normal medical care relating to hospitalisation and medications, and particularly with respect to the paediatric age group. Adverse events were commonly reported related to this. The adverse event literature relating to the chiropractic care of infants and children reports the practice as a low-risk intervention. It highlights the importance of a thorough history and examination, an ability to refer when appropriate to minimize delayed diagnosis of medically treatable conditions, and age appropriate modification of technique.   The review has documented a range of literature to underpin the evidence base for the chiropractic care of children and infants. This base is small, and it is noted that it has grown substantially over the past decade. Australian chiropractors are university educated and regulated under the Australian Health Practitioners Regulatory Authority along with 13 other health professions including medicine, nursing and midwifery, dentistry, and physiotherapy. [43] The literature reviewed does not support the claims that the chiropractic care of children and infants has no evidence to support the practice, and that it is dangerous.

Developmental Advancements Following Chiropractic Care in a
Four-year-old Child with Dyspraxia and Associated
Developmental Delays: A Case Report

Journal of Clinical Chiropractic Pediatrics 2015 (Oct);   15 (1):   1207–1210 ~ FULL TEXT

The child experienced a number of developmental advancements over the duration of chiropractic care, specifically in speech, fine motor control and coordination. After 8 visits the patient learned 20 new words in one week, after 12 visits all primitive reflexes were tested to be within normal limits and after 15 visits their vocabulary consisted of hundreds of words and continued to expand.

Resolution of Recurrent Acute Otitis Media in a Child Undergoing
Chiropractic Care: A Case Report

Journal of Clinical Chiropractic Pediatrics 2015 (Oct);   15 (1):   1203–1206 ~ FULL TEXT

23-month-old female presenting with 6 acute otitis media episodes since the age of 6 months. Current allopathic treatment consists of antibiotic therapy but episodes of otitis media are still recurrent. The patient received 6 full spine diversified chiropractic adjustments with myofascial release of cervical muscles and effleurage of the frontal and maxillary sinuses over the course of one month. Treatment protocol was then changed to 1 visit per 2 weeks, 1 visit per month and lastly, prevention visits at 1 visit per 2 months or whenever the patient presented with cold symptoms. During the year following the first chiropractic treatment, the patient continued chiropractic care every two months and has had no reoccurrence of AOM.

First-Contact Care With a Medical vs Chiropractic Provider After
Consultation With a Swiss Telemedicine Provider: Comparison of
Outcomes, Patient Satisfaction, and Health Care Costs
in Spinal, Hip, and Shoulder Pain Patients

J Manipulative Physiol Ther. 2015 (Sep);   38 (7):   477–483 ~ FULL TEXT

JMPT's Editor-in-Chief Claire Johnson, DC, MEd, emphasized the importance of the latest findings:
“Comparative studies – in other words, research that compares the outcomes between two different providers or modalities – are rare for chiropractic care,” she said.   “Thus, this study by Houweling, et al., is especially important if payers and policy-makers are to better understand the 'triple aim' as it relates to chiropractic. Specifically, this study helps us better understand what type of care provides better patient satisfaction, is more cost effective, and improves population health.”

Use of Complementary Health Approaches Among Children Aged 4–17 Years
in the United States: National Health Interview Survey, 2007–2012

National Health Statistics Report 2015 (Feb 10);   (78):   1–19 ~ FULL TEXT

This report presents national estimates of the use of complementary health approaches among children aged 4–17 years in the United States. Selected modalities are compared for 2007 and 2012 to examine changes over time.   The combined sample included 17,321 interviews with knowledgeable adults about children aged 4–17 years.

A Survey of Parent Satisfaction with Chiropractic Care of the Pediatric Patient
Journal of Clinical Chiropractic Pediatrics 2014 (Nov);   14 (3):   1167–1171 ~ FULL TEXT

This study showed that parents generally were very satisfied with chiropractic care of their child. Correlations between high satisfaction and improvement of the infant’s presenting complaint, improved sleep quality, and lower levels of parental distress were observed.

Outcomes Of Pregnant Patients With Low Back Pain Undergoing
Chiropractic Treatment: A Prospective Cohort Study With
Short Term, Medium Term and 1 Year Follow-up

Chiropractic & Manual Therapies 2014 (Apr 1);   22 (1):   15 ~ FULL TEXT

Pregnant patients with low back or pelvic pain, no contraindications to manipulative therapy and no manual therapy in the prior 3 months were recruited. Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded. 52% of 115 recruited patients 'improved' at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There were significant reductions in NRS and Oswestry scores (p < 0.0005).

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

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

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.

Is There a Difference in Head Posture and Cervical Spine Movement
in Children With and Without Pediatric Headache?

Eur J Pediatr. 2013 (Oct);   172 (10):   1349–1356 ~ FULL TEXT

This study found evidence of impaired function of the cervical spine in children with purported CGH. When compared with an asymptomatic group of children, those with headache had significantly reduced active ROM in all directions, significantly less range recorded during the FRT, significantly higher pain scores following the FRT, and significantly greater forward head posture. This information may be useful to clinicians in the identification of children with suspected CGH. Decreased ROM and pain provocation during the FRT appears to have potential diagnostic value. This study sets the groundwork for future studies investigating headache in children. Future studies should investigate the diagnostic value of these tests in the identification of CGH from other headache forms such as migraine or tension-type headache. In addition, impairments of the cervical spine as a contributing factor to different pediatric headache forms needs to be clarified in more detail.

A Randomized Controlled Trial Comparing A Multimodal Intervention
and Standard Obstetrics Care For Low Back
and Pelvic Pain In Pregnancy

Am J Obstet Gynecol. 2013 (Apr);  208 (4):   295. e1–7 ~ FULL TEXT

A prospective, randomized trial of 169 women was conducted. Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants. The group that received standard obstetric care demonstrated no significant improvements. The chiroprtactic group demonstrated significant mean reductions in Numerical Pain Rating Scale scores.

Pre-Eclampsia and the Impact on Chiropractic Management of the Pregnant Patient
Journal of Clinical Chiropractic Pediatrics 2012 (Dec);   13 (1): 1032–1036 ~ FULL TEXT

Pre-eclampsia (also known as toxemia of pregnancy) is one of the major causes of maternal mortality and morbidity. 10%–15% of maternal deaths are directly associated with pre-eclampsia and eclampsia. [1] Up to 10% of pregnant women develop pre-eclampsia. [2] The incidence of pre-eclampsia in the nulliparous woman is cited as being between 3%–7% and for the multiparous woman 1%–3%. [1, 3] This diagnosis is based on the presence of hypertension, proteinuria, with or without edema. As primary contact health care providers, chiropractors must be aware of the risk factors, clinical signs of pre-eclampsia, and the need to modify their management appropriately.

Energy Drinks and Adolescents – What Should Health Practitioners Know?
Journal of Clinical Chiropractic Pediatrics 2012 (Dec);   13 (1):   1042–1044 ~ FULL TEXT

Energy Drinks are readily available in supermarkets throughout the world. There are currently no restrictions or guidelines on safe consumption by children. Energy drink consumption by adolescents is on the rise, as companies continue to aggressively market their product to this demographic. It has become socially acceptable for children to consume these drinks, as there is a perception that the products are safe. In addition, they have become a popular accessory in the youth extreme-sport culture. Overall, research on adolescent energy drink consumption is lacking, however side effects similar to that seen in adults, have been reported in the adolescent population.

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

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

In this study, chiropractic manual therapy improved crying behavior in infants with colic (50% reduction).   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.

Dr. Miller wrote a follow-up 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 Pediatrics 2013 (Jun);   14 (1):   1063–1069

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

  1. Chiropractic care lowered overall costs more than 400% compared with medical management

  2. That 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.

Recognition of Perinatal Stroke in a Chiropractic Practice:
Case Report and Clinical Challenges Related to a Late Diagnosis

J Clinical Chiropractic Pediatrics 2012 (Jun);   13 (1): 958–967 ~ FULL TEXT

In recent years, improvements in medical techniques and technology have enabled primary health care practitioners to diagnose perinatal strokes in infants far earlier than ever before. This new technology can also support chiropractors, especially those working with pediatric patients, in order to validate their diagnosis when they recognize these initial symptoms.

Chiropractic or Osteopathic Manipulation for Children in the United States:
An Analysis of Data from the 2007 National Health Interview Survey

J Clinical Chiropractic Pediatrics 2012 (Jun);   13 (1): 958–967 ~ FULL TEXT

The chief limitations of this study were related to the construction of the questions available for analysis. First, chiropractic and osteopathic manipulation was combined in a single variable, making it impossible to make conclusions about the characteristics or complaints of patients of either practitioner. This is an important distinction, since osteopathic scope of practice includes the use of drugs and surgery as well as manipulation, so it is possible that patients who see osteopathic practitioners for manipulation might have different characteristics and chief complaints than those who see chiropractic practitioners.

An Investigation of Musculoskeletal Dysfunctions in Infants
Including a Case Series of KISS Diagnosed Children

J Clinical Chiropractic Pediatrics 2012 (Jun);   13 (1):   958–967 ~ FULL TEXT

The purpose of this study was to describe etiology, presentation and treatment of musculoskeletal issues in early infancy by integrating a case series of infants diagnosed with kinematic imbalance due to suboccipital sprain (KISS) and treated in a teaching clinic in the United Kingdom with a critical review of the concept of KISS. The concept has been developed by Heiner Biedermann and medical doctors in Germany and contributed significantly to the development of manual therapy in children in that country.

Effect of Backpack Load Carriage on Cervical Posture in Primary Schoolchildren
Work. 2012 (Jan 1);   41 (1):   99–108

Subjects demonstrated immediate and statistically significant changes in craniovertebral angle (CVA), indicating increased forward head positions upon donning the backpacks containing 15% and 20% body weight. Following the walking of 6 minutes, the CVA demonstrated further statistically significant changes for all backpack loads indicating increased forward head postures. For the 15 & 20% of body weight conditions, more than 50% of the subjects reported discomfort after walking, with the neck as the primary location of reported pain.

Attitudes and Views on Chiropractic: A Survey of United States Midwives
Complement Ther Clin Pract. 2011 (Aug);   17 (3):   135–140

A total of 187 midwife respondents completed the (online) questionnaire resulting in a superficial response rate of 2.1%. Responders were certified nurse-midwives and had some form of training regarding chiropractic. The responders were aware that chiropractors worked with "birthing professionals" and attended to patients with both musculoskeletal and non-musculoskeletal disorders.   The vast majority indicated a positive personal and professional clinical experience with chiropractic and that chiropractic was safe for pregnant patients and children. There is great awareness of and positive personal and professional experience with chiropractic on the part of midwives who participated in this survey.

Attitudes of Clinicians at the Canadian Memorial Chiropractic College
Towards the Chiropractic Management of Non-musculoskeletal Conditions

J Can Chiropr Assoc. 2011 (Jun);   55 (2):   107–119

Twenty of 22 clinicians responded. The conditions garnering the greatest positive ratings include: asthma, constipation, chronic pelvic pain, dysmenorrhea, infantile colic, and vertigo. The options regarding vertigo and asthma, while demonstrating an overall positive attitude towards the benefits of chiropractic care, were stratified amongst clinicians with varying years in clinical practice.   This study suggests clinicians at this college are moderately open towards the chiropractic treatment of some non-musculoskeletal disorders.

Nutritional Factors Affecting Postpartum Depression
J Clinical Chiropractic Pediatrics 2011 (Jun);   12 (1):   849–860

Pregnancy and lactation represent a period of substantial physiological changes for the mother and increased nutritional requirements to meet these adjustments. A number of nutritional depletions occur during pregnancy. Serum concentrations of iron and folate take months before they normalize to pre-pregnancy levels. Additionally, many micronutrients required during pregnancy interfere with each other, making absorption difficult. Postpartum depression is the primary complication of childbirth, possibly caused by several nutritional and non-nutritional factors. The current review highlights the impact nutrition may have on the etiology of this debilitating disorder, most notably on prevention of inflammation and maintenance of a healthy central nervous system. The most notable nutritional deficiencies associated with postpartum depression include omega-3 fatty acids, folate, iron, and zinc; however, supplementation trials for prevention of postpartum depression are severely lacking. Practical recommendations are given to minimize micronutrient interference and reduce the risk of postpartum depression.

The Pediatric Elbow: A Review of Fractures
Dynamic Chiropractic ~ June 3, 2011 ~ FULL TEXT

The elbow fracture is one of the most common fractures in children. Assessing the elbow for fracture can be difficult because of the changing anatomy of the growing skeleton and the subtlety of some of these fractures. It's important to be aware of the radiographic signs of fracture in the elbow, along with knowing the appearance and fusion of the ossification centers in the pediatric patient, to avoid confusing an ossification center with a fracture fragment. Of course, alignment and radiographic positioning are also extremely important in making a diagnostic assessment.

Chiropractic Care during Pregnancy: Survey of 100 Patients Presenting
to a Private Clinic in Oslo, Norway

J Clinical Chiropractic Pediatrics 2010 (Dec);   11 (2):   771–774 ~ FULL TEXT

Musculoskeletal (MSK) problems in pregnancy constitute a tremendous cost to society, both in regards to sick leave and chronic pain, and are a major public health concern. (In Norway one-third of all pregnant women are on sick leave at any given time, and many of these because of back pain). There is little agreement on the best treatment for the various MSK problems in pregnancy and very little is known about the efficacy of chiropractic treatment in pregnancy. However, chiropractic care has been shown to be both popular with patients during pregnancy, as well as being considered safe and appropriate by chiropractors. The purpose of this paper is to describe a survey which investigated the characteristics of pregnant women who sought chiropractic care in Norway.

Demographic Survey of Pediatric Patients Presenting to
a Chiropractic Teaching Clinic

Chiropractic & Osteopathy 2010 (Dec 15);   18:   33 ~ FULL TEXT

This data review included 2,645 pediatric patients (0–15 years of age). Of these, 2,303 (87%) were under the age of five and 342 (13%) were between the ages of 5 and 15. The complaints of all children over five years were categorized as musculoskeletal. In all age groups, just over a third (34.7%) presented with musculoskeletal problems, 29.6% presented with excess crying (previously known as infant colic) and 15.7% with feeding disorders. All children had previously presented to at least one medical practitioner for the same condition and some had presented to multiple healthcare practitioners (Figure 3). The younger the child, the more common the referral with 83% of infants under 12 weeks of age being sent by a medical practitioner, 39% between 3 and 12 months of age and a 4–5% rate of referral in age groups over one year.

Musculoskeletal Development and Sports Injuries in Pediatric Patients
Dynamic Chiropractic ~ October 21, 2010 ~ FULL TEXT

Physical activity is extremely important for everyone, but especially for children. A well-designed exercise program enhances the physical and intellectual development of a child. Competitive sports are often a child's first introduction to programmed exercise. In the past decade, there has been an increase in the number of children participating in team and solo sports. Younger children are allowed to participate in sports for enjoyment, health and personal development. However, this changes as competitive elements become more dominant and young athletes train harder and longer, and may practice a sport throughout the whole year. Consequently, sports-related injuries in children have significantly increased.

