Current Issue:  Vol. 19, Issue 1 ( 2020)

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, FICCP, Cheryl Hawk, DC, PhD and Joyce Miller, 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.


A message from the International Chiropractors Association Council on Chiropractic Pediatrics

By Meghan Van Loon, DC, DICCP, ICA Pediatrics Council Vice President

So much has been happening and challenging us, personally and professionally, since the last issue of JCCP became available online. With the global pandemic, we are all dealing with our patients’ stress (if you have been able to see patients) and the effect that it is having on them emotionally and physically. Depending on the patient’s age level, that stress will be evident in different ways: emotional lability, withdrawal, pain, and many other various symptoms.

Thank you for all that you do!

By Sharon A. Vallone, DC, FICCP

In these surreal times, whether you are in your office or sheltering in place, We on the JCCP staff would like to send you our heartfelt regards for your courage and persistence in taking care of yourselves, your families and your patients. We are all doing the best that we can. We are all in this together. Are any of you dealing with new roles in your life in addition to practicing chiropractic? Some of us are homeschooling children, caring for elders, working online (telehealth!), supporting patients emotionally and sharing information on how to stay safe and stay well. Some of you are writing, some teaching and many of us learning new skills we never gave much thought to ever having to learn. Zoom, for some of us, was to move fast, as we do when chasing a child around the adjusting table. Now “ZOOM” is a door into futuristic communication and opportunities to reach others around the world.

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Is CBD appropriate for pediatric disorders?

By By Eric C Epstein, MsT, DC, CCP

Childhood is considered a time of good health. Certainly, it is not routinely accepted that marijuana-type-products would be useful to support and promote childhood health. As a clinician who manages difficult childhood cases, particularly autistic-spectrum disorders, this author must look widely for whatever benefits are available for these children. For the first time since the enactment of the Marijuana Tax Act in 1937, Americans have access to cannabinoids, the alkaloids found in cannabis, the plant that provides both industrial hemp and marijuana. Over the last several years, many people have reported the benefits of using hemp extracts, particularly cannabidiol (CBD), that include pain control, improved sleep, relief of a variety of digestive distress, reduction in seizures and improvements of mood. Children suffer from these disorders, as well as adults.

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Development of an outcome assessment instrument for suboptimal breastfeeding in infants with musculoskeletal dysfunction

By Cheryl Hawk, DC, PhD, Sharon Vallone, DC, FICCP, Jessie Young, DC and Valérie Lavigne, DC, MSc

Objectives: 1) to develop an outcome assessment instrument for suboptimal breastfeeding, the Musculoskeletal Infant Breastfeeding Assessment Questionnaire (MIBAQ); and 2) to collect preliminary data on short-term breastfeeding outcomes of infants receiving chiropractic care. Methods: This descriptive cohort study was conducted in chiropractic offices using practice-based research methods. Participating Doctors of Chiropractic (DC) all reported frequently providing chiropractic care to infants with musculoskeletal imbalances accompanied by suboptimal breastfeeding. Their staff collected and transmitted data electronically to the central site. Participants were mothers of breastfeeding infants < 6 months of age first presenting for nursing dysfunction during the study period. Data forms were a brief focused history, pre-MIBAQ, one-week post-MIBAQ and patient disposition. MIBAQ content was based on published observer-based questionnaires. The post-form included the Patient’s Global Impression of change (PGIC). The MIBAQ consisted of 23 questions about suckling-related symptoms using a 4-point Likert scale. Responses were summed for a total score (0-69). Pre- and post-scores were compared using a paired t-test. The Pearson correlation between the change score and the PGIC was also calculated. Results: From May 15 through August 15, 2019, data were collected from 94 participants in 10 chiropractic offices; 100% collected the pre-MIBAQ and 81% the post-MIBAQ. Infants’ mean age was 51 days. The difference between the mean pre-MIBAQ score (23.5) and post-(one-week) MIBAQ score (17.1) was highly significant (p< .000), as was the correlation between the change score (6.4 points) and the PGIC (76% reported improvement; Pearson correlation= .562). Conclusion: The MIBAQ appears to be a feasible instrument for use in chiropractic practices, and correlates highly with the PGIC, an established general outcome measure.

