Pediatric

A case study published in February 2009 in the Journal of Pediatric, Maternal & Family Health, documented the case of a woman in the midst of a difficult birth receiving help with chiropractic. This case study showed the successful collaboration of chiropractors and midwives, as the authors describe the care of a woman in labor with problems.

This case study involved a 26 year old first time mother experiencing problems while in labor. She was attempting a home birth delivery with 3 midwives and her chiropractor in attendance. At 23 hours of labor, the woman had lack of cervical dilation, descent but diminished uterine contractions along with decreased fetal heart tones. Due to the variety of problems the midwives discussed the possibility of transferring the patient to the hospital. At that point the decision was made to initiate chiropractic care with the “Webster Technique”.

The Webster Technique, created by famed pediatric Chiropractor, Dr. Larry Webster, is the application of a specific chiropractic adjustment, which reduces interference to the nervous system (subluxation) and helps return balance in the pelvic structures thereby improving the physiological functioning of the pelvic muscles and ligaments. This in turn removes in-utero constraint and allows for the fetus to get into the best possible position for birth.

After the application of chiropractic care, the midwives reported a significant improvement in labor progression. The patient’s contractions became stronger and more frequent, and the fetal heart tones stabilized. The midwives again attempted various patient positioning, more homeopathic remedies and performed a surgical rupture of the patients membranes. As the labor continued, they recommended further chiropractic care.

At 34 hours of labor, the attending chiropractor rendered care again. One-half hour later, the patient finally reached complete cervical dilation. The labor progressed rapidly thereafter, and the patient began pushing. A healthy baby girl was born vaginally at home one hour after receiving her last chiropractic spinal adjustment.

Dr. Jeanne Ohm, Executive Director of the International Chiropractic Pediatric Association (ICPA) and one of the co-authors of the study stated, “Research is revealing that chiropractic care is extremely beneficial before, during and after the birth process, helping the mother enjoy a healthier pregnancy, a more normal delivery and giving the child a better start in life. Study after study is showing that a chiropractor is an indispensable part of the birthing team.”

In the September 22, 2011 issue of the Journal of Pediatric, Maternal & Family Health a case study was published that documents chiropractic care helping a baby with severe constipation and excessive crying.

In this case an 11 week old boy was brought to the chiropractor by his mother. The boy’s mother related that her baby was fussy since birth and that several times a day, the baby was uncomfortable and would cry and scream as if he was in a great deal of pain. These episodes would last up to 2 hours at a time.

The mother explained that these fits of crying seemed to be associated with her son trying to have a bowel movement as he would seem to be grunting and pushing without any success. Over the previous 8 weeks, it was reported that the child only had 5 bowel movements. Medical attempts to correct this issue included over the counter remedies and leg exercises. His bowel issues were affecting his eating and sleeping habits.

A chiropractic examination was performed where it was noticed that the baby’s color was grey looking, and his abdomen was distended. Additionally, there were several spinal findings that indicated the presence of nerve system irritation from subluxations at the top and bottom of the child’s spine.

Chiropractic care was initiated with a specific set of pediatric spinal adjustments being administered to the baby. The mother brought the baby back in six days for a follow-up visit. Upon her arrival she informed the doctor that after her son’s first adjustment, her baby had his first bowel movement without assistance. By the third chiropractic visit the boy’s mother reported that her son had an increased number of bowel movements as well as an improvement in his overall demeanor, a reduction in crying, and improvement in his ability to sleep.

The study notes that after about 10 weeks of chiropractic care, the child’s bowel habits had returned to a normal level that would be expected in a child unaffected by constipation.

In a series of articles dated July 21 and 22, 2002 from the Chicago Tribune comes a frightening report of needless deaths of thousands of infants due simply to actions of hospitals and their workers. According to an analysis done by the Tribune of records at the federal Centers for Disease Control and Prevention, pediatric intensive care units experience up to three times the number of infections as other hospital areas, including operating rooms. The article reports that state and federal health-care records show that the rate of lethal pediatric infections acquired in hospitals is rising.

The article highlighted a tragic case from Sinai-Grace Hospital in Detroit, during a three month period in the spring of 1997, on the same floor, within the same nursery unit, along the same row of bassinets, hospital germs contributed to the deaths of three babies and slipped undetected into 15 more newborns.

