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Children's alternative Therapy info and products
Children Use "Alternative Therapies"


Children use Alternative Therapies

     A recent article in the electronic edition of Pediatrics sought to compare the use of "alternative therapies" by children with cancer vs. children receiving routine checkups in a medical outpatient setting. While this study has a significant bias in that it only includes children receiving care within the medical model, it still underscores a trend that the medical community cannot help but recognize.
    The study interviewed the parents of 81 children with cancer and 80 children receiving routine medical care. What they discovered is that most parents who utilize medicine for their children's health care also utilize forms of care that extend beyond what is traditionally offered under the medical model.
    The authors begin by reciting the usual litany on the significance of alternative therapy in the United States:  "Alternative therapy (AT), also known as complementary, non-allopathic, unconventional, holistic, or natural therapy, refers to healing practices that have become increasingly popular with the general public, but not widely accepted by the medical profession. Examples of AT techniques include therapeutic massage, acupuncture, imagery, energy healing, prayer, and use of medicinal herbs.  According to 1990 data, the number of visits to practitioners of AT was greater than the number of visits to all primary care physicians nationwide.  
2. Reasons patients use AT include a belief that it will cure or help a condition not treatable by conventional medicine, dissatisfaction with allopathic medicine, and a desire to use more natural methods of healing."
"It is estimated that Americans spend $10 billion a year on unproven cancer remedies.                                                                                                                          
3. AT is thought to be used more frequently in patients with cancer than in patients with minor illnesses. According to Fletcher4, between 20% and 50% of cancer patients use or consider using AT." One of the unique qualities of this study is its inclusion of "prayer" in the list of "alternative medicine used."                                                                                  But the authors defended their decision citing:
"Many parents questioned the inclusion of prayer as an AT. We included it when it was being used specifically to treat illness, because few physicians prescribe prayer or consider it part of standard therapy. Religion and spirituality are not consistently addressed in medical school curricula, and even may be considered inappropriate teaching subjects. However, physicians are beginning to recognize the role of spirituality and prayer in the healing practices of their patients, as indicated by conferences sponsored by the National Institutes of Health."
"The findings suggest that many Americans use prayer and faith healing as a therapeutic adjunct. Discussions of spiritual practices may improve well-being and compliance. In a much reported study, Byrd conducted a randomized, double-blind study of 393 patients, in which patients on the University of California, San Francisco, coronary care unit were prayed for by various religious groups who had only their first name and a brief description of their condition. The test patients and families did not know they were being prayed for. Fewer patients in the prayed-for group died, and significantly fewer developed pulmonary edema, received antibiotics, or needed intubation. The researchers concluded that the prayed-for group endured less suffering. Although this study has been criticized for its design, it shows the important role that prayer may play in illness."
The study results are presented in the following graph which provides an interesting profile of the current use of alternative care by parents of children:

Type of AT
Cancer Patients
Control Patients
%
%
Prayer
64.2
40.0
Exercise
16.1
6.3
Spiritual healing
16.0
21.2
Relaxation techniques
11.1
17.5
Other
9.9
3.8
Medicinal herbs
8.6
6.3
Massage therapy
7.4
25.0
Megavitamin therapy
7.3
3.8
Imagery
4.9
3.7
Folk remedies
2.5
13.7
Energy healing
2.5
2.5
Macrobiotic diet
2.5
1.3
Self-help group
2.5
0
Homeopathy
1.2
2.5
Biofeedback
1.2
1.3
Chiropractor
1.2
1.3
Acupuncture
0
2.5
Hypnosis
0
0
Another interesting facet of the study was the reasons given for using alternative forms of care:

Reason for Use of AT
Cancer Patients
Control
%
%
No reason given
58.0
62.5
Faith, spiritual
21.0
10
Supplement to conventional medicine
7.4
5.0
Dissatisfied with conventional medicine
2.5
3.7
Lifestyle, general well-being
2.5
1.3
Want to help
2.5
0
Other
2.5
2.5
Support, participation in illness
1.2
0
Hope
1.2
1.3
Belief in treatment
1.2
10
Relaxation
0
3.7
In addition, the study reveals how the parents learned about the alternative care:
Sources From Which Parents Received Information about AT

Cancer Patients
Control Patients
%
%
Friends and family
58.8
56.1
Other
29.4
19.5
Doctor
15.7
12.2
Health food store
9.8
2.4