Practice Patterns of Doctors of Chiropractic With a Pediatric Diplomate:
A Cross-sectional Survey

BMC Complement Altern Med. 2010 (Jun 14);   10:   26 ~ FULL TEXT

A total of 135 chiropractors responded (62.2% response rate); they were predominantly female (74%) and white (93%). Techniques most commonly used were Diversified, Activator, and Thompson with the addition of cranial and extremity manipulation to their chiropractic treatments. Adjunctive therapies commonly provided to patients included recommendations for activities of daily living, corrective or therapeutic exercise, ice pack\cryotherapy, and nutritional counseling.

Chiropractic Diagnosis and Management of Non-musculoskeletal Conditions
in Children and Adolescents

Chiropractic & Osteopathy 2010 (Jun 2);   18:   14 ~ FULL TEXT

The efficacy of chiropractic care in the treatment of non-musculoskeletal disorders has yet to be definitely proven or disproven, with the burden of proof still resting upon the chiropractic profession.

The Evidence Base for Chiropractic Treatment of Musculoskeletal
Conditions in Children and Adolescents: The Emperor's New Suit?

Chiropractic & Osteopathy 2010 (Jun 2);   18:   15 ~ FULL TEXT

All over the world, chiropractors treat a large variety of conditions in many ways. However, the core area of chiropractic practice is the musculoskeletal system, with special focus on the spine. Surveys of chiropractic patients in different countries have shown that spinal pain is the most common reason for seeking chiropractic care with 64%–86% reporting spine-related symptoms. [1–5] Other disorders related to the musculoskeletal system are also quite common, whereas non-musculoskeletal problems represent only 2–6% of the complaints. [1–5]

Chiropractic Approach to the Management of Children
Chiropractic & Osteopathy 2010 (Jun 2);   18:   16 ~ FULL TEXT

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.

Chiropractic Care for Children: Too Much, Too Little or Not Enough?
Chiropractic & Osteopathy 2010 (Jun 2);   18:   17 ~ FULL TEXT

This editorial provides an overview of this Thematic Series of the journal titled Chiropractic Care for Children. In commissioning this series of articles we aimed to bring the busy clinician up to date with the current best evidence in key aspects of evaluation and management of chiropractic care for children. Individual articles address a chiropractic approach to the management of children, chiropractic care of musculoskeletal conditions in children and adolescents, chiropractic care of non-musculoskeletal conditions in children and adolescents, chiropractic care for attention-deficit/hyperactivity disorder and possible adverse effects from chiropractic management of children. The final article by Charlotte Leboeuf-Yde and Lise Hestbaek is an overview of the current state of the evidence and future research opportunities for chiropractic care for children. We conclude this editorial discussing the strengths and weaknesses of contemporary research relevant to chiropractic care of children and the implications for chiropractic practice.

The Chiropractic Care of Children
J Altern Complement Med. 2010 (Jun);   16 (6):   621–626 ~ FULL TEXT

A majority of the responders were female with an average practice experience of 8 years. They attended an average of 133 patient visits per week, with 21% devoted to the care of children (<18 years of age). Practice income was derived primarily from out-of-pocket reimbursement with charges of an average of $127 and $42 for the first and subsequent visits, respectively. These visits were reimbursed to address common conditions of childhood (i.e., asthma, ear infections, etc.). Approach to patient care was spinal manipulative therapy (SMT) augmented with herbal remedies, exercises, rehabilitation, and so on. Wellness care also figured prominently as a motivator for chiropractic care. Fifty-eight percent (58%) indicated an established relationship with an osteopathic or medical physician. Eighty percent (80%) of the responders indicated referring patients to medical practitioners while only 29% indicated receiving a referral from a medical/osteopathic physician.

The Effect of Backpacks on the Lumbar Spine in Children:
A Standing Magnetic Resonance Imaging Study

SPINE (Phila Pa 1976) 2010 (Jan 1);   35 (1):   83–88 ~ FULL TEXT

This is the first study to use advanced imaging to demonstrate how backpack loads are responsible for a significant amount of back pain in children, which in part, may be due to changes in lumbar disc height or curvature. This is the first upright MRI study to document reduced disc height and greater lumbar asymmetry for common backpack loads in children.

Safety of Chiropractic Manual Therapy for Children:
How Are We Doing?

J Clinical Chiropractic Pediatrics 2009 (Dec);   10 (2):   655–660

Based on the published literature, chiropractic spinal manipulation, when performed by skilled chiropractors, provides very low risk of adverse effect to the pediatric patient. Vigilance to detect occult pathology as well as other steps to maintain safe practice are of utmost importance.

Injuries in the Pediatric Patient:
Review of Key Acquired and Developmental Issues

J Clinical Chiropractic Pediatrics 2009 (Dec);   10 (2):   665–670 ~ FULL TEXT

A plethora of conditions specifically target children and adolescents which are not prevalent in the adult population. Understanding the age-related differences in this population can help clinicians improve diagnosis and therefore management of these conditions. Though it is beyond the scope of this paper to extensively address diseases targeting the pediatric population, common key injuries will be discussed with emphasis on the role imaging plays in establishing accurate diagnosis.

Diagnosis and Chiropractic Treatment of Infant Headache Based on
Behavioral Presentation and Physical Findings: A Retrospective
Series of 13 Cases

J Manipulative Physiol Ther. 2009 (Oct);   32 (8):   682–686 ~ FULL TEXT

This case series offers information about potential signs of benign infant headache. The patients in this study responded favorably to chiropractic management.

Outcome of Pregnancy-Related Lumbopelvic Pain Treated According to
a Diagnosis-Based Decision Rule: A Prospective Observational Cohort Study

J Manipulative Physiol Ther 2009 (Oct);   32 (8):   616–624 ~ FULL TEXT

Fifty-seven patients (73%) reported their improvement as either "excellent" or "good." The mean patient-rated improvement was 61.5%. The mean improvement in BDQ was 17.8 points. The mean percentage of improvement in BDQ was 39% and the median was 48%. Mean improvement in pain was 2.9 points. Fifty-one percent of the patients had experienced clinically significant improvement in disability and 67% patients had experienced clinically significant improvement in pain. Patients were seen an average 6.8 visits. Follow-up data for an average of 11 months after the end of treatment were collected on 61 patients. Upon follow-up, 85.5% of patients rated their improvement as either "excellent" or "good." The mean patient-rated improvement was 83.2%. The mean improvement in BDQ was 28.1 points. The mean percentage of improvement in BDQ was 68% and the median was 87.5%. Mean improvement in pain was 3.5 points. Seventy-three percent of the patients had experienced clinically significant improvement in disability and 82% patients had experienced clinically significant improvement in pain.

Scheuermann's Disease: A Poorly Understood
Abnormality of the Adolescent Spine

Dynamic Chiropractic ~ August 26, 2009 ~ FULL TEXT

Scheuermann's disease (SD) – osteochondritis of vertebral epiphyseal plates or adolescent kyphosis – was first described in 1921 by Holger Werfel Scheuermann, a Danish surgeon, as an osteochondrosis with cause unknown involving the spine and frequently causing lower thoracic kyphosis. The term juvenile kyphosis has sometimes been used to designate this condition. Although many theories have been proposed, the cause of SD is still unknown. Currently under investigation are the roles of juvenile osteoporosis, hereditary factors, biomechanical factors, and a variety of other causes, but to date no specific etiology has been determined, except that there is a disruption in the normal development of the vertebral end plate.

Chiropractic Care of a Pediatric Patient with Symptoms Associated with
Gastroesophageal Reflux Disease, Fuss-cry-irritability with Sleep Disorder
Syndrome and Irritable Infant Syndrome of Musculoskeletal Origin

J Can Chiropr Assoc. 2008 (Dec);   52 (4):   248–255 ~ FULL TEXT

The mother of a 3-month old girl presented her daughter for chiropractic care with a medical diagnosis of gastroesophageal reflux disease. Her complaints included frequently interrupted sleep, excessive intestinal gas, frequent vomiting, excessive crying, difficulty breastfeeding, plagiocephaly and torticollis. Previous medical care consisted of Prilosec prescription medication. Notable improvement in the patient's symptoms was observed within four visits and total resolution of symptoms within three months of care. This case study suggests that patients with complaints associated with both musculoskeletal and non-musculoskeletal origin may benefit from chiropractic care.

Self-reported Nonmusculoskeletal Responses to Chiropractic Intervention:
A Multination Survey

J Manipulative Physiol Ther 2005 (Jun);   28 (5):   294–302 ~ FULL TEXT

Positive reactions were reported by 2% to 10% of all patients and by 3% to 27% of those who reported to have such problems.   Most common were improved breathing (27%), digestion (26%), and circulation (21%).

Assessing the Evidence for the Use of Chiropractic Manipulation
in Paediatric Health Conditions: A Systematic Review

Paediatr Child Health. 2005 (Mar);   10 (3):   157–16 ~ FULL TEXT

Health claims made by practitioners regarding the application of chiropractic manipulation as a health care intervention for paediatric health conditions are, for the most part, supported by low levels of scientific evidence. Chiropractors, in particular, employ manipulation for the treatment of a wide variety of paediatric health conditions. The evidence rests primarily with clinical experience, descriptive case studies and a few randomized controlled trials. There is a need for more rigorous scientific inquiry to examine the value of manipulative therapy in the treatment of paediatric conditions. To advance the health interests of paediatric patients, health care decisions made on the basis of expert opinion or clinical experience must integrate the best research evidence available from high-quality, scientific studies.

Manual Therapy in Children: Proposals for an Etiologic Model
J Manipulative Physiol Ther 2005 (Mar);   28 (3):   e1–e15 ~ FULL TEXT

Manual therapy in children (MTC) is receiving greater attention. Several monographs and reviews deal with this subject (1–4). Although these publications cover the field from the viewpoint of a classic pediatric approach, discussing which diagnoses of pediatric medicine might be successfully treated by MTC, they do not furnish an independent concept for the functional disorders that we see in these children. This article proposes such a framework through a model: the kinematic imbalances due to suboccipital strain (KISS) concept. This concept groups the symptoms and signs associated with functional disorders of the cervical spine into an entity linked to easily recognizable clinical situations. By using this concept as a term in the communication with other caregivers of infants and children, we may be able to improve the contact between pediatricians and specialists of MTC, thus facilitating the identification of those cases where the use of MTC will be most useful.

Chiropractic Care of a Pediatric Patient with Myasthenia Gravis
J Manipulative Physiol Ther 2003 (Jul);   26 (6):   390–394 ~ FULL TEXT

The patient was cared for with contact-specific, high-velocity, low-amplitude adjustments to sites of vertebral subluxation complexes in the upper cervical and sacral spine. The patient's response to care was positive and after 5 months of regular chiropractic treatment her symptoms abated completely. There are indications that patients suffering from disorders “beyond low back pain” as presented in this case report may derive benefits from chiropractic intervention/management.

Spinal Manipulation May Benefit Asthma Patients
Foundation for Chiropractic Education and Research (FCER) ~ October 24, 2002

Patients afflicted with asthma may benefit from spinal manipulation in terms of symptoms, immunological capacity, and endocrine effects, an audience was told on October 5 at the 9th International Conference on Spinal Manipulation in Toronto. The investigative team, headed by Ray Hayek, Ph.D., has been conducting a trial at 16 treatment centers in Australia involving 420 patients with an average age of 46 in an effort to find out what effects spinal manipulation has on symptoms, depression and anxiety, general health status, and the levels of immunity as reflected by the concentrations of both an immunoglobulin (IgA) and an immunosuppressant (cortisol).

Adolescent Idiopathic Scoliosis
Dr. Diane Benizzi DiMarco

Due to the close association of spinal maturity with lateral spinal curve progression, adolescent idiopathic scoliosis represents a sensitive topic for those treating females who have entered menarche or will be soon. A lateral bending of the spine, adolescent idiopathic scoliosis can present with a lateral and rotary deformity. Spinal curvatures can be the result of varied factors including; muscle diseases or spasms, neurological disease, diseases of the CNS or PNS, congenital vertebral deformities, leg length inequalities, tumors, pain, injury and degenerative spinal arthrosis. The most common cause of scoliosis, adolescent idiopathic scoliosis, accounts for approximately 80% of all diagnosed scoliosis cases. (1) Females are affected at a rate of 9:1. Idiopathic scoliosis, juvenile and adolescent affect females ages three to ten years of age and ten years to skeletal maturity, respectively. [2, 3]

The Importance of Prenatal Exposures on the Development of Allergic Disease
Am J Respir Crit Care Med 2002 (Sep 15);   166 (6):   827–832 ~ FULL TEXT

This study of British children suggests that women who have an infection or take antibiotics during pregnancy are more likely to have a child with an allergy-related condition such as asthma, hay fever or eczema. Researchers at the University of Nottingham evaluated the medical records of nearly 25,000 British children and their mothers. The study found that children exposed to antibiotics in the womb had a higher risk of developing asthma, hay fever and eczema than did children whose mothers did not take the medication during pregnancy.

The Webster Technique: A Chiropractic Technique with Obstetric Implications
J Manipulative Physiol Ther 2002 (Jul);   26 (6):   E1–9 ~ FULL TEXT

Intrauterine constraint is defined as any force external to the developing fetus that obstructs the normal movement of the fetus. Intrauterine constraint has been casually related to a number of structural defects of the peripheral and craniofacial skeleton of the fetus. [1–10]   Taylor [11] and others [12, 13] have described how the forces of intrauterine constraint adversely affect the spine during the prenatal and perinatal periods. Moreover, intrauterine constraint can prevent the developing fetus from attaining a head-down vertex position and achieving a vaginal birth, thereby necessitating a cesarean section delivery.

Dramatic Rise in Childhood Obesity
JAMA 2001 (Dec 12):   286 (22):   2845–2848

The authors of a recent study in the JAMA determined obesity trends in over 8,000 children, ages 4 to 12, between 1986 and 1998. The prevalence of overweight children increased over 120% among Hispanic and African-American children and over 50% among Caucasian children in the 12-year study. Nearly one-quarter of Hispanic/African-American children and roughly one-eighth of Caucasian children were considered overweight in 1998.

To Treat or Not to Treat Otitis Media: That's Just One of the Questions
J Am Board Fam Pract 2001 (Nov);   14 (6):   474–476

Recent evidence has thrown into question the use of antibiotics and the length of treatment, if prescribed. The growing worldwide development of multidrug-resistant bacteria, the uncertainty of diagnosis, and that up to one third of cases of AOM are viral in origin [12] have made popular a wait-and-see approach to the initial prescription of antibiotics, especially in many European countries. In several randomized clinical trials, antibiotics provided only a small benefit. [13–15] In a meta-analysis of more than 2000 children with AOM, ear pain resolved spontaneously without antibiotics in two thirds by 24 hours and in 80% by day 7.

Ritalin:   This Children's Drug Is More Potent Than Cocaine
The London Observer September 9, 2001

Using brain imaging, scientists have found that, in pill form, Ritalin – taken by thousands of British children and four million in the United States – occupies more of the neural transporters responsible for the “high” experienced by addicts than smoked or injected cocaine. The research may alarm parents whose children have been prescribed Ritalin as a solution to Attention Deficit Hyperactive Disorder.

