Findings in 62 patients suffering from vertebragenic hearing disorders are reported before and after chiropractic management. Results indicate that these hearing disorders are reversible, as demonstrated by audiometry and OAE. The therapy of choice is chiropractic manipulation of the upper cervical spine. The commoness of vertebragenic hearing disorders emphasizes their clinical and forensic importance. You can review many other articles on chiropractic and Hearing Loss in the Research Section.
Twenty-four of 43 patients (53%) died, with an additional three surviving after orthotopic liver transplantation. Parents should be advised about the potential hepatotoxicity of acetaminophen when given to ill children in doses exceeding weight-based recommendations.
A Randomized, Placebo-Controlled Trial of Antimicrobial Treatment for Children With Clinically Diagnosed Acute Sinusitis
Neither amoxicillin nor amoxicillin-clavulanate offered any clinical benefit compared with placebo for children with clinically diagnosed acute sinusitis.
The majority of drugs given to children have never been tested specifically for them. Physicians are prescribing drugs based on a “best guess” as to the dosage, efficacy and even safety. The FDA understands that giving medications to children for which there is only adult data available could be harmful, considering that children have dosing concerns and side-effect risks that differ from adults. The latest legislation has made some headway in the battle against the lack of proper labeling; yet, it still fails to completely overcome the absence of research, particularly in the older medications.
At What Age Does Low Back Pain Become a Common Problem? A Study of 29,424 Individuals Aged 12-41 Years
The prevalence of the various definitions of low back pain increased greatly in the early teen years (earlier for girls than for boys), and by the ages of 18 years (girls) and 20 years (boys) more than 50% had experienced at least one low back pain episode. The pattern for the 1-year period prevalence of low back pain was very similar to that for the lifetime prevalence; both started at 7% (95% confidence interval, 5-9%) for the 12-year-old individuals and reached 56% (95% confidence interval, 53-59%) and 67% (95% confidence interval, 62-71%), respectively, for the 41-year-old individuals.
An international congress about “the back of children and teenagers and the prevention of backache” was held in March 1999 in Grenoble (France). Beside specific low back pain following progressive and growth diseases, special attention was paid to non-specific low back pain (LBP).
Prolonged Low-Back Pain in Young Athletes: A Prospective Case Series Study of Findings and Prognosis
We investigated the prognosis of low-back pain and the association of clinical symptoms and anatomic findings among young athletes. Consecutive patients, aged between 12 and 18 years, who had low-back pain that had interfered with their training for at least 4 weeks were included in the case series.
The findings from this cross-sectional study indicate a need for a longitudinal prospective study designed to identify etiologic and prognostic factors of back pain in adolescents, with the goal of devising preventive strategies likely to reduce the risk of low back pain in adulthood.
When present, pediatric back pain is most often musculoskeletal, associated with an acute infectious illness or a traumatic event. Although the etiology is rarely serious, back pain often affects the daily activities of symptomatic children.
For clinical and research purposes, neck pain, middle back pain, and low back pain in childhood should be regarded as three specific entities. In future research the data for different age groups should be reported separately.
Pain in the neck, shoulder, and lower back is becoming more common in Finnish adolescents. This pain suggests a new disease burden of degenerative musculoskeletal disorders in future adults.
Evaluation of Chiropractic Management of Pediatric Patients with Low Back Pain: A Prospective Cohort Study
Patients responded favorably to chiropractic management, and there were no reported complications. Future investigations should establish the natural history and compare chiropractic management with other forms of treatment to gain knowledge about the effectiveness of chiropractic in managing pediatric LBP.
In children, degenerative disc findings are relatively common, and some are associated with LBP. There appears to be a gender difference.Disc protrusions, endplate changes, and anterolisthesis in the lumbar spine were strongly associated with seeking care for LBP.
Our study clearly demonstrates correlations between low back pain in childhood/adolescence and low back pain in adulthood. This should lead to a change in focus from the adult to the young population in relation to research, prevention, and treatment.
Is Comorbidity in Adolescence a Predictor for Adult Low Back Pain? A Prospective Study of a Young Population
Young people from 12 to 22 years of age with persistent LBP during the previous year have an odds ratio of 3.5 persistent LBP eight years later. Both headache and asthma are also positively associated with future LBP and there is a large clustering of LBP, headache and asthma in adolescence.
