| Children & Chiropractic?
Teenagers Need Chiropractic More
A recent study of Swiss secondary schools discovered a very
high lifetime and point prevalence of back pain in children
ages 12 to 17: Lifetime prevalence of back pain -- 74%
Lifetime prevalence of low back pain -- 51% Point prevalence
of disabling low back pain -- 24.3% (Disabling low back pain
is defined as having interfered with school work or leisure
time).
Reference: Balague F, Skovron ML et al. Low back pain in
school children: a study of familial and psychological
factors. Spine, 1995, 20(11):1265-1270
Is Chiropractic Safe For My Child?
International Chiropractic Pediatric Association
Newsletter
September/October 1997
Recently I was asked "What are the risks of chiropractic
care for my child". I conducted an extensive medline search
covering the years 1966-1997, using the terms "chiropractic"
and "children", so that I may find reports of adverse events
which may have occurred in children as a result of
chiropractic care. In more than 31 years of medical
literature I have only found one reported case of damage to
a child as a result of chiropractic care and even this case
is speculative at best.
According to this report a child with a rare spinal tumor
presented to a chiropractor with reports of torticollis (Wry
Neck). It is alleged by the author that tissue damage
(necrosis) found in the area of the tumor, discovered during
autopsy, was caused by 'chiropractic manipulation'. However,
there exist no scientific proof that this damage was the
result of a chiropractic adjustment. Speculation by this
author is irresponsible. This particular tumor (an
astrocytoma) has been commonly reported to be a congenital
condition in numerous medical publications. Additionally the
credentials of the person performing the manipulation are
not discussed. While it may seem common sense that only
chiropractors would be credited with making chiropractic
adjustments, such is not the case.
Terrett has done an extensive review of literature, going
back to 1934, and found that of 78 cases of vertebrobasilar
stroke (none of which occurred in children) following
'chiropractic manipulation' 36% were not performed by
chiropractors. You might then ask who is performing such
manipulations, which are incorrectly being attributed to
chiropractors? The answer is an Indian barber, a kung-fu
practitioner, a blind masseur, medical doctors, nurses,
osteopaths, physiotherapists, victim's wives', and persons
doing self neck wrenching manipulation. I find that it is
sad that such irresponsible reporting by so-called
responsible medical researchers is printed and is misleading
the public.
Estimates of risk of chiropractic adjustment are extremely
low. I will use some figures to illustrate this point:
Chiropractic Care for the Child Athlete Joel
Miller D.C., F.I.C.P.A
September/October 1998
International Chiropractic Pediatric Newsletter
There are some negative opinions in chiropractic regarding
contact sports like boxing and football. Some of our
colleagues feel these sports should be avoided. Whatever
your particular opinion, these sports (pee-wee football,
boxing and the like) have been around for decades and are
here to stay. The sports chiropractor should not attempt to
replace the medical staff already in place at any level of
competition. However, it has been my experience that as
chiropractors if we care for the athletes chiropractically
and not attempt to interfere with or replace the trainers,
medics or EMTS, our acceptance both on and off the field is
much greater. Having been a team chiropractor for numerous
athletic teams from professional baseball, wrestling, and
boxing to the little league football and soccer levels, I'd
like to share some information, as well as my experience, as
such. Almost all organized levels of childrens sports have
age and weight limitations. In some sports, such as martial
arts, events not only have an age and weight requirement but
they also have the children categorized (or matched)
according to their skill level. Team chiropractors' should
be aware of the proper use of safety equipment and proper
fit of protective gear like football helmets, pads and
sparring gear used in contact sports.
Injuries to children's spines are not unique to contact
sports like football or martial arts. They are also seen in
non-contact sports like gymnastics and competitive
cheerleading. Injuries to the pediatric spine vary according
to the specific mechanism of injury. Therefore, the
pediatric sports chiropractors knowledge of particular
sports is helpful in assessing the care he or she will
render. Specific to the child athletes' spine one should
have knowledge of the ossification centers. The primary
centers at the vertebrae, or centrum, and the neural arch
unite forming the vertebral arch. Fusion of the body with
the posterior elements occurs as early as 3-6 years and as
late as 16 years. The secondary centers of ossification,
consisting of the two vertebral body end plates, the two
transverse processes and the spinous process fuse between 14
and 25 years of age. Also the joints of Luschka are not
fully formed until age 7. Additionally, some bones, such as
the sacrum, do not fuse until well into the second decade of
life, and thus may function as individual vertebrae
depending on age.