Probably the most chilling part of the expose were the statistics gathered by the Tribune that linked the deaths of 2,610 infants in the year 2000 alone to preventable hospital-acquired infections. The Tribune further identified 75,000 preventable deaths where hospital-acquired infections played a major role. Their analysis was based on the most recent national data, and was the most comprehensive of its kind drawing on information from thousands of hospital and government inspection reports.

According to a Tribune inspection and investigation of files at the U.S. Department of Health and Human Services, the majority of cases in pediatric intensive care units where needless deaths occurred, lives might have been saved by such simple acts such as washing hands or isolating patients the moment infections were detected. The Tribune’s analysis found an estimated 103,000 total deaths linked to hospital infections in 2000. The Centers for Disease Control and Prevention (CDC), which bases its numbers on extrapolations from 315 hospitals, estimated there were 90,000 that year. The Tribune article estimated that 75,000 of the deadly hospital infections took place in conditions that were preventable.

In an article on the same subject in the July 21, 2002 issue of the Atlanta Journal-Constitution it was also noted that according to the federal Centers for Disease Control and Prevention in Atlanta, deaths linked to hospital germs now represent the fourth-leading cause of mortality among Americans, behind heart disease, cancer and strokes. To put this in perspective these infections kill more people each year than car accidents, fires and drowning combined.

A study published in the September 13, 2006 issue of the Journal of the American Medical Association (JAMA) starts off with a chilling statement. “Much of pediatric drug use is off-label because appropriate pediatric studies have not been conducted and the drugs have not been labeled by the US Food and Drug Administration (FDA) for use in children.” In other words, according to the authors in JAMA, most of the drugs being sold for children have not been approved by the FDA for use in children.

The study, also reported on in a September 13, 2006 Associated Press story, notes that very little of the research that is done gets published in scientific journals. This then makes it hard for doctors to know about the medications or the study results. Dr. Danny Benjamin, an associate professor at Duke University who led the study and also works for the U.S. Food and Drug Administration commented, “Ironically, some of the times when drugs do work (in children), they’re still not getting published.”

Dr. Benjamin noted that many of the studies that do get done are never submitted for publication in journals. Dr. Catherine DeAngelis, JAMA editor-in-chief noted in the AP story that few studies submitted to JAMA involve the effects of medication on children.

It is not known if the reason for these lack of submissions is the change in 2004 by many of the scientific journals that now require drug tests be pre-registered before the testing in order to be considered for publication after the tests are complete. The reason the publications did this was because drug companies were running multiple studies on some drugs then only publishing the best results from drug trials while hiding the ones that may not have been so successful. Gregory D. Curfman, executive editor of the New England Journal of Medicine explains the rationale by stating, “When a pharmaceutical company sponsors a clinical trial and the results turn out not to be in the best financial interests of the company, it has been our experience these results are never made public.”

By not submitting the pediatric drug tests for publication in the journals, the drug companies could conceivably bury those tests that were not favorable, while distributing only those that seemed to work. In response, Scott Lassman of Pharmaceutical Research and Manufacturers of America, noted that drug companies often present data at medical conferences and or post them on an online industry database. This type of dissemination does not undergo the same scrutiny as publication in a peer reviewed scientific journal.

A November 7, 2001 report on a study conducted by the International Chiropractic Pediatric Association showed that a chiropractic technique known as the “Webster Breech Turning Technique” was statistically very successful in resolving breech pregnancies without medical procedures. A Breech pregnancy is when the baby is not properly positioned in the mother’s womb near the date for delivery. If the baby is not positioned head-first, the delivery may be difficult or even dangerous for both the mother and child.

This chiropractic technique was created by the late Dr. Larry Webster, who was affectionately known as “The grandfather of chiropractic pediatrics.” The study entailed surveying members of the International Chiropractic Pediatric Association, Inc (ICPA – www.icpa4kids.com) throughout the United States and Canada. The survey noted that there were a reported 112 cases of breech recorded by the chiropractors. Of these, the results were 102 positive resolutions. This means that in 102 of 112 cases the baby turned properly after the chiropractic procedure was performed. This represents a success rate of almost 92%!

The conclusions of this study clearly stated, “When successful, the Webster Technique avoids the costs and/or risks of either, ECV, cesarean section or vaginal trial of breech. In view of these findings the Webster Technique deserves serious consideration in the health care management of expectant mothers exhibiting adverse fetal presentation.”