Chronic Pediatric Asthma and Chiropractic Spinal Manipulation:
A Prospective Clinical Series and Randomized Clinical Pilot Study

J Manipulative Physiol Ther 2001 (July);   24 (6):   369–377 ~ FULL TEXT

After 3 months of combining chiropractic SMT with optimal medical management for pediatric asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. These improvements were maintained at the 1-year follow-up assessment.
More information like this may be found in our Chiropractic and Asthma Page

Epilepsy and Seizure Disorders: A Review of Literature
Relative to Chiropractic Care of Children

J Manipulative Physiol Ther 2001 (Mar);   24 (3):   199–205 ~ FULL TEXT

Chiropractic care may represent a nonpharmaceutical health care approach for pediatric epileptic patients. Current anecdotal evidence suggests that correction of upper cervical vertebral subluxation complex might be most beneficial. It is suggested that chiropractic care be further investigated regarding its role in the overall health care management of pediatric epileptic patients.

Children and Scoliosis
Dynamic Chiropractic ~ February 12, 2001

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.

Otitis Media and the Sanctity of Medical Guidelines
Dynamic Chiropractic ~ January 1, 2001

Within recent times, however, we need only consider otitis media as an example of the extreme volatility of medical guidelines. A complete reversal appears to have taken place within just the past six years! Traditionally, the initial recommended intervention in the United States has been tympanostomy with the option to use antibiotics, [4] despite that in the United Kingdom, the Scandinavian countries and the Netherlands, physicians have embarked upon a policy of watchful waiting with no deleterious consequences from their reluctance to use antibiotics. [5]

Resolution of Suckling Intolerance in a 6-month-old Chiropractic Patient
J Manipulative Physiol Ther 2000 (Nov);   23 (9):   615–618 ~ FULL TEXT

The patient was treated 5 times through use of cranial adjusting; 4 of these visits included atlas (C1) adjustment. The suckling intolerance resolved immediately after the first office visit and did not return.

The Risk of Carcinogenesis From Radiographs to Pediatric Orthopaedic Patients
J Pediatr Orthop 2000 (Mar);   20 (2):   251–254

The use of serial radiographs during the treatment of idiopathic scoliosis, hip dysplasia, and leg-length discrepancy appears relatively safe. The increased risk of carcinogenesis or hereditary defects in these patients is minimal.

The Short–Term Effect of Spinal Manipulation in the Treatment of Infantile Colic:
A Randomized Controlled Clinical Trial with a Blinded Observer

J Manipulative Physiol Ther 1999 (Oct);   22 (8):   517–522 ~ FULL TEXT

By trial days 4 to 7, hours of crying were reduced by 1 hour in the dimethicone group compared with 2.4 hours in the manipulation group (P = .04). On days 8 through 11, crying was reduced by 1 hour for the dimethicone group, whereas crying in the manipulation group was reduced by 2.7 hours (P = .004). From trial day 5 onward the manipulation group did significantly better that the dimethicone group. The authors then conclude: Spinal manipulation is effective in relieving infantile colic.
You may also enjoy FCER's review of this article.

Research Perspectives in Asthma: A Rationale for the Therapeutic Application
of Magnesium, Pyridoxine, Coleus forskholii and Ginkgo biloba in the
Treatment of Adult and Pediatric Asthma

The Internist 1998 (Sep);   5 (3):   14–16

Thanks to the American Chiropratic Association's Council On Family Practice for their permission to reprint this article exclusively at Chiro.Org!
More information like this may be found in our Chiropractic and Asthma Page

Acquired Verbal Aphasia in a 7-Year-Old Female: Case Report
Journal of Clinical Chiropractic Pediatrics 1998 (Apr);   1 (2)

A case report is presented of a seven-year-old female patient with acquired verbal aphasia. Despite appropriate referral to specialists in pediatrics, audiology and speech and language pathology, the patients verbal difficulties failed to respond to conventional therapies. Chiropractic evaluation disclosed disclosed biomechanical abnormalities in the spinal and pelvic region and cranium, which had previously gone unrecognized. The patient's speech difficulties improved following the commencement of chiropractic care. Follow-up evaluations over a period of 18 months demonstrated that speech improvements had been maintained. It is impossible to generalize the results of a single case to the population of patients with aphasia. Hoewver, this case study raises important issues regarding the role of chiropractic care in the multidisciplinary management of patients with acquired aphasia.

Back Pain Risk Continues After Pregnancy
Obstetrics & Gynecology 1998 (Feb);   91 (2):   182–186

Women with severe low back pain during pregnancy are at high risk for back pain for more than 10 years after the pregnancy –– and the problem is likely to recur in a subsequent pregnancy, according to a new study in the journal Obstetrics & Gynecology. More seriously, (19%) of the women with previous low back pain stated they had refrained from another pregnancy because of their fear of the recurrence of their low back pain.

The Role of the Chiropractic Adjustment in the Care
and Treatment of 332 Children with Otitis Media

Journal of Clinical Chiropractic Pediatrics 1997 (Oct);   2 (2)

To our knowledge this is the first time that tympanography has been used as an objectifying tool with respect to the efficacy of the chiropractic adjustment in the treatment of children with otitis media. In addition, the role of the occipital adjustment needs to be examined. This study begins the process of examining the role of the vertebral cranial subluxation complex in the pathogenesis of otitis media, and the efficacy of the chiropractic adjustment in its resolution.
More information like this may be found in our Chiropractic and Otitis Media Page

Cervicogenic Hearing Loss
HNO 1994 (Oct);   42 (10):   604–613

Findings in 62 patients suffering from vertebragenic hearing disorders are reported before and after chiropractic management. Results indicate that these hearing disorders are reversible, as demonstrated by audiometry and OAE. The therapy of choice is chiropractic manipulation of the upper cervical spine. The commoness of vertebragenic hearing disorders emphasizes their clinical and forensic importance.
More information like this may be found in our Chiropractic and Hearing Loss Page

Musculoskeletal Injuries in Child Athletes
British Medical Journal 1994 (Jun 11);   308:   1556–1559

The growing skeletons of children may be injured more easily than the mature skeletons of adults because the bones are more porous and the long bones are further weakened by the epiphysical plates at their proximal and distal ends.

A Comparative Study of the Health Status of Children Raised Under
the Health Care Models of Chiropractic and Allopathic Medicine

J Chiropractic Research 1989 (Summer);   5:   101–103

This 1989 study compared the health of two hundred children under chiropractic care and two hundred children under medical care. The chiropractic children had fewer ear infections, fewer allergies, fewer cases of tonsillitis, and needed less medical treatment (antibiotics and other medications). The authors noted that there is a “definite correlation between chiropractic care and superior health.” In fact, this study “has shown that children raised under chiropractic care are less prone to infectious processes such as otitis media and tonsillitis, and that their immune systems are better able to cope with allergens such as pollen,weeds, grasses, etc. compared to children raised under allopathic care. There is also a significant decreased history of antibiotic use among the ‘Chiropractic’ children, indicating a lower susceptibility to bacterial infections as a result of their greater immune system response.”

Endometriosis and the Anterior Coccyx: Observations on 5 Cases
Research Forum 1985 (Summer);   1 (4):   120–122 ~ FULL TEXT

This case review involves five women presenting with medically-diagnosed endometriosis. All five women had been advised that they were surgical candidates. Relief of symptoms is effected by adjusting the anteriorally displaced coccyx. The author suggests a relationship between the displaced coccyx and endometriosis and counsels upon the recognition of same.

Chiropractic Advice for Moms-to-Be
American Chiropractic Association

During pregnancy, a woman's center of gravity almost immediately begins to shift forward to the front of her pelvis, according to Dr. Jerome McAndrews, spokesperson for the American Chiropractic Association (ACA). Although a woman's sacrum – or posterior section of her pelvis – has more depth than a man's to enable her to carry a baby, the displaced weight still increases the stress on her joints. "As the baby grows in size," Dr. McAndrews explains, "the woman's weight is projected even farther forward, and the curvature of her lower back is increased, placing extra stress on her spinal disks in that area. As a result, the spine in the upper back area must compensate – and the normal curvature of her upper spine increases as well."

Prenatal Nutrition
Nutrition Science News (February 2000)

Often when a woman becomes pregnant, or is trying to get pregnant, she develops a new perspective on her health. For most this means a new or renewed interest in nutrition and healthy food choices. Some women are afraid their diet is insufficient and worry it might affect their baby. Others simply want to do everything in their power to have an easy pregnancy and a normal infant. All are valid concerns. They are also opportunities for you to discuss the reasons to supplement, even for those already eating healthfully.

The National Institute of Health (NIH) Takes a Closer Look
at Pollution and Children's Health

Reuters Health ~ Mon Feb 24, 2003

The National Institute of Environmental Health Sciences (NIEHS) convened the three-day meeting, which will look at indoor and outdoor pollutants' role in asthma, brain and reproductive system disorders, behavioral problems like autism and attention deficit hyperactivity disorder and cancer. Children are especially vulnerable to pollutants because they breathe in more air and take in more food and liquid, proportional to their size, than adults, said Phil Lee, a senior scholar at the University of California, San Francisco, and former assistant secretary at the Department of Health and Human Services

Top Child Health Agencies Urge Testing to Protect Early Brain
Development From Toxins: One Out of Six Affected

Learning Disability Association of America ~ 1-22-2001

One out of six children are suffering from behavioral disorder according to the Learning Disabilities Association and the National Institute of Environmental Health Sciences (NIEHS–NIU). Both are calling for research testing to recognize, reduce and eliminate the environmental toxins scientifically linked to learning disabilities.

The Risk of Injury for Children Exposed to Whiplash Trauma
Arthur C. Croft, DC, MS, FACO
Dynamic Chiropractic – December 14, 2000

Less than two percent of the literature about whiplash is devoted to children. When I wrote the first edition of my textbook in 1988, [1] I cited an older German study placing the risk for children at approximately one-sixth the risk of adults. By the time the second edition was published in 1995, a Swedish study had since been published putting the risk proportion in children closer to two-thirds that of adults. [2]

Research: New Challenges for Chiropractic
Chiro.Org Editorial on 10-08-1998

Review the article and controversy associated with this New England Journal of Medicine article on chiropractic and asthma.   We also have the press releases and responses from the Research and Academic Community.

Children Not Eating Enough Fruit and Vegetables
Reuters News Service ~ August 18, 1998

Of 168 US preschoolers who participated in a week-long nutrition study, none ate the five recommended daily servings of fruits and vegetables, report researchers in the Journal of the American College of Nutrition.


Neck and Back Pain in Children

Chiropractic and Spinal Pain
A Chiro.Org article collection

Review a collection of articles that focus on the effectiveness of chiropractic for reducing pain.

Chronic Neck Pain and Chiropractic
A Chiro.Org article collection

Review a collection of articles that focus on the effectiveness of chiropractic for reducing neck pain.

Low Back Pain and Chiropractic
A Chiro.Org article collection

Review a collection of articles that focus on the effectiveness of chiropractic for reducing low back pain.

Spinal Pain in Pre-adolescence and the Relation with Screen Time
and Physical Activity Behavior

BMC Musculoskelet Disord 2021 (Apr 26);   22 (1):   393 ~ FULL TEXT

Findings indicate that duration of screen time and physical inactivity are correlated with spinal pain in pre-adolescents with the strongest associations for screen time. Reducing screen time or increasing physical activity might help preventing spinal pain in pre-adolescents, particularly among high frequent screen users. Future prospective studies investigating the causal relationship between screen time, physical activity and development of spinal pain in children and adolescents are necessary as further understanding of the interplay is of great public health relevance.

What Are Important Consequences in Children with Non-specific Spinal Pain?
A Qualitative Study of Danish Children Aged 9-12 Years

BMJ Open 2020 (Oct 20);   10 (10):   e037315 ~ FULL TEXT

The negative impact of non-specific spinal pain on children aged 9-12 years pivots around codes which are considerably different to adults. Psychological and social factors were more prominent and pain anxiety was dominant in the lived lives of children. New questionnaires should be age specific and include the identified codes within each theme.

Early-life Programming of Pain Sensation?
Spinal Pain in Pre-adolescents with Pain Experience in Early Life

European J Pediatrics 2019 (Dec);   178 (12):   1903-1911~ FULL TEXT

Children with pain experience in early life are seeminglymore likely to report spinal pain in pre-adolescence. This study highlights that painful early-life experiences can influence programming of future pain responses; however, whether the influence is related to the nociceptive system, the stress response or psychosocial factors remain to be explored.

Epidemiology of Spinal Pain in Children:
A Study Within the Danish National Birth Cohort

European J Pediatrics 2019 (May);   178 (5):   695-706~ FULL TEXT

A considerable number of children suffer from spinal pain. Spinal pain is more common in girls and the prevalence increases with increasing age. In addition, children in more disadvantaged families are more likely to experience spinal pain. Awareness of the consequences of applying different case-definitions is essential in the assessment of spinal pain. Our findings provide a basis for further in-depth examination of spinal pain etiology with the aim of informing efficient and targeted prevention of spinal pain.

   Potential Risk Factors and Triggers for Back Pain in Children and Young Adults   

  A 2-Part Scoping Review, plus a Secondary Analysis

Potential Treatment Effect Modifiers for Manipulative Therapy for Children
Complaining of Spinal Pain. Secondary Analyses of a
Randomised Controlled Trial

Chiropractic & Manual Therapies 2019 (Dec 10);   27:   59 ~ FULL TEXT

This study was a secondary analysis of data from a randomised controlled trial comparing advice, exercises and soft tissue treatment with and without the years complaining of spinal pain. A text message system (SMS) and clinical examinations were used for data collection (February 2012 to April 2014).Five pre-specified potential effect modifiers were explored: Number of weeks with spinal pain 6 months prior to inclusion, number of weeks with co-occurring musculoskeletal pain 6 months prior to inclusion, expectations of the clinical course, pain intensity, and quality of life.Outcomes were number of recurrences of spinal pain, number of weeks with pain, length of episodes, global perceived effect, and change in pain intensity. To explore potential effect modification, various types of regression models were used depending on the type of outcome, including interaction tests.

Part I: Incident and Episodic Back Pain
Chiropractic & Manual Therapies 2019 (Nov 19);   27:   58 ~ FULL TEXT

The search identified 7,356 articles, of which 91 articles were eligible for this scoping review. The majority of the eligible articles had an unclear definition of back pain (results presented in scoping review part II). There were 7 inception cohort studies included and 1 cohort study that met the criteria for part I. The most consistent risk factors for incident and episodic back pain are female sex and older age.   Due to inconsistent ways of reporting on the type of back pain, no definitive risk factor for back pain has been identified. In general, females often report more symptoms, also for other diseases, and older age is not a useful risk factor as it merely indicates that the onset may not be in childhood. Clearly, the time has come to study the causes of back pain from different angles.

