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FINAL

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'Removal of dairy/wheat from diet' 'Review of medication/side effects' ... Chiropractic management of deformational plagiocephaly in infants: An ... – PowerPoint PPT presentation

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Title: FINAL


1
FINAL
  • In addition to the last unit covered in class
  • 10 questions related to
  • Pregnancy adjusting Websters
  • Pediatric chiro evaluation adjusting
  • Pediatric radiology
  • Normal variants, anomolies
  • Chiro Management of Common Conditions

2
Hawks review of the chiro literature
  • Adequate research supporting chiropractic
  • Asthma
  • Colic
  • Promising
  • Otitis
  • Insufficient
  • Enuresis

3
Asthma - Chiropractic Management
  • Chiropractic adjustments
  • Full spine, ribs, upper cervical
  • Trigger avoidance environmental control
    measures
  • Evaluation of stress/environment
  • Evaluation of environmental pollutants
  • Removal of dairy/wheat from diet
  • Review of medication/side effects

4
More research is needed but
  • Avoid dairy/wheat
  • Highly allergenic remember the allergic march?
  • Dairy in a mucous-producing agent
  • Limit processed sugars
  • Avoid food additives preservatives (MSG)
  • May trigger attacks
  • Relaxation techniques, stress control and
    reduction
  • May benefit lung function

Schetchikova NV. Asthma An Enigma Epidemic ,
Part II-Asthma Treatment. J Am Chiropr Assoc
JUL 2003 (407) 30-37.
5
More research is needed but
  • Probiotics
  • May reduce inflammation, reduce allergic symptoms
  • Omega-3 fatty acids
  • May decrease inflammation
  • Calcium and magnesium
  • May cause bronchial smooth muscle relaxation and
    reduces histamine response
  • Antioxidants (vitamins C and E, selenium, zinc)
  • May reduce allergic reactions and wheezing

Schetchikova NV. Asthma An Enigma Epidemic ,
Part II-Asthma Treatment. J Am Chiropr Assoc
JUL 2003 (407) 30-37.
6
Colic
  • Low allergen diet (breastfeeding mothers)
  • Eliminate milk, eggs, wheat, nuts
  • Hypoallergenic formulas
  • Soy formulas?
  • May develop allergy to soy
  • Herbal tea
  • Chamomile, vervain, licorice, fennel, and
    balm-mint
  • Reduce infant stimulation

Roberts DM, Ostapchuk M, OBrien JG. Infantile
Colic. Am Fam Physician 2004 70 735-40.
Garrison MM, Christakis DA. A Systematic Review
of Treatments for Infant Colic. Pediatrics 2000
106184-90.
7
  • New Research
  • Probiotics (Lactobacillus reuteri)
  • Improved colicky symptoms within 1 week
  • No adverese effects were reported
  • Many parents try remedies recommended by family
    friends, or found online
  • White noise, car ride, walk in the stroller
  • Gripe water
  • Relief from flatulence and indigestion?
  • Avoid versions made with sugar or alcohol
  • Look for products made in the USA

Savino F, et al. Lactobacillus reuteri Versus
Simethicone in the Treatment of Infantile Colic
A Prospectice Randomized Study. Pediatrics
2007119e124-30. Roberts DM, Ostapchuk M,
OBrien JG. Infantile Colic. Am Fam Physician
200470735-40.
8
Chiropractic Care Colic
  • Evidence is adequate to support the total
    package of chiropractic care as providing
    benefit to patients with colic
  • Improvement with SMT
  • Improved parent-reported outcomes with
    chiropractic care
  • No adverse effects were reported

Hawk C, et al. Chiropractic Care for
Nonmusculoskeletal Conditions A systematic
Review with Implications for Whole Systems
Research. J Altern Complement Med 200713
491-512.
9
Enuresis
  • Positive Reinforcement Systems
  • earns points for every night he or she remains
    dry gt prize
  • Responsibility training
  • child is given age-appropriate responsibility, in
    a nonpunitive way, for the consequences of
    bed-wetting (strip wet linens from the bed)
  • Elimination diet
  • Hypnosis
  • Retention control
  • Biofeedback
  • Acupuncture
  • Scheduled awakenings
  • Caffeine restriction

More research is needed but they have been shown
to have positive effects
Thiedke CC. Nocturnal Enuresis. Am Fam
Physician 2003 671499-506,1509-10.
10
Chiropractic Care Enuresis
  • Evidence is insufficient at this time
  • Promising
  • Adverse effects were mild and self-limiting