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Primary monosymptomatic nocturnal enuresis: can chiropractors handle this? An evidence-based case report

By Kiara Defrancq, MChiro, MSc APP (Pediatrics), DC

Abstract: A case report of an eight-year-old child suffering from persistent nocturnal enuresis investigated different therapies for primary monosymptomatic nocturnal enuresis and the efficacy of chiropractic management. Slight improvements were noted after a short trial of chiropractic therapy.

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What are the effects of vitamin D interactions on the developing musculoskeletal system?

By Anna E. Papadopoulou MChiro, DC, DACNB

Introduction: Vitamin D deficiency is a global public health issue and large health agencies encourage the use of vitamin D supplementation. Vitamin D is an essential hormone which is responsible for both musculoskeletal development and systemic health. The goal of this narrative review was to investigate the following clinical issues: 1) Impact of Vitamin D on the developing musculoskeletal system in the pediatric patient and the growing child’s need for nutritional intake or supplementation, 2) Factors important to determine the need for supplementation and appropriate supplementation, 3) Risk for overdose of Vitamin D. Methods: Literature search of large search engines. Limits used: age 0-18 years, English language and published in the last 10 years. Key words used ‘Vitamin D and pediatric’, Vitamin D and development’, ‘Vitamin D and deficiency’, ‘Vitamin D and side effects’. Results: One Cochrane review, two global epidemiological reviews on nutritional rickets, six guidelines on Vitamin D supplementation, and several articles on vitamin D and musculoskeletal development were identified and considered in the study. The American Academy of Pediatrics and the Canadian Pediatric Society and European guidelines recommended 400 IU/day for infant - adolescent. The US Institute of Medicine and World Health Organization recommended adequate nutritional intake prior to supplementing children 0 –1 and 1–18 years old with 400 and 600 IU/day, respectively. Clinicians must be aware of key points that would significantly affect the correct recommendation and supplementation of Vitamin D. These are history, anthropometric measurements, physical activity levels, dietary habits and sun exposure parameters to achieve optimal musculoskeletal results. Conclusion: At present, 400-600IU/day Vitamin D supplementation is the daily recommendation for pediatric population based on the global healthcare agencies. Understanding the great impact of vitamin D on the musculoskeletal system, future work must be done to examine the prophylactic use of vitamin D and its appropriate adapted supplementation.

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Positive outcome from a chiropractic multidisciplinary approach for congenital torticollis in an infant three-weeks of age: A case report

By Lacerte, Fannie, DC, DICCP

Background: The purpose of this case report was to discuss the care of a pediatric patient with congenital torticollis who was treated by a chiropractor who initiated a multidisciplinary approach. Methods: Databases searched were PubMed, Cochrane, Index to Chiropractic Literature, CINAHL and google scholar. Keywords were torticollis, congenital torticollis, pseudotumor, plagiocephaly, spinal manipulation, chiropractic. Case summary: A mother brought her three-week-old infant to the chiropractor because she felt a nodule in the upper neck. After a thorough investigation of her history and an age appropriate physical exam, the diagnosis was congenital torticollis with a pseudo-tumor of the left sternocleidomastoid muscle (SCM). The intervention consisted of gentle spinal manipulation of the occipito-atlantal area, soft tissue therapy performed on the SCM, cranial manipulation along with home exercise instruction given to the parents. There was also a referral made to a physiotherapist for a consultation on the case with subsequent recommendations. The observed outcome was the resolution of congenital torticollis. Conclusion: This case report records the progress and positive outcome of a chiropractic multidisciplinary approach on pediatric congenital torticollis.

Keywords: Torticollis, congenital torticollis, pseudotumor, sternocleidomastoid muscle, plagiocephaly, spinal manipulation, chiropractic, pediatric, multidisciplinary.

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The impact of feeding modalities on infants’ orofacial development: Breastfeeding versus bottle-feeding in infancy, a scoping review

