|
International peer-reviewed chiropractic
pediatric history and examination forms for the
infant, child, and adolescent
Sue A. Weber BSc, DC, MScAPP (Pediatric
musculoskeletal health)
Chairperson/faculty European Academy
Chiropractic special interest group in
pediatrics (FEAC)
Faculty Royal College of Chiropractors
Pediatrics (FRCC)
Practitioner, Stockholm Sweden
dr.sue@telia.com
ABSTRACT
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 together with an international group
of pediatric musculoskeletal experts have
expanded on the previously published basic
history and examination forms for infants,
children and adolescents. The aim of these forms
is to further assist the chiropractor in
identifying red flags and differentially
diagnosing problems in musculoskeletal and
mental health as they present throughout growth
and development. The process of development of
the forms is outlined, and the three forms are
presented in this article.
Key Words: chiropractic
pediatric, pediatric history form, pediatric
examination form, pediatric red flags, pediatric
musculoskeletal health.
Introduction
Chiropractic education typically includes a
cursory level of education within pediatrics1
which varies from institution to institution.
Practitioners interested in pediatrics can
pursue additional education through continuing
professional development courses, a diplomate, a
Master’s degree or a PhD through a range of
providers. Surveys show that the majority of
practitioners see children of all ages but feel
they have inadequate skills in assessment and
treatment.1
Triaging musculoskeletal and non-musculoskeletal
complaints is of the highest priority for the
chiropractor.2 This is a vital skill
and knowledge base for those seeing the
pediatric patients to develop, as differential
diagnosis and treatment are significantly
different than in the adult patient.3
Children, and particularly infants, are not
miniature adults. There are specific and
different concerns for each age group which must
be addressed with an appropriate history and
examination. Basic forms for the infant, child
and adolescent have been published to establish
a minimum competency for chiropractors who lack
advanced education in this area.4
These forms address skills specifically in
musculoskeletal differential diagnosis as well
as recognizing for referral the ill child
ensuring safe care of this population.
Additional exam forms addressing specific
pediatric complaints commonly presenting to
chiropractors were initiated and intended to
complement the basic forms. As these were being
drawn up there seemed to be unnecessary
repetition so this idea was abandoned. More
comprehensive history and exam forms were deemed
more appropriate and are presented in this
article. They address more age-specific issues
in musculoskeletal health, sensory issues, and
psychosocial health. For the purposes of safety,
the forms include a review of systems, a
neurological examination, and red flags. The
infant forms include, besides history, a review
of the mothers’ health and the perinatal period.
AIMS
The European Academy of Chiropractic (EAC) is
working to provide cost-free postgraduate
education for practitioners. One of the EAC
special interest groups (SIG) is pediatrics,
where members are working to advance education
specific to pediatric practice. The SIG team in
pediatrics published in 2021 basic history and
exam forms for the infant, child and
adolescent.4 The work since
publication of these forms has been to draw up
regional forms covering specific conditions
within pediatric musculoskeletal health. Due to
unnecessary repetition, we decided to enhance
and expand the original forms to include these
areas along with mental health and wellbeing in
the different age groups. Psychosocial health
was deemed important as is has become such
burden for some children with an increased risk
for suicide in adolescents. Pediatric headache
history, exam and questionnaire have been
recently published separately,5 so
this will be referenced for use in the
comprehensive form. An outcome assessment for
suboptimal breastfeeding with a musculoskeletal
origin has been published recently6
and is referred to in these forms. Malignancies
in children, though rare are different than
those presenting in
adults.7Clinicians should remain
abreast of current prevalence statistics and
include in the differential diagnosis when
appropriate. They are listed in Table 1.
The SIG team engaged the participation of
several other chiropractors, most with advanced
academic education within pediatrics (Masters or
PhD) to review these forms. We intentionally
invited practitioners from several different
countries to participate to make this an
international peer-reviewed pediatric project. A
long-term goal is to have these forms
implemented internationally to be able to
collect data for use in future research
projects. The forms are also intended for use as
an outline for an academic musculoskeletal
pediatric post-graduate education.