Part II: Unclear or Mixed Types of Back Pain
Chiropractic & Manual Therapies 2019 (Nov 19);   27:   61 ~ FULL TEXT

Our comprehensive search strategy identified 7356 articles, of which 83 articles were considered eligible for this review (part II). There were 53 cross-sectional studies and 30 cohort studies. Potential risk factors for back pain were: female sex, older age, later pubertal status, positive family history of back pain, increased growth, and a history of back pain, most of which are temporal precursor variables. There was limited research for the illness factors, spinal posture, and muscle endurance in the development of back pain.   Many of the included studies approached risk factors in similar ways and found factors that were associated with back pain but were not obvious risk factors as causality was uncertain. Future research should be more rigorous and innovative in the way that risk factors are considered. This could be through statistical approaches including cumulative exposures, or longitudinal approaches including multi-trajectory methods. Additionally, data on proposed risk factors should be collected before the onset of back pain.

Pubertal Development and Growth are Prospectively Asociated with Spinal Pain
in Young People (CHAMPS study-DK)

European Spine Journal 2019 (Jul);   28 (7):   1565–1571 ~ FULL TEXT

In young people, pubertal development and linear growth are likely to be independent risk factors for the development of spinal pain. Pubertal development demonstrates evidence of dose-response in its relationship with spinal pain. This knowledge may assist healthcare providers with clinical decision-making when caring for pediatric patients.

Change in Young People's Spine Pain Following Chiropractic Care at a
Publicly Funded Healthcare Facility in Canada

Complement Ther Clin Pract. 2019 (May);   35:   301–307 ~ FULL TEXT

Young people from a socioeconomically disadvantaged, underserved community with spinal pain experienced both statistically and clinically significant improvements in pain severity. A pragmatic course of chiropractic management, that was multimodal in nature, was found to have a favorable outcome as a treatment option for young people suffering with spinal pain of musculoskeletal etiology from a socioeconomically disadvantaged community. Further prospective research is warranted to explore the response of young people with specific diagnoses as the etiology of their spinal pain, and the changes in their functionality and disability, in response to chiropractic management.

The Natural Course of Low Back Pain From Childhood to Young Adulthood -
A Systematic Review

Chiropractic & Manual Therapies 2019 (Mar 20);   27:   10 ~ FULL TEXT

Although methodological heterogeneity, mainly due to different age ranges, an indication of a natural course of LBP was seen across studies. The majority of children and adolescents repeatedly reporting no or low probability of LBP. With recall periods between one week to three months and sampling rates ranging from one to four years, a very low rate repeatedly reported LBP, and approximately one-fifth to one-third of children and adolescents had fluctuating reports of LBP. A need of future research of LBP trajectories with short reporting period lengths and narrower sampling windows in a long-term perspective is emphasized in order to study childhood influences on the development of LBP throughout life.

The Association Between Psychological and Social Factors and
Spinal Pain in Adolescents

European Journal of Pediatrics 2019 (Mar);   178 (3):   275–286 ~ FULL TEXT

This study indicated that psychological and social factors are associated with SP in adolescents with a higher frequency of these reported factors resulting in higher odds of reporting SP, especially “substantial SP”. Psychological factors appear to be more strongly related to SP than the social variables. Together, this reinforces the importance of understanding psychological and social factors in adolescents reporting SP.

Conservative Care with or without Manipulative Therapy in the Management
of Back and/or Neck Pain in Danish Children Aged 9-15:
A Randomised Controlled Trial Nested in a School-based Cohort

BMJ Open. 2018 (Sep 10);   8 (9):   e021358 ~ FULL TEXT

The primary outcome was number of recurrences of spinal pain. Secondary outcomes were duration of spinal pain, change in pain intensity and Global Perceived Effect.We found no significant difference between groups in the primary outcome (control group median 1 (IQR 1-3) and intervention group 2 (IQR 0-4), p=0.07). Children in the group receiving manipulative therapy reported a higher Global Perceived Effect: OR 2.22, (95% CI 1.19 to 4.15). No adverse events were reported. Main limitations are the potential discrepancy between parental and child reporting and that the study population may not be comparable to a normal care-seeking population.

Spinal Manipulation and Exercise for Low Back Pain in Adolescents:
A Randomized Trial

Pain. 2018 (Jul);   159 (7):   1297–1307 ~ FULL TEXT

For adolescents with chronic LBP, spinal manipulation combined with exercise was more effective than exercise alone over a 1–year period, with the largest differences occurring at 6 months. These findings warrant replication and evaluation of cost effectiveness.

Spinal Pain in Danish School Children - How Often and How Long?

BMC Musculoskelet Disord. 2017 (Mar 27);   18 (1):   67 ~ FULL TEXT

Although rates of spinal pain report were high, for most children the pain was short-lived and did not recur frequently. Of concern though, was the rather substantial number of children who reported either persistent or recurrent pain. In at least a quarter of those with spinal pain, the episodes lasted for more than 4 weeks and/or occurred three times or more during a study year. It is towards this group that a concerted research effort is needed to inform evidence-based prevention and management.

Complementary and Alternative Medicine Use by Children
with Pain in the United States

Acad Pediatr. 2017 (Feb 20).  pii: S1876-2859(17)30063-3

Parents reported that 26.6% of children had pain conditions (e.g. headache, abdominal, musculoskeletal pain) in the past year; of these children, 21.3% used CAM. In contrast only 8.1% of children without pain conditions used CAM (χ2: p<.001). CAM use among children with pain was associated with female sex (adjusted odds ratio (aOR)=1.49, p=0.005), higher income (aOR=1.61, p=0.027), and presence of 4+ comorbidities (aOR=2.01, p=0.013). Among children with pain who used CAM the 2 most commonly used CAM modalities were biologically-based therapies (47.3%) (e.g., special diets and herbal supplements) and manipulative or body-based therapies (46.3%) (e.g., chiropractic and massage).   CONCLUSIONS:   CAM is frequently used by children with pain in the USA and many parents report benefits for their child's symptoms.

Multivariable Modeling of Factors Associated with Spinal Pain in Young Adolescence
European Spine Journal 2016 (Sep);   25 (9):   2809–2821 ~ FULL TEXT

Psychosomatic symptoms and pain comorbidities had the strongest association with 1-month period prevalence of spinal pain in young adolescents, followed by factors from the physical and psychosocial domains. The role that "physical factors" play in non-adult spinal pain may have been underestimated by previous studies.

Neck Pain In Children: A Retrospective Case Series
J Can Chiropr Assoc. 2016 (Sep);   60 (3):   212–219 ~ FULL TEXT

Spinal pain is common amongst the paediatric population (including children and adolescents). It is a significant health issue [1, 2], where 52% of paediatric patients report musculoskeletal (MSK) symptoms over a one-year period.[3] Neck pain is the most common spinal pain in pediatric patients [3, 4] with 60% reporting neck pain persisting at two years after this study began. [5] A survey of Finnish school children reported neck pain experienced at least once during the week.

Whose Pain Is It Anyway? Comparability of Pain Reports
From Children and Their Parents

Chiropractic & Manual Therapies 2016 (Aug 1);   24:   24 ~ FULL TEXT

Percentage agreement between parent and child assessment was around 50% in Sample 1 and 68% in Sample 2. The poor agreement was due to children reporting pain when their parent did not, the reverse very rarely occurred. Pain of greater intensity or longer duration resulted in better agreement between the child and parent. Child age and gender did not influence the likelihood of agreement.

Musculoskeletal Pain in Children and Adolescents
Brazilian Journal of Physical Therapy 2016 (May);   20 (3):   275–284 ~ FULL TEXT

Musculoskeletal (MSK) pain in children and adolescents is responsible for substantial personal impacts and societal costs, but it has not been intensively or systematically researched. This means our understanding of these conditions is limited, and healthcare professionals have little empirical evidence to underpin their clinical practice. In this article we summarise the state of the evidence concerning MSK pain in children and adolescents, and offer suggestions for future research.

Is Back Pain During Childhood or Adolescence Associated with
Muscle Strength, Muscle Endurance aerobic Capacity:
Three Systematic Literature Reviews with one Meta-analysis

Chiropractic & Manual Therapies 2015 (Jul 16);   23:   21 ~ FULL TEXT

The present review revealed there to be no association between increased BMS in trunk extension and BP, whereas such an association was clearly present when testing for BME. When adding the results of the meta-analysis for the BME data, the previous findings were confirmed that there is a small but statistically significant protective effect of BME on BP. However, the association between AC and BP requires further studies to evaluate if there is a modifying or confounding link with BME.

Quality of Life, School Backpack Weight, and Nonspecific Low Back Pain
in Children and Adolescents

J Pediatr (Rio J). 2015 (May);   91 (3):   263–269 ~ FULL TEXT

Girls reported higher disability than boys (p = 0.01), and lower QoL in the domains of physical (p < 0.001) and emotional functioning (p < 0.01), psychosocial health (p = 0.02) and physical health summary score (p < 0.001), and on the total PedsQL score (p < 0.01). School backpack weight was similar in both genders (p = 0.61) and in participants with and without LBP (p = 0.15). After adjustments, participants with LBP reported lower physical functioning (p < 0.01), influencing lower physical health summary score (p < 0.01).

Pain Characteristics of Adolescent Spinal Pain
BMC Pediatr. 2015 (Apr 17);   15 (1):   42 ~ FULL TEXT

Adolescents who suffered from pain in more than one spinal area reported higher pain intensity and frequency than those with pain in only one spinal area. Sleep disorders were a significant predictor for pain in more than one spinal area (p < 0.01) as well as a trend for frequent pain (p = 0.06). Adolescents with frequent pain showed impaired balance on one leg standing with closed eyes (p = 0.02).

Back Pain in Children Surveyed with Weekly Text Messages -
A 2.5 Year Prospective School Cohort Study

Chiropractic & Manual Therapies 2014 (Nov 18);   22 (1):   35 ~ FULL TEXT

BP does not appear to be a major problem in childhood. Knowledge about the causes of BP in childhood might allow early prevention, however, and the topic is therefore important from a public health viewpoint. It would be productive for further research to study the circumstances surrounding the appearance of back pain in childhood, as well as how various bio-psycho-social factors affect its onset and later recurrence. A better understanding of the severity and consequences of back pain in childhood is also needed. From a clinical viewpoint, health professionals should be vigilant if children present with constant or recurring back pain, as such a pattern appears to be unusual in this population group.

Is Puberty a Risk Factor For Back Pain in the Young?
A Systematic Critical Literature Review

Chiropractic & Manual Therapies 2014 (Oct 15);   22 (1):   27 ~ FULL TEXT

Four articles reporting five studies were included, two of which were longitudinal. 1) Some studies show a weak and others a strong positive association between puberty and back pain, which remains after controlling for age and sex; 2) Results were consistent across the studies; 3) There was a linear increase of back pain according to the stage of puberty 4) Temporality has not been sufficiently studied.   All our criteria for causality were fulfilled or somewhat fulfilled indicating the possibility of a causal link between puberty and back pain. Future research should focus on specific hypotheses, for example investigating if there could be a hormonal or a biomechanical aspect to the development of back pain at this time of life.

Spinal Pain in Adolescents: Prevalence, Incidence, and Course:
A School-based Two-year Prospective Cohort Study
in 1,300 Danes Aged 11–13

BMC Musculoskelet Disord. 2014 (May 29);   15:   187 ~ FULL TEXT

Spinal pain is common at the age of 11–15 years, but some have more pain than others. The pain is likely to progress, i.e., to more locations, higher frequency, and higher pain intensity over a two-year period.

Spinal Manipulation and Exercise for Low Back Pain in Adolescents:
Study Protocol for a Randomized Controlled Trial
Chiropractic & Manual Therapies 2014 (May 23);   22:   21 ~ FULL TEXT

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.

An International Survey of Pain in Adolescents
BMC Public Health. 2014 (May 13);   14 (1):   447 ~ FULL TEXT

Adolescence marks the transition from childhood to adult life. Pain during adolescence is an important predictor of future pain. [1–3] A Danish twins study [4] found adolescents with persistent low back pain were 3.5 times more likely to have low back pain in adulthood. Co-occurrence of low back pain and headache in adolescence further increases the risk of developing future pain which draws attention to the significance of multiple pains. [4]

High Prevalence of Daily and Multi-site pain -- A Cross-sectional
Population-based Study Among 3000 Danish Adolescents

BMC Pediatr. 2013 (Nov 19);   13:   191 ~ FULL TEXT

In this population-based cohort of school-attending Danish adolescents, nearly two out of three reported current pain and, on average, one out of three reported pain in more than one body region. Female sex, and high level of sports participation were associated with increased odds of having almost daily pain and multi-site pain. The study highlights an important health issue that calls for investigations to improve our understanding of adolescent pain and our capacity to prevent and treat this condition.

Early Adolescent Lumbar Intervertebral Disc Injury: A Case Study
Chiropractic & Manual Therapies 2013 (Apr 26);   21:   13 ~ FULL TEXT

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.

Prevalence of Low Back Pain in Children and Adolescents: A Meta-analysis
BMC Pediatr. 2013 (Jan 26);   13:   14 ~ FULL TEXT

The most recent studies showed higher prevalence rates than the oldest ones, and studies with a better methodology exhibited higher lifetime prevalence rates than studies that were methodologically poor. Future studies should report more information regarding the definition of LBP and there is a need to improve the methodological quality of studies.

School Children's Backpacks, Back Pain and Back Pathologies
Arch Dis Child. 2012 (Aug);   97 (8):   730–732

Carrying backpacks increases the risk of back pain and possibly the risk of back pathology. The prevalence of school children carrying heavy backpacks is extremely high. Preventive and educational activities should be implemented in this age group.

Effect of Backpack Load Carriage on Cervical Posture in Primary Schoolchildren
Work. 2012 (Jan 1);   41 (1):   99–108

Subjects demonstrated immediate and statistically significant changes in craniovertebral angle (CVA), indicating increased forward head positions upon donning the backpacks containing 15% and 20% body weight. Following the walking of 6 minutes, the CVA demonstrated further statistically significant changes for all backpack loads indicating increased forward head postures. For the 15 & 20% of body weight conditions, more than 50% of the subjects reported discomfort after walking, with the neck as the primary location of reported pain.
There are more articles like this at our: Backpacks and Children Page

Chronic Idiopathic Pain in Adolescence--High Prevalence and Disability:
The Young HUNT Study 2008

Pain. 2011 (Oct);   152 (10):   2259–2266 ~ FULL TEXT

This study shows that chronic idiopathic pain in adolescence is common, particularly among girls, and may have a major negative impact on everyday life, with high disability. The disability increases with frequency of pain and number of pain locations; and adolescents with musculoskeletal pain in 3 or more locations, as well as those with daily pain, constitute a group with high subjective disability index. Further studies are needed to analyze pain-associated factors, such as psychosocial and lifestyle factors, in order to suggest appropriate intervention strategies.

Prevalence and Tracking of Back Pain From Childhood to Adolescence
BMC Musculoskelet Disord. 2011 (May 16);   12:   98 ~ FULL TEXT

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.

Neck and Back Pain in Children: Prevalence and Progression Over Time
BMC Musculoskelet Disord. 2011 (May 16);   12:   98 ~ FULL TEXT

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.

Improving Schoolchildren's Knowledge of Methods for the Prevention
and Management f Low Back Pain: A Cluster Randomized Controlled Trial

Spine (Phila Pa 1976). 2011 (Apr 15);   36 (8):   E505–512 ~ FULL TEXT

Positive results from this study suggest that it may be advisable to generalize this campaign to larger populations of that age, and that for very young children, a “comic book” format, in which messages are conveyed in simple terms and with drawings that catch the children’s attention, is probably an appropriate way to educate children at such an early age on preventive mechanisms.