Hawk C, et al. Chiropractic Care for
Nonmusculoskeletal Conditions A systematic
Review with Implications for Whole Systems
Research. J Altern Complement Med 200713
491-512.
11
AOM - Medical Management
  • Watchful waiting
  • symptomatic treatment for 24 to 48 hours before
    initiating antimicrobial treatment
  • Pain management
  • acetaminophen, ibuprofen, or topical otic
    anesthetic drops for pain control
  • Antibiotic therapy
  • reserve antibiotic therapy for specific cases
  • lt 6 months of age
  • Severe illness (fever of gt102.6, severe ear pain)

AAP and AAFP Clinical Practice Guideline
Diagnosis and Management of Acute Otitis Media.
Pediatrics 20041131451-65. Garbutt J, et al.
Diagnosis and Treatment of Acute Otitis Media An
Assessment. Pediatrics 2003112,143-9.
12
Reducing Risk Factors
  • Breastfeeding
  • Minimum of 6 months
  • If bottle-fed, avoid supine bottle feeding
  • Reduce or eliminate pacifier use (gt6 months)
  • Daycare increased incidence of URTI
  • Tobacco smoke

AAP and AAFP Clinical Practice Guideline
Diagnosis and Management of Acute Otitis Media.
Pediatrics. 2004113(5)1451-65.
13
Newer Research
  • Tubes marginally effective in Otitis Media with
    Effusion
  • Improves hearing in children who have otitis
    media with effusion over the short term
  • Outcomes within 18 months, however, are the same
  • Tubes have no effect on language development
  • Watchful waiting is a reasonable option in most
    of these children

Rovers MM, et al.Brommets in otitis media with
effusion an individual patient data
meta-analysis. Arch Dis Child 200590480-5.
14
Chiropractic Care Otitis media
  • Evidence is promising for the potential benefit
    of manual procedures for children with otitis
    media
  • Improvement with manual procedures
  • Natural course of the illness?
  • Fewer surgical procedures compared to usual
    medial care
  • Parent-reported positive side effects
  • relaxation, good nap
  • No adverse effects were reported

Hawk C, et al. Chiropractic Care for
Nonmusculoskeletal Conditions A systematic
Review with Implications for Whole Systems
Research. J Altern Complement Med 200713
491-512.
15
Erbs Palsy - Chiropractic Management
  • More research is needed
  • Chiropractic adjustments
  • vs. natural history?
  • Splinting
  • Active and passive range-of-motion exercises

16
Torticollis - Chiropractic Management
  • Chiropractic adjustments
  • Parental education
  • Passive stretches
  • Tummy time
  • Positional changes
  • Car seat, sleeping,etc.

17
Plagiocephaly - Management
  • Preventive counseling
  • Mechanical adjustments
  • Exercises
  • Skull modling helmets
  • Surgery

Most improve within 2-3 months If parents
follow these guidelines
Biggs WS. Diagnosis and Management of Positional
Head Deformity. Am Fam Physician 2003671953-6.
18
Chiropractic Management
  • Retrospective 25 cases, mean age 3.74 months
  • Intervention
  • Chiropractic pediatric adjusting techniques
  • Spine extremities
  • All 25 patients achieved complete resolution
  • Mean time to full resolution - 3.64 months
  • Mean number of adjustments - 1.8
  • Resolution
  • All criteria for establishing the diagnosis were
    no longer evident and a minimum period of 4 weeks
    in which the subluxation complex was no longer
    demonstrable

Davies NJ. Chiropractic management of
deformational plagiocephaly in infants An
alternative to device-dependent therapy. Chiropr
J Aust 2002 32 52-55.
19
Headache When is a neurological consult indicated?
  • May depend on the doctors experience and
    confidence
  • Children lt3 years
  • Rarely have primary headache syndrome
  • Neurologic fundoscopic exam can be difficult
  • Acute headache w/ focal neurologic symptoms/signs
  • Neuroimaging should be performed
  • Chronic-progressive headaches
  • Associated w/ increased ICP

Lewis DW. Headaches in Children and Adolescents.
J Am Fam Phys 200265(4)625-32.
20
Management of Primary Headache
  • Once determined, reassure that the headache is
    not due to brain tumor or CNS pathology
  • Quiet, dark room
  • Sleep
  • Manage stress
  • Encourage family to develop a schedule
  • Relaxation techniques
  • Biofeedback
  • Psychotherapy
  • Diet (avoid triggers)

