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.
Send all comments or additions to:   Frankp@chiro.org

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.

Pediatric Articles of Interest

	Colic and Sleep Outcomes of Nonpharmacological Intervention in Infants with Infantile Colic: Systematic Review and Meta-analysis Rev Assoc Med Bras 2023 (May 19); 69 (5): e20230071 ~ FULL TEXT According to the meta-analysis findings, it was determined that the risk of bias was low in the studies included and that nonpharmacological chiropractic, craniosacral, and acupuncture treatments applied to infantile colic infants in the three included studies reduced crying time and intensity and increased sleep duration.
	Best-Practice Recommendations for Chiropractic Care for Pregnant and Postpartum Patients: Results of a Consensus Process J Manipulative Physiol Ther 2021 (Nov 23); S0161 ~ FULL TEXT This best-practice recommendations article is a synthesis of the current evidence and collective expert opinion about a reasonable clinical approach for chiropractic care and management of pregnant and postpartum populations. This article provides an initial framework for chiropractors who wish to manage these populations and to help chiropractic researchers determine and examine the gaps in the literature to implement a robust research program that informs future clinical guidelines. As the first best-practices recommendations document for pregnant and postpartum patients, it is expected to evolve as new evidence emerges.
	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   NCT02595515 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   NCT02595515 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 J 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.
	Estimation of Total Usual Dietary Intakes of Pregnant Women in the United States JAMA Network Open 2019 (Jun 5); 2 (6): e195967 This study suggests that a significant number of pregnant women are not meeting recommendations for vitamins D, C, A, B6, K, and E, as well as folate, choline, iron, calcium, potassium, magnesium, and zinc even with the use of dietary supplements. Almost all pregnant women in this study were at risk of excessive consumption of sodium, and many were at risk of excessive consumption of folic acid and iron. Improved dietary guidance to help pregnant women meet but not exceed dietary recommendations is warranted.
	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   NCT02595515 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 Reportand 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 Review 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 J 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 J 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 J 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 J 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 J 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? European Journal of Pediatrics 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 J 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? J 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.
	The Treatment Experience of Patients With Low Back Pain During Pregnancy and Their Chiropractors: A Qualitative Study Chiropractic & Manual Therapies 2012 (Oct 9); 20 (1): 32 ~ FULL TEXT Chiropractors approach pregnant patients with low back pain from a patient-centered standpoint, and the pregnant patients interviewed in this study who sought chiropractic care appeared to find this approach helpful for managing their back pain symptoms.
	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 an 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: Chiropractic care lowered overall costs more than 400% compared with medical management 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.
	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.
	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 study.
	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 J 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 J 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.