The authors conclude that "use of AT is not limited to children with life-challenging illnesses, but is commonly practiced by those with routine medical problems." They go on to cite the increase inclusion of "AT and other integrated health approaches" in half of the US medical schools. They also discuss the need for MDs to learn more about alternative forms of care.  But there is a louder message for the chiropractor.  This study shows that a majority of parents seek alternative care for their children. And while most don't give a reason, they learn about the benefits of alternative care from their friends and family.
The use of chiropractic is quite low in children who routinely seek medical care. Why? The parents are obviously open to alternative care, but they haven't heard about chiropractic enough to make that choice.
Chiropractic has attracted a significant portion of the population that is dissatisfied with medical care. But, according to this study, only a tiny percentage (less than 2%) of the children of current medical users are also chiropractic users.
This group obviously represents a majority of the US population. The chiropractic profession should explore ways to better communicate with this portion of the public, particularly through current chiropractic patients who are the "friends and family" of those who routinely utilize medical care.  
References:
Friedman T, Slayton WB, Allen LS, Pollock BH, Dumont-Driscoll M, Mehta P, Graham-Pole J. Use of alternative therapies for children with cancer. Pediatrics December 1997, vol. 100, no. 6, p. e1.

Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med 1993;328:246-252.
Cassileth B, Lusk E, Guerry D. Survival and quality of life among patients receiving unproven as compared with conventional cancer therapy. New England Journal of Medicine 1991;324:1180-1185.

Fletcher DM. Unconventional cancer treatments: professional, legal and ethical issues. Oncol Nurs Forum 1992;19:1351-1354.

King D, Bushwick B. Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract 1994;39:349-352.

Marwick C. Should physicians prescribe prayer for health? Spiritual aspects of well-being considered. JAMA 1995;273:1561-1562.

Dossey L. Prayer and healing: reviewing the research. In: Healing Words: the Power of Prayer and the Practice of Medicine. New York, NY, Harper Collins, 1993, pp. 179-184.

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Attention Deficit Hyperactivity Disorder
by Tracy Barnes, DC, Kentuckiana Children's Center

      Observe any of the classrooms at Kentuckiana and at first glance all the children might appear to be "normal" school kids. But look a little closer into classroom one: there in the back at a table all his own is Chris. Chris' legs are constantly moving, his hands are always busy and his teachers have a difficult time keeping him focused on his work. He continually blurts out answers and pesters his classmates.

     Chris is a 10-year-old student who was referred to the Center after being unable to perform in a mainstream public school. He tripped fellow students, played pranks on them and started a number of fights. Yet through all of his problem behavior, he seemed unwilling to take any personal responsibility for his actions. Chris is far from a dull boy. He has an IQ in the superior range relative to his peers.
Chris is a classic example of Attention Deficit Hyperactivity Disorder (ADHD). However, unlike many of the other children diagnosed with ADHD, Chris is not medicated. In his three years as a student in the Kentuckiana Special School, and as a patient in the Kentuckiana Clinic, his progress has been characteristically, "four steps up, two steps back; three steps up, two steps back," says Roberta Davis, M.Ed, director of Special Education at Kentuckiana. He is a prime example of the need for multidisciplinary care in cases of ADHD.
ADHD's main components are "developmentally inappropriate degrees of inattention, impulsiveness and hyperactivity."

 It has been estimated that some 5-10 percent of school-aged children are affected. They are commonly diagnosed before four years of age with males being six to nine times more likely than females to have the disorder. Approximately one-third of all ADHD cases have manifestations that progress into adulthood, although the numbers may be much higher.

  Work at Kentuckiana, as well as three known studies show the benefits of chiropractic adjustments on these children. The importance of the nervous system is certainly not to be overlooked. However, it has been our experience that the stability of chiropractic care is greatly enhanced when combined with other factors affecting the structural, chemical, and mental aspects of this complex disorder.

 Among the many possible causes for ADHD, there are those that cannot generally be changed by the time these children enter our offices.
The possible causes are fetal alcohol syndrome and fetal alcohol effect (FAS/FAE), are maternal prenatal smoking, genetics and vaccination.

   There are, however, other predisposing factors to ADHD that must be acknowledged and investigated to ensure maximal success in treatment. These causes include candida albicans proliferation, temporomandibular joint dysfunction, heavy metal toxicity, food sensitivities, environmental allergies, neurologic disorganization, hearing problems, visual perceptual disorders, and multiple aspects of psychological disorders.

     As William Crook, MD, describes in the vicious cycle of treating childhood infections with broad-spectrum antibiotics. Yeasts, which are not affected by antibiotics, are allowed to multiply and release harmful toxins into the child's body. These toxins weaken the immune system, lower the body's natural resistance, and in turn set up the child to develop more infections.
     Our student Chris had a history of repeated ear infections during his infancy. Even though this was some years ago, it is likely that he is still affected by the disruption of his normal flora caused by the antibiotics. In addition, Chris has a history of allergies to pollen, dust, ragweed, Johnson grass, eggs, wheat, milk, corn, and chocolate. His mother attributes Chris' recurring headaches and sinus infections to these allergies.
     The role of allergies and the hyperactive child involves both food intolerance and environmental sensitivities. A recent study looked at 40 children with food-induced hyperkinetic syndrome. They found some 15 foods that provoked an increase in hyperkinetic behavior including chocolate, colorings, cow's milk, eggs, citrus, wheat, nuts, cheese, banana, tomato, apple, pears, beef, pork, and beans.