By Luisanna Ciuti, MsC, Pg Cert Paediatrics, DC

Introduction: Exclusive breastfeeding is recommended for at least six months in infants and encouraged up to two years of age. However, only 35% of infants are breastfed up to six months in the US. This rate drops down to 16% for breastfeeding at 12 months. Some authors suggest that breastfeeding also plays an important role in optimal musculoskeletal development of the orofacial system in the infant. On the contrary, bottle feeding could negatively affect these musculoskeletal structures resulting in abnormal development of the stomatognathic system. This review aims to answer the question: “What are the musculoskeletal effects of bottle feeding versus breastfeeding in infants’ orofacial development and function?” Methods: Online databases (PubMed, ResearchGate, Cochrane; ICL, EBSCO, SCielo) have been searched to identify relevant articles. No limit was set for date, study design and level. Results: The search resulted in identifying four systematic reviews and two case control studies. Four literature reviews highlighted great heterogeneity in methodology and findings. Authors agreed that exclusive breastfeeding and breastfeeding duration were associated with optimal development of palate, dentition and myofunctional habits. Bottle feeding, on the other hand, influenced the activity and function of masseter, tongue and temporalis muscles, leading to a V shaped palate and long-term malocclusions. Conclusion: There were few large-sample high-quality studies focusing specifically on infants’ orofacial development; further research is needed to deepen the knowledge of factors relating to musculoskeletal development during infancy.

Keywords: Breastfeeding, bottle feeding, orofacial complex, stomatognathic development, infants.

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The transition from gavage feeding in premature infants: What is the effect of non-nutritive suck on improving oral and breast feeding and hospital discharge in this population? A literature review

By Anna E. Papadopoulou MChiro, DC, DACNB

Background: Premature infants born prior to 34 weeks gestation have difficulty with immature suck- swallow-breath reflex, and thus gavage feeding is the most common method of delivering adequate nutrition. Objective/aims: The aim of this study was to investigate the current research and determine if non-nutritive suck (NNS) as part of sensory motor oral-facial stimulation (SMOS) is an appropriate early intervention and to identify whether this intervention facilitates transition to oral feeding in premature babies. Methods: A literature search was undertaken from 2000 to May 2020 to identify articles that assess this area. A variety of terms were used including MeSH Terms “enteric nutrition” “gavage tube feeding’, “breastfeeding”, ‘‘premature infants’’ ‘‘oral-motor stimulation’’, ‘non-nutritional sucking’. Inclusion criteria: Articles in English language; population of preterm infants less than 34 weeks; articles that looked at non-nutritive suck and its effects. Exclusion criteria: any other feeding devices than gavage feeding/naso-gastric tube used, premature infant with congenital anomalies, or ventilation support, older than 34 weeks gestation. Results: Eleven studies in total were identified as relevant: 3 systematic reviews, 5 RCTs, 2 cohort studies, 1 observational cross sectional study. Pacifiers (non-nutritive suck) along with sensory motor oral stimulation were found to improve coordination of suck-swallow-respiration and breastfeeding and earlier release from hospital in multiple cases. However, the research is heterogenous and overall, inconclusive. Conclusion: The research demonstrated mixed outcomes for the effectiveness of pacifiers and the use of NNS. No clear guidelines exist to facilitate smooth transition to oral feeding in the NICU. Given the lack of negative outcome with the use of NNS as well as understanding the effect of NNS on the activation of vagal tone and the benefits this has on the gut motility and overall health of preterm infants, it appears to be a viable tool to help reduce hospital stay and facilitate infants toward oral feeding.

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Demographic profile of chiropractors who treat children: A multinational survey
Matthew F. Doyle, MSc, Joyce E.Miller, DC, PhD
Journal of Manipulative and Physiological Therapeutics, Volume 42, Issue 1, January 2019, Pages 1-11

The safety of spinal manipulative therapy in children under 10 years: a rapid review
Corso M., Cancelliere C., Mior S., Taylor-Vaisey A., Côté P
BMC Complement Med Ther., January 15, 2020; 20(1):12. doi: 10.1186/s12906-019-2803-2

Chiropractic care of the pregnant woman and neonate
Erin Curnow, Sadie Geraghty
British Journal of Midwifery, May 2, 2019
Full article can be accessed by requesting a copy at:

Added sugars intake among US infants and toddlers
Herrick KA, Fryar CD, Hamner HC, Park S, Ogden CL.
J Acad Nutr Diet, 2020 Jan;120(1):23-32. doi:10.1016/j.jand.2019.09.007. Epub 2019 Nov 14.
Published by Elsevier Inc.