Neck or occipital pain and shoulder pain are very common symptoms among adolescents, and both prolonged sitting and a high level of physical activity seem to be related to them.
Although there is wide discrepancy in the manner in which adolescent spinal pain is reported, it is evident that lifetime prevalence rates increase steadily with age and approximate adult levels by around the age of 18 years. There is an opportunity for further longitudinal research, with standardized methodology, to be undertaken that builds on the findings from this large group of studies.
Doctors Likely to Encounter Children With Musculoskeletal Complaints Have Low Confidence in Their Clinical Skills
Self-rated confidence in pediatric musculoskeletal clinical assessment was lowest, compared with other bodily systems, within doctors to whom children with MSK problems are likely to present. Core clinical skills are learnt at undergraduate level, and this study reflects poor levels of pMSK training which needs to be addressed.
The most recent studies showed higher prevalence rates than the oldest ones, and studies with a better methodology exhibited higher lifetime prevalence rates than studies that were methodologically poor. Future studies should report more information regarding the definition of LBP and there is a need to improve the methodological quality of studies.
This article describes and discusses the case of an adolescent male with lumbar intervertebral disc injury characterized by chronic low back pain (LBP) and antalgia. A 13-year-old boy presented for care with a complaint of chronic LBP and subsequent loss of quality of life. The patient was examined and diagnosed by means of history, clinical testing and use of imaging. He had showed failure in natural history and conservative management relief in both symptomatic and functional improvement, due to injury to the intervertebral joints of his lower lumbar spine. Discogenic LBP in the young adolescent population must be considered, particularly in cases involving even trivial minor trauma, and in those in which LBP becomes chronic. More research is needed regarding long-term implications of such disc injuries in young people, and how to best conservatively manage these patients. A discussion of discogenic LBP pertaining to adolescent disc injury is included.
Somatic pain is very common in adolescents, more often coexisting than occurring in isolation. Our data supports the need for further research to improve the understanding of these pains in adolescents.
Less than two percent of the literature about whiplash is devoted to children. When I wrote the first edition of my textbook in 1988,  I cited an older German study placing the risk for children at approximately one-sixth the risk of adults. By the time the second edition was published in 1995, a Swedish study had since been published putting the risk proportion in children closer to two-thirds that of adults.
Within recent times, however, we need only consider otitis media as an example of the extreme volatility of medical guidelines. A complete reversal appears to have taken place within just the past six years! Traditionally, the initial recommended intervention in the United States has been tympanostomy with the option to use antibiotics,  despite that in the United Kingdom, the Scandinavian countries and the Netherlands, physicians have embarked upon a policy of watchful waiting with no deleterious consequences from their reluctance to use antibiotics.
Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study
The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for 15 weeks and no solid foods are introduced during this time. Breast feeding and the late introduction of solids may have a beneficial effect on childhood health and subsequent adult disease.
When present, pediatric back pain is most often musculoskeletal, associated with an acute infectious illness or a traumatic event. Although the etiology is rarely serious, back pain often affects the daily activities of symptomatic children.
The Short-term Effect of Spinal Manipulation in the Treatment of Infantile Colic: A Randomized Controlled Clinical Trial with a Blinded Observer
By trial days 4 to 7, hours of crying were reduced by 1 hour in the dimethicone group compared with 2.4 hours in the manipulation group (P = .04). On days 8 through 11, crying was reduced by 1 hour for the dimethicone group, whereas crying in the manipulation group was reduced by 2.7 hours (P = .004). From trial day 5 onward the manipulation group did significantly better that the dimethicone group. The authors then conclude: Spinal manipulation is effective in relieving infantile colic.