   Current literature is in debate as to the role of dietary sugar in hyperactivity. One recent study claims that sugar and Nutrasweet have absolutely no adverse effects on children's behavior. However, other reports show sugar consumption to correlate significantly with restlessness and destructive-aggressive behavior. Glucose metabolism has been shown to be hampered in hyperkinetic adults and children.
   Other studies show that sugar leads to an increase in deviant behavior primarily when sugar is in combination with a high carbohydrate meal. The negative effects are sometimes negated when sugar is eaten with a high protein meal.
Having a complete recording of what each child eats for at least one week is the first step toward assessing the importance of dietary change. Questions concerning artificial sweetener consumption should also be included in the history-taking process since these have been linked to many symptoms common to ADHD.
Heavy metal toxicity is another important piece in the puzzle of hyperactivity. A complete history will also include information concerning where the child lives and plays, paying particular attention to areas of highly industrial nature. Toxic chemicals such as lead, copper, and aluminum can be found in high levels in many ADHD children.  Locating the source of the chemical toxicity is essential in effectively eliminating its harmful barrage on the nervous system.

    Possible avenues for heavy metal ingestion include drinking water, beverages served in aluminum cans, and food prepared in aluminum cookware. In addition, children who are regularly exposed to second-hand smoke are at risk for increased cadmium intake. It is important to find out who takes care of the hyperactive child on a regular basis and whether or not tobacco smoke is part of the environment.

    Other trace mineral imbalances to look for include mercury, calcium, magnesium, zinc, and chromium. Hair analysis is one method of screening for toxic metals and deficiencies of essential minerals. This analysis provides a way to functionally understand the body chemistry. Chris' beginning trace mineral hair analysis showed a lead level of four parts per million (ppm). Levels as low as 1ppm have been shown to correlate with high attentional deficit ratings. He also had increased levels of aluminum and cadmium. Chris comes from a home where his father smokes a pipe. On a retest analysis done approximately 19 months later, his aluminum went from 24ppm to 9ppm and his cadmium went from 0.80ppm to 0.26ppm. Nutritional supplements such as chelated proteinates can help to detoxify and stabilize these nutrient mineral imbalances.
     A consistent temporomandibular joint problem is also a part of Chris' history. His head pain was so intense at times that he would bang his head against the wall. We have found with some children that addressing TMJ dysfunction has made marked improvement in their behavior. Upon examination of the ADHD child, the TMJ area should be evaluated as well as thorough inspection of the oral cavity.                                                                                         A high raised palate may be found in many of them.

     Another element for Chris is that he was adopted at 21 months. This kind of early disruptive experience can have lasting emotional effects on children. For this reason, psychological evaluation can be helpful in determining the need for individual and family counseling. Support of the parents in all aspects of treatment can be the determining factor in any success with ADHD children. Mothers and fathers need to understand the full spectrum of ADHD care and realize the role that they play in its outcome. Parents may often be pushed by school administrators and others into thinking that they have somehow failed or that they lack proper parenting skills. While appropriate discipline is not to be underestimated, they need to know that ADHD children have a problem. It is our job to unravel the problem and theirs is to accept it. Together we can do something about it.
Getting good results with calming down an ADHD child takes time. This is evident in young Chris' story. In recent months, Chris has been improving academically, but his behavior continues to fluctuate. When accepting a case such as this, one must be prepared for extended care, frequent re-evaluations and perseverance. The need for research on this subject is evident.

    Additionally, it has been our experience that those children who begin their course of treatment before the onset of puberty benefit the most. With the rush of hormones and the change in body chemistry, it becomes very difficult to affect positive changes after puberty sets in.
There is no cookie cutter approach to dealing with ADHD. No protocol can universally be applied to its treatment. As in all thorough care, each child must be individually assessed and evaluated to determine where the imbalances lie. In subsequent articles, we will be examining in detail some of the etiological factors of ADHD and suggest ways of helping the children and their families cope with this disorder.
References:
Diagnostic and Statistical Manual of Mental Disorders -- III. American Psychiatric Association, Washington, D.C. 1987.

Berkow R, et al: The Merck Manual of Diagnosis and Therapy. Merck Sharp & Dohme Research Laboratories, Rahway, NJ, 1987.
Weiss L: Attention Deficit Disorder in Adults. Taylor Publishing, Dallas, Texas, 1992.