Clinical consensus statement: Ankyloglossia in children
Anna H.Messner, MD, Jonathan Walsh, MD, Richard M. Rosenfeld, MD, MPH, MBA, Seth R. Schwartz, MD, MPH, Stacey L. Ishman, MD, MPH, Cristina Baldassari, MD, Scott E. Brietzke, MD, MPH, David H. Darrow, MD, DDS, Nira Goldstein, MD, MPH, Jessica Levi, MD, Anna K. Meyer, MD, Sanjay Parikh, MD, Jeffrey P. Simons, MD, Daniel L. Wohl, MD, Erin Lambie, MS, MPH, Lisa Satterfield, MS, MPH, CCC-A
Otolaryngology–Head and Neck Surgery,
First published: April 14, 2020

The role of nutrition in asthma prevention and treatment
Jihad Alwarith, Hana Kahleova, Lee Crosby, Alexa Brooks, Lizoralia Brandon, Susan M Levin, Neal D Barnard
Nutrition Reviews, nuaa005,
Published March 13, 2020

The effects of early nutritional interventions on the development of atopic disease in infants and children: The role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods
Pediatrics, April, 2019, 143 (4) e20190281; DOI:
Full paper Accessed at:

Pediatric Spine Disorders
DePaola K and Cuddihy LA
Pediatr Clin North Am., 2020 Feb;67(1):185-204. doi: 10.1016/j.pcl.2019.09.008.
Copyright © 2019 Elsevier Inc. All rights reserved.

Effectiveness of craniosacral therapy in the treatment of infantile colic. A randomized controlled trial
Castejón-Castejón M, Murcia-González MA, Martínez Gil JL, Todri J, Suárez Rancel M, Lena O4, Chillón-Martínez R.
Complement Med Ther., December, 2019 doi:10.1016/j.ctim.2019.07.023. Epub 2019 Aug 13.
Copyright © 2019. Published by Elsevier Ltd.

Surface Electromyographic Analysis of the Suprahyoid Muscles in Infants Based on Lingual Frenulum Attachment during Breastfeeding
Ellia Christinne Lima França, Lucas Carvalho Aragão Albuquerque, Roberta Lopes de Castro Martinelli, Ilda Machado Fiuza Gonçalves, Cejana Baiocchi Souza and Maria Alves Barbosa
Int. J. Environ. Res. Public Health, 2020, 17(3), 859;
Received: December, 18 2019 / Accepted: January 27, 2020 / Published: January 30, 2020.

Milk and Health
Walter C. Willett, M.D., Dr.P.H., and David S. Ludwig, M.D., Ph.D.
New England Journal of Medicine,

Breakfast consumption, family breakfast, and adiposity trajectory in adolescence — The adolescent nutritional assessment longitudinal cohort study
Hassan BK, Cunha DB, da Veiga GV, Pereira RA, Hoffman DJ and Sichieri R.
J Acad Nutr Diet., 2019 Jun;119(6):944-956. doi:10.1016/j.jand.2018.11.014. Epub 2019 Feb 8
Copyright © 2019 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Adherence to timely vaccinations in the United States
Allison L. Hargreaves, Glen Nowak, Paula Frew, Alan R. Hinman, Walter A. Orenstein, Judith Mendel, Ann Aikin, Jessica A. Nadeau, Louise-Anne McNutt, Allison T. Chamberlain, Saad B. Omer, Laura A. Randall and Robert A. Bednarczyk
Pediatrics, March 2020, 145 (3) e20190783; DOI:
Accepted November 27, 2019.
Copyright © 2020 by the American Academy of Pediatrics.

Changes in motor skill proficiency after equine-assisted activities and brain-building tasks in youth with neurodevelopmental disorders
B. Rhett Rigby, Ronald W. Davis, Melissa D. Bittner, Robin W. Harwell, Eileen J. Leek, Geoben A. Johnson and David L. Nichols
Front. Vet. Sci., 31 January 2020

Dairy, soy, and risk of breast cancer: those confounded milks
Gary E Fraser, Karen Jaceldo-Siegl, Michael Orlich, Andrew Mashchak, Rawiwan Sirirat, Synnove Knutsen
International Journal of Epidemiology, dyaa007,
Published February 25, 2020.

Health impacts of early complementary food introduction between formula-fed and breastfed infants
Rippey PLF, Aravena F, Nyonator JP.
J Pediatr Gastroenterol Nutr., 2020 Mar;70(3):375-380. doi:10.1097/MPG.0000000000002581.

Therapeutic use of cannabis and cannabinoids: an evidence mapping and appraisal of systematic reviews
Montero-Oleas N, Arevalo-Rodriguez I, Nuñez-González S, Viteri-García A and Simancas-Racines D.
BMC Complementary Medicine and Therapies, 20, Article number: 12 (2020)
Published January 15, 2020.