This study set out to determine whether cumulative radiograph exposure of children significantly increases their risk of radiation-induced carcinogenesis or hereditary defects. Records of children treated for idiopathic scoliosis, hip dysplasia, or leg-length discrepancy between 1980 and 1993 at the Shriners Hospital in Spokane, WA, were retrospectively reviewed. Total radiation and organ dose exposures were calculated using information from individual radiology reports. Surgically treated idiopathic scoliosis patients had the largest total radiation skin entrance and organ dose exposures. This group’s risks for developing leukemia, breast cancer, or a heritable defect, respectively, were 0.8%, 2.1%, and 3.0% higher than baseline risks. The other treatment groups had increased carcinogenic risks of <1%. The use of serial radiographs during the treatment of idiopathic scoliosis, hip dysplasia, and leg-length discrepancy appears relatively safe. The increased risk of carcinogenesis or hereditary defects in these patients is minimal.
Chiropractic care of the infant is a topic that is in need of exploration in the scientific literature. Future case series and randomized comparative group clinical trials, as well as research comparing the outcomes of upper cervical and cranial adjusting, could shed valuable light on the appropriate role(s) of the chiropractor in managing certain neonatal feeding dysfunction cases.
In this case, a 6-month-old male infant had reportedly experienced significant discomfort while attempting to drink from a bottle over a period of 2 months. He drank freely and without fussing after the first of 5 chiropractic visits, which consisted of C1 and cranial adjusting.
Chiropractic care may represent a nonpharmaceutical health care approach for pediatric epileptic patients. Current anecdotal evidence suggests that correction of upper cervical vertebral subluxation complex might be most beneficial. It is suggested that chiropractic care be further investigated regarding its role in the overall health care management of pediatric epileptic patients.
Chronic Pediatric Asthma and Chiropractic Spinal Manipulation: A Prospective Clinical Series and Randomized Clinical Pilot Study
After 3 months of combining chiropractic SMT with optimal medical management for pediatric asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. These improvements were maintained at the 1-year follow-up assessment. There were no important changes in lung function or hyperresponsiveness at any time. The observed improvements are unlikely to be the result of the specific effects of chiropractic SMT, but other aspects of the clinical encounter that should not be readily dismissed. Further research is needed to assess which components of the chiropractic encounter are responsible for important improvements in patient-oriented outcomes so that they may be incorporated into the care of all asthmatic patients.
The doctors surveyed in this study reported a high rate of success with the Webster Technique (82%). Although the sample size was small, the results suggest that it may be beneficial to perform the Webster Technique in month 8 of pregnancy, when breech presentation is unlikely to spontaneously convert to cephalic presentation31 and when ECV is not effective. [83, 85]
This study has some limitations. The response rate of 17.86% is low, and the 11% response rate is inherently subject to bias. In 59 reported cases, the breech presentation was not confirmed with ultrasound, which introduced the potential for medical misdiagnosis. Furthermore, there was no way to objectively confirm how long after employment of the Webster Technique that the resolution of breech presentation occurred (Question 16). Because this was a retrospective trial, the results are subject to recall bias and, consequently, respondents may have reported more socially desirable results, particularly with respect to selection of cases reported. I attempted to limit self-report bias and recall bias by asking respondents to report the results of all documented cases in which the Webster Technique was used in the previous 6 months, regardless of outcome. However, because I relied on retrospective self-report data, the sample size was small, and there were potential design weaknesses, these results should be tempered with caution. Nonetheless, when successful, the Webster Technique avoids the costs and/or risks of ECV, cesarean section, or vaginal trial of breech. In view of these findings, the Webster Technique deserves serious consideration in the management of expectant mothers exhibiting adverse fetal presentation.
I am not suggesting that chiropractic care is a substitute for prudent, proper obstetric care for the expectant mother. Moreover, not all chiropractors are trained in the performance of the Webster Technique. Currently, the ICPA maintains a database of chiropractors certified in the proper performance of the technique.
The results of this study warrant a larger, more extensive observational study on this promising noninvasive technique. Furthermore, it is suggested that the Webster Technique be further investigated regarding its role in the overall health care of pregnant patients.
This study of British children suggests that women who have an infection or take antibiotics during pregnancy are more likely to have a child with an allergy-related condition such as asthma, hay fever or eczema. Researchers at the University of Nottingham evaluated the medical records of nearly 25,000 British children and their mothers. The study found that children exposed to antibiotics in the womb had a higher risk of developing asthma, hay fever and eczema than did children whose mothers did not take the medication during pregnancy.