Subluxations, fractures or failure of fusion of secondary
ossification centers can result from head impacts as
experienced in football or martial arts, or from falling on
the child's feet or buttocks as in gymnastics or
cheerleading. Development of the normal spinal curves
will assist in dissipating compressive forces or loads.
However, athletics may induce concussive forces the body
cannot adapt to thus resulting in vertebral subluxation
complexes.
The common area of injury from a head impact is the mid to
lower cervical (C4-C6). The common area of injury from a
forces from below, as in falling on the feet or buttocks, is
T-9 - L2. Flexion injuries of the spine commonly affect the
C4-C6, T5-6 and L1-L2. And one should always check the upper
cervical spine. T. K. Videman, M.D. from the University of
Helsinki in 1988 found that the slightest hypomobility in
diarthrodial joints (facet joints) would cause joint
degeneration in 5-7 days, which becomes irreversible in 2-3
weeks. Following 5 weeks of joint fixation, 18 months of
care was required for optimal healing which was almost
always incomplete. The sooner we as chiropractors can care
for the child athlete, and correct his or her subluxation,
the less likely they are to have life long patterns of ill
health and who better than the chiropractor to care for
these little athletes.
Caring for the children during an event should be discussed
next. The team chiropractor should be able to assess the
athlete's specific needs. Never disregard the need for a
comprehensive chiropractic evaluation. And please, no public
display of adjusting. (P.D.A.) Team chiropractors who will
spend time working with children athlete should educate
themselves regarding specialized training in the field of
chiropractic pediatric adjusting techniques. That is not to
say adjusting the child with bilateral supine, rotary breaks
and lumbar roll both sides as is sometimes done on adults.
Rather learn how to adjust children correctly through
programs like ICPA's certification program, which Dr.
Webster started and we are continuing to promote. When
evaluating a child either on or off the field before
applying a chiropractic adjustment, one should be able to
objectively evaluate as many components of the vertebral
subluxation complex as possible. The sports chiropractor
needs to be aware of the functional uniqueness of the
child's spine when doing so. For example, the normal range
of motion in a child's spine is greater than that of an
adult. This is important to know when assessing a child's
spine. Also, as a team chiropractor for any sport, and any
level, there will come a point in time when you are the only
attending health care provider. It would be a good idea to
know when you should transport via EMT in emergency
situations. My experience is that no one will belittle you
if you play it safe. One of our chiropractic colleagues from
an opposing team thought he could tape a knee and get the
star player back into the game only to learn later that the
child had suffered a fractured fibula. As chiropractors, we
must focus on the vertebral subluxations and the dangers of
such especially those arising out of sports injuries. We
should also educate the players, parents and coaches. Each
year I hold a coach's clinic for all the area "Pop Warner"
football coaches. This clinic is well attended because we
bring in a certified athletic trainer to teach basic
training and taping techniques. I also do a chiropractic
health orientation and educate coaches and trainers on the
cause and the harmful effects of subluxations. In my
presentation, I use the Emmett Smith quote "playing in a
football game is like being in 30-40 care accidents" and
then I multiply that by the 10 games the kids have each
season. I also use this opportunity to show them the benefit
of chiropractic care for the athletes, both pre and post
game. This clinic is held in my office so the coaches,
parents and players have the opportunity to see it first
hand. Whether the children are participating in contact or
non-contact sports, a proper chiropractic evaluation by a
qualified pediatric chiropractor can keep them in the game
and help to minimize if not prevent injuries leading to
vertebral subluxations. Dr. Joel Miller is professor of
pediatrics at Life University, School of Chiropractic. He
has been an I.C.P.A. member since 1990. Dr. Miller has
served as a team chiropractor for the Minnesota Twins, the
Boston Red Sox, WWF Wrestling, Florida State University
atheltic teams and numerous childrens sports organizations.
Dr. Miller is also a member of the I.C.P.A.'s distinguished
speakers bureau and conducts seminars for the I.C.P.A.
Friday February 16 1:13 PM ET
Infants' Runny Nose May Cut Asthma Risk Later On
NEW YORK (Reuters Health) - If your baby has a runny nose it
may actually be a good thing, study results suggest. It
seems that children who get such minor infections may be
less likely to develop asthma later on in life.
The findings appear to support the theory that common
infections shape the immature immune system in a way that
cuts the risk of asthma and allergies later in life.
In a study of more than 1,300 children followed from birth
to age 7, German researchers found that those who had two or
more bouts of runny nose before age 1 were half as likely as
other children to develop asthma later on. They were also
less likely to have allergies by the age of 5.
Researchers led by Dr. Sabina Illi of University Children's
Hospital in Munich report the findings in the February 17th
issue of the British Medical Journal.