The three forms presented with this article are
more comprehensive than those published in
2021.4 They have been designed to
organize the pediatric history and examination,
giving it consistency, aiding the practitioner
in undertaking a thorough assessment. The age
groups have been changed to reflect that the
period of infancy and toddlerhood were better
suited together (0-2 years) than toddler with
the young child (Table 2).6,8,9,10







The second group is two years to six years, the
young child (Table 3)5,9,10 and the
third is 6-16 years which covers the child and
the adolescent (Table 4).5,9,10 The
primary focus of the forms is on triaging common
MSK and non-MSK presentations in the three
pediatric age groups, and on identifying red
flags for referral.12-15 In
highlighting non-MSK and red flag presentations,
there is an emphasis on safety, particularly
identifying and referring the ill child for
medical assessment and care.













These forms are intended to address
musculoskeletal problems which typically present
during the different stages of growth and
development. These forms also address more
thoroughly issues of mental health, sensory
issues, and neurodevelopment in all age groups.
They may be helpful not only in reaching the
correct diagnosis or diagnoses in order that
proper management can be recommended in a timely
manner, but that children who need co-management
are recognized early in the process.
Process
The pediatric history, examination and red flag
forms have been reviewed by 24 different
chiropractors, representing 10 different
countries: Australia, Belgium, Canada, Cyprus,
Denmark, Germany, Malaysia, Norway, South
Africa, Sweden, Switzerland, the UK and the
United States. The UK was over-represented with
nine chiropractors participating. Six
participants have a DC degree of which two have
a diplomate, fifteen of the participants have
MSc in advanced pediatric musculoskeletal
health, and three have a PhD with focus in
pediatrics. Twenty-three participants work
clinically with patients, two of which have
graduated less than five years ago.
This process started on December 13, 2022.
Thirty-two chiropractors were contacted of which
eight chiropractors either did not respond or
did not want to participate. One of these
chiropractors had a conflict of interest as she
is preparing pediatric history and exam forms
for financial gain. Emails, tele-conferences,
and telephone calls have been made monthly since
then to ask for participation, to disperse and
discuss each of the forms and to remind
participants about the forms. Twenty- three
participants who agreed to evaluate the forms
reviewed and commented on all three forms, one
participant commented on just the child form.
Changes were made based on comments and the
final iteration was then shared with educators
within the field for their final comments.
Recent graduates were asked to review the final
forms for their completeness and practicality.
All participants were asked for their permission
to publish their names with educational degrees
or diplomate.
Recommendations for chiropractors
It is recommended that chiropractors and other
practitioners using manual therapy who are
working with pediatrics regardless of their
specialty education review these comprehensive
forms to enhance their skills. Those without
advanced education in pediatrics are encouraged
to adopt these more comprehensive forms for
clinical practice. Due to the comprehensive
nature of the forms, it is understood that the
practitioner should focus on the area of
complaint and get more detailed information in
areas that are problematic. The infant form
differs in that it guides the practitioner
through a detailed history before the primary
complaint. The information gathered gives more
clues to the origin of the problem and direction
for the exam. Although the forms may be a bit
cumbersome for the seasoned practitioner, they
guide the newer and less experienced
practitioners through a thorough process. These
forms address psychosocial health, sensory and
neurodevelopmental issues which may be new for
the more experienced chiropractor and serve as a
good reference in this area. Just as these forms
reflect the fact that the child is growing and
developing, treatment is also adjusted based on
age and development.
A series of recorded lectures to accompany these
forms are in progress, discussing key aspects of
the history and examination of the pediatric
patient. These will be soon available through
the European Chiropractic Union home page,
European Academy of Chiropractic (EAC) and the
EAC Academy.
Conclusion
These forms represent a more comprehensive
musculoskeletal assessment of pediatric patients
from infancy through adolescence with a goal to
ensure safe and effective management. The
implementation of these forms should not only
raise competence of practitioners, but with
widespread use, enable data collection on a
large scale for future research. The forms are
also to serve as an outline for a postgraduate
pediatric education in musculoskeletal health.