We report the successful chiropractic case management of a 2-year-old patient with antibody-negative, generalized MG. To the best of our knowledge, this is the first report in the scientific literature describing chiropractic in a pediatric patient with MG. Adjustive care was provided based on the objective and subjective parameters of vertebral and sacral findings, interpreted as vertebral subluxation complex. Prospective research into the efficacy of this approach to health care is encouraged. The possible role of an environmental trigger (eg, spinal trauma) antecedent to the development of MG symptoms and the salutary effects of chiropractic care need to be explored.
Manual therapy in children (MTC) is receiving greater attention. Several monographs and reviews deal with this subject (1-4). Although these publications cover the field from the viewpoint of a classic pediatric approach, discussing which diagnoses of pediatric medicine might be successfully treated by MTC, they do not furnish an independent concept for the functional disorders that we see in these children. This article proposes such a framework through a model: the kinematic imbalances due to suboccipital strain (KISS) concept. This concept groups the symptoms and signs associated with functional disorders of the cervical spine into an entity linked to easily recognizable clinical situations. By using this concept as a term in the communication with other caregivers of infants and children, we may be able to improve the contact between pediatricians and specialists of MTC, thus facilitating the identification of those cases where the use of MTC will be most useful.
The findings in the present study were largely similar to those of the previous Swedish study. A minority of patients with self-reported nonmusculoskeletal symptoms report definite improvement after chiropractic care, and very few report definite worsening. Some factors relating to the chiropractor, the treatment, and the patient were found to be weakly associated with the outcome but these factors “explained” only a small fraction, approximately 3%, of the variance.
It is recommended that further research in this area would concentrate on specific disorders that are most likely to produce positive results, such as specifically identified subgroups of digestive problems or tinnitus, and that such research, whether purely experimental or clinical, use stringent research criteria such as random allocation, objective measurements, sham treatment, and observer blindness.
Low back pain is a common complaint in pregnancy, with a reported prevalence of 57% to 69% and incidence of 61%. Although such pain can result in significant disability, it has been shown that as few as 32% of women report symptoms to their prenatal provider, and only 25% of providers recommend treatment. Chiropractors sometimes manage low back pain in pregnant women; however, scarce data exist regarding such treatment. This retrospective case series was undertaken to describe the results of a group of pregnant women with low back pain who underwent chiropractic treatment including spinal manipulation. Seventeen cases met all inclusion criteria. The overall group average Numerical Rating Scale pain score decreased from 5.9 (range 2-10) at initial presentation to 1.5 (range 0-5) at termination of care. Sixteen of 17 (94.1%) cases demonstrated clinically important improvement. The average time to initial clinically important pain relief was 4.5 (range 0-13) days after initial presentation, and the average number of visits undergone up to that point was 1.8 (range 1-5). No adverse effects were reported in any of the 17 cases. The results suggest that chiropractic treatment was safe in these cases and support the hypothesis that it may be effective for reducing pain intensity.
Chronic daily headache (CDH) was common in a large nonreferred adolescent sample. Based on the International Classification of Headache Disorders, 2nd edition, criteria, chronic tension-type headache was the most common subtype; however, a majority of adolescents with CDH had headaches with features of migraine.
Development, Testing, and Findings of a Pediatric-Focused Trigger Tool to Identify Medication-Related Harm in US Children’s Hospitals
Adverse drug event rates in hospitalized children are substantially higher than previously described. Most adverse drug events resulted in temporary harm, and 22% were classified as preventable. Only 3.7% were identified by using traditional voluntary reporting methods. Our pediatric-focused trigger tool is effective at identifying adverse drug events in inpatient pediatric populations.
Adverse Effects of Spinal Manipulative Therapy in Children Younger Than 3 Years: A Retrospective Study in a Chiropractic Teaching Clinic
This study shows that for the population studied, chiropractic manipulation produced very few adverse effects and was a safe form of therapy in the treatment of patients in this age group.