The airway inflammation that marks asthma is often caused by
an abnormal immune reaction to environmental irritants such
as pollen, dust and mold.
. Previous studies have suggested that certain infections
early in life may ward off asthma by pushing the developing
immune system toward infection-fighting mode. This, the
theory goes, may make children's immune systems less likely
to overreact to normally benign environmental factors.
*ALL immune reactions work this wayEDr. Acosta
According to Illi's team, these new findings lend support to
this idea. The investigators found that repeated ``mild
infections''--runny nose or infection with a herpes
virus--were linked to a lower risk of asthma and allergy. On
the other hand, repeated infections of the lower respiratory
tract, such as the flu or pneumonia, were associated with a
higher asthma risk. This, the researchers report, suggests
that children predisposed to asthma may be more vulnerable
to such infections.
Over the past 20 years, asthma has become more and more
prevalent worldwide. Some experts put part of the blame on
the increasingly sterile conditions in which children are
growing up. They point out that smaller families, fewer
germs, and more antibiotics early in life may be shaping
children's immune systems to overreact to normally
harmless irritants.
*I find this interesting because in the last 20 years, our
drug and prescription usage has increased to an all-time
high. There is certainly no shortage of asthma medication in
the U.S., and if we look at the numbers from other
countries, you'll see that our efforts from a
drug-philosophy are working against us. Remember, only the
power that makes the body heals the body. Don't lose faith
in your own immune and nerve systemEr. Acosta
SOURCE: British Medical Journal 2001;322:390-395
Wednesday February 14 10:49 AM ET
Safety of Supplements for Children Unclear
WASHINGTON (Reuters Health) - US researchers warned Tuesday
that the safety and efficacy of many dietary
supplements have not been tested in children, and said that
parents should exercise caution when giving supplements to
their kids.
``There's potential for harm (in children taking dietary
supplements), especially considering that, as children,
they're still growing and developing,'' Michelle Rusk, an
attorney with the Federal Trade Commission's Division of
Advertising Practices, said at a meeting with the National
Institutes of Health (news
- web sites).
Rusk was referring to young people, particularly adolescent
boys, who take ``body-building'' supplements in an effort to
build strength and muscles. ``Children may take steroid
hormone supplements to emulate popular athletes,'' Rusk
noted at the meeting.
For example, while products containing gamma butyrolactone
are typically marketed for adults as performance enhancers,
they can be very dangerous for children. ``Parents should
not assume that that supplements work the same way in
children as they do in adults,'' Rusk stressed.
``While the judicious use of dietary supplements can be
viewed as a strategy for optimizing nutrition, it remains to
be resolved who will and will not benefit from their use and
under what circumstances,'' noted Dr. John Milner of the
National Cancer Institute (news
- web sites).
Researchers can assess the ways in which a particular
dietary supplement or nutrient may affect a certain child by
looking at the child's genetic profile, dietary intake and a
variety of environmental factors, Milner noted. But he
warned that as with drug trials, the findings from dietary
supplement studies will not be universally optimistic.
``I suspect we will find many supplements that will have a
positive effect on one tissue and a negative effect on
another tissue,'' Milner said. Scientific research is fast
verifying a link between certain nutrients and health
benefits, such as the benefits of fiber in lowering blood
pressure or the connection between folate and the risk of
developing colon cancer, Milner pointed out.
Yet without independent studies of the specific effects of
those nutrients in children, that know-how remains
incomplete, he added. ``We cannot assume that one size fits
all,'' he said. The US Food and Drug Administration (news
- web sites)
(FDA) currently does not regulate dietary supplements as
long as their makers market them not as treatments for a
particular disease but rather to help maintain a ``structure
or function'' of the body.
It remains unclear whether the rising concern over the use
of dietary supplements in children will build a stronger
case for the FDA's increased regulation over the products,
Dr. Steven Hirschfeld, with the agency's Division of
Oncology Drugs, told Reuters Health. ``I personally feel
that it is not safe for people to take dietary supplements
without more information,'' he said. The surest route to
getting that information is ''regulation,'' Hirschfeld said.
However, he cautioned that any eventual FDA regulation of
dietary supplements should not ''impede marketing'' but
serve as a means to guide their development in order to
``minimize risks.''
Friday February 9 1:20 PM ET
'Wait-And-See' Approach May Be Okay for Earache
By Merritt McKinney
NEW YORK (Reuters Health) Waiting a few days to see
whether symptoms of an ear infection improve before
beginning a course of antibiotics appears to be a practical
way to reduce the use of antibiotics, according to results
of a UK study. This may help prevent the overuse of the
drugs, and thus prevent bacteria from becoming resistant to
antibiotics. And even though physicians often
complain that that parents pressure them to prescribe
antibiotics, most parents in the study were satisfied
with a ``wait-and-see'' approach for treating the common ear
infection otitis media.
