Current Issue:  Vol. 15, Issue 3 (2016)

The Journal of Clinical Chiropractic Pediatrics (JCCP) is the official peer-reviewed journal of the ICA Council on Chiropractic Pediatrics. It is committed to publishing research, scientific and professional papers, literature reviews, case reports and clinical commentaries for chiropractors and other health care professionals interested in the treatment of the pregnant, postpartum and pediatric patient. Through the publication of these papers and the dissemination of this information, the JCCP seeks to encourage professional dialogue and awareness about chiropractic pediatric care to help enhance patient care and improve patient outcomes.

Editors: Sharon A. Vallone, DC., DICCP., Cheryl Hawk, DC, PhD.

We are hopeful that this venue will provide field clinicians interested in maternal health and pediatric chiropractic with current research, case reports and clinical commentary that they will find both useful and informative.  We invite you to submit your own research or scientific writing for consideration for publication in this journal.

Editorial

A Short History of Chiropractic Pediatric Education

By Peter Fysh, DC, FICCP
Professor Emeritus, Palmer College of Chiropractic West

Chiropractic care for children is increasingly becoming a vital part of a family’s health care program. The educational opportunities and access to pediatric research provided by the ICA Council on Chiropractic Pediatrics and the Journal of Clinical Chiropractic Pediatrics offer doctors of chiropractic the knowledge and tools they need to meet the challenges of family practice with a greater level of skill and confidence.


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Articles

Chiropractic care for the cervical spine as a treatment for plagiocephaly: a prospective cohort study

By By Nicola Ann Douglas, MChiro, MSc, Maria Browning, BSc, DC, MSc (Chiro Paeds), Cert Med, and Joyce Miller, BS, DC, PhD

Background: Plagiocephaly is a condition that affects the shape of the skull in infants. The research has suggested that there is a growing association between plagiocephaly and developmental delay later in infancy extending into childhood. Plagiocephaly is an increasingly common condition in society which often presents to a chiropractic practice. There have been no studies prospectively investigating the outcome of chiropractic care on a group of infants with plagiocephaly. Objectives: To observe any change in head deformation measurements in a single cohort group of infants aged 0-12 months old presenting to a chiropractic clinic and receiving chiropractic care over a course of six weeks. Setting: This single cohort observational study took place at a chiropractic teaching clinic between February and July 2015, on the south coast of England. Methods: Infants presenting to the chiropractic clinic with the complaint of plagiocephaly were measured from the external occipital protuberance (EOP) to the anterior ear both right and left sides during their routine course of treatment. These measurements were re-examined at the end of their course of care or at six weeks after presentation, which ever occurred first. Results: A total of 64 infants were included. The mean change in the plagiocephaly measurement was a reduction of 1.13cm ± 0.89cm, p= 0.00, 95%CI (-1.36 to -0.92cm). Overall, 20 out of the 64 participants showed a full resolution of plagiocephaly, with a final measurement below 0.4cm difference in occipital measurement side to side, which is considered normal. No adverse events were reported for any of the infants. Conclusions: Overall, there was both a statistically and clinically significant reduction in plagiocephaly measurement for this cohort of infants after a course of chiropractic care. As this was an observational study, this cannot be interpreted as cause and effect. However, these results encourage further research, particularly a RCT to investigate the effect of chiropractic care on plagiocephaly in infants.


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Clinical effects of spinal manipulation in the management of children and young adults diagnosed with autism spectrum disorder – a systematic review of the literature

By Sabine Kronau DO, MSc Paed Ost, Bettina Thiel Dipl.-Ing., Anne Jäkel DPhil, and Torsten Liem DO, MSc Ost, MSc Paed Ost

