Current Issue:  Vol. 20, Issue 2 ( 2021)

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.


The unlimited potential of the mentor mentee relationship

By Sharon Vallone, DC, FICCP, Editor.

Recently, I had a wonderful conversation with a young, highly motivated colleague who has played a role in linking up doctors of chiropractic with students of chiropractic in a mentor-mentee relationship. She was inspirational! Our talk was a walk down memory lane for me and a reminder of how much gratitude I have for those who have mentored me.

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Safety in chiropractic care for the pediatric patient: Can we rest on our reputation?

By Joyce Miller DC, Ph.D.

The top priority in chiropractic care for the pediatric patient, in fact, the only priority, is the safety of our care for that child. When I have spoken to a wide scope of clinicians and health care providers on this topic, I realized that they could not hear any details about our care until they were assured of the safety of our care. A hospital midwife familiar with our service and who referred many infants to our university-affiliated clinic* stated, “Chiropractic care may not help EVERY baby, but it will not hurt ANY baby.”

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Improvements in developmental delay in a female child following chiropractic care: a case report and selective review of the literature

By Matthew Doyle GCTEd, MSc Paed Chiro, BAppSc(Clinical)/BChiroSc, ACP, and Mike Marinus MSc Paed Chiro, MTech Chiro, FRCC.

Objective: To describe the improvement in developmental delay in a female child following age-appropriate chiropractic care for the assessment and reduction of vertebral and cranial subluxation. Clinical features: A three year four-month-old female was presented to clinic by her mother seeking help with concerns about communication and walking delay. Previous care included general practitioner visits and a speech therapist. Clinical assessment revealed she could partially manage two-year-old expected capacities. Additionally, vertebral and cranial subluxations were found. Intervention and Outcome: Age-appropriate chiropractic was delivered at seven visits over one month. Improvements in gross motor control, central sensitization, sleep, communication, balance, emotional regulation, and weight were noted. Conclusion: Chiropractic care involving touch and hold, cranial release and adapted diversified technique were associated with improvements in a child exhibiting developmental delay. Further research is warranted in this area including larger and more controlled sample groups utilizing validated testing tools.

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Headaches in children: Part 2 - The changing phenotypes of headaches in children

By Sue Weber DC, MSc, Chiropractic Pediatrics FRCC, FEAC

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.

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Demographic Profile of Chiropractors and their Pediatric Patients in Cyprus: A Cross–sectional Survey

By Anna E. Papadopoulou, MChiro, DC, MSc, DACNB, FRCC

Background: Pediatric chiropractic care is a popular special interest within the chiropractic profession. Ongoing observational research is important for gathering demographic information on this patient population as well as characteristics of the chiropractors that provide such care. This study investigated the profile of pediatric chiropractic patients in Cyprus and the chiropractors who treated them over a four-month period in 2019 and 2020. Method: All 16 members of Cyprus Chiropractor’s Association (CyCA) were invited to participate in the two-part observational cross-sectional study. Retrospective data of pediatric patients was anonymized and a separate chiropractor’s characteristics survey was completed. Results: One hundred and fifty-one pediatric anonymized case records were collected from nine Cypriot chiropractors in the interval November 2019 - February 2020. Patient characteristics showed a slightly higher male to female ratio of cases with adolescent and school age groups having the biggest representation for musculoskeletal (MSK) issues followed by infants with a variety of conditions. Positive outcomes in terms of physical activity levels and reduction of pain were reported by patients within one to five treatments. Data shows a male dominance (11 males:5 females) in the CyCA organization. However, there were equal numbers of male and female chiropractors (5 of each) treating pediatric cases. All chiropractors were graduates of USA, Australian and UK institutions. Members had an average of 23.8 (SD=13.19) years in practice. All chiropractors reported advanced degrees in pediatric practice or had updated continued professional development. Conclusion: The country of Cyprus has one of the smallest chiropractic associations in the world with only 16 members. Nevertheless, both the demographic profiles of the chiropractors and their pediatric patients revealed strong similarities to other European chiropractic practices. Demographic studies every five years would be beneficial for making longitudinal observations and recommendations for the Cyprus Chiropractic Association (CyCA) in addition to comparing international results.