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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.
	Potential Effect Modifiers for Treatment with Chiropractic Manipulation Versus Sham Manipulation for Recurrent Headaches in Children Aged 7-14 Years: Development of and Results From a Secondary Analysis of a Randomised Clinical Trial   NCT02684916 Chiropractic & Manual Therapies 2023 (Jul 11); 31: 20~ FULL TEXT Five variables had a treatment effect difference of more than 0.7 points on the GPE scale between the lower and the upper end of the spectrum: Frequency of headache (p = 0.056), Sport activity (p = 0.110), Sleep duration (p = 0.080), History of neck pain (p = 0.011), and Headache in the family (0.050). A new summary index could be constructed giving highest weight to History of neck pain and Headache in the family and Frequency of headache. The index suggests a difference of about 1 point in GPE between low and high values of the index. Chiropractic manipulation offers a moderate benefit for a broad spectrum of children. However, it cannot be excluded that specific headache characteristics, family factors, or a history of neck pain may modify the effect. This question must be addressed in future studies.
	Description of Recurrent Headaches in 7-14-year-old Children: Baseline Data From a Randomized Clinical Trial on Effectiveness of Chiropractic Spinal Manipulation in Children with Recurrent Headaches NCT02684916 Chiropractic & Manual Therapies 2023 (Jan 30); 31 : 5 ~ FULL TEXT This study describes a selected cohort of children with recurrent headaches and highlights that they are quite severely affected, has a rather large intake of medication and that there is a great variation in management. Although only questionnaire data could be used, requiring a modification of the ICHD criteria, it was feasible to distinguish between migraine and tension-type headaches in nearly half of the children. The large group of non-classifiable headaches might include probable migraines and probable tension-type headaches, as well as mixed, cervicogenic and medication overuse headaches. A migraine-tension-type-index can be generated allowing to include all children in the diagnostic assessment and may be used for further management decisions. Given the risk of lifelong trajectories of recurrent headaches, good diagnostic tools are essential to explore the options of best possible care and management as early as possible.
	Pediatric Headache Questionnaire, Exam and History Forms for the Chiropractor J Clinical Chiropractic Pediatrics 2022 (May); 21 (1): 1871–1876 ~ FULL TEXT The academic arm of the European Chiropractic Union (ECU) is the European Academy of Chiropractic (EAC). Within the EAC are special interest groups (SIG) focusing on postgraduate education for chiropractors in the areas of pediatrics, neurology, clinical chiropractic and sports chiropractic. Children are one of the unique populations presenting to the chiropractor requiring a different skill set than that utilized to assess the adult patient. In recognition of this, the EAC’s SIG for pediatrics has developed history, examination and questionnaire forms for children with headache. The aim of these forms is to assist the chiropractor in identifying red flags and to skillfully differentially diagnose headaches as they present throughout growth and development. The process of development of these forms is outlined, and three forms are presented in this article.
	Headaches in Children: Part 1. The Changing Phenotypes of Migraine Headache in Infants, Children and Adolescents J Clinical Chiropractic Pediatrics 2022 (May); 20 (1): 1747–1756 ~ FULL TEXT Headaches in children are common and the prevalence is increasing worldwide. The phenotype of migraine headache changes with continuing development of the nervous system. Children of all ages experience headaches but these are typically difficult to recognize and diagnose in the younger ages. Early intervention addressing the chemical, mechanical and psychological factors contributing to an individual’s headache is essential. This reduces the risk for central sensitization associated with chronicity and disability including reducing the risk for headache in adulthood.
	Headaches in Children: Part 2. The Changing Phenotypes of Migraine Headache in Infants, Children and Adolescents J Clinical Chiropractic Pediatrics 2021 (Nov); 20 (2): 1802–1813 ~ FULL TEXT Headaches in children are common and the prevalence is increasing worldwide. The phenotypes of headaches change throughout growth and development making differential diagnosis a challenge. Children of all ages experience headaches but these can be difficult to recognize and diagnose particularly in the younger ages. Early intervention addressing the chemical, mechanical and psychological factors contributing to an individual’s headache is essential. This reduces the risk for central sensitization associated with chronicity and disability including the risk for headache in adulthood.
	Effectiveness of Chiropractic Manipulation Versus Sham Manipulation for Recurrent Headaches in Children Aged 7-14 Years - A Randomised Clinical Trial   NCT02684916 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.
	Effectiveness of Chiropractic Manipulation Versus Sham Manipulation on Recurrent Headaches in Children Aged 7-14 Years, Protocol for a Randomized Clinical Trial   NCT02684916 Chiropractic & Manual Therapies 2019 (Aug 23); 27: 40 ~ FULL TEXT Headache is one of the most common pain symptoms in childhood having a negative impact on many aspects of the lives of affected children, both short-term and long-term. Therefore, it is important to document safe and effective treatment options. Chiropractic spinal manipulation is a commonly used treatment option for these patients, although there are no randomized clinical trials documenting the effectiveness of this in pediatric headache. However, there is moderate evidence for effectiveness of spinal manipulation for adults with tension-type and cervicogenic headaches.This paper describes the protocol for a two-armed randomized superiority clinical trial aiming to investigate the effectiveness of chiropractic manipulation versus sham manipulation in the treatment of recurrent headache in children aged 7–14.
	Parent Proxy Report and Pre-adolescent Self-report of Pain and Trauma: A Cross-sectional Observational Study in Sweden J Clinical Chiropractic Pediatrics 2019 (May); 18 (2): 1596–1590 ~ FULL TEXT Forty percent of the pre-adolescents in this middle school setting reported recurring neck pain and/or headaches. Four out of five parents reported headaches, neck pain and trauma experienced by the child significantly less frequently than the child. This is important not only because recurrent musculoskeletal pain in this age group can have a significant impact on quality of life, but the discordance in reporting may be a factor in why report of pain changes significantly between pre-adolescence and adolescence. Because musculoskeletal pain in adolescence is a predictor for pain in adulthood, early attention in pre-adolescence could serve as a preventive measure for the long-term.
	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.
	Prevalence of Headache and Migraine in Children and Adolescents: A Systematic Review of Population-based Studies Dev Med Child Neurol 2010 (Dec); 52 (12): 1088–1097 Headache is common across the world, with about 60% of children and adolescents being prone to it over at least a 3–month period. Migraine is also common, and despite small variations in reporting across the world it is safe to state that around 8% of children and adolescents suffer from it over periods ranging from 3?months to lifetime. This analysis confirms the frequently reported observation of a significantly lower prevalence of migraine in children under the age of 14?years than in the general childhood population. Small regional and possibly interracial differences in its prevalence are also evident. Migraine affects males and females equally at a young age (<14y), and more females than males in adolescence and young adulthood.
	Recurrent Headaches in Children: An Epidemiological Survey of Two Middle Schools in Inner City Chicago Pain Pract. 2010 (May); 10 (3): 214—221 In conclusion, this study demonstrates that headaches are a common complaint among children. A significant subset of the cohort reported experiencing headaches in successive weeks, suggesting that headache symptoms were a chronic problem for many study participants. Finally, this study found headaches to be associated with concurrent somatic symptoms, feelings of anxiety, functional restrictions, and a discernibly diminished quality of life. Consequently, early headache recognition and treatment may represent an important means for improving the physical and psychosocial health of children and adolescents.
	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.