An article in the December 6, 2007 issue of the New England Journal of Medicine (NEJM) calls for the US Food and Drug Administration (FDA) to take action concerning over the counter pediatric medications targeted at children under 12 years of age. “We believe that it (FDA) should immediately ask companies to remove these products from store shelves and begin legal proceedings to require them to do so.”

The original NEJM article by by Joshua M. Sharfstein, M.D., Marisa North, B.A., and Janet R. Serwint, M.D., highlights some very interesting facts related to over the counter drugs being advertised for children. The article notes that, “Since 1985, all six randomized, placebo-controlled studies of the use of cough and cold preparations in children under 12 years of age have not shown any meaningful differences between the active drugs and placebo.”

The NEJM article noted that as far back as 1997, the American Academy of Pediatrics created a policy statement on cough medications stating “indications for their use in children have not been established.” Additionally, the authors of the article noted that as recently as 2006, the American College of Chest Physicians stated that “literature regarding over-the-counter cough medications does not support the efficacy of such products in the pediatric age group.”

Some additional and chilling statistics brought forth in the article note that since January of 2000 there have been 750,000 calls of concern related to cough and cold products to poison-control centers. Additionally they reported that the US Centers for Disease Control and Prevention in 2004 and 2005 identified more than 1500 emergency room visits for children under 2 years of age related to cough or cold products.

The article notes that in 1976, the FDA adopted a system for determining children’s medications doses using a crude formula. This formula simply determined the use of pediatric medication by age only. For children between 6 and 11 years of age, the formula said that medications should be dispersed based upon half the adult dose. For children between 2 and 5 years of age, the formula recommended a quarter of the adult dose. The NEJM article notes that this very crude formulation was not based upon any science and has not been changed for over 30 years.

Interestingly, the New England Journal of Medicine article was also reported in several Canadian news outlets but NOT in any major US news publications. In a December 06, 2007 article in the Canadian National Post, Dr. Michael Rieder of the Canadian Pediatric Society commented on the importance of this NEJM article by stating, “Every regulator in the world will pay attention to [the article], and because we share the same unprotected border, Canada will pay more attention than other countries. The pressure has been building to this for over the past 12 to 18 months, and people in the community are saying, ‘Let’s get this done.'”

In an article from Reuters Health Information, printed in the Journal of the AMA is a report of a survey that showed many children with asthma were seeking what the article termed, “complementary medicine” for their problem. Dr. Sheldon Spier, of Alberta Children’s Hospital in Calgary, surveyed the parents of 117 pediatric asthma patients. Thirty percent reported using complementary medicine to help manage their children’s asthma symptoms, most commonly herbal medications, chiropractic, homeopathy, and vitamin C supplementation. One of the common reasons given for the usage was, the non-medical practitioners were perceived as “treating the whole patient.”

The International Chiropractic Pediatric Association lists several studies on their web site ( www.icpa4kids.org ) discussing the benefits of chiropractic for children with asthma. The following are some of those excerpts: “76.5% of patients with bronchial asthma said they benefited from chiropractic treatment. Peak flow rate and vital capacity increased after the third treatment. Significantly lower quality of life impairment rating scores were reported for 90.1% of children after 60 days of chiropractic care. During this same time period the average number of asthma attacks decreased an average of 44.9%, and asthma medication usage was decreased an average of 66.5%. Among parents of asthmatic children who had received chiropractic treatment, 92% considered this treatment beneficial.”

In an article from Reuters Health Information, printed in the Journal of the AMA is a report of a survey that showed many children with asthma were seeking what the article termed, complementary medicine for their problem. Dr. Sheldon Spier, of Alberta Children’s Hospital in Calgary, surveyed the parents of 117 pediatric asthma patients. Thirty percent reported using complementary medicine to help manage their children’s asthma symptoms, most commonly herbal medications, chiropractic, homeopathy, and vitamin C supplementation. One of the common reasons given for the usage was, the non-medical practitioners were perceived as treating the whole patient.”