Scheuermann’s disease (SD) – osteochondritis of vertebral epiphyseal plates or adolescent kyphosis – was first described in 1921 by Holger Werfel Scheuermann, a Danish surgeon, as an osteochondrosis with cause unknown involving the spine and frequently causing lower thoracic kyphosis. The term juvenile kyphosis has sometimes been used to designate this condition. Although many theories have been proposed, the cause of SD is still unknown. Currently under investigation are the roles of juvenile osteoporosis, hereditary factors, biomechanical factors, and a variety of other causes, but to date no specific etiology has been determined, except that there is a disruption in the normal development of the vertebral end plate.
The Safety and Effectiveness of Pediatric Chiropractic: A Survey of Chiropractors and Parents in a Practice-based Research Network
Both sets of responders indicated a high rate of improvement with respect to the children’s presenting complaints, in addition to salutary effects unrelated to the children’s initial clinical presentations.
Contribution of Chiropractic Therapy to Resolving Suboptimal Breastfeeding: A Case Series of 114 Infants
This case series found that in a population of 114 infants referred by a medical practitioner to chiropractors for feeding difficulties, 89 (78%) were exclusively breast fed after 4 treatments. It is not known whether this is a result of chiropractic manual treatment, the cotreatment provided along with other health care providers or the natural course of this condition. Cooperative care may go some way forward to meet the enormous challenge of exclusive breastfeeding as a goal in developed populations where breastfeeding initiation is high but numbers rapidly decline after the first week.
Best Practices Recommendations for Chiropractic Care for Infants, Children, and Adolescents: Results of a Consensus Process
A broad-based panel of experienced chiropractors was able to reach a high level (80%) of consensus regarding specific aspects of the chiropractic approach to clinical evaluation, management, and manual treatment for pediatric patients, based on both scientific evidence and clinical experience.
Outcome of Pregnancy-Related Lumbopelvic Pain Treated According to a Diagnosis-Based Decision Rule: A Prospective Observational Cohort Study
The management strategy used in this study appeared to yield favorable outcomes in this patient population and appears to be a safe option for patients with PRLP, although because of this study’s sample size, rare complications are not likely to be detected. In addition, the absence of randomization and a control group limits interpretation with regard to clinical effectiveness. Randomized, controlled trials are necessary to distinguish treatment effects from the natural history of PRLP.
Current US breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths. Investment in strategies to promote longer breastfeeding duration and exclusivity may be cost-effective.
To the best of our knowledge, this study provides the largest database to characterize the practice of pediatric chiropractic in North America. With continuing popularity and utilization of chiropractic for adults and their children, we support further studies to examine the safety and effectiveness of pediatric chiropractic.
The efficacy of chiropractic care in the treatment of non-musculoskeletal disorders has yet to be definitely proven or disproven, with the burden of proof still resting upon the chiropractic profession.
Studies in the United States show that over the last several decades, chiropractors are the most common complementary and alternative medicine providers visited by children and adolescents. Chiropractors continue to seek integration with other healthcare providers to provide the most appropriate care for their paediatric patients.
In the interest of what is best for the paediatric population in the future, collaborative efforts for research into the effectiveness and safety of chiropractic care as an alternative healthcare approach for children should be negotiated and are welcomed.
There is currently insufficient research evidence related to adverse events and manual therapy. However, clinical studies and systematic reviews from adult patients undergoing manual therapy, particularly spinal manipulation report that mild to moderate adverse events are common and self limiting. However serious adverse events are rare and much less than for medication commonly prescribed for these problems. More high quality research specifically addressing adverse events and pediatric manual therapy is needed.
We believe that the answer to the question proposed in the title “Is more research enough?” is “No”. We must not be satisfied with quantity but strive towards high standards of quality of the published research and work harder at all levels on implementing research into practice.
Physical activity is extremely important for everyone, but especially for children. A well-designed exercise program enhances the physical and intellectual development of a child. Competitive sports are often a child’s first introduction to programmed exercise. In the past decade, there has been an increase in the number of children participating in team and solo sports. Younger children are allowed to participate in sports for enjoyment, health and personal development. However, this changes as competitive elements become more dominant and young athletes train harder and longer, and may practice a sport throughout the whole year. Consequently, sports-related injuries in children have significantly increased.