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Mastitis : a guide for the chiropractor working with the breastfeeding dyad

By Sharon Vallone, DC, FICCP, and Cheryl Hawk, DC, LMT, PhD

In 2021, it is generally acknowledged that the promotion of breastfeeding provides multiple benefits for the mother and child, both psychological and nutritive. The World Health Organization promotes initiating breastfeeding immediately after birth and exclusive breastfeeding for the first six months of life with breastmilk remaining a staple supplement to a whole foods diet until the child’s second birthday. Health benefits associated with the nutritional and bioactive components in human milk are many and dependent on breastfeeding duration. Duration of breastfeeding is influenced by social and physiologic factors including, and for our purposes in this paper, pain. In a study of 1,323 mothers who stopped breastfeeding during the first month postpartum, 29.3% cited pain and 36.8% identified sore, cracked, or bleeding nipples as an important reason.

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Chiropractic history and examination forms for the infant, pre-school, and school-aged child

By Sue Weber DC, MSc, FEAC, FRCC, and Amy Sarah Miller MSc, PhD, FEAC

The assessment of the pediatric patient is a specialized area of chiropractic practice, requiring additional knowledge and skills. In recognition of this, European Academy of Chiropractors’ special interest group for Pediatrics have developed basic history and examination forms for the infant, pre-school, and school-aged child. The aim of these forms are to assist the chiropractor to identify red flags and to triage musculoskeletal and non-musculoskeletal complaints in these age groups. The process of development of the forms is outlined, and the three forms are presented in this article.

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Chiropractic Care for Adults With Pregnancy-Related Low Back, Pelvic Girdle Pain, or Combination Pain: A Systematic Review
Carol Ann Weis, Katherine Pohlman, Crystal Draper, Sophia daSilva-Oolup, Kent Stuber, Cheryl Hawk
Journal of Manipulative and Physiological Therapeutics 2020, 43 (7): 714-731
The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of chiropractic care options commonly used for pregnancy-related low back pain (LBP), pelvic girdle pain (PGP), or combination pain for both experienced practitioners and students of chiropractic.

Chiropractic Care of Adults With Postpartum-Related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review
Carol Ann Weis, Katherine Pohlman, Crystal Draper, Sophia da Silva-Oolup, Kent Stuber, Cheryl Hawk
Journal of Manipulative and Physiological Therapeutics 2020, 43 (7): 732-743
The purpose of this study was to conduct a systematic review (SR) of the literature to assess the effectiveness of specific chiropractic care options commonly used for postpartum low back pain (LBP), pelvic girdle pain (PGP), or combination (LBP and PGP) pain.

Adverse events from spinal manipulations in the pregnant and postpartum periods: a systematic review and update
Carol Ann Weis, Kent Stuber, Kent Murnaghan, Shari Wynd
Journal of the Canadian Chiropractic Association 2021, 65 (1): 32-49
The purpose of this study is to update a previous critical review of adverse events in pregnant and postpartum populations. This update found one case study that demonstrated a serious adverse event in the cervical spine following SMT and a handful of minor and transient adverse events in the low back following SMT.

Physical activity throughout pregnancy: guideline critical appraisal and implementation tool
Gaelan Connell, Carol Ann Weis, Heather Hollman, Kelsey Nissen, Leslie Verville, Carol Cancelliere
J Can Chiropr Assoc. 2021 Apr;65(1):50-58
The 2019 Canadian guideline for physical activity throughout pregnancy provides evidencebased recommendations to promote maternal, fetal, and neonatal health. We aimed to 1) critically appraise the 2019 Canadian guideline for physical activity throughout pregnancy; and 2) develop a guideline summary for clinicians to facilitate the uptake of recommendations into practice.