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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 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 ~ FULL TEXT 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.

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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 J 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.

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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).
	Clinical Practice Guideline for Best Practice Management of Pediatric Patients by Chiropractors: Results of a Delphi Consensus Process Integr Complement Med 2024 (Mar); 30 (3): 216–232 ~ FULL TEXT Chiropractors are concerned with the assessment, diagnosis, treatment, and prevention of disorders of the neuromusculoskeletal system and the potential effects of these disorders on general health for people of all ages. [1, 2] Although other types of health care providers, such as physical therapists, treat musculoskeletal symptoms in children (patients 3] chiropractic is the most common complementary and integrative medicine practice used by children in the United States [4] and is also commonly used by children around the world, including in Australia. [5] In Australia, the best estimates are that chiropractors provide care to more than 30,000 child patients (0–18 years old) every week. [6] According to a 2017 scoping review, ?8% of chiropractic patients are 18 years of age and under. [7] Manual care for children is most often sought for the treatment of musculoskeletal (MSK) conditions. [8]
	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

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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.

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Pediatric LINKS of Interest

   Pediatric Journals

  European Journal of Pediatrics

   JAMA Pediatrics

   J 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!

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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 Therapy by Chiropractors for Infants with Musculoskeletal-related Suboptimal Infant Breastfeeding: A Pilot Study J Clinical Chiropractic Pediatrics 2022 (Nov); 21 (2): 1902–1903 ~ FULL TEXT These results demonstrate that the Musculoskeletal Infant Breastfeeding Assessment Questionnaire (MIBAQ) appears to be clinically responsive to changes in SIB-related symptoms and could facilitate larger practice-based research studies of infants with musculoskeletal dysfunction contributing to SIB. In this study, significant clinical change was reported by mothers of infants with SIB utilizing the MIBAQ-SF after one week of chiropractic manual therapy.
	Development of an Outcome Assessment Instrument for Suboptimal Breastfeeding in Infants with Musculoskeletal Dysfunction J Clinical Chiropractic Pediatrics 2020 (Jun); 19 (1): 1621–1328 ~ FULL TEXT The Musculoskeletal Infant Breastfeeding Assessment Questionnaire (MIBAQ) is a feasible and clinically responsive patient-oriented outcome measure that may be useful as a method to collect outcomes of manual treatment of musculoskeletal dysfunctions in infants with suboptimal breastfeeding. Future studies should employ larger and more representative samples, perhaps of other practitioners as well as chiropractors who care for infants with musculoskeletal factors related to suboptimal breastfeeding
	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 J Clinical Chiropractic Pediatrics 2017 (Sep); 6(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 J 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 J 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 J 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.
	Chiropractic Management of Breast-feeding Difficulties: A Case Report J Chiropractic Medicine 2011 (Sep); 10 (3): 199–203 ~ FULL TEXT This case demonstrated that an infant with breast-feeding problems improved under chiropractic care. Multiple regions of the neuromusculoskeletal system that did not optimally function were noted during the examination. After several chiropractic treatments, the dysfunctions resolved and suckling improved. Breast-feeding has a complex functional mechanism. The entire neuromusculoskeletal system, jaw, neck, cranium, and nervous system, must function properly and work in harmony for optimal breast-feeding.
	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.

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Torticollis in Children

	Unresolved Congenital Torticollis and Its Consequences: A Report of 2 Cases J 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 J 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 J 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.

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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.

Measuring Musculoskeletal Pain in Infants, Children, and Adolescents J Orthop Sports Phys Ther 2017 (Oct); 47 (10): 712–730~ FULL TEXT To date, little research has been done to evaluate the use of measures designed for assessment of pain in infants, children, and adolescents outside the hospital setting. This constitutes an important evidence gap, given that primary care, community outpatient, and rehabilitation clinics have frequent contact with infants, children, and adolescents with pain. Though further work is needed, this paper provides clinicians with a pragmatic, evidence-based overview of scales that can be used to measure pain intensity in infants, children, and adolescents, with and without cognitive impairment, and to assess the impact of pain.

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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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.
	Pregnancy-related Low Back and Pelvic Pain A Chiro.Org article collection Enjoy this collection of articles that detail the benefits of chiropractic care for the low back pain or pelvic pain of pregnancy.
	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.
	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).

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Other Topical Reference Pages:

Antibiotic Abuse	Backpacks and Children	Women's Health
Vaccine Information	Vertebral Subluxation

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