Webster L: The hyperactive child and chiropractic. Health Naturally, February 1994.

Pigg N: Chiropractic effectiveness with emotional, learning, and behavioral impairments. International Review of Chiropractic, September 1975.

Giesen J, Center D, Leach R: An evaluation of chiropractic manipulation as a treatment of hyperactivity in children. JMPT vol. 12, num. 5, October 1989.

Caruso K, ten Bensel R: Fetal alcohol syndrome and fetal alcohol effects. Minnesota Medicine, vol. 76, April 1993.

Fried P, Watkinson B, Gray R: A follow-up study of attentional behavior in 6-year-old children exposed prenatally to marijuana, cigarettes, and alcohol. Neurotoxicology and Teratology, vol. 14, 1992.

Berkow R et al: The Merck Manual of Diagnosis and Therapy. Merck Sharp & Dohme Research Laboratories. Rahway, NJ, 1987.

Coulter H: Vaccination, Social Violence, and Criminality. North Atlantic Books, Berkeley, California, 1990.

Crook W: The Yeast Connection. Professional Books Inc. Jackson, TN, 1991.

Crook W: Help for the Hyperactive Child. Professional Books Inc., Jackson, TN, 1991.

Schaub J: Hyposensitisation in children with food-induced hyperkinetic syndrome. European Journal of Pediatrics, vol. 151, November 1992.

Mahan K, et al: Sugar allergy and children's behavior. Immunology and Allergy Practice, July 1985.

Prinz R, et al: Journal of Behavioral Ecology, vol. 2, num. 1, 1981.

Zametkin A, et al: Cerebral glucose metabolism in adults with hyperactivity of childhood onset. New England Journal of Medicine, vol. 323, Nov. 15, 1990.

Conners C: Medical Tribune. January 9, 1985.

Barnes B, Colquhoun I: The Hyperactive Child. Thorsons Publishers Limited, Wellingborough, Northhamptonshire, 1984.

Tuthill R: Low Hair Lead Concentrations in Children. Doctors' Data, West Chicago, Illinois, 1982.

Haddad P, Garralda M: Hyperkinetic syndrome and disruptive early experiences. British Journal Psychiatry, vol. 161, Nov. 1992.



 Study on Chiropractic Care for Adolescent Scoliosis is Encouraging


Charles "Skip" Lantz, DC, PhD: "This was a very significant project. This was the first large-scale research ever to study chiropractic care and scoliosis."
Children with mild scoliosis treated with chiropractic adjustments have shown a reduction in their spinal curvature, according to the findings of a three-year, $143,000 study funded by the Foundation for Chiropractic Education and Research.
   This cohort study was conducted by Charles "Skip" Lantz, DC, PhD, director of research of Life Chiropractic College West, and his associates. The researchers were studying the effects of chiropractic full-spine adjustive procedures, heel-lifts, and postural counseling on children 9-15 years old with mild idiopathic scoliosis (less than 20 degrees of curvature, with no complicating conditions).

    Dr. Lantz released his team's findings in a presentation to the International Conference on Spinal Manipulation this past November in Bournemouth, England.
"This was a very significant project," explained Dr. Lantz. "This is the first large-scale research ever to study chiropractic care and scoliosis. It was also one of the few studies ever to look at chiropractic management in a pediatric population." Analysis and Procedures
     The study was conducted at Life Chiropractic College West's public clinic in Hayward, California. X-rays were taken of the children standing, from posterior to anterior, using a rigorous positioning protocol. The participants were given full-spine adjustments, typically once to three times a week over a one year period. Particular attention was on the sacroiliac joints, the lowest segment in the curve, the apex of the curve, and segments above the curve that reacted compensatorily to the primary curve,including the cervical spine.

     Prior to the adjustments, muscle work was done to the paraspinal muscles of the curve. Additionally, if the x-ray analysis found pelvic tilt, heel-lifts were provided to level the pelvis. The children were encouraged to exercise regularly, including hanging by the hands to flex the spine to open the concavity of the curve.  Results of the 150 children who qualified for the study, 40 completed the one year course of care and had follow-up x-rays. Preliminary results indicate an average reduction of 1.4 degrees in the curvature of the subjects' spines; the children less than 10 years old showed an average improvement of 2.6 degrees; those over 10, showed an average improvement of 0.9 degrees.

     A preliminary observation was made of a high incidence of pelvic tilt to the side of convexity in children with lumbar curves, however, there is no quantitative data on this observation.
The researchers noted that their lack of a control group "hampers an interpretation," but their intent was to study the effect of chiropractic care on the "curve itself, and the results are very promising."