Cow’s milk substitutes for children: Nutritional aspects of milk from different mammalian species, special formula and plant-based beverages
Elvira Verduci [OrcID] , Sofia D’Elios, Lucia Cerrato, Pasquale Comberiati [OrcID] , Mauro Calvani, Samuele Palazzo, Alberto Martelli,
Nutrients. 2019 Aug; 11(8): 1739.
Published online July 27, 2019 doi: 10.3390/nu11081739
Full paper Accessed at:

Production-related contaminants (pesticides, antibiotics and hormones) in organic and conventionally produced milk samples sold in the USA
Jean A Welsh, Hayley Braun, Nicole Brown, Caroline Um, Karen Ehret, Janet Figueroa and Dana Boyd Barr
DOI: Published online by Cambridge University Press: 26 June 2019
Volume 22, Issue 16 November 2019 , pp. 2972-2980.

Vaping-associated respiratory distress syndrome: Case classification and clinical guidance
Lilly, Craig M. MD; Khan, Shahzad MD; Waksmundzki-Silva, Kathryn MD amd Irwin, Richard S. MD
Critical Care Explorations, February 2020 - Volume 2 - Issue 2 - p e0081

Re-examination of dairy as a single commodity in US dietary guidance
Elizabeth T Jacobs, Janet A Foote, Lindsay N Kohler, Meghan B Skiba, Cynthia A Thomson
Nutrition Reviews, Volume 78, Issue 3, March 2020, Pages 225–234,
Published February 7, 2020.Vaping-associated respiratory distress syndrome: Case classification and clinical guidance
Lilly, Craig M. MD; Khan, Shahzad MD; Waksmundzki-Silva, Kathryn MD amd Irwin, Richard S. MD
Critical Care Explorations, February 2020 - Volume 2 - Issue 2 - p e0081

Altered gut microbiota is present in newly diagnosed pediatric patients with inflammatory bowel disease
Sila S, Jeli M, Trivi I, Tambi Andraševi A, Hojsak I and Kolaek S
J Pediatr Gastroenterol Nutr., 2020 Apr;70(4):497-502. doi:10.1097/MPG.0000000000002611.

Acupuncture or acupressure for pain management during labour
Smith CA, Collins CT, Levett KM Armour M, Dahlen HG, Tan AL, Mesgarpour B.
Cochrane Database Syst Rev. 2020 Feb 7;2:CD009232. doi:10.1002/14651858.CD009232.pub2.
Update of Acupuncture or acupressure for pain management in labour. [Cochrane Database Syst Rev. 2011]
PMID:32032444 PMCID:PMC7007200 [Available on 2021-02-07]
Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Trends in diet quality among youth in the United States, 1999-2016
Liu J, Rehm CD, Onopa J, Mozaffarian D.
JAMA. 2020 Mar 24;323(12):1161-1174. doi:10.1001/jama.2020.0878.
PMID:32207798 PMCID:PMC7093765 [Available on 2020-09-24].

What is the effect of spinal manipulation on the pressure pain threshold in young, asymptomatic subjects? A randomized placebo-controlled trial, with a cross-over design
Honoré M, Picchiottino M, Wedderkopp N, Leboeuf-Yde C, Gagey O.
Chiropr Man Therap. 2020 Feb 7;28(1):6. doi:10.1186/s12998-020-0296-1.
PMID:32028982 PMCID:PMC7006124

Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei Province, China
Xinyan Xie, BA; Qi Xue, MPH; Yu Zhou, BA; et al, Kaiheng Zhu, BA; Qi Liu, MS; Jiajia Zhang, PhD, MS; Ranran Song, PhD, MS
JAMA Pediatr. Published online April 24, 2020. doi:10.1001/jamapediatrics.2020.1619.

Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units
Lara S. Shekerdemian, MD, MHA; Nabihah R. Mahmood, MD; Katie K. Wolfe, MD; Becky J. Riggs, MD; Catherine E. Ross, MD; Christine A. McKiernan, MD; Sabrina M. Heidemann, MD; Lawrence C. Kleinman, MD, MPH; Anita I. Sen, MD; Mark W. Hall, MD; Margaret A. Priestley, MD; John K. McGuire, MD; Konstantinos Boukas, MD; Matthew P. Sharron, MD; Jeffrey P. Burns, MD, MPH; for the International COVID-19 PICU Collaborative.
JAMA Pediatr. Published online May 11, 2020. doi:10.1001/jamapediatrics.2020.1948.

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