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

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.

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.

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.

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.

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.

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.

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.

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.