Pediatric Chiropractic Evaluation

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Pediatric Chiropractic Evaluation
2
Wellness Care

• Fysh recommends spinal check-ups
• school-aged children at least every 3 months
• pre-school children at least every 2 months
• infants in the first 2 years of life at least
  every month
• Joan Fallon published The Child Patient A Matrix
  for Chiropractic Care. Available at
  www.icapediatrics.com.

Fysh P. Chiropractic Care for the Pediatric
Patient. Arlington, VA ICA Council on
Pediatrics, 2002.
3
Determining Visit Frequency

• Several things should be taken into account
• History
• physical, chemical, and/or mental trauma will
  increase the likelihood s/he will require a
  higher frequency
• Examination findings
• Lifestyle, activity and stress levels

Fysh P. Chiropractic Care for the Pediatric
Patient. Arlington, VA ICA Council on
Pediatrics, 2002.
4
Newborn Evaluation

• Reverse Fencer Maneuver
• Heel swing
• Acetabular pump
• Supine Leg Check
• Instrumentation - atlas fossa reading
• Posture analysis
• Static Palpation
• Motion palpation

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McMullen Reverse Fencer

• Used only with infants (lt6 months old)
• Less accurate once the child gains strength and
  control of the cervical spine musculature
• Landaus
• Two part assessment protocol
• Reference
• McMullen M. Assessing Upper Cervical
  Subluxations in Infants Under Six Months-
  Utilizing the Reverse Fencer Response. ICA
  International Review of Chiropractic.
  March/April1990,39-4.

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Reverse Fencer- Part 1

• Heel swing
• Hold infant upside down, making sure to have a
  solid grip on their ankles
• Release one foot slowly, watch the childs head
  turn to that side
• Repeat on other side
• Compare motion from side to side
• restricted? twitching?

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What if...?

• Infant arches backwards (opisthotonis)
• Meningeal tension?
• Infant doesnt turn to one side
• According to McMullen, a negative response (heel
  swing) indicates a subluxation complex between
  the atlas-axis or atlas-occ. on that side

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Reverse Fencer-Part 2

• Acetabular pump
• Infant supine, apply pressure along the shaft of
  the femur into the acetabular fossa
• Compare the resistance on each side
• The spongy side is said to be the side of atlas
  laterality
• If theyre even, consider the occiput

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Supine Leg Check

• Lay the infant supine
• Gently straighten the legs
• make sure that the head is in a neutral position
• Compare medial malleoli, fat folds at the knee,
  etc.

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Gluteal Cleft Deviation

• Pinch gluteal cheeks together, cleft should be
  midline
• If it deviates...
• may either be to the side of posterior-inferior
  sacroiliac subluxation (P-R, PI-R, P-L, PI-L) or
  to the side of anterior-inferior sacral movement
  at the lumbosacral junction
• Other things to note when assessing the pelvis...
• Hold infant upright, legs dangling
• Inspect for ilium rotation
• Gluteal fold observation sacral tilts

Fysh P. Chiropractic Care for the Pediatric
Patient. Arlington, VA ICA Council on
Pediatrics, 2002.
11
Prone Leg Check Older Child
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Instrumentation

• Accuracy?
• Size of probes
• Patient relaxation
• Cant sit up...
• Skin folds

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Atlas fossa reading

• Measure atlas fossa temperatures
• DT-25 or Tytron
• If using the DT-25, remember that it rounds to
  the nearest whole number and you may need to
  repeat each side 3x...
• Remember to take into consideration the way the
  child was being held, sitting in the sun in the
  car seat, etc.

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Clinical Note

• What if?
• Atlas fossa R 85 L86
• No other findings in the cervical spine
• _ _ _ _ _ _

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Posture analysis

• Head tilt
• Head rotation
• High shoulder
• Scoliosis
• High ilium
• Genu varus and valgum
• Internal extenal foot rotation

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• Normal evolution from bowlegs to
  knock-knees to normal valgus

2 years 3 years 5 years
Toe-In Toe-Out
EX ilium IN ilium
Tibial torsion
Femoral anteversion
Weak psoas or glut. max Hypertonicity
Cerebral Palsy (bilat. toe-in)
???????
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Static Palpation

• Taut and tender fibers
• Muscle spasm
• common with congenital torticollis
• Sudoriferous changes
• stickiness/dryness
• Temperature

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Just because it sticks out doesnt mean its
subluxated!

• L1 is often prominant in infants (similar to the
  adults T4) but it is not always fixed
• You must evaluate the motion, feel for
  springiness, TT fibers, sudoriferous changes,
  instumentation findings, etc.

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Motion palpation

• Similar to adults but much more subtle
• ligament laxity, cartilagenous vertebrae

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Gross Range of Motion

• Can be evaluated by playing with them
• Can they bend in half forward?
• Can they bend ear to foot equally on both sides?
• Can they cross shoulder to opposite foot
  comfortably?
• Remember, newborns should be flexible!

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Older Babies and Toddlers

• As they start to be mobile, you have to become
  more creative...
• Do they have to be on a table to get adjusted?
• Follow them as they crawl, play, etc.

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Toddlers School Aged Kids

• Flying Airplane
• Child lays on their tummy
• (table, dads lap, your lap)
• Have them hold their arms out like wings
• You lift both legs and go through motion
  palpation of lumbars gt thoracics

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Communicating with Kids

• They want to be in control of their world
• Important to respect their need for autonomy but
  you also have to maintain control of the
  interaction
• Use positive language
• Give them a choice between two acceptable
  options
• Do you want to lay on your front or on your
  back? instead of Do you want to get adjusted?