The Effectiveness of Non-Pharmaceutical Interventions Upon Pregnancy-Related Low Back Pain: A Systematic Review and Meta-Analysis
Ioannis Koukoulithras Sr, Alexandra Stamouli, Spyridon Kolokotsios, Minas Plexousakis Sr, Christine Mavrogiannopoulou
PMID: 33728108 PMCID: PMC7934802 doi: 10.7759/cureus.13011.
Low back pain (LBP) is a very common pathology among pregnant women and various methods are used to reduce the pain. The aim of this study is to conduct an evidence-based systematic review and meta-analysis regarding the effectiveness of the interventions used to reduce low back pain related to pregnancy.

Comparative Efficacy and Safety of Conservative Care for Pregnancy-Related Low Back Pain: A Systematic Review and Network Meta-analysis
Lingxiao Chen, Manuela L Ferreira, Paula R Beckenkamp, Eduardo L Caputo, Shiqing Feng, Paulo H Ferreira
PMID: 33210717 doi: 10.1093/ptj/pzaa200.
More than one-half of pregnant women experience pregnancy-related low back pain (LBP). Pregnancy-related LBP greatly affects activities of daily life, and although many interventions have been proposed, the optimal treatment for pregnancy-related LBP remains unclear. The purpose of this study was to compare conservative care strategies on their efficacy and safety for women with pregnancy-related LBP through systematic review with pairwise meta-analysis and network meta-analysis.

Effects of elastic tape in pregnant women with low back pain: A randomized controlled trial
Matchimamart Chamnankrom , Nuttaset Manimmanakorn , Apiwan Manimmanakorn, Kiattisak Kongwattanakul, Michael J Hamlin
J Back Musculoskelet Rehabil. 2021;34(1):111-119.
Low back pain is a common problem in pregnant woman. Elastic tape is an alternative method that may reduce low back pain. After the application of stretched elastic tape, lower back pain was significantly reduced by 29.4% (p= 0.003) immediately post-taping and by a further 75.4% after wearing the tape for a week.

Effectiveness of kinesiotaping in pregnant women with sacroiliac joint pain: A randomised controlled study
Banu Ordahan , Jule Eriç Horasanl
Int J Clin Pract. 2021 Sep;75(9):e14432. doi: 10.1111/ijcp.14432.
Sacroiliac joint (SIJ) dysfunction is an especially common cause of pain during pregnancy. Treatment options during pregnancy are very limited in order to reduce pain and increase the quality of life. We aimed to determine the efficacy of kinesiotaping (KT) in the treatment of SIJ pain in pregnant women. KT treatment improved the pain levels, functioning and quality of life among pregnant women with SIJ pain.

Breastfeeding Support Team: When to Add a Chiropractor
Miller, Joyce, BS, DC, PhD
Clinical Lactation Vol 11 Issue 1, doi: 10.1891/2158-0782.11.1.7.
Chiropractors are primary care clinicians with a musculoskeletal focus. As community-based practitioners, they are educated and available to treat the common problems of infancy, including sub-optimal breastfeeding. The objective of this investigation was to highlight some of the key skills and techniques used by chiropractors to assist the breastfeeding dyad.

Adverse events associated with pediatric complementary and alternative medicine in the Netherlands: a national surveillance study
Björn Vos, Jan Peter Rake, Arine Vlieger
Eur J Pediatr. 2021 Jul;180(7):2165-2171. doi: 10.1007/s00431-020-03899-8. Epub 2021 Mar 1.
Pediatric use of complementary and alternative medicine (CAM) in the Netherlands is highly prevalent. The risks of pediatric CAM use are, however, largely unknown. Therefore, a 3-year survey was carried out at the Dutch Pediatric Surveillance Unit. Pediatricians were asked to register cases of adverse events associated with pediatric CAM usage.