    The researchers pointed out that the medical community does not offer treatment for spinal curves of less than 20 degrees, and indeed often doesn't even consider such variance as scoliosis. While the researchers assert that many questions remain to be answered about chiropractic care and scoliosis, they note: "Chiropractic appears to offer a distinct advantage in the management and monitoring of early stage scoliosis."
"The next step," says Dr. Lantz, "is to conduct a randomized, controlled clinical trial. One of the best options is to study children in braces with larger curves. This would require a collaboration with orthopedists in a major medical facility."



 Infants and Allergies

Late last year, the results of an extensive Italian study involving diet, environment and infant allergies came across my desk. The study compared more than 300 high risk infants with multiple types of intervention. The focus of the intervention was in three areas:
mother's diet;
infant's diet;
environmental factors.
The mothers in the intervention group's dietary modifications included:
No more than six ounces of milk per day were given to nursing mothers.
No eggs were allowed in the diet of nursing mothers.
The infants in the intervention group's dietary modifications included:
No solid foods were introduced until the 5th month of life.
Solid foods were introduced at a rate of no more than one new food every 7 to 10 days.
Only low allergy solid foods were given from the 5th through 12th months.
The solid foods that were considered low allergy included: cereal from rice, corn or tapioca; vegetables excluding all beans and tomatoes; olive oil; no dairy products except for Parmesan cheese; no eggs; turkey, lamb and rabbit were allowed, but no beef, pork, chicken or fish.
From the 12th month to the 24th month, all foods were introduced except eggs, nuts and cocoa, which were not given until after two years of age.

The environmental controls for the intervention group included:
no smoking in the child's house;
no cats, dogs or other pets with fur;
weekly carpet cleaning; * isolation from nurseries and preschool until two years of age.
The authors concluded that many of the preventive measures in theŚ infants. At the end of the three year follow up, when the intervention group was compared to the nonintervention group, the authors determined the top six factors that caused infant allergies. They were:
1. introduction of formula during the first week of life;
2. weaning before four months of age;
3. feeding beef at less than six months of age;
4. feeding cow's milk at less than six months of age;
5. second hand tobacco smoke exposure;
6. entering day care before two years of age. Conclusion
Although this was just one study, the intervention was extensive. The results are pleasing in that many common causes of infant allergies are easy to control.  Reference
1. Effects of a dietary and environmental prevention program on the incidence of allergic symptoms in high atopic risk infants: three years follow up. Acta Pediatrica 1996;85:414(121).
G. Douglas Andersen, DC, DACBSP, CCN, Brea, California




 Breast Milk Is Best

American Academy of Pediatrics Releases New Guidelines
According to new guidelines1 released by the American Academy of Pediatrics, breast milk is the preferred choice for baby, mother and society in general. The guidelines cite "extensive research, especially in recent years, documents diverse and compelling advantages to infants, mothers, families, and society from breastfeeding and the use of human milk for infant feeding. These include health, nutritional, immunologic, developmental, psychological, social, economic, and environmental benefits."
The paper goes on to state:
"Human milk is uniquely superior for infant feeding and is species-specific; all substitute feeding options differ markedly from it."
According to numerous studies from "developed countries," the benefits of breastfeeding to the baby includes decreased risk for "a large number of acute and chronic diseases." This includes decreases in the incidence and/or severity of:
diarrhea
lower respiratory infection
otitis media
bacteremia
bacterial meningitis
botulism
urinary tract infection
necrotizing enterocolitis
And a "possible protective effect" against:
sudden infant death syndrome
insulin-dependent diabetes mellitus
Crohn's disease
ulcerative colitis
lymphoma
allergic diseases
other chronic digestive diseases
Additional studies relate breastfeeding to "possible enhancement of cognitive development."
There appear to be almost as many benefits to the mother who breastfeeds:
less postpartum bleeding and more rapid uterine involution  
less menstrual blood loss over the months after delivery
earlier return to pre-pregnant weight  
delayed resumption of ovulation with increased child spacing
improved bone remineralization postpartum
reduction in hip fractures in the postmenopausal period
reduced risk of ovarian cancer
reduced risk of premenopausal breast cancer

The societal benefits are also significant. These include "reduced health care costs reduced employee absenteeism for care attributable to child illness." Among the direct economic benefits to the family is the savings of an estimated $855 for the purchase of formula.
The American Academy of Pediatrics also made some very straight forward recommendations for breastfeeding:
Human milk is the preferred feeding for all infants, including
premature and sick newborns, with rare exceptions.
Breastfeeding should begin as soon as possible after birth, usually
within the first hour.
Newborns should be nursed whenever they show signs of hunger, such as
increased alertness of activity, mouthing, or rooting.
No supplements (water, glucose water, formula, and so forth) should be
given to breastfeeding newborns unless a medical indication exists.
Exclusive breastfeeding is ideal nutrition and sufficient to support
optimal growth and development for approximately the first six months after birth.
In the first six months, water, juice, and other foods are generally
unnecessary for breastfed infants.
Should hospitalization of the breastfeeding mother or infant be
necessary, every effort should be made to maintain breastfeeding, preferably directly, or by pumping the breasts and feeding expressed breast milk, if necessary.
This is important information for every expectant mother to know, especially with so many "opinions" circulating in the public sector.