Background: Autism spectrum disorders (ASD) are classified as pervasive developmental disorders that permanently affect essential mental functions. Symptoms include quality-related disorders in areas of social interaction, verbal and non-verbal communication, the variability of behaviours and specific learning disabilities. Abnormalities in development are already apparent in early childhood. Aim: To identify evidence for the clinical benefits of manual therapy of the musculoskeletal system in children diagnosed with ASD. Methods: The following databases and search interfaces were searched from Database start up until October 2015: Bio Med Central, Chiropractic Library Collaboration, Clinical Trials, Cochrane library, Dimdi, EBSCO host, Pubmed, Pubmed central, Medline Plus, Osteopathic research Digital repository, Osteopathic Research Web, and Physiotherapy Evidence Database. Further searches included journals provided by the University of Wales and the University of Duisburg-Essen. Studies were included if participants were children and young adults aged 0-21 years; studies published in English, German, or French; a diagnosis of autism or ASD, and study designs of randomized clinical trial, case-control studies, case series, case reports, and single subject studies (N of 1), which include manual therapeutic interventions of the musculoskeletal system. Two authors independently screened the studies for inclusion criteria, extracted the data and assessed for risk of bias. Methodological quality of randomized clinical trials was assessed by the Downs and Black tool. Quality of reporting for case series and case reports was assessed with the appropriate checklists provided by the QUAlity and Transparency Of health Research (EQUATOR) network. Results: Included in the review were one randomized clinical trial (uncontrolled), one case series, and 11 case reports. The methodological quality of the included randomised clinical trial was rated as being poor. Quality of reporting for the included case series and case reports was also insufficient. All included studies used spinal manipulation, and indicated an improvement in autistic symptoms after the manual therapeutic intervention. Conclusion: 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.


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Development and testing of a multidimensional parent reported outcome measure for common presenting complaints of infancy: the UK infant questionnaire.

By Amy Sarah Miller BSc MSc, Brechtje Huizinga BSc MSc, Manu Pinkster BSc MSc, Anna Clarissa Jeanne Telford BSc MSc, Jorieke Maria ten Heggeler BSc MSc, and Joyce Elaine Miller BS, DC, PhD

Objective: This case report discusses the evolution of an infant with gastroesophageal reflux disease (GERD) under chiropractic care. It is the hope of the author to encourage more research about the role of chiropractic as a safe alternative in the resolution of GERD in infants. Method: A literature search on Google Scholar and PubMed was done to find recent and relevant papers using the keywords infant, GERD, regurgitation and chiropractic. Clinical features: A 4-month-old female presented for chiropractic care for recurrent regurgitation after feeding. The infant was exclusively breastfed. She was averse to being carried and her complaints included frequent post prandial regurgitation, difficult eructation, interrupted sleep, choking and rumination, wheezing during sleep, fussiness, distended stomach and excessive intestinal gas. No medication was taken by the infant or the mother and lifestyle changes were made before consulting a chiropractor. Intervention and outcomes: The infant was treated with chiropractic manipulation using craniosacral therapy, myofascial therapy and Diversified adjusting technique. The treatment consisted of 17 visits over a 20-week period using a full spine protocol adapted for the pediatric patient based on size and gestational age. The original diagnosis of GERD improved to physiologic gastroesophageal reflux (GER) after 14 visits and then totally resolved at the 17th visit. Conclusion: Since current evidence fails to support traditional medicinal methods to treat GERD in infants, chiropractic care merits investigation as a safe alternative that might prove more efficient than medication and with fewer side effects. This case report constitutes an addition to the scientific literature regarding chiropractic care of infants suffering from GERD.


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Evaluation and treatment of breastfeeding difficulties associated with cervicocranial dysfunction: a chiropractic perspective

By Sharon Vallone, DC, FICCP

Abstract: 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 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.


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What is Tummy Time : is it necessary for newborns?

By Joyce Miller, BSc, DC, PhD, and Sharon Vallone, DC, FICCP

Introduction: Chiropractic offices are receiving large numbers of infant patients into their practices. Consequently, new guidelines have been forthcoming to assist chiropractors in applying their best evidence practice to this age group. However, very little has been said in how we give advice, particularly in the important topic of prone play (“tummy time”) for the infant. It is not always recognized that research data must be translated into clinical practice in order for the practical applications to benefit the end user, the patient, and in this case the parent and the infant. Why would such a simple concept, such as an infant playing in prone position be an issue for discussion between the doctor and parents? It is because the simple messages have become convoluted, confusing and difficult to follow. It is perhaps time to go back to the beginning.