The International Chiropractic Pediatric Association lists several studies on their web site ( www.icpa4kids.org ) discussing the benefits of chiropractic for children with asthma. The following are some of those excerpts: 76.5% of patients with bronchial asthma said they benefited from chiropractic treatment. Peak flow rate and vital capacity increased after the third treatment. Significantly lower quality of life impairment rating scores were reported for 90.1% of children after 60 days of chiropractic care. During this same time period the average number of asthma attacks decreased an average of 44.9%, and asthma medication usage was decreased an average of 66.5%. Among parents of asthmatic children who had received chiropractic treatment, 92% considered this treatment beneficial.

A study published in the December 2009 issue of the scientific periodical, the Journal of Clinical Chiropractic Pediatrics shows that chiropractic care is extremely safe for children. In research for this report, the study author undertook a review of all previously published reports of “adverse events” for chiropractic care delivered to children.

In this study the author, a chiropractor from the Anglo European College of Chiropractic, and lead tutor for Advanced Practice for Chiropractic Pediatrics, Joyce Miller, B.Sc., D.C., D.A.B.C.O., set out to review and examine the chiropractic safety record for care of children in comparison to the safety record of medications given to children. She noted that the safety issue of medications given to children is an increasing concern.

In her published study, Dr. Miller reported that according to the United Kingdom’s, National Patient Safety Agency, in 2006 out of a total of 33,446 reports of medical pediatric care, 19% experienced a medication problem, 14% had a procedural safety breech, 9% showed errors in documentation, and an additional 7% had errors in medical clinical assessment.

The reported results of the authors research showed that there were six separate published reports that addressed safety of what was called “Manual Therapy” for children delivered by either chiropractors or medical practitioners. The author specifically looked at the care rendered by chiropractors for the purpose of this study.

The results showed that over a 59 year time frame, a systematic review of the literature only uncovered 8 incidences of hurt or harm to children due to chiropractic adjustments. With an estimated 30 million pediatric adjustment visits to chiropractors made each year, the risk factor is calculated to be extremely low.

In her conclusion, Dr. Miller wrote, “Based on the published literature, it appears that manipulation, when given by a skilled chiropractor with years of training carried out with low forces recommended for pediatric care, has few side effects in the healthy infant and child and their recorded incidence is exceedingly low.

From the July 2008 issue of the scientific periodical, the Journal of Manipulative and Physiological Therapeutics (JMPT) comes a 3-year retrospective study of pediatric case files from the Anglo-European College of Chiropractic (AECC) teaching clinic practice in Bournemouth, England. This JMPT study reviewed 781 pediatric cases of children younger than 3 years of age to see if there were any adverse side effects of chiropractic care on children.

The authors of this study also reviewed previous literature to look for reports of any adverse events related to chiropractic care for patients under the age of 18. In this review they found a total of 9 events of problems that could have been related to chiropractic care for all the years between 1969 to 2001. Using the number of children under care in that time period and the number of chiropractic visits for those children the authors estimated that the risk of an adverse effect was 1 in 250 million.

In their more current review, the authors of the study looked at 781 cases of children younger than 3 years of age between January 2002 to December 2004 that received care at the Anglo-European College of Chiropractic (AECC) teaching clinic. Each of these cases was reviewed and information was recorded on how many chiropractic adjustments were received, the type of care rendered, the outcome of care, and whether any negative side effects were reported.

The study noted that of the 781 pediatric patients who presented for examination, 462 (59.15%) were male and 319 (40.85%) were female. Most (73.5%) patients were 12 weeks or younger of age (n = 574). The most common age group was between 5 and 8 weeks of age. They also reported that most infants were brought in for care by their parents because of problems with colic or irritability that was attributed to birth trauma.

In this review 699 (89.5%) received chiropractic care, and 82 (10.5%) were referred out to seek help elsewhere. Of the 699 initial children, a follow up was made on 697. Of these children, the parents of 594 (85.22%), reported an improvement in their child’s original symptoms. One hundred three (14.78%) parents reported that there was no change in their child’s symptoms. Of the total of 697 pediatric patients whose parents reported outcomes to care, there were 7 cases in which the parents reported some form of an adverse reaction to care. This translates into approximately 1% of patients experiencing some form of a negative side effect.

The study noted that all of these negative reactions were mild and required no medical care. The study also noted that there were no serious complications resulting from chiropractic care. The researchers stated in their conclusions, “This study provides evidence that chiropractic treatment is a safe form of therapy for children younger than the age of 3 and documents that there were no serious complications resulting from chiropractic manipulation in this group of children of this age range.”