(Editor's note: A copy of the AAP's policy statement on "Breastfeeding and the Use of Human Milk" can be viewed or downloaded http://www.aap.org/policy/re9729.html
References
Breastfeeding and the Use of Human Milk (RE9729). American Academy of Pediatrics. Pediatrics, Dec. 1997;100(6):1035-1039.
Dewey DG, Heinig MJ, Nommsen-Rivers LA. Differences in morbidity between breast-fed and formula-fed infants. Pediatr. 1995:126:696-702.
Howie PW, Forsyth JS, Ogston SA, et al. Protective effect of breast feeding against infection. Br med J. 1990;300:11-16.
Kovar MG, Serdula MK, Marks JS, et al. Review of the epidemiologic evidence for an association between infant feeding and infant health. Pediatrics, 1984;74:S615-S638.
Popkin BM, Adair L, Akin Js, et al. Breast-feeding and diarrheal morbidity. Pediatrics, 1990;86:874-882.




 Evaluation and Treatment of Children with Earache

Earache is the most common reason for office visits to pediatricians. By the age of three years, more than 70 percent of children will have had at least one episode of earache and about a third will have had more than three episodes. It is not surprising, therefore, that earache is also the most common reason for children under the age of five years presenting to the chiropractor's office.
1 .According to 1992 survey data, children with earache attending the chiropractor will usually respond within about three visits.
2 . Many of these children with middle ear infections that respond to treatment by the chiropractor have had a long history of middle ear infections coupled with several courses of seemingly ineffective antibiotic treatment.

Middle Ear Infection:
When a child with earache is diagnosed with middle ear infection by the pediatrician, the usual treatment involves a course of antibiotics. Why then do some of these children continue to have ear problems? Well, there may be several answers to this question.
First, the cause of the child's middle ear infection may not be due to bacteria, and since antibiotics are only effective against bacterial pathogens, then frequently there will be no response. Since numerous cases of middle ear infection can be caused by a virus, and viruses do not respond to antibiotics, this may be the reason why children develop chronic ear infections. Also, not all bacteria will succumb to antibiotics, so several different formulations may have to be tried.
Next, even though the selected antibiotics may be quite effective in eliminating the invading bacteria, the residual fluid may be retained inside the ear due to impaired drainage from the middle ear cavity. This fluid may become an ideal culturing medium for the next pathogen which arrives on the scene. Previous ENT research has shown that children with chronic ear infections also have restrictions of the natural lymphatic drainage from the middle ear.

3 . Finally, the anatomy of young children is somewhat different in that they have shorter and more horizontal eustachian tubes, making drainage difficult.

The Chiropractor's Role:
What role does the chiropractor play in evaluating and treating these children?
The chiropractor's task is to ascertain if the reason for the body's inability to combat the infection is caused by irritation of the small nerves in the spine (called free nerve endings).
When these nerve endings are irritated, an abnormal tension is produced in the small muscles of the neck. This muscle tension can place pressure on the lymphatic drainage ducts resulting in inadequate drainage from inside the ear, thus preventing the body from being able to naturally correct the problem.
Identification of such a problem is made by detecting increased tension in the neck and paraspinal muscles, usually more tension is felt on the side of earache. The chiropractor also looks for spinal vertebrae which are either slightly out of alignment or are not moving within their normal range. This problem may have been due to any one of the number of bangs, jolts and falls that most children experience in the early years of their life.

Experience:
The chiropractor is the doctor most experienced in identifying these spinal problems and in correcting them, usually with a very light finger-tip adjustment.
A most important task for the chiropractor is to carefully evaluate each child to ensure that the cause of the earache has been accurately identified. A previous diagnosis of middle ear infection, made by a pediatrician some weeks earlier, cannot be presumed to be still accurate. A thorough examination of the patient must include consideration of other possible complicating factors since earache can be caused by many disorders, including mastoiditis, sinusitis, tooth infections, tumors, temporomandibular joint dysfunction, pharyngitis, external canal infections, and foreign bodies in the ear.

