Kids First, Part 1
By Ogi Ressel DCFeatures Clinical Patient Care
OK…you’ve made it this far. You have made a mother realize the
importance of a chiropractic checkup for her child. Congratulations!
Quite a feat! And I say this with all seriousness. Why? Because moms
make most of the health-care decisions in the family.
OK…you’ve made it this far. You have made a mother realize the importance of a chiropractic checkup for her child. Congratulations! Quite a feat! And I say this with all seriousness. Why? Because moms make most of the health-care decisions in the family.
Intake forms for children
The child is in your office with a very nervous mother – her maternal instinct is in high gear – although on the surface she is really cool about it. Don’t get me wrong, she thinks you are terrific, but don’t forget this fact for a second – this is her child you are about to see.
Now there are the usual initial forms to be filled out. By the time she has completed your intake forms, a mother should have the realization that you are well equipped to see children – that this is not new for you. This means that your clinical forms should speak of your expertise. They should ask about her pregnancy, labour, delivery, medical/chemical intervention, ultrasound, epidurals, forceps, C-section, etc. For a chiropractor, these questions are very important – many such procedures tend to lead to Traumatic Birth Syndrome (TBS), producing many negative health consequences for the child – it is your job to make a mom aware of this.
She should also be aware of in-uterine constraint, a situation where a baby may be trapped in a certain position in the uterus, and is unable to free itself. This generally happens in the last trimester of pregnancy and is often the most common cause of vertebral subluxations. For instance, if the baby is in a transverse lie – a horizontal position across the uterus – it may be born with a C-curve scoliotic configuration. This may necessitate a fairly rigorous schedule of care in order to reverse the neural patterning the baby has learned.
It is important that your forms also ask about the child’s APGAR score – a numerical value assigned immediately after birth, and, again, at five minutes. The