The work to provide these clinical exam forms is
to elevate the safety and quality of care
provided by chiropractors to infants, children,
and their families.
Limitations
The age groups presented cover more than one
area of development. Ideally the pediatric forms
should be more specific to distinctive periods
of growth and development. Future work in this
area would be to further breakdown the age
groups and have forms for the neonate, infant,
preschooler, child, pre-adolescent, and
adolescent.
References:
1. Porcino A, Solomonian L, Zylich S, Gluvic B,
Doucet C, Vohra S. Pediatric training and
practice of Canadian chiropractic and
naturopathic doctors: a 2004-2014 comparative
study.
BMC Complementary and Alternative
Medicine. 2017;17(1):512.
doi:
10.1186/s12906-017-2024-5.
2. Smith N, Mercer V, Firth J, Jandial S, Kinsey
K, Light H, Nye A, Rapley T, Foster HE. Right
Path: a model of community-based musculoskeletal
care for children.
Rheumatology Advances in Practice.
2020;4(2).
doi:
10.1093/rap/rkaa057.
3. Chance-Larsen K, Backhouse MR, Collier R,
Wright C, Gosling S, Harden B, et al. Developing
a national musculoskeletal core capabilities
framework for first point of contact
practitioners,
Rheumatology Advances in Practice.
2019;3(2)rkz036.
doi.org/10.1093/rap/rkz036.
4. Weber S, Miller AS. Chiropractic history and
examination forms for the infant, pre-school,
and school-aged child. JCCP;2021(20)2:1826-41.
5. Weber S. Pediatric headache questionnaire,
exam and history forms for the chiropractor.
JCCP;2022(1)1:1871-6.
6. Hawk, C. Vallone S, Young J, Lavigne V.
Development of an outcome assessment instrument
for suboptimal breastfeeding in infants with
musculoskeletal dysfunction. JCCP;
2020(19)1:1621-8.
7. Siegel R, Miller K, Wagle, N, Jemal A. Cancer
statistics. CA Cancer J Clin. 2023;
73:17–48.
8. Matthey S, Barnett B, White T. The Edinburgh
Postnatal Depression Scale.
The British Journal of Psychiatry.
2003;182(4)368-368.
doi:10.1192/bjp.182.4.368.
9. Atwell K, Michael W, Dubey J, James S,
Martonffy A, Anderson S, et al. Diagnosis and
management of hypermobility spectrum disorders
in primary care.
The journal of the American board of family
medicine. 2021;34(4)838-848.
10.
https://pediatrics.tuftsmedicalcenter.org/The-Survey-of-Wellbeing-of-Young-Children/Age-Specific-Forms
11. Foster HE, Jandial S. pGALS – paediatric
Gait Arms Legs and Spine: a simple examination
of the musculoskeletal system.
Pediatr Rheumatol. 2013;11(44).
doi.org/10.1186/1546-0096-11-44.
12. Zablotsky B, Black LI, Maenner MJ, Schieve
LA, Danielson ML, Bitsko RH, Blumberg SJ, Kogan
MD, Boyle CA. Prevalence and Trends of
Developmental Disabilities among Children in the
US: 2009–2017.
Pediatrics 2019;144(4):e20190811.
13. Choo YY, Agarwal P, How CH, Yeleswarapu SP.
Developmental delay: identification and
management at primary care level.
Singapore Med J. 2019
Mar;60(3):119-123.
doi:
10.11622/smedj.2019025. PMID: 30997518; PMCID: PMC6441684.
14. Xue L, Liu C, Xue W, Xue R, Liu P, Wang F.
The Role of Nurses in the Management of
Respiratory Disorders in Children.
Altern Ther Health Med. 2022
Jan;28(1):65-71. PMID: 34653020.
15. Frosch M, Mauritz MD, Bielack S, Blödt S, et
al. Etiology, Risk Factors, and Diagnosis of
Back Pain in Children and Adolescents: Evidence-
and Consensus-Based Interdisciplinary
Recommendations. Children (Basel). 2022 Feb
2;9(2):192.
doi:
10.3390/children9020192. PMID: 35204913; PMCID: PMC8870422.
|