Treatment:
Chiropractic management of the patient with earache involves a detailed and thorough evaluation, usually followed by a short course of spinal adjustment and manipulation of the neck muscles to help restore normal lymph drainage. Treatment is usually short and the resolution is frequently swift. Patients who, at the time of examination, are on antibiotics probably don't have a high risk for serious complicating infections. Those patients who are not on antibiotics may need to be watched more closely and alternative treatments considered if no short-term
 response to spinal adjusting is apparent.
References
Fysh P: Kids Need Chiropractic Too -- What For? Dynamic Chiropractic, Dec 4, 1992.
Fysh P: Pediatric Patient Survey. National Conference on Chiropractic & Pediatrics, Colorado, November 1992.
Pulek J, et al: Eustachian tube lymphatics. Ann. Oto., 84:483, 1975.
Peter N. Fysh, DC




 Chiropractic .. Is It Safe for Children?

The benefits of chiropractic care for children have become increasingly evident as the number of children receiving chiropractic care continues to rise.
1. Chiropractic research has overwhelmingly shown the benefit of chiropractic care for children.
2. However, there continue to be reports which question the safety of chiropractic care.
3. In light of this trend of care for increased numbers of children, and those safety considerations, it has become important to evaluate the risk potential to the pediatric patient presenting for chiropractic care.
In response to these safety concerns, the research department of the ICPA has published a first paper concerning the safety of adjusting children. In the current issue of the Journal of Vertebral Subluxation Research, ICPA research assistant Rich Pistolese has published a report entitled, "Risk Assessment of Neurological and/or Vertebrobasilar Complications in the Pediatric Chiropractic Patient."
4.This timely paper specifically addresses the safety issues associated with chiropractic care for children.
Reports of serious complications (regardless of age) following chiropractic adjustments and/or manipulation are extremely rare.
5. Nevertheless, since disturbance of vertebral artery circulation is the most commonly reported adverse event associated with the adult population under chiropractic care, the study focused on evaluating the risk of occurrence of neurovascular complications in the pediatric patient.
The study acknowledges most complications following cervical manipulation are caused by disturbances of vertebral artery circulation, and the resultant damage to neurological components supplied by the vertebrobasilar system. While it has been reported that vertebral artery dissection is an uncommon cause for stroke in children,
 current statistics reveal that the pediatric population is not exempt from this phenomenon. Reports show the annual incidence of strokes for children under 15 years of age to be 2.7 per 100,000 children.

There is a strong correlation between the severity of spinal cord injury and the immaturity of the spine.
 It behooves the chiropractic profession to pay special attention to avoiding procedures that could induce stroke or other related complications in the pediatric patient, since the majority of complications attributed to spinal manipulative procedures are related to rotational manipulation of the cervical spine.
 Adjusting procedures should exclude any maneuver that includes rotation, extension and traction. The author also suggests a change from manipulative methods to low force movements, which may help to minimize neurovascular complications and other types of potential harm.
In regards to risk assessment, in this report the research department of the ICPA has conducted an extensive search of Medline and Mantis and found only two questionable reports of adverse neurovascular events in pediatric patients following chiropractic care. While the author has heard claims from pediatricians and other health care professionals that chiropractic may cause epiphyseal plate fractures in children, no such cases were found reported in the scientific literature. Any health care professional who makes such claims should be quickly challenged to provide documentation of such claims.
Based on information gathered in this study, the ICPA's research department has concluded the following:
last 32+ years, there are only two reported cases of neurovascular complications related to pediatric patients receiving chiropractic care.
sources, a conservative estimate of the number of pediatric visits to chiropractors in the U.S. over the same time span amount to over 1/2 billion visits.
result of chiropractic care is approximately one out of every 250 million visits.
When considering the use of any health care procedure, the expected benefit must be weighed against the inherent risks. Based on this axiom, chiropractic care relative to neurovascular complications appears to present little risk to the pediatric patient when compared to cited reports related to benefits of chiropractic care. While some preexisting conditions may predispose the pediatric patient to a higher probability of complication, the estimate provided is considered applicable to the general pediatric population.
To obtain your copy of this report, contact the Journal of Vertebral Subluxation Research, 2950 N. Dobson Road, Suite 1, Chandler, AZ 85524, tel: 1 800 347 1011. You can also contact the ICPA at 5295 Highway 78, Suite D362, Stone Mountain, GA 30087, tel: 770 982 9037.
References
Goertz C. Summary of 1995 ACA annual statistical survey. JACAŚ
Vange B. Contact between preschool children with chronic diseases and the authorized health services and forms of alternative therapy. Ugeskr Laeger 1989;151(28):1815©8.
Ernst E, Assendelft WJJ. Chiropractic for low back pain. BMJ 198;317(7152):160.
Pistolese RA. Risk assessment of neurological and/or vertebrobasilar complications in the pediatric chiropractic patient. J Vertebral Sublux Res 1998;2(2):73©81.
Crawford JP, Byoung YH, Asselbergs PJ, Hickson GS. Vascular ischemia of the cervical spine: a review of the relationship to therapeutic manipulation. J Manipulative Physiol Ther 1984;7(3):149©55.
Dvorak J, Baumgartner L, Burn JB, et al. Consensus and recommendations as to the side effects and complications of manual therapy of the cervical spine. J Manual Medicine 1991;6:117©8.
Fossgren J. Complications in manual medicine. J Manual Medicine 1991;6:83©4.
Khuruna DS, Bonnemann CG, Dooling EC, et al. Vertebral artery dissection: issues in diagnosis and management. Pediatr Neurol 1996;14(3):255©8.
Alvarez Sabin J. Stroke in teenagers. Rev Neurol 1997;25(142):919©23.
Ruge JR, Sinson GP, McLone DG, et al. Pediatric spinal injury: the very young. J Neurosurg 1998;68:25©30.
Greenman PE. Principles of manipulation of the cervical spine. J Manual Medicine 1991;6:106©13.