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Positive chiropractic treatment outcome of migraine without aura in a 6-year-old presenting with sleep bruxism and chronic sinus congestion: a case-report

By Eve Laferrière, DC, DICCP

Abstract: Migraine is a common disorder affecting up to 10% of children which can interfere with school attendance, academic and sport performances. The proposed pathophysiology has evolved from one purely vascular in origin to perhaps a neuro-inflammatory etiology. Clinical evaluation is the mainstay of diagnosis and should include family history, sleep habits and environmental triggers. Spinal manipulation of the cervical spine in adults and teenagers has shown similar effectiveness as prophylactic medications. A Canada-wide survey revealed that 7% of chiropractic pediatric patients presented for headaches. Unfortunately, there is no substantial data at this point to support the benefit of spinal manipulation in the pediatric sufferers of migraine. Recent research found a link between sleep parasomnia (bruxism), colic and migraine sufferers. To achieve a precise diagnosis, clinicians must refer to the latest diagnostic criteria to differentiate true migraines from tension headaches, sinus headaches or other organic causes. This case report discusses the chiropractic treatment outcome of a 6-year-old female patient suffering from migraine without aura, sleep bruxism and chronic sinus congestion. The patient was treated with mechanical assisted and manual manipulation techniques, massage and sinus lymphatic drainage. After 4 visits migraine intensity reduced from a 5/10 to a 2/10 and the frequency of headaches were reduced from 3 times per week to once a week without the use of medication. After 6 weeks of care, patient symptoms were significantly reduced but the treatment plan was not completed because the family relocated and continued travel to the office was prohibitive. After 17 weeks, the patient relapsed and 3 weeks later, they resumed care with progressive improvement of the child’s well-being once we eliminated migraine triggers such as sun exposure, incorporation of resting periods with naps in the afternoon and cardiac coherence training exercises before bedtime. This case report highlights the need for high quality research on the effect of spinal manipulation in the treatment of pediatric migraine to provide a potential alternative option to the traditional medical treatment of migraine. This case also opens the discussion on the benefits cervical manipulations and cranial work may potentially have on sinus drainage and immune system response in autonomic conditions like sinus congestion.


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The importance of clinical examination and collaborative care in the successful chiropractic management of a 31-month-old boy with acquired torticollis: a case report

By Danica Brousseau, MSc, DC, DICCP and Marie-Hélène Nicolas, DC

Introduction: Acquired torticollis in children may present a diagnostic challenge as many different underlying causes are possible, ranging from benign mechanical concerns to serious and potentially life-threatening conditions. Presenting concerns: A 31-month old boy presented to a chiropractic clinic with acquired torticollis of possibly traumatic origin. Although it appeared to be a typical muscular torticollis, certain elements of the history and examination findings could point to more serious diagnoses. Thorough intake, physical examination, and interdisciplinary collaboration are paramount for practitioners to help rule out potentially serious conditions before initiating conservative care. Interventions: The initial chiropractic evaluation was performed over the course of one week, and included intraprofessional consultation with a pediatric chiropractor. Previous examinations had been performed at a pediatric hospital. Gentle soft tissue and cervical and pelvic joint mobilization, adapted to the patient’s age and size, were performed for a total of six visits over a three-week period. Outcomes: Upon re-evaluation, complete resolution of the aforementioned symptoms was noted. The results were maintained at follow-up five weeks later. Conclusion: Pediatric chiropractic care proved beneficial for this young boy with acquired torticollis. Intraprofessional consultation and collaboration was helpful in the case and should be encouraged.


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Special Needs Corner

   Marfan’s Syndrome
   By Jennifer Veit. DC. CCSP, DICCP

   ANDAS : A Synopsis
   By Chandra L. Sasseville, DC, DICCP


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Journal Abstracts

Bracing and exercise-based treatment for idiopathic scoliosis.

Kalichman L, Kendelker L, Bezalel T.

J Bodyw Mov Ther. 2016 Jan;20(1):56-64. doi: 10.1016/j.jbmt.2015.04.007. Epub 2015 Apr 23.


Current management of pregnancy-related low back pain: a national cross-sectional survey of U.K. physiotherapists.