Lewis DW. Headaches in Children and Adolescents.
J Am Fam Phys 200265(4)625-32. Lopez JI.
Headache Pediatric Perspectives. eMedicine.
Retrieved 1 March 2007 from www.emedicine.com/neur
o/topic528.htm
21
7 Warning Signs for Pediatric Back Pain
  • Child is lt4 years old
  • Infection or neoplasm are common causes of back
    pain in this age group
  • Back pain causes a functional disability
  • Children like to play, if the pain causes them
    to ask to miss sports, gym or recess, the pain is
    serious
  • Duration gt4 weeks
  • Musculoligamentous injuries should resolve in
    that time
  • Fever is present
  • Suggests infection osteomyelitis should be
    ruled out
  • Antalgic posture
  • Disc herniation (not common in children) can be
    associated with bone tumor pain (osteoid osteoma)
  • Neurologic abnormality
  • Limitation of motion due to pain

D'Alessandro MP. Back Pain in Children.
Retreived 1 March 2007 from www.virtualpediatricho
spital.org/providers/BackPainInChildren/Algorithm.
shtml
22
Scheuermanns
  • Signs/Symptoms
  • Fatigue pain in the upper back
  • Exaggerated mid-thoracic kyphosis, cervical and
    lumbar lordosis and anterior pelvic tilt
  • Diagnosis
  • X-ray anterior vertebral body wedging, loss of
    disc height and irregularity of the vertebral
    end-plates (3 or more adjacent vertebrae)
  • Management
  • Adjustments and soft tissue therapy
  • Stretch hamstrings strengthen abdominal muscles
  • Strengthening exercises for the back

Fysh P. Chiropractic Care for the Pediatric
Patient. Arlington, VA ICA Council on
Pediatrics, 2002. Fysh P. Low Back Pain in
Children. Presented at that ICA Conference on
Pediatrics. Nashville, TN November 2006.
23
Facet Tropism
  • Signs/Symptoms
  • Specific site of palpable tenderness in the
    lumbar region
  • Diagnosis
  • X-ray sagittally oriented facet which correlates
    w/ the side and level of pain (L4/5, L5/S1
    normally coronal)
  • Essentially a lumbar lig. sprain overuse facet
    syndrome
  • Management
  • Adjustments
  • Avoid the sagittal facet - already hypermobile
  • Side posture may exacerbate symptoms should be
    avoided
  • Strengthening exercises (abdominals)
  • Short-term limitation of activities
  • Avoid hyperextension and rotation of the lumbar
    spine

Fysh P. Chiropractic Care for the Pediatric
Patient. Arlington, VA ICA Council on
Pediatrics, 2002.
24
Spondylolysis
  • Signs/Symptoms
  • LBP aggravated by activity asymptomatic in some
    cases
  • Increased lumbar lordosis, hamstring tightness,
    gait abnormalities
  • Diagnosis
  • X-ray A-P, lat., oblique
  • CT, MRI or bone scan may be necessary
  • Uni- or bilateral, acquired interruption of the
    pars stress Fx
  • Management
  • If acute, bed-rest and restriction of activities
  • Allow Fx to heal before displacement occurs
  • Radiographic follow-up yearly to assess
    progression
  • Every 6 months in the adolescent (increased risk
    of slippage)

Fysh P. Chiropractic Care for the Pediatric
Patient. Arlington, VA ICA Council on
Pediatrics, 2002.
25
Spondylolisthesis
  • Signs/Symptoms
  • Often asymptomatic in children
  • During or after growth spurt dull ache in the
    LB, buttocks and thighs during or after physical
    activity
  • Flattening of the post. sacrum and pelvis,
    shortening of the trunk, forward translation of
    the chest, lumbar hyperlordosis, changes in gait
  • Diagnosis
  • X-ray anterior vertebral slippage
  • Myerding grading (1-5)
  • Management
  • Grades 1-2 carefully supervise activities
  • Grades 3 refer for evaluation for possible
    surgery

Fysh P. Chiropractic Care for the Pediatric
Patient. Arlington, VA ICA Council on
Pediatrics, 2002.
26
Musculoligamentous Injury - Subluxation
  • Subluxation is the most common cause of back pain
    seen in the chiropractors office
  • The chiropractor must, however, be careful to
    include all possible differentials in their
    clinical thinking
  • Avoid prolonged, painful, frustrating, expensive
    programs of care d/t inaccurate diagnosis

Fysh P. Low Back Pain in Children. Presented at
that ICA Conference on Pediatrics. Nashville,
TN November 2006.
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