``A wait-and-see approach in the management of acute otitis
media is feasible and was acceptable to most parents, and
resulted in a 76% reduction in the use of antibiotic
prescriptions,'' according to Dr. Paul Little
from the University of Southampton, UK, and colleagues. The
authors report their findings in the February 10th issue of
the British Medical Journal.
Each year millions of children are prescribed antibiotics to
treat the middle ear infection, but the evidence that the
drugs speed a child's recovery is mixed. Plus,
antibiotics can cause side effects such as diarrhea, and
widespread prescription of the drugs is thought to be
increasing the risk that bacteria will become resistant to
antibiotics.
In a study of 315 children aged 6 months to 10 years who had
an acute ear infection, parents were randomly assigned to
one of two treatment options. Some parents were given a
prescription for antibiotics to be filled immediately.
Others were also given a prescription, but were encouraged
to wait 72 hours before using the medication, although they
could begin them sooner. Parents were advised to begin
antibiotics after 3 days if a child still had substantial
ear pain or fever, or was not feeling any better. On
average, children who took antibiotics immediately after
seeing a doctor improved sooner than children who delayed
treatment, the report indicates. Immediate treatment
appeared to reduce by about one day the length of earache
symptoms including discharge of fluids from the ear.
Children who started antibiotics sooner also cried less,
woke up during the night less frequently and took slightly
less paracetamol (acetaminophen, which is the active
ingredient in Tylenol and other over-the-counter pain
relievers). But the researchers point out that most of these
improvements occurred more than 24 hours after the children
started taking antibiotics, when the illness was already
beginning to ``settle.'' And there was no significant
difference in the reduction of pain or distress in either
treatment group. Little's team also points out that a
higher percentage of children who received immediate
treatment developed diarrhea than children in the
wait-and-see group, 19% versus 9%.
The team also notes that parents of children who were
treated immediately were more likely to believe in the
effectiveness of antibiotics for otitis media,
, even though the infection can clear up on its own.This
may encourage repeat visits for future ear infections,
leading to even more antibiotic prescriptions, according
to the authors.
Of course, it is difficult to fault parents who want to seek
treatment for a child in pain, but Little told Reuters
Health that parents can help a child without resorting to
antibiotics. Little pointed out that most parents in the
study did not use full doses of over-the-counter pain
relievers. He encouraged parents to treat children's ear
pain with adequate doses of paracetamol, ibuprofen or both,
particularly at bedtime since pain often wakes children
during the night.
SOURCE: British Medical Journal 2001;322:336-342.
Friday February 9 10:31 AM ET
Breath Holding Occurs Automatically in Some Kids
NEW YORK (Reuters Health) - For some children, holding their
breath until they turn blue or pass out is a way to
manipulate parents or express their frustration. But for
others it is an automatic reaction that may occur in babies
as young as 6 months, study findings reveal. Such breath
holding spells (BHS) typically begin with crying, followed
by noiseless exhalation of breath, a change in skin color
and a loss of consciousness.
According to a report in the February issue of Pediatrics,
BHS occurs in 0.1% to 4.6% of healthy children and many
cases of severe breath holding spells start at age 6 to 12
months, with 12% of cases occurring in younger children. One
baby began to experience BHS within hours after birth. In
this study, 95 children with BHS were followed for up to 9
years. About one third of the children were found to have a
family history of BHS. The highest number of spells occurred
between 13 to 18 months in boys and between 19 to 24 months
in girls. About 30% of children had breath holding spells at
least once a day but the average number of spells was one a
week. Spells stopped between 37 and 42 months of age in most
children but lasted as long as 7 years in others, the report
indicates.
According to Dr. Francis J. DiMario, Jr., of the Connecticut
Children's Medical Center in Hartford, the results can be
used to develop treatments and to help parents deal with
episodes. ``An important part of evaluating children with
BHS is counseling their parents,'' DiMario writes. Knowing
what to expect ''can allay some parental anxiety.''
Indeed, DiMario published a study last year showing that
breath holding can cause severe stress in mothers. Stress
caused mothers to view their child more negatively than
mothers of children without medical conditions, that study
revealed. ``Because the parent-child relationship is under
stress, mothers of children with BHS...are at risk of
developing dysfunctional parenting behaviors and/or their
children are at risk of developing behavioral problems,''
the earlier study reported.
SOURCE: Pediatrics 2001;107:265-269.
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