 Chiropractic Found Effective for Infantile Colic

Randomized Controlled Trial Shows Manipulation More Effective than Drugs.
A randomized, controlled clinical trial on colic in Denmark that compared chiropractic adjustments to daily doses of dimethicone has concluded: "Spinal manipulation has a positive short-term effect on infantile colic."1
Infantile colic is a curious and mysterious condition. It is estimated that, on average, 22.5% of all newborns suffer from colic, defined as "uncontrollable crying in babies from 0-3 months old, more than three hours a day, more than three days a week for three weeks or more, usually in the afternoon and evening hours." But only "47 percent of infantile colic cases have disappeared by the age of three months, a further 41 percent disappeared before six months of age, and the remaining 12 percent of cases persevered until between the ages of 6 and 12 months."
First described in 1894, colic has no verified cause(s). Countless studies have, however, determined what it is not caused by: air or constrictions in the intestines; gastrointestinal transit time; intestinal hormones; intestinal microflora; method of delivery (vaginal, Cesarean section or vacuum extraction); use of pudendal block; epidural analgesia; general anesthesia; or intravenous oxytocin.
Numerous medical and nonmedical treatments have been studied, including: music and sounds; vibration; dicyclomine hydrochloride; gripe-water; alcohol; atropine; skopyl; phenobarbital; merperidine; homatropine; and merbentyl. These treatments have shown either "no effect when compared to placebo treatment" or "serious side effects." Treatment with sucrose does seem to have a "generalized analgesic effect in infants and may therefore also help in infantile colic."
Dimethicone, the drug used in this randomized trial, has been shown to be "no better than placebo treatment" in several good controlled studies.
The first retrospective chiropractic study on treating colic was conducted in 1985, followed by a prospective multicenter study in 1989. "Both studies suggest that there seems to be a positive effect of spinal manipulation for infantile colic," but since neither study had a control group, it was impossible to assess whether the chiropractic treatments were significantly better than placebo.
The Danish National Health Service recruited 50 infants meeting the criteria for colic. After they were reviewed and monitored, they were randomly assigned to two groups: dimethicone daily for two weeks or spinal manipulation for two weeks by a local chiropractor. The 25 infants under chiropractic care received motion palpation to locate "articulations" mostly found in the upper and mid-thoracic area. The infants in the chiropractic group received an average of 3.8 adjustments.
During the two-week treatments, the parents kept a colic diary and nurses visited the families to administer a weekly "infantile colic behavior profile." The results were:
   The dimethicone group would have fared much worse than these results suggest if not for the dropout rate of the medicated group. All 25 infants in the manipulation group completed the 13 days of treatment, but there were nine dropouts in the dimethicone group: five dropped out before the first week's diary could be completed, and thus there was no data on the hours of crying for those five subjects. But the study did register the subjective evaluation of four of the five in the dimethicone group that quit in the first week: two described their child's condition as "worsened" and two others described it as "much worsened." Had these four infants completed the study, they would have significantly affected the limited positive effect of dimethicone. To quote the authors:
"By excluding data from the dropouts, we are excluding more severe cases from the dimethicone group, and this has the effect of making that group appear better than it actually was." The authors make another comment that speaks directly to the issue:
"Spinal manipulation is normally used in the treatment of musculoskeletal disorders, and the results of this trial leave open two possible interpretations. Either spinal manipulation is effective in the treatment of the visceral disorder infantile colic or infantile colic is, in fact, a musculoskeletal disorder, and not, as normally assumed, visceral. This study does not address this issue."
Reference
1. Wiberg JMM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: A randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther 1999;22:517-22.

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Dr. Lisbeth Baird D.C. , FIACA

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