Pain in Children and Adolescents: Prevalence, Impact on Daily Life,
and Parents' Perception, A School Survey

Scand J Caring Sci. 2011 (Mar);   25 (1):   27–36

Sixty per cent of the children and adolescents reported pain within the previous 3 months. Pain increased with age, where girls aged 16–18 years reported the most pain. Total prevalence of chronic pain was 21%. Children reported impact on social life; inability to pursue hobbies, disturbed sleep, absence from school, and inability to meet friends because of pain. The girls reported significantly more frequently disturbed sleep, loss of appetite, and use of medication, compared to the boys. There was little agreement between parents and children regarding pain.

Chiropractic and Children: Is More Research Enough?
Chiropractic & Osteopathy 2010 (Jun 2);   18:   11 ~ FULL TEXT

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.

Children and Chiropractic Care: A Window of Opportunity
J Manipulative Physiol Ther. 2009 (Oct);   32 (8):   603–605 ~ FULL TEXT

Health and lifestyle early in life have profound impact on health and quality of life in later years. Common public health problems such as musculoskeletal disorders, cardiovascular disease, and depression tend to cluster in individuals, and this pattern is established early. At present, no health care profession has convincingly assumed the responsibility of spinal and musculoskeletal health for children. Considering the magnitude of the challenges ahead for both researchers and clinicians, this may be a good opportunity for doctors of chiropractic to take responsibility and engage in a determined effort to bring forward evidence-based strategies for prevention of spinal pain and other musculoskeletal problems.

A Description of Children and Adolescents in Danish Chiropractic Practice:
Results from a Nationwide Survey

J Manipulative Physiol Ther. 2009 (Oct);   32 (8):   607–615 ~ FULL TEXT

For the older children, musculoskeletal problems were the most dominant complaint, ranging from 33% among the preschool children to 75% among the teenagers. These complaints were often chronic and about a third of the children older than 2 years had experienced symptoms for more than 1 year before seeing the chiropractor. Among the older children and the adolescents, musculoskeletal complaints were most common and mostly of a chronic nature. The large number of pediatric patients in chiropractic practices and the paucity of evidence of treatment effectiveness indicate the need for further research in these age groups.

Chronic Muloskeletal Pain in Children: Assessment and Management
Rheumatology (Oxford). 2009 (May);   48 (5):   466–474 ~ FULL TEXT

Pediatricians and pediatric rheumatologists review a large number of children with ongoing pain (disease and non-disease related). A small number of these develop chronic pain conditions that are complex and distressing. Over recent years studies of the epidemiology, aetiology and rehabilitation of pain and pain-associated disability in children have revealed a large prevalence of clinically relevant pain, and have emphasized the need for early recognition and intervention. Medication has a role when part of a multidisciplinary framework, although there is little evidence for or against the effectiveness of most pharmacotherapy. There is strong evidence to support early targeted psychological and physical intervention, and an understanding that parental education and involvement is essential if progress is to be maintained. In this review, an overview of the assessment is presented and management of childhood chronic musculoskeletal pain conditions with reference to main research findings to date.

Medical Doctors Likely to Encounter Children With Musculoskeletal
Complaints Have Low Confidence in Their Clinical Skills

The Journal of Pediatrics 2009 (Feb);   154 (2):   267–271

Questionnaires, filled out by a broad spectrum of medical providers in England [Primary Care (n = 75), Pediatrics (n = 39), Emergency (n = 39), Orthopedics (n = 40), and experienced doctors in Primary Care (n = 93), and Pediatrics (n = 60).], revealed that 74% of them scored their personal confidence in pediatric musculoskeletal clinical assessment as "no" to "low".

Non-specific Neck Pain in Schoolchildren: Prognosis and Risk Factors for
Occurrence and Persistence. A 4-year Follow-up Study

Pain. 2008 (Jul 15);   137 (2):   316–322 ~ FULL TEXT

In conclusion, neck pain in schoolchildren tends to fluctuate, but there also seems to exist a subgroup (5%) with persistent NP already in pre-/early adolescents, or even earlier. Co-occurrence of frequent other musculoskeletal symptoms and/or markers of psychological stress with frequent NP are risk indicators for a more persistent course, at least within next few years. Since adult chronic NP problems might originate in childhood, further studies are needed, including preventive interventions.

Epidemiology of Adolescent Spinal Pain:
A Systematic Overview of the Research Literature

Spine (Phila Pa 1976). 2007 (Nov 1);   32 (23):   2630–2637 ~ FULL TEXT

Although there is wide discrepancy in the manner in which adolescent spinal pain is reported, it is evident that lifetime prevalence rates increase steadily with age and approximate adult levels by around the age of 18 years. There is an opportunity for further longitudinal research, with standardized methodology, to be undertaken that builds on the findings from this large group of studies.

Neck and Shoulder Pains in Relation to Physical Activity
and Sedentary Activities in Adolescence

Spine 2007 (Apr 20);   32 (9):   1038–1044

Almost half of the girls and one third of the boys reported mild neck or occipital pain, or shoulder pain, and 3% of girls and 2% of boys reported severe neck or occipital pain, or shoulder pain during the past 6 months. High-level physical activity associated with an increased prevalence of both severe neck or occipital pain and severe shoulder pain in girls, but not in boys. Prolonged sitting was associated with a high prevalence of neck or occipital pain and shoulder pain in girls, and neck or occipital pain in boys. Of various sedentary activities, television watching and reading books associated with neck or occipital pain in girls, whereas playing or working with a computer associated with neck or occipital pain in boys. In girls, television watching also associated with mild shoulder pain.

Back and Pelvic Pain in an Underserved United States Pregnant Population:
A Preliminary Descriptive Survey

J Manipulative Physiol Ther. 2007 (Feb);   30 (2):   130–134 ~ FULL TEXT

Low back pain (LBP) in the general population is recognized as a major health concern, and left untreated, this malady can lead to chronic, disabling morbidity. [1, 2] Accordingly, chronic pain is a major health care expense in the United States, and LBP is responsible for the majority of chronic musculoskeletal pain. [3] Low back pain and pelvic pain (PP) in pregnancy, however, are frequently viewed as transient conditions that are anticipated to subside after childbirth. In fact, recent studies have identified that women who do have LBP/PP during pregnancy receive little recommendations and/or treatment for their complaints. [4, 5]

Is Comorbidity in Adolescence a Predictor for Adult Low Back Pain?
A Prospective Study of a Young Population

BMC Musculoskelet Disord 2006 (Mar 16);   7:   29 ~ FULL TEXT

Your chiropractic care may be working out “kinks” in your lower back that have been around a lot longer than you realize. This new study of 10,000 Danish residents shows a link between adolescent and adult low back pain (LBP). Researchers studied twins born between 1972 and 1982 by sending out questionnaires in 1994 and again in 2002. The outcomes showed that a high percentage of those who had LBP in 1994 still suffered from LBP in 2002. They also found that those with persistent LBP were 4.5 times more likely than the average person to have future LBP episodes!

The Course of Low Back Pain from Adolescence to Adulthood:
Eight-year Follow-up of 9600 Twins

Spine 2006 (Feb 15);   31 (4):   468–472 ~ FULL TEXT

High prevalence rates of low back pain among children and adolescents have been demonstrated in several studies, and it has been theorized that low back pain in childhood may have important consequences for future low back pain. Almost 10,000 Danish twins born between 1972 and 1982 were surveyed by means of postal questionnaires in 1994 and again in 2002. The questionnaires dealt with various aspects of general health, including the prevalence of low back pain, classified according to number of days affected (0, 1–7, 8–30, >30).   Low back pain in adolescence was found to be a significant risk factor for low back pain in adulthood with odds ratios as high as four. We also demonstrated a dose-response association: the more days with low back pain at baseline, the higher the risk of future low back pain.

An Epidemiologic Study of MRI and Low Back Pain in 13-year-old Children
Spine (Phila Pa 1976). 2005 (Apr 1);   30 (7):   798–806

In children, degenerative disc findings are relatively common, and some are associated with LBP. There appears to be a gender difference. Disc protrusions, endplate changes, and anterolisthesis in the lumbar spine were strongly associated with seeking care for LBP.

Persistence and Change in Nonspecific Low Back Pain Among Adolescents:
A 3-year Prospective Study

Spine (Phila Pa 1976). 2004 (Nov 1);   29 (21):   2452–2457

Our findings indicate that reports of LBP in midadolescence are strong predictors of future LBP in late adolescence, although half of those reporting LBP at baseline did not report LBP at follow-up and one fourth had forgotten minor previous episodes. The data confirm the general trend that LBP, often provoked by manual work and prolonged sitting, is common, and the results indicate a consistent, but changeable, pattern of juvenile LBP. Future research should study the significance of reports of LBP provoked by manual work and sitting during adolescence for future LBP and disability in adulthood.

Evaluation of Chiropractic Management of Pediatric Patients
with Low Back Pain: A Prospective Cohort Study

J Manipulative Physiol Ther 2003 (Jan);   26 (1):   1–8 ~ FULL TEXT

Fifteen chiropractors provided data on 54 consecutive pediatric patients with LBP. The average age of the patients was 13.1 years, 57% were male, 61% were acute, with 47% attributing onset to a traumatic event (most commonly sports-related); 24% reported an episode duration of greater than 3 months. Almost 90% of cases presented with uncomplicated mechanical LBP, most frequently diagnosed as lumbar facet dysfunction or subluxation.

Back, Neck, and Shoulder Pain in Finnish Adolescents:
National Cross Sectional Surveys

British Medical Journal 2002 (Oct 5);   325 (7367):   743–745 ~ FULL TEXT

To study changes in the prevalence of pain in the back or neck in adolescents between the years 1985 and 2001, the authors compared biennial nationwide postal surveys, between 1985–2001, and annual classroom surveys, from 1996–2001.   They found that pain in the neck, shoulder, and lower back is becoming more common in Finnish adolescents. This pain suggests a new disease burden of degenerative musculoskeletal disorders for future adults. Prevalence of pain in the back and neck was greater in the 1990s than in the 1980s and increased steadily from 1993 to 1997. Pain of the neck and shoulder and pain of the lower back was much more common in 1999 than in 1991 and in 2001 than in 1999. Pain was more common among girls and older groups: pain of the neck and shoulder affected 24% of girls and 12% of boys in 14 year olds, 38% of girls and 16% of boys in 16 year olds, and 43% of girls and 19% of boys in 18 year olds; pain in the lower back affected 8% of girls and 7% of boys in 14 year olds, 14% of girls and 11% of boys in 16 year olds, and 17% of boys and 13% of girls in 18 year olds.

Back Pain Reporting Pattern in a Danish
Population-based Sample of Children and Adolescents

Spine (Phila Pa 1976). 2001 (Sep 1);   26 (17):   1879–1883

The 1-month prevalence of back pain was 39%. Thoracic pain is most common in childhood, whereas thoracic pain and lumbar pain are equally common in adolescence. Neck pain and pain in more than one area of the spine are rare in both age groups. No gender differences were found. Of those who had back pain, 38% also reported some type of consequence, usually either visits to a medical physician or diminished physical activities.

Neck or Shoulder Pain and Low Back Pain in Finnish Adolescents
Scand J Public Health. 2000 (Sep);   28 (3):   164–173

Both symptoms were more prevalent among girls than among boys, and the prevalence increased with age. Among the determinants investigated, the number of perceived psychosomatic symptoms had the strongest association with NSP and LBP. Our study confirmed the co-morbidity of NSP and LBP, and indicated that NSP is more frequent than believed among 16–18-year-old girls.

Back Pain in Children Who Present to the Emergency Department
Clin Pediatr 1999 (Jul);   38 (7):   401–406

When present, pediatric back pain is most often musculoskeletal, associated with an acute infectious illness or a traumatic event. Although the etiology is rarely serious, back pain often affects the daily activities of symptomatic children.

Nonspecific Back Pain in Children:
A Search for Associated Factors in 14-year-old Schoolchildren

Rev Rhum Engl Ed 1999 (Jul);   66 (7–9):   381–388

The findings from this cross-sectional study indicate a need for a longitudinal prospective study designed to identify etiologic and prognostic factors of back pain in adolescents, with the goal of devising preventive strategies likely to reduce the risk of low back pain in adulthood.

Prolonged Low-Back Pain in Young Athletes:
A Prospective Case Series Study of Findings and Prognosis
European Spine Journal 1999 (Dec);   8 (6):   480–484

We investigated the prognosis of low-back pain and the association of clinical symptoms and anatomic findings among young athletes. Consecutive patients, aged between 12 and 18 years, who had low-back pain that had interfered with their training for at least 4 weeks were included in the case series.

Why the Back of the Child? ~ FULL TEXT
European Spine Journal 1999;   8 (6):   426–428

An international congress about "the back of children and teenagers and the prevention of backache" was held in March 1999 in Grenoble (France). Beside specific low back pain following progressive and growth diseases, special attention was paid to non-specific low back pain (LBP).

At What Age Does Low Back Pain Become a Common Problem?
A Study of 29,424 Individuals Aged 12–41 Years

Spine (Phila Pa 1976). 1998 (Jan 15);   23 (2):   228–234

The prevalence of the various definitions of low back pain increased greatly in the early teen years (earlier for girls than for boys), and by the ages of 18 years (girls) and 20 years (boys) more than 50% had experienced at least one low back pain episode. The pattern for the 1-year period prevalence of low back pain was very similar to that for the lifetime prevalence; both started at 7% (95% confidence interval, 5–9%) for the 12-year-old individuals and reached 56% (95% confidence interval, 53–59%) and 67% (95% confidence interval, 62–71%), respectively, for the 41-year-old individuals.

ABC of Sports Medicine:
Musculoskeletal Injuries in Child Athletes

British Medical Journal 1994 (Jun 11);   308:   1556–1559

The growing skeletons of children may be injured more easily than the mature skeletons of adults because the bones are more porous and the long bones are further weakened by the epiphysical plates at their proximal and distal ends.


Headaches in Children

Headache and Chiropractic
A Chiro.Org article collection

Review a collection of articles that focus on the effectiveness of chiropractic for reducing headache pain.

Effectiveness of Chiropractic Manipulation Versus Sham Manipulation for
Recurrent Headaches in Children Aged 7-14 Years - A Randomised Clinical Trial

Chiropractic & Manual Therapies 2021 (Jan 7);   29:   1~ FULL TEXT

Chiropractic spinal manipulation resulted in fewer headaches and higher global perceived effect, with only minor side effects. It did not lower the intensity of the headaches. Since the treatment is easily applicable, of low cost and minor side effects, chiropractic spinal manipulation might be considered as a valuable treatment option for children with recurrent headaches.

Diagnostic Testing Considerations in Pediatric Cervicogenic Headache
ACA News ~ May 23, 2016 ~ FULL TEXT

Cervicogenic headache is common in pediatric patients and is defined by the International Headache Society as a condition caused by cervical spine dysfunction that is usually accompanied by neck pain. We chose this type of headache because it is commonly seen in chiropractic offices. With these thoughts in mind, we performed a search for office-based tests to help substantiate a diagnosis of cervicogenic headache diagnosis in a pediatric patient.