Effectiveness of chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7–14 years - a randomised clinical trial
Susanne Lynge, Kristina Boe Dissing, Werner Vach, Henrik Wulff Christensen, Lise Hestbaek
Chiropr Man Therap. 2021 Jan 7;29(1):1. doi: 10.1186/s12998-020-00360-3.
To investigate the effectiveness of chiropractic spinal manipulation versus sham manipulation in children aged 7-14 with recurrent headaches. Chiropractic spinal manipulation resulted in significantly fewer days with headaches (reduction of 0.81 vs. 0.41, p = 0.019, NNT = 7 for 20% improvement) and better global perceived effect (dichotomized into improved/not improved, OR = 2.8 (95% CI: 1.5-5.3), NNT = 5) compared with a sham manipulation procedure.

Complementary and Alternative Therapies for Infantile Colic: A Systematic Review of the Literature
Bengü Çetinkaya
Altern Ther Health Med. 2021 Mar;27(2):42-47.
Infantile colic is defined as paroxysms of uncontrollable and unexplained crying in the first three months of life. Complementary and alternative therapy methods are one of the methods used to treat infantile colic, which has negative effects on parents and infants. Further study of the complementary and alternative therapy methods will help to increase the evidence for their effective use in the treatment of infantile colic.

Effects of Osteopathic T9-T10 Vertebral Manipulation in Tonsillitis: A Randomized Clinical Trial
Agustín Luceño-Mardones, Irene Luceño-Rodríguez, Elena Sonsoles Rodríguez-López, Jesús Oliva-Pascual-Vaca, Ignacio Rosety, Ángel Oliva-Pascual-Vaca
Healthcare (Basel). 2021 Apr 1;9(4):394. doi: 10.3390/healthcare9040394.
This study aimed to determine whether osteopathic manipulation of the T9-T10 vertebrae improves the evolution of tonsillitis. A randomized, stratified, controlled clinical trial with blinded patients, evaluator and data analyst was performed. The patients in the control group (CG) underwent a “sham” manipulation.

Physical Therapist Interventions for Infants With Nonsynostotic Positional Head Deformities: A Systematic Review
Irene Cabrera-Martos, Salvador Jesús Ortigosa-Gómez, Laura López-López, Araceli Ortiz-Rubio, Irene Torres-Sánchez, María Granados-Santiago, Marie Carmen Valenza
Phys Ther. 2021 Aug 1;101(8):pzab106. doi: 10.1093/ptj/pzab106.
This study sought to examine the methodological quality and summarize the evidence from clinical trials that examined the effectiveness of physical therapist interventions in the management of nonsynostotic positional head deformities in infants.

Chiropractic Care for the Pregnant Body
Shayna N Conner, Amanda S Trudell, Craig A Conner
Clin Obstet Gynecol. 2021 Sep 1;64(3):602-610. doi: 10.1097/GRF.0000000000000621.
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.

Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis
Omar Irfan, Fiona Muttalib, Kun Tang, Li Jiang, Zohra S Lassi, Zulfiqar Bhutta
Arch Dis Child. 2021 Feb 16;106(5):440-448. doi: 10.1136/archdischild-2020-321385. Online ahead of print.
Compare paediatric COVID-19 disease characteristics, management and outcomes according to World Bank country income level and disease severity. 129 studies were included from 31 countries comprising 10 251 children of which 57.4% were hospitalised. Mean age was 7.0 years (SD 3.6), and 27.1% had a comorbidity. Paediatric COVID-19 has a favourable prognosis. Further severe disease characterisation in children is needed globally.

Assessment of Studies Evaluating Spinal Manipulative Therapy and Infectious Disease and Immune System Outcomes: A Systematic Review
Ngai Chow, Sheilah Hogg-Johnson, Silvano Mior, Carol Cancelliere, Stephen Injeyan, Julita Teodorczyk-Injeyan, J David Cassidy, Anne Taylor-Vaisey, Pierre Côté
JAMA Netw Open. 2021 Apr 1;4(4):e215493. doi: 10.1001/jamanetworkopen.2021.5493.
Claims that spinal manipulative therapy (SMT) can improve immune function have increased substantially during the COVID-19 pandemic and may have contributed to the rapid spread of both accurate and inaccurate information (referred to as an infodemic by the World Health Organization).

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