Bishop A, Holden MA, Ogollah RO, Foster NE; EASE Back Study Team.

Physiotherapy. 2016 Mar;102(1):78-85. doi: 10.1016/j.physio.2015.02.003. Epub 2015 Apr 19.


Sick leave and healthcare utilization in women reporting pregnancy related low back pain and/or pelvic girdle pain at 14 months postpartum.

Bergström C, Persson M, Mogren I.

Chiropr Man Therap. 2016 Feb 15;24:7. doi: 10.1186/s12998-016-0088-9. eCollection 2016.


Intakes of fish and polyunsaturated fatty acids and mild-to-severe cognitive impairment risks: a dose-response meta-analysis of 21 cohort studies.

Zhang Y, Chen J, Qiu J, Li Y, Wang J, Jiao J.

Am J Clin Nutr. 2016 Feb;103(2):330-40. doi: 10.3945/ajcn.115.124081. Epub 2015 Dec 30.


What Is Evidence-Based About Myofascial Chains: A Systematic Review.

Wilke J, Krause F, Vogt L, Banzer W.

Arch Phys Med Rehabil. 2016 Mar;97(3):454-61. doi: 10.1016/j.apmr.2015.07.023. Epub 2015 Aug 14.


Cannabis and tobacco exposure in relation to brain morphology: a prospective neuroimaging study in young children.

El Marroun H, Tiemeier H, Franken IHA, et al.

Prenatal Biol Psychiatry. Published online June 16, 2016.
http://www.biologicalpsychiatryjournal.com/article/S0006-3223%2815%2900692-7/abstract. Accessed June 23, 2016.


Maternal Exposure to Childhood Trauma Is Associated During Pregnancy With Placental-Fetal Stress Physiology.

Moog NK. Buss C. Entringer S. Shahbaba B. Gillen DL. Hobel CJ. Wadhwa PD.

Biological Psychiatry. May 15, 2016; 79(10):831-839. DOI: http://dx.doi.org/10.1016/j.biopsych.2015.08.032


Effect of childhood maltreatment and brain-derived neurotrophic factor on brain morphology.

van Velzen LS. Schmaal L. Jansen R. Milaneschi Y. Opmeer EM. Elzinga BM. van der Wee NJA. Veltman DJ. Penninx BWJH.

Soc Cogn Affect Neurosci (2016) doi: 10.1093/scan/nsw086First published online: July 12, 2016.


Early life stress dampens stress responsiveness in adolescence: Evaluation of neuroendocrine reactivity and coping behavior.

Hsiao YM. Tsai TC. Lin YT. Chen CC. Huang CC. Hsu KS.

Psychoneuroendocrinology. Volume 67 , 86 - 99
DOI: http://dx.doi.org/10.1016/j.psyneuen.2016.02.004


Childhood adversity and psychiatric disorder in young adulthood: An analysis of 107,704 Swedes.

Björkenstam E. Burström B. Vinnerljung B. Kosidou K.

Journal of Psychiatric Research, Volume 77, 67 - 75
DOI: http://dx.doi.org/10.1016/j.jpsychires.2016.02.018


Childhood Trauma and Illicit Drug Use in Adolescence: A Population-Based National Comorbidity Survey Replication–Adolescent Supplement Study.

Carliner H. Keyes KM. McLaughlin KA. Meyers JL. Dunn EC. Martins SS.

Journal of the American Academy of Child and Adolescent Psychiatry. August 2016Volume 55, Issue 8, Pages 701–708,
DOI: http://dx.doi.org/10.1016/j.jaac.2016.05.010\


The effects of maternal alcohol use disorders on childhood relationships and mental health.

Wolfe, J.D.

Soc Psychiatry Epidemiol (2016):1-10.
doi:10.1007/s00127-016-1264-x


Commentary
Randomized Trial of Introduction of Allergenic Food in Breast-Fed Infants

Perkin MR, Logan K, Tseng A, et al; EAT Study Team
N Engl J Med. 2016 Mar 4. [Epub ahead of print]

Cite this article: Introducing Allergenic Foods in Breastfed Infants: Does Timing Matter? Medscape. May 02, 2016.

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