An International Survey of Pain in Adolescents
BMC Public Health. 2014 (May 13);   14 (1):   447 ~ FULL TEXT

Adolescence marks the transition from childhood to adult life. Pain during adolescence is an important predictor of future pain. [1–3] A Danish twins study [4] found adolescents with persistent low back pain were 3.5 times more likely to have low back pain in adulthood. Co-occurrence of low back pain and headache in adolescence further increases the risk of developing future pain which draws attention to the significance of multiple pains. [4]

Is There a Difference in Head Posture and Cervical Spine Movement
in Children With and Without Pediatric Headache?

European Journal of Pediatrics 2013 (Oct);   172 (10):   1349–1356 ~ FULL TEXT

Cervical range of motion (ROM) in each cardinal plane was significantly less in the children with purported cervicogenic headache (CGH) compared to those without headache (Table 1). ROM values recorded in the asymptomatic group are comparable with a previous report for children. [3] While no previous studies have reported ROM values for children with CGH, these results are consistent with reports in adult populations. [23, 51, 52] Interestingly, ROM does not appear to be restricted in all directions in adults with headache [23, 51, 52], but the explanation for this is not clear. This study finding of reduced ROM in children with purported CGH supports the current criteria for CGH diagnosis. [20, 44]

Referred Pain from Myofascial Trigger Points in Head and Neck-shoulder
Muscles Reproduces Head Pain Features in Children With
Chronic Tension type Headache

J Headache Pain. 2011 (Feb);   12 (1):   35–43 ~ FULL TEXT

The current controlled and blinded study showed the existence of multiple active TrPs in head, neck and shoulder musculature in children with chronic tension type headache (CTTH). Both local and referred pain characteristics elicited by palpation of active muscle TrPs reproduced the head pain patterns in children with CTTH. Referred pain areas elicited by active TrPs were larger in children with CTTH as compared to healthy children. The size of referred pain areas of some muscles was positively related to some headache clinical parameters. Our results support a role of active TrP in children with CTTH.

Recurrent Neck Pain and Headaches in Preadolescents Associated with
Mechanical Dysfunction of the Cervical Spine: A Cross-Sectional
Observational Study With 131 Students

J Manipulative Physiol Ther 2009 (Oct);   32 (8):   625–634 ~ FULL TEXT

Forty percent of the children (n = 52) reported neck pain and/or recurrent headache. Neck pain and/or headache were not associated with forward head posture, impaired functioning in cervical paraspinal muscles, and joint dysfunction in the upper and middle cervical spine in these subjects. However, joint dysfunction in the lower cervical spine was significantly associated with neck pain and/or headache in these preadolescents. Most of the students had nonsymptomatic biomechanical dysfunction of the upper cervical spine. There was a wide variation between parental report and the child's self-report of trauma history and neck pain and/or headache prevalence.

Headache in a National Sample of American Children:
Prevalence and Comorbidity

J Child Neurol 2009 (May);   24 (5):   536–543 ~ FULL TEXT

The purpose of this study was to determine the prevalence, sociodemographic correlates, and comorbidity of recurrent headache in children in the United States. Participants were individuals aged 4 to 18 years (n = 10,198) who participated in the National Health and Nutrition Examination Surveys. Data on recurrent and other health conditions were analyzed. Frequent or severe headaches including migraine in the past 12 months were reported in 17.1% of children. Asthma, hay fever, and frequent ear infections were more common in children with headache, with at least 1 of these occurring in 41.6% of children with headache versus 25.0% of children free of headache. Other medical problems associated with childhood headaches include anemia, overweight, abdominal illnesses, and early menarche. Recurrent headache in childhood is common and has significant medical comorbidity. Further research is needed to understand biologic mechanisms and identify more homogeneous subgroups in clinical and genetic studies.

Clinical Features, Classification and Prognosis of Migraine and Tension-type
Headache in Children and Adolescents: A Long-term Follow-up Study

Cephalalgia. 2006 (Jul);   26 (7):   820–830

Of 140 patients initially diagnosed with migraine, 25.7% were headache free, 48.6% still had migraine and 25.7% had TTH at follow-up.   Of 87 patients with TTH, 37.9% were headache free, 41.4% still had TTH and 20.7% had migraine.

Chronic Daily Headache in Adolescents: Prevalence,
Impact, and Medication Overuse

Neurology 2006 (Jan 24);   66 (2):   193–197

Chronic daily headache (CDH) was common in a large nonreferred adolescent sample. Based on the International Classification of Headache Disorders, 2nd edition, criteria, chronic tension-type headache was the most common subtype;
Although this article does not discuss care options for chronic tension-type headache, conservative chiropractic care is the natural choice.

Chiropractic Spinal Manipulation for Cervicogenic Headache in an 8-Year-Old
J Neuromusculoskeletal System 2002 (Fall); 10 (3): 98–103

A case of cervicogenic headache (CEH) in an 8-year-old boy that improved after chiropractic spinal manipulation is reported. An 8-year-old boy presented with a complaint of daily headache. The duration of symptoms was over 3 years. The patient met the diagnostic criteria for CEH. Awkward head position reproduced head pain, as did palpation of the upper cervical region. Decreased range of motion of the neck was evident, as well as abnormal tenderness and primarily of the right upper cervical region, and ancillary myofascial release. A significant decrease in headache frequency as reported by the patient and parent was seen after the first treatment. After four treatments the headache frequency decreased to approximately one per month.


Drugs & Children

Children and the Caffeine Culture
Here is a two-part article on the increasing caffeine consumption by children and youths in the U.S. that appeared in the San Mateo County Times on October 26 and 28, 1998, and probably in other ANG Newspapers in the San Francisco Bay Area. It was written by Dr. Ron Eisenberg and Dr. Virgil Williams, staff physicians at Highland General Hospital in Oakland, California, who apparently write other medical related columns for the newspaper group.

Pediatric Drug Prescriptions
Dynamic Chiropractic ~ March 11, 2008 ~ FULL TEXT

The majority of drugs given to children have never been tested specifically for them. Physicians are prescribing drugs based on a “best guess” as to the dosage, efficacy and even safety. The FDA understands that giving medications to children for which there is only adult data available could be harmful, considering that children have dosing concerns and side-effect risks that differ from adults. The latest legislation has made some headway in the battle against the lack of proper labeling; yet, it still fails to completely overcome the absence of research, particularly in the older medications.

Antibiotic Use In Infants Linked To Asthma
The Science Advisory Board ~ June 13, 2007

New research indicates that children who receive antibiotics before their first birthday are significantly more likely to develop asthma by age 7. The study, published in the June issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), reports that children receiving antibiotics in the first year of life were at greater risk for developing asthma by age 7 than those not receiving antibiotics. The risk for asthma doubled in children receiving antibiotics for nonrespiratory infections, as well as in children who received multiple antibiotic courses and who did not live with a dog during the first year.

Drug Research and Children
FDA Consumer Magazine ~ January–February 2003

Most drugs prescribed for children have not been tested in children. Only 20 percent to 30 percent of drugs approved by the Food and Drug Administration are labeled for pediatric use. So by necessity, doctors have routinely given drugs to children "off label," which means the drug hasn't been studied in children in adequate, well-controlled clinical trials approved by the agency.

Reported Adverse Drug Events in Infants and Children Under 2 Years of Age
PEDIATRICS 2002 (Nov);   110 (5):   E53–E53

Less than 1% of the nearly 2,000 drugs identified in the study were associated with over half of all serious or fatal side-effects. Deaths linked to side-effects were far more likely in the first few months after birth (41% in the first month). In a full quarter of cases, drugs were administered to the mother, not the infant, and then passed to the child through the womb or through breastfeeding.   Included in the list of the drugs most likely to cause dangerous side-effects in children were ibuprofen and acetaminophen (drugs more commonly known by such brand names as Advil and Tylenol).

Ritalin:   This Children's Drug Is More Potent Than Cocaine
The London Observer September 9, 2001

Using brain imaging, scientists have found that, in pill form, Ritalin – taken by thousands of British children and four million in the United States – occupies more of the neural transporters responsible for the “high” experienced by addicts than smoked or injected cocaine. The research may alarm parents whose children have been prescribed Ritalin as a solution to Attention Deficit Hyperactive Disorder.

Antibiotics/Antimicrobials Ineffective for Treatment of Children With Acute Sinusitis
PEDIATRICS 2001 (Apr);   107 (4):   619–625

This randomized trial found that neither amoxicillin nor amoxicillin-clavulanate offered any clinical benefit compared with placebo for children with clinically diagnosed acute sinusitis.

Pediatric Drug Studies: Protecting Pint-Sized Patients
FDA Consumer Magazine ~ May–June 1999

Of the nine-item laundry list of medicines Goldberg's 6-year-old daughter Abby was taking for her severe asthma, not a single one was tested or approved in the United States for children under 12. "I feel as though I am testing drugs on my own child, every day, and it isn't helping anyone," Goldberg said... Because of their immature organs and different metabolic and immune systems, children react unlike adults to many drugs. Treating children with adult drugs, then, can carry the risk of unforeseen adverse reactions.

Therapeutic Misadventures With Acetaminophen:
Hepatoxicity After Multiple Doses in Children

J Pediatr 1998 (Jan);   132 (1):   22–27

Twenty-four of 43 patients (53%) died, with an additional three surviving after orthotopic liver transplantation. Parents should be advised about the potential hepatotoxicity of acetaminophen when given to ill children in doses exceeding weight-based recommendations.

Are Antibiotics Indicated as Initial Treatment for Children
With Acute Otitis Media? A Meta-Analysis

British Medical Journal 1997 (May 24);   314 (7093):   1526–1529 ~ FULL TEXT

Early use of antibiotics provides only modest benefit for acute otitis media: to prevent one child from experiencing pain by 2–7 days after presentation, 17 children must be treated with antibiotics early.

Even Small Amounts of Tylenol May Be Dangerous for
Infants and Small Children

In a paper published in Contemporary Pediatrics, Dr. James E. Heubi states that in infants and small children, studies have indicated that the toxic dose is less than twice the recommended dose. Studies have also shown that it is very easy to mistakenly give children too much acetaminophen and, as a result, endanger their lives and health.

Child Acetaminophen Deaths Reported
Reuters News Service

At least 24 children in the United States have died and three have required liver transplants after receiving accidental overdoses of acetaminophen -- the most widely used medication for relief of pain and fever in children and infants, according to a report in the Journal of Pediatrics.


Adverse Events in Children

The Adverse Events Page
A Chiro.Org article collection

This page compiles reports on adverse events following evey form of care.

A Literature Review of Pediatric Spinal Manipulation and Chiropractic
Manipulative Therapy: Evaluation of Consistent Use of Safety Terminology

J Manipulative Physiol Ther. 2015 (Nov);   38 (9):   692–698 ~ FULL TEXT

Of the 9 relevant articles identified in this study, 3 reported methodology for classifying safety incidents, and all 9 used safety terminology (adverse effects or adverse events). However, terminology was not used consistently.   Most of the articles identified in this literature review did not use terminology consistent with the standards established by the ICH when reporting on safety incidents following pediatric spinal manipulation or chiropractic manipulative therapy. More efforts should be taken to include consistent terminology for studies of spinal manipulation and chiropractic manipulative therapy for children.

Adverse Events Due to Chiropractic and Other Manual Therapies
for Infants and Children: A Review of the Literature

J Manipulative Physiol Ther. 2015 (Nov);   38 (9):   699–712 ~ FULL TEXT

Published cases of serious adverse events in infants and children receiving chiropractic, osteopathic, physiotherapy, or manual medical therapy are exceedingly rare. There have been no cases of deaths associated with chiropractic care reported in the academic literature to date. Three deaths were reported caused by other types of manual therapists (1 physical therapist, 1 unknown practitioner, and 1 craniosacral therapist). Performing a thorough history and examination to exclude anatomical or neurologic anomalies before the provision of care, appropriate technique selection and its application may further reduce adverse events across all manual therapy professions.

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

Journal of Clinical Chiropractic Pediatrics 2014 (Mar);   14 (2) ~ FULL TEXT

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.

Chiropractic Care of Children from Birth to Adolescence and Classification
of Reported Conditions: An Internet Cross-Sectional Survey
of 956 European Chiropractors

J Manipulative Physiol Ther. 2012 (Jun);   35 (5):   372–380 ~ FULL TEXT

Pediatric patients represent between 5% and 17% of general chiropractic practice and 39% of specialist pediatric chiropractic practice. In the absence of high levels of evidence, doctors of chiropractic have relied on clinical experience and education to provide care. Pediatric health conditions seen by chiropractors have been reviewed systematically.   Several authors have traditionally reported conditions in 2 distinct categories of musculoskeletal and nonmusculoskeletal conditions. The rationale behind such a separation has not been investigated (to the author's knowledge). The safety of spinal manipulative therapy in pediatric care has been addressed in the literature with few safety incidents reported. Of the 956 (23.3%) participating chiropractors, 921 reported 19,821 pediatric patients per month. Children represented 8.1% of chiropractors' total patient load over the last year. A total of 557 (534 mild, 23 moderate, and 0 severe) negative (adverse) side effects were reported for an estimated incidence of 0.23%. On the given treatment statements, chiropractors reported varying agreement and disagreement rates based on patient age.   The 8,309 answers on conditions were grouped into skeletal (57.0%), neurologic (23.7%), gastrointestinal (12.4%), infection (3.5%), genitourinary (1.5%), immune (1.4%), and miscellaneous conditions (0.5%). The number of treatment sessions delivered varied according to the condition and the patient age.

Adverse Events From Spinal Manipulation in the Pregnant
and Postpartum Periods: A Critical Review of the Literature

Chiropractic & Manual Therapies 2012 (Mar 28);   20:   8 ~ FULL TEXT

Five articles identifying adverse events in seven subjects following spinal manipulation were included in this review, along with two systematic reviews. The articles were published between 1978 and 2009. Two articles describing adverse effects from spinal manipulation on two postpartum patients were included, while the remaining three articles on five patients with adverse effects following spinal manipulation were on pregnant patients. Injury severity ranged from minor injury such as increasing pain after treatment that resolved within a few days to more severe injuries including fracture, stroke, and epidural hematoma. SIGN scores of the prospective observational cohort study and systematic reviews indicated acceptable quality.

Is Chiropractic Pediatric Care Safe? A Best Evidence Topic
Clinical Chiropractic 2011 (Sep);   14 (3):   97–105 ~ FULL TEXT

The reviewed published chiropractic literature suggests a rate of 0.53% to 1% mild adverse events (AE) associated with chiropractic paediatric manipulative therapy (PMT). Put in terms of individual patients, between one in 100 to 200 patients presenting for chiropractic care; or in terms of patient visits, between one mild AE per 1310 visits to one per 1812 visits. For a comparison, Osteopathic PMT have a reported rate of 9%, and medical practitioners utilising PMT under the auspices of ‘chiropractic therapy’ have reported a rate of 6%. A reasonable caution to the parent/guardian is that one child per 100 to 200 attending may have a mild adverse events, with irritability or soreness lasting less than 24 hours, resolving without the need for additional care.