In this chiropractic clinic, pediatric patients most commonly presented for excessive crying in the early months and for musculoskeletal complaints at all ages. Parents often brought their child to this clinic on the recommendation of medical professionals, particularly in the infant population. All children had consulted a medical practitioner prior to their presentation to this clinic. Further research is required to ascertain therapeutic benefit, cost/benefit and rates of satisfaction for this type of treatment.
The elbow fracture is one of the most common fractures in children. Assessing the elbow for fracture can be difficult because of the changing anatomy of the growing skeleton and the subtlety of some of these fractures. It’s important to be aware of the radiographic signs of fracture in the elbow, along with knowing the appearance and fusion of the ossification centers in the pediatric patient, to avoid confusing an ossification center with a fracture fragment. Of course, alignment and radiographic positioning are also extremely important in making a diagnostic assessment.
There is great awareness of and positive personal and professional experience with chiropractic on the part of midwives who participated in this survey. We encourage further research in this field.
The application of modern chiropractic paediatric care within the outlined framework is safe. A reasonable caution to the parent/guardian is that one child per 100 to 200 attending may have a mild adverse events, with irritability or soreness lasting less than 24 hours, resolving without the need for additional care beyond initial chiropractic recommendations.
Backpack loads carried by schoolchildren should be limited to 10% body weight due to increased forward head positions and subjective complaints at 15% and 20% body weight loads.
Chiropractic Care of Children from Birth to Adolescence and Classification of Reported Conditions: An Internet Cross-Sectional Survey of 956 European Chiropractors
This study showed that pediatric patients represented 8.1% of European chiropractic practices; patients were seen mainly for skeletal and neurologic conditions, and few NSEs were reported after chiropractic care. The most common conditions reported by chiropractors were different by patient age, and the number of treatment sessions delivered varied by patient age for most reported conditions.
Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial
In conclusion, the findings of this study demonstrate a greater decline in crying behavior in colicky infants treated with chiropractic manual therapy compared with infants who were not treated. The findings also showed that knowledge of treatment by the parent did not appear to contribute to the observed treatment effects in this study. Thus, it is unlikely that observed treatment effect is due to bias on the part of the reporting parent.
A child with a scoliosis must receive a careful spinal examination to determine the cause of the lateral curvature. In all cases, an assessment of the alignments and lengths of the lower extremities must be included. Accurate, standing x-ray films are also necessary; first, to measure the amount of lateral deviation, rotation, and angulation of vertebrae; second, to determine the spinal maturity (and risk of progression); and finally, to rule out any leg length inequality. In many cases, custom-fitted orthotics (sometimes with added heel lifts) are needed for long-term results.
When conservative treatment of idiopathic scoliosis is indicated, nutritional support for the pineal gland should be considered. Perhaps most importantly, the neurological system needs to be checked thoroughly, and any interferences and sources of incoordination eliminated. Exercises to develop fine control of balance and posture, as well as gait training, may be helpful. Custom-fitted orthotics should be provided early in treatment of all patients with scoliosis to improve bilateral balance and gait symmetry.
Energy drink consumption is a growing trend in adolescent culture, particularly among active youths. There is no known safe consumption level of energy drinks in the adolescent population yet there are currently no restrictions on the marketing, sale or consumption of energy drinks by minors. Chiropractors should be aware of potential side effects of energy drink consumption, which may lead to clinical presentation. The education of adolescent patients on the potential dangers of energy drink consumption is also required of the chiropractic clinician. Further research is needed in this area before regulation in the sale of such drinks can be mandated.
A Randomized Controlled Trial Comparing A Multimodal Intervention and Standard Obstetrics Care For Low Back and Pelvic Pain In Pregnancy
A prospective, randomized trial of 169 women was conducted. Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants. The group that received standard obstetric care demonstrated no significant improvements. The chiroprtactic group demonstrated significant mean reductions in Numerical Pain Rating Scale scores.
Outcomes Of Pregnant Patients With Low Back Pain Undergoing Chiropractic Treatment: A Prospective Cohort Study With Short Term, Medium Term and 1 Year Follow-up
Most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points. No single variable was strongly predictive of ‘improvement’ in the logistic regression model.