Anatomy in Action Series: Shining a Light on our Littlest Patients
Laurie Mueller
BA, DC, CFMP
Children in the Chiropractic Office
Kids bring amazing energy into the office. Some of my favorite patients in practice were the littlest ones. Just as with adults, joint dysfunction in children can occur as part of daily life and from a variety of sources, such as prolonged awkward positioning, personal injuries during play, sports, exposures to environmental toxins, and with newborns from traumatic birth experiences such as long labors, very fast labors, forceps, breech, or caesarean delivery.
In our modern society we also see the weight of heavy backpacks, and altered posture from the prolonged use of cell phones, tablets, or other electronic devices. Please harken back to a prior article published here regarding anterior weight bearing of the spine, "text neck," and how it can lead to premature degeneration and deformity.
Kids feel pain and discomfort, too, but may not always be able to express it. There are many reasons (outside of frank injury) that parents might bring their child into the office to be evaluated for joint dysfunction. These may include but are not limited to changes in gait or posture (the condition of torticollis causes spasm and a sideways bend in the neck that prevents motion, for example). Parents might also seek out care for behavior changes, altered sleep patterns, infants that aren't hitting musculoskeletal milestones (such as crawling) or babies that are experiencing colic or only seem to be able to nurse on one side. These could all be clues to a possible underlying joint issue.
How Kids Spines are Different
Infants and children have skeletal systems that are still developing. In newborns and infants, for example, the bones in the skull don't fully fuse until ages 1-2. Kids have more dense, elastic tissue (cartilage) in all of their joints, which make them more flexible. The cartilage allows the child to continue to grow. Over time the extra cartilage develops into bone. By age 16 most extra cartilage has matured into bone. By age 14-18, the growth plates (located in long bones of the spine) have fused.
Treating with Kid Gloves
You may have noticed that doctors of chiropractic (DCs) in your office use slightly different techniques when working with children. The differences in their skeletal structures are the reason. Small infants may only take the pressure of a finger in the proper line of correction...that pressure may actually be no more than what we'd use to see if a tomato is ripe...but it is effective and all that is required. DCs may also opt to use little or no rotation in the cervical spine (neck) due to the extreme flexibility in the joints. In general, children do not need the same type of pressure for adjusting that adults do.
For physiotherapy modalities, it is also important to understand that many modalities are contraindicated on small children. Studies have shown that the use of therapeutic ultrasound, for example, even at low doses, might induce microscopic changes to the histology of the growth plate; thus, use of it around the plates (medically termed the physis) should be avoided. Even thermal therapies (heat or cold) should be utilized with extreme caution as small children and infants may not be able to communicate pain or discomfort.
For certain conditions, like torticollis, the DC may opt for manual soft tissue work and stretching along with spinal manipulative therapies to help alleviate muscle spasm and bypass other modalities. Always keep lines of communication open with your DC should physiotherapies be considered for kids. If certain modalities are to be utilized ask you DC for help with modality placement to ensure safety.
Communicating with Parents and Kids
As a CA, parents may also ask you questions that they may have forgotten or are too shy to ask the DC. They may wonder why the technique on the kids was different from what they experience, or why the DC isn't offering a child with muscle spasm the same type of physiotherapy that they may have received themselves. Parents considering chiropractic for their kids might also reach out for reassurance from you. Your knowledge and communication to the parents about how careful and light the techniques are can make all of the difference as they decide to pursue care for their little one.
CAs are also on the front line as the first impression that a child has in an office. They may initially be very scared. Keep in mind that typical medical visits for them likely involve not feeling good, strep tests, blood tests, and shots. Welcome them with big smiles and tell them how much they will love the doctor and how good it feels to get adjusted. One of my favorite memories is of a mom that told me that her little boy loves to come and see me. He called me "the popcorn doctor" or "the tickle doctor" because that is how he saw the treatment. I had told him on his first visit that if hears a little noise when we adjust him, don't worry, it's not the bones... it's just a little sound that happens in the joints...think of it as "making popcorn." This made him giggle. On future visits he'd run up to me and say "Let's make popcorn!" Analogies like this do wonders to put kids at ease.
Ask Your Doc about Continuing Education!
An understanding of anatomy and clinical applicability helps CAs better communicate with patients and provide care more safely. Expand your expertise with coursework designed for CAs.
Laurie Mueller, BA, DC, CFMP served in private practice in San Diego, California. She was the post-graduate director at Palmer College from 2000-2010; served as the ACC Post Graduate subcommittee chair for 6 years; peer reviewed for the Research Agenda Conference, and wrote the informal role determination study that aided in the development of FCLB's guidelines for chiropractic assistants (CCCAs). Dr. Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions LLC, and subsidiaries www.CCCAonline.com and www.fxmedonline. com . She is a clinician, an educator, and an expert in online learning pedagogy. Use AMCHIRO as your discount code during the registration process at CCCAonline to automatically provide a $15 discount!
References
1. https://www.saintlukeskc.org/health-library/pediatric-skeletal-growth#
2. https://journals.lww.corn/pedpt/Abstract/2022/01000/Effects_of_Therapeutic_Ultrasound_on_Growth.2.aspx
3. https://www.utpjournals.press/doi/abs/10.3138/physio.62.4.327
4. https://www.sciencedirect.com/science/article/abs/pii/ S1550830715001494