Possible Adverse Events in Children Treated By Manual Therapy: A Review
Chiropractic & Osteopathy 2010 (Jun 2);   18:   12 ~ FULL TEXT

Miller and Benfield [16] estimate 1% of pediatric patients (one in 749 treatments) suffered from a minor and self limited AE. A detailed description of the AE allowed the authors to review and classify them. Based on their analysis, three of the events attributed as AE may have been incorrectly attributed as a result of treatment (i.e. pre-existing constipation, common behavior of child, etc.). If these are excluded, the AE rate becomes one reaction per 1310 treatments.

The Safety and Effectiveness of Pediatric Chiropractic: A Survey
of Chiropractors and Parents in a Practice-based Research Network

Explore (NY) 2009 (Sep);   5 (5): 290–295 ~ FULL TEXT

The indicated primary reason for chiropractic care of children was "wellness care." With respect to condition-based presentations, musculoskeletal conditions were the most common, in addition to nonmusculoskeletal conditions of childhood. The most common techniques used were diversified technique, Gonstead technique, Thompson technique, and activator methods. Treatment-associated complications were not indicated by the chiropractic and parent responders. Chiropractor responders indicated three adverse events per 5,438 office visits from the treatment of 577 children. The parent responders indicated two adverse events from 1,735 office visits involving the care of 239 children.

Adverse Effects of Spinal Manipulative Therapy in Children Younger Than
3 Years: A Retrospective Study in a Chiropractic Teaching Clinic

J Manipulative Physiol Ther 2008 (Jul);   31 (6):   419–423 ~ FULL TEXT

This study shows that for the population studied, chiropractic manipulation produced very few adverse effects and was a safe form of therapy in the treatment of patients in this age group.

Development, Testing, and Findings of a Pediatric-Focused Trigger Tool to
Identify Medication-Related Harm in US Children's Hospitals

Pediatrics 2008 (Apr);   121 (4):   e927–935

Adverse drug event rates in hospitalized children are substantially higher than previously described. Most adverse drug events resulted in temporary harm, and 22% were classified as preventable. Only 3.7% were identified by using traditional voluntary reporting methods. Our pediatric-focused trigger tool is effective at identifying adverse drug events in inpatient pediatric populations. [Editorial Commentary:   These findings (that only 3.7% of adverse events find their way into hospital error reports) is very alarming, and suggests that previous reports have only documented the tip of the iceberg.]

ICPA and FCER Responds to Pediatrics Article ~ February 2007
It’s a battle that the chiropractic profession is familiar with–a “scientific” article appears in a medical journal decrying the risks of chiropractic cervical manipulation, and newspapers and television news programs spread the conclusions without either comparison to risks associated with common medical treatments or rebuttal from within chiropractic. The latest front in this battle is over the chiropractic treatment of the pediatric population. Published in the January 1, 2007 issue of Pediatrics, the Journal of the American Academy of Pediatrics, the article
Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review has quickly reached the airwaves of the popular media.

Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy:
A Retrospective Case Series

J Midwifery Womens Health 2006 (Jan);   51 (1):   e7–10

Sixteen of 17 (94.1%) cases demonstrated clinically important improvement. The average time to initial clinically important pain relief was 4.5 (range 0–13) days after initial presentation, and the average number of visits undergone up to that point was 1.8 (range 1–5). No adverse effects were reported in any of the 17 cases. The results suggest that chiropractic treatment was safe in these cases and support the hypothesis that it may be effective for reducing pain intensity.


Chiropractic Pediatric Care Guidlines

The Pediatric Guidelines Section
A Chiro.Org collection

Our Guidelines Page includes the collected guidelines from around the world, including:   Alternative Medicine Guidelines, The “Best Practice” Initiative, Diagnostic Imaging Guidelines, Headache Guidelines (Canada), Insurance Industry Guidelines, Low Back Pain Guidelines from Around the World, Neck Disorder Guidelines, Physiotherapy and Rehabilitation Guidelines, State and National Guidelines for Chiropractic Practice, Subluxation–based Guidelines, Workers Compensation Guidelines (California) and our Guidelines Book Shelf.

A Summary of Current Studies Related to Chiropractic and Manual Therapies
for Pediatric Patients

J Clinical Chiropractic Pediatrics 2019;   18 (1) ~ FULL TEXT

The current studies summarized above suggest that manual therapies are rarely associated with serious adverse events in children, even infants. For additional protection of patients, our profession has also developed an evidence-based set of recommendations for “best practices” for chiropractic care of children.

Attitudes and Opinions of Doctors of Chiropractic Specializing in
Pediatric Care Toward Patient Safety: A Cross-sectional Survey

J Manipulative Physiol Ther. 2016 (Sep);   39 (7):   487–493 ~ FULL TEXT

Compared with 2014 Agency for Healthcare Research and Quality physician referent data from medical offices, pediatric DCs appear to have more positive patient safety attitudes and opinions. Future patient safety studies need to prospectively evaluate safety performance with direct feedback from patients and compare results with these self-assessed safety attitudes, as well as make further use of this survey to develop a comparable database for spinal manipulation providers.

Core Competencies of the Certified Pediatric Doctor of Chiropractic:
Results of a Delphi Consensus Process

J Evid Based Complementary Altern Med. 2016 (Apr);   21 (2):   110–114 ~ FULL TEXT

An outline of the minimum core competencies expected from a certified pediatric doctor of chiropractic was developed using a Delphi consensus process. The initial set of seed statements and substatements was modeled on competency documents used by organizations that oversee chiropractic and medical education. These statements were distributed to the Delphi panel, reaching consensus when 80% of the panelists approved each segment. The panel consisted of 23 specialists in chiropractic pediatrics (14 females) from across the broad spectrum of the chiropractic profession. Sixty-one percent of panelists had postgraduate pediatric certifications or degrees, 39% had additional graduate degrees, and 74% were faculty at a chiropractic institution and/or in a postgraduate pediatrics program. The panel were initially given 10 statements with related substatements formulated by the study's steering committee. On all 3 rounds of the Delphi process the panelists reached consensus; however, multiple rounds occurred to incorporate the valuable qualitative feedback received.

Best Practices for Chiropractic Care of Children: A Consensus Update
J Manipulative Physiol Ther. 2016 (Mar);   39 (3):   158–168 ~ FULL TEXT

Chiropractic 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. [1] Chiropractic care is the most common complementary and integrative medicine practice used by children in the United States. [2] A recent Gallup survey found that approximately 14% of US adults reported that they had used chiropractic care in the prior 12 months, that more than 50% had ever used a doctor of chiropractic (DC) for health care, and that more than 25% would choose chiropractic care as a first treatment for neck or back pain. [3] The findings from this survey also were consistent with a previous study that found that patients use chiropractic services in different ways, sometimes for treatment and sometimes for health promotion. [4]
This is an update of the 2009 Consensus Document titled:
Best Practices Recommendations for Chiropractic Care for Infants, Children, and Adolescents

A Proposed Model With Possible Implications for Safety and Technique Adaptations
for Chiropractic Spinal Manipulative Therapy for Infants and Children

J Manipulative Physiol Ther 2015 (Nov);   38 (9):   713–726 ~ FULL TEXT

The literature showed that tensile strength differences have been observed between pediatric and adult specimens. A preliminary model of care including pediatric SMT technique adaptation based on patient age is proposed, which may possibly contribute to further knowledge of safety and clinical implications for SMT for children and infants.

Best Practices Recommendations for Chiropractic Care for Infants,
Children, and Adolescents: Results of a Consensus Process

J Manipulative Physiol Ther. 2009 (Oct);   32 (8):   639–647 ~ FULL TEXT

There has been much discussion about the role of chiropractic care in the evaluation, management, and treatment of pediatric patients. To date, no specific guidelines have been adopted that address this issue from an evidence based perspective. Previous systematic reviews of the chiropractic literature concluded that there is not yet a substantial body of high quality evidence from which to develop standard clinical guidelines. The purpose of this project was to develop recommendations on "best practices" related primarily to the evaluation and spinal manipulation aspects of pediatric chiropractic care; nonmanipulative therapies were not addressed in detail.
These recommendations have been updated by the 2016 article:
Best Practices for Chiropractic Care of Children: A Consensus Update


Pediatric Associations

ACA Council on Chiropractic Pediatrics
The American Chiropractic Association's Council on Chiropractic Pediatrics (also known as the ACA Pediatrics Council) was established in 2005. Our goals are to support our members who take care of children in their chiropractic practices, and to promote the acceptance and advancement of pediatric chiropractic care.

ICA Council on Chiropractic Pediatrics
The ICA Council on Chiropractic Pediatrics is one of the post-graduate councils of the International Chiropractors Association. It was established in 1993 to bring together doctors of chiropractic who have a special interest caring for children and pregnant women.

International Chiropractic Pediatric Association (ICPA)
The I.C.P.A. is the professions oldest, largest and most respected chiropractic pediatric association. The I.C.P.A. is a non-profit organization, founded by Larry Webster, D.C. who perceived the need for more information, training and research in the field of chiropractic pediatrics. The I.C.P.A. is an independent, non-political organization, and is not affiliated with any other national organization.

Kentuckiana Children's Center
The ongoing emphasis at Kentuckiana is on special programs individually designed to help the child with special needs. Our goal is to have each child reach his or her optimum potential.

Oklahaven Children’s Chiropractic Center
Oklahaven began in response to the needs of chronically ill children in 1962, many of whom in the early 1960’s were paralyzed, in braces and wheelchair bound. The founders chose to provide chiropractic care through a nonprofit 501 (c)(3) organization. They relied on the generosity of the private sector who shared their vision of natural drug-free health care and of other colleagues to donate their services. Oklahaven has continued to operate through private donations without federal, state or United Way funding for 55 years.


Pediatric LINKS of Interest

   Pediatric Journals

  European Journal of Pediatrics

  JAMA Pediatrics

  Journal of Clinical Chiropractic Pediatrics

  Pediatrics Journal

  Pediatric Pharmocotherapy

Child-Neurology Home Page
This website points to many useful neurology resources.

EPA's Office of Children's Health Protection
Children may be more vulnerable to environmental (toxic) exposures than adults because: Their bodily systems are still developing, They eat more, drink more, and breathe more in proportion to their body size, and their behavior can expose them more to chemicals and organisms. Learn more here!


Breastfeeding Dysfunction

Breastfeeding Information @ CDC
CDC is committed to increasing breastfeeding rates throughout the United States and to promoting optimal breastfeeding practices. This goal can be achieved by supporting breastfeeding mothers, their families, communities, employers, and health care providers by providing education, training, funding, technical assistance, and research.

Manual Interventions for Musculoskeletal Factors in Infants
with Suboptimal Breastfeeding: A Scoping Review

J Evidence-Based Integrative Medicine 2018 (Dec 12); 23: 1–12 ~ FULL TEXT

This scoping review adds to the evidence base on one aspect of manual therapy for infants, a controversial topic that has even received attention on network television. Previous literature reviews of the topic of manual therapy for infant musculoskeletal problems linked to suboptimal breastfeeding have been discipline specific and focused on using spinal manipulation as the primary treatment. [42, 44] Relevant information about similar procedures and assessments used by other manual therapy professions remains unshared and unknown. Therefore, we searched literature that was oriented toward both chiropractic and osteopathic medicine because the two professions are most closely associated with spinal manipulation and use other manual therapies. We also searched websites of organizations that focus on infants with breastfeeding issues associated with the compensatory musculoskeletal problems resulting from congenital anomalies like ankyloglossia. Casting this wide net resulted in a surprisingly large number of articles and a higher quality of evidence than we anticipated.

Prevalence of Musculoskeletal Dysfunction in Infants Presenting
for Chiropractic Care in Norway: A Cross-sectional Study

Journal of Clinical Chiropractic Pediatrics 2017 (Sep);   16(1):   1355–1361 ~ FULL TEXT

Mild to moderate musculoskeletal injuries are common at birth, but frequently missed. [1] Although these injuries are common, their association with quality of life conditions like sleeping, feeding or excessive crying may not always be understood in professional practice. However, birth injuries are implicated in infant complaints. For example, a difficult birth has the highest association with infant colic (now known as excessive crying) than any other factor. [2]

Evaluation and Treatment of Breastfeeding Difficulties Associated
with Cervicocranial Dysfunction: A Chiropractic Perspective

Journal of Clinical Chiropractic Pediatrics 2016 (Dec);   15 (3):   1301–1307 ~ FULL TEXT

Increasingly, parents are presenting to the chiropractic office with the chief complaint of breastfeeding dysfunction. Early and consistent breastfeeding support is paramount to the dyad’s ability to establish a functional breastfeeding relationship. It is critical that chiropractors treating this population recognize feeding dysfunction and understand the mechanics of breastfeeding, what might alter those mechanics, and the importance of the role of the International Board Certified Lactation Consultant (IBCLC) in supporting the restoration of functional breastfeeding after the chiropractic adjustments have reduced the NMSK dysfunction. This paper outlines some of the mechanical dysfunctions that might interfere with the normal transfer of milk for a neonate.

The Infant with Dysfunctional Feeding Patterns –
The Chiropractic Assessment

Journal of Clinical Chiropractic Pediatrics 2016 (May);   15 (2):   1230-1235 ~ FULL TEXT

The World Health Organization recommends exclusive breastfeeding for the first 6 months of an infant’s life, followed by the introduction of complementary foods while breastfeeding for 2 years and beyond. Early and consistent breastfeeding support can often make the difference in a dyad’s ability to establish a functional breastfeeding relationship. While challenged dyads can sometimes accomplish competent breastfeeding given appropriate support, necessary interventions, and an opportunity to learn; timing is critical when a neonate has not been transferring adequate milk volume or is managing feeding in a passive or compensatory manner. Chiropractors should be most familiar with the diagnosis and treatment of musculoskeletal dysfunctions that could result in an inability to feed. They should also recognize and treat the compensatory changes that will develop in a healthy, neurotypical neonate who is challenged by an inability to feed efficiently in order to prevent the evolution of long term physiologic and postural ramifications.

Parent Reports of Exclusive Breastfeeding After Attending a
Combined Midwifery and Chiropractic Feeding Clinic in the
United Kingdom: A Cross-Sectional Service Evaluation

J Evid Based Complementary Altern Med. 2016 (Apr); 21 (2): 85–91 ~ FULL TEXT

The preponderance of evidence suggests that breastfeeding is the optimal nutrition for infants, emphasizing the importance of finding ways to enhance breastfeeding rates and assisting mothers and babies suffering from suboptimal feeding. The results from this study demonstrate high maternal satisfaction and improved breastfeeding rates associated with attending the clinic, although no cause and effect can be determined from this type of evaluation. The outcomes indicate that a cooperative approach between midwives and chiropractors can be a useful step toward effectively addressing the issue of suboptimal feeding. A testable hypothesis resulting from a service evaluation requires future research to determine if multidisciplinary care may provide additional benefits not accrued through routine care. Improving our understanding of what type of resources are helpful to the breastfeeding dyad has potential to positively influence public health.

The Chiropractic Care of Infants with Breastfeeding Difficulties
Explore (NY) (Nov) 2015; 11 (6): 468–474 ~ FULL TEXT

A total of 24 articles met our inclusion criteria. These consisted of 8 case reports, 2 case series, and 3 cohort studies. We were also able to identify 6 manuscripts (5 case reports and a case series) that involved breastfeeding difficulties as a secondary complaint. Our findings reveal a theoretical and clinical framework based on the detection of spinal and extraspinal subluxations involving the cervico-cranio-mandibular complex and assessment of the infant while breastfeeding.

Chiropractic and Breastfeeding Dysfunction: A Literature Review
Journal of Clinical Chiropractic Pediatrics 2014 (Mar);   14 (2) ~ FULL TEXT

Limited evidence exists to support chiropractic treatment for infants with breastfeeding dysfunction. Of the 6 case studies, 3 case series and 1 clinical trial found in this report there was a trend towards resolution of breastfeeding issues with chiropractic treatment of biomechanical imbalances. More meticulous, higher evidence studies are needed to provide further evidence of this.

The Use of Spinal Manipulative Therapy For Pediatric Health Conditions:
A Systematic Review of the Literature

J Can Chiropr Assoc. 2012 (Jun);   56 (2):   128–141 ~ FULL TEXT

Six clinical trials investigated the effectiveness of SMT on colic, two each on asthma and enuresis, and one each on hip extension, otitis media, suboptimal breastfeeding, autism, idiopathic scoliosis and jet lag. Studies that monitored both subjective and objective outcome measures of relevance to both patients and parents tended to report the most favorable response to SMT, especially among children with asthma.

Low Breastfeeding Rates Incur Billions in Medical Costs
MedPage Today ~ April 05, 2010

A new study published today determined that if 90% of new mothers exclusively breastfed their infants for the first 6 months that it could save $13 billion each year, as well as the lives of 911 newborns. "Exclusive breastfeeding" means only breast milk -- no water, infant food, juice, formula, cow's milk, or sugar water for the first 6 months.

Contribution of Chiropractic Therapy to Resolving Suboptimal Breastfeeding:
A Case Series of 114 Infants

J Manipulative Physiol Ther 2009 (Oct);   32 (8):   670–674 ~ FULL TEXT

Cooperative multidisciplinary care to support breastfeeding was demonstrated in this population. Chiropractic treatment may be a useful adjunct to routine care given by other professionals in cases of diagnosed breastfeeding problems with a biomechanical component.

Chiropractic Care of a Pediatric Patient With Symptoms Associated with
Gastroesophageal Reflux Disease, Fuss-cry-irritability with Sleep Disorder
Syndrome and Irritable Infant Syndrome of Musculoskeletal Origin

J Canadian Chiropractic Association 2008 (Dec);   52 (4): 248–255

The mother of a 3-month old girl presented her daughter for chiropractic care with a medical diagnosis of gastroesophageal reflux disease. Her complaints included frequently interrupted sleep, excessive intestinal gas, frequent vomiting, excessive crying, difficulty breastfeeding, plagiocephaly and torticollis. Previous medical care consisted of Prilosec prescription medication. Notable improvement in the patient’s symptoms was observed within four visits and total resolution of symptoms within three months of care. This case study suggests that patients with complaints associated with both musculoskeletal and non-musculoskeletal origin may benefit from chiropractic care.investigated.

Chiropractic Manipulation In Pediatric Health Conditions --
An Updated Systematic Review

Chiropractic & Osteopathy 2008 (Sep 12);   16:   11 ~ FULL TEXT

The search identified 1275 citations of which 57 discrete citations met the eligibility criteria determined by three reviewers who then determined by consensus, each citation's appropriate level on the strength of evidence scale. The new evidence from the relevant time period was 1 systematic review, 1 RCT, 2 observational studies, 36 descriptive case studies and 17 conference abstracts. When this additional evidence is combined with the previous systematic review undertaken up to 2003, there are now in total, 2 systematic reviews, 10 RCT's, 3 observational studies, 177 descriptive studies, and 31 conference abstracts defining this body of knowledge.

Full Breast-feeding May Lower Hospitalizations
for Infections During First Year of Life

Medscape Medical News ~ July 14, 2006

“On the basis of the present data, we conclude that full breastfeeding would lower the risk for hospital admission as a result of infections among infants who are younger than 1 year within an industrialized country,” the authors write. “The results are consistent with early studies and add to the body of evidence confirming the hypothesis that full breastfeeding lowers the risk for hospitalization as a result of infectious diseases during the first year of life in a developed country.”

Chiropractic Evaluation and Treatment of Musculoskeletal Dysfunction
in Infants Demonstrating Difficulty Breastfeeding

J Clinical Chiropractic Pediatrics 2004 (Dec); 6 (1): 349–366~ FULL TEXT

Observation of breastfeeding infants early in the neonatal period allows the chiropractor to determine the infant’s ability to root, latch onto and suckle the breast. Chiropractors may serve as effective members of an interdisciplinary team to identify and ameliorate biomechanical dysfunction before inappropriate imprinting or a disorganized suck is established. Cross professional education and communication will facilitate early referral and help establish a network of support for the new mother and infant. Craniocervical subluxation is one of the most important conditions to rule out when addressing difficulties with breastfeeding whether manifesting as neurologic (rooting or suckling reflex, hypertonic musculature) or mechanical (reduced mandibular excursion, decreased cervical range of motion) dysfunction. Chiropractic adjustments in the early stages of neurologic imprinting appear to safely and effectively address the craniocervical dysfunction and help restore natural, efficient suckling patterns for infants who are unable to successfully latch.

Relation of Infant Diet to Childhood Health: A Seven Year Follow Up.
British Medical Journal 1998 (Jan 3);   316 (7124):   21–25

The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for 15 weeks and no solid foods are introduced during this time. Breast feeding and the late introduction of solids may have a beneficial effect on childhood health and subsequent adult disease.


Torticollis in Children

Unresolved Congenital Torticollis and Its Consequences: A Report of 2 Cases
Journal of Chiropractic Medicine 2017 (Sep);   16 (3):   257–261 ~ FULL TEXT

Two male children (ages 6 and 10 years) presented to a chiropractic clinic with a history of congenital torticollis. They showed signs and symptoms of postural deficiency and developmental delay: posterior plagiocephaly, facial scoliosis, head tilt, compensatory thoracic scoliosis, decreased range of motion in the cervical spine, palpable decreased segmental motion of the upper cervical spine, and an age-related delay in throwing and catching a ball and in one-leg standing.

Conservative Care of Pediatric Acquired Torticollis: A Report of 2 Cases
Journal of Chiropractic Medicine 2017 (Sep);   16 (3):   252–256 ~ FULL TEXT

The search identified 1275 citations of which 57 discrete citations met the eligibility criteria determined The purpose of this case report is to describe the conservative management of 2 cases of acquired torticollis in children under 3 years of age. Both children were treated with chiropractic care that consisted of light myofascial release, use of an Activator instrument, and home stretching. Patients improved in pain and range of motion immediately posttreatment and returned to normal ranges in 1 or 2 visits.

Chiropractic Management of Infantile Torticollis With Associated Abnormal
Fixation of One Eye: A Case Report

Journal of Chiropractic Medicine 2015 (Mar);   14 (1):   51-56 ~ FULL TEXT

A mother presented with a concern regarding her 23-month-old son who had a history of torticollis and an abnormal fixation of the right eye. She noticed the head tilt when he was about 7 months old and abnormal alignment of the right eye when the boy was 18 months old. At 15 months when he took his first steps, his head tilt became worse. At 21 months old, a neurological and orthopedic examination at the regional university children`s hospital ruled out presence of a tumor of the cervical spine or posterior fossa. The orthopedist sent the baby for chiropractic evaluation and treatment. Chiropractic exam found decreased active and passive range of motion in the cervical spine and no evidence of mass or contracture of the sternocleidomastoid muscle. Segmental palpation showed a decreased joint play and pain reaction at level C1/C2 on the right.

Successful Management of Acute-onset Torticollis in a Giraffe
(Giraffa camelopardalis reticulata)

Journal of Zoo and Wildlife Medicine 2013 (Mar);   44 (1):   181–185 ~ FULL TEXT

A 2-yr-old male reticulated giraffe (Giraffa camelopardalis reticulata) presented with severe midcervical segmental torticollis upon arrival as an incoming shipment. Despite initial medical management, the giraffe developed marked neck sensitivity, focal muscle spasms, and decreased cervical range of motion. Using operant conditioning to assist patient positioning and tolerance to cervical manipulation, a series of manually applied chiropractic treatments were applied to the affected cervical vertebrae in an effort to restore normal cervical mobility. Laser therapy and cervical range of motion exercises were also used to reduce cervical muscle hypertonicity. The combined application of these nontraditional therapies produced marked clinical improvement. This case highlights the potential benefits of combining traditional medical management with chiropractic treatment and physical therapy techniques for management of severe acute-onset torticollis in a giraffe.

Comanagement and Collaborative Care of a 20-Year-Old Female
With Acute Viral Torticollis

J Manipulative Physiol Ther. 2009 (Feb);   32 (2):   160–165 ~ FULL TEXT

The patient was initially assessed in a teaching clinic of a university medical health center for acute meningitis. A consultation was requested by the senior attending physician for an opinion by the chiropractic services of the university health center to assess the patient for nuchal rigidity and to provide treatment of the torticollis. After an evaluation of the status of the patient, a diagnosis of acute viral torticollis was established, and chiropractic manual therapy was initiated with a significant improvement in the ability of the patient to execute cervical ranges of motion without undue limitation and pain. Follow-up chiropractic care resulted in resolution of the torticollis without residual symptoms.


Outcome Assessment in Children

Patient-centered Outcomes Used in Pediatric Focused Manual Therapies
Research Studies: A Secondary Data Analysis of a Systematic Review

J Patient Rep Outcomes 2021 (Apr 1);   5 (1) :  31~ FULL TEXT

This secondary analysis documents the need to develop high-quality PROMs on manual therapy for pediatric populations. Without such PROMs, manual therapy research, as well as practitioners using this therapy, are at a loss for an approach to collect valuable patient data that could best assess patient progress. Further research to establish and implement PROMs to be used in future research studies and in clinical settings should become a priority for professions using manual therapy in children.


   Young Spine Questionnaire   

Young Spine Questionnaire ~   in Word   and   Acrobat (PDF)
The Young Spine Questionnaire is a novel self-report questionnaire designed to measure spinal pain prevalence, pain intensity, the consequences in terms of activity restrictions, school absenteeism and care seeking behaviour, and finally the influence of parental back trouble. Feasibility, item understanding and item agreement between questionnaire scores and interview findings were acceptable, and from our preliminary findings we conclude that the YSQ has content validity, is well understood by the target population and can be used in cross-sectional cohort studies of children aged 9 to 11 years. Further psychometric testing is warranted.

Development of the Young Spine Questionnaire
BMC Musculoskelet Disord 2013 (Jun 12);   14:   185 ~ FULL TEXT

Back pain in children is common and early onset of back pain has been shown to increase the risk of back pain significantly in adulthood. Consequently, preventive efforts must be targeted the young population but research relating to spinal problems in this age group is scarce. Focus has primarily been on the working age population, and therefore specific questionnaires to measure spinal pain and its consequences, specifically aimed at children and adolescents are absent. The purpose of this study was to develop a questionnaire for schoolchildren filling this gap.


   The PROMIS-25 Questionnaire   

The Quality of Life of Children Under Chiropractic Care Using PROMIS-25:
Results from a Practice-Based Research Network

J Altern Complement Med. 2018 (Apr);   24 (4):   378–384 ~ FULL TEXT

The original data set consisted of 915 parent-child dyads. After data cleaning, a total of 881 parents (747 females, 134 males; mean age = 42.03 years) and 881 children (467 females and 414 males; mean age = 12.49 years) comprised this study population. The parents were highly educated and presented their child for mainly wellness care. The mean number of days and patient visits from baseline to comparative QoL measures was 38.12 days and 2.74 (SD = 2.61), respectively. After controlling for the effects of motivation for care, patient visits, duration of complaint, sex, and pain rating, significant differences were observed in the probability of experiencing problems (vs. no reported problems) across all QoL domains. Post hoc comparisons demonstrated the children were less likely to report any symptoms of depression, anxiety, fatigue, and pain interference after a trial of chiropractic care.

The Use of the Patient Reported Outcomes Measurement Information System
and the RAND VSQ9 to Measure the Quality of Life and Visit-Specific
Satisfaction of Pregnant Patients Under Chiropractic Care Utilizing
the Webster Technique

J Altern Complement Med. 2018 (Jan);   24 (1):   90–98 ~ FULL TEXT

A convenience sample of 343 pregnant patients (average age = 30.96 years) comprised their study population. They were highly educated with 75% attaining a 2-year associate's degree or higher. The pregnant patients presented for chiropractic care with a mean week of gestation of 25.67 weeks and parity (i.e., the number of live births) of 0.92 live births. From baseline (i.e., at study entrance with minimum first visit) and comparative (i.e., following a course of chiropractic care), the VSQ9 measurements revealed increasingly high satisfaction on the part of the subjects. The median number of visits (i.e., visits attended) at baseline and comparative measures was 1.00 and 3.30, respectively. Across outcomes, QoL improved from baseline to comparative measurement after holding constant for visit number and time lapse, trimester of pregnancy, and care provider type. There was a reduction in mean T scores associated with fatigue, pain interference, sleep disturbance, and an improvement in satisfaction with social roles. A significant decrease was also found with pain interference. No evidence was found that anxiety or depression.


   The United Kingdom Infant Questionnaire (UKIQ)   

An Electronic Parent Reported Infant Outcome Measure in Chiropractic Clinics:
A Feasibility Study

J Clinical Chiropractic Pediatrics 2017 (Sep);   16 (1):   1355–1361 ~ FULL TEXT

During the testing period, 100 intake and 46 follow-up forms were completed. All feasibility benchmarks were achieved, except for follow-up rate (46%) and lower than anticipated participation of recruited clinics (n=2). No technical difficulties prevented mothers from completing the form and collected data had a high rate of completeness with <0.03% missing data for standard questions and no undecipherable answers. No incidents of maternal non-consent occurred and 98.9% of mothers found the tool easy to use. Clinicians and receptionists rated their experience with the tool highly (mean 5/5 for clinician perception of clinical utility and likelihood of continued use and mean 4.5/5 for receptionist’s ease of administering and 5/5 for receptionist perception of willingness of mothers to complete and ease with which mothers completed the questionnaire).

Development and Testing of a Multidimensional Parent Reported Outcome Measure
for Common Presenting Complaints of Infancy: The UK Infant Questionnaire

J Clinical Chiropractic Pediatrics 2017 (Sep);   15 (3):   1292–1300 ~ FULL TEXT

The UK Infant Questionnaire is the first parent reported outcome measure for use with the most common complaints of the infant patient based on maternal views. As such, this instrument meets the standard set by the UK National Health Service to involve the parent’s voice in their child’s care, and is therefore innovative in its field. Although further testing is indicated, and we make no claims that this instrument is comprehensive in all aspects of infant well-child care, it may be used by individual clinicians in routine daily practice to gain understanding of clinical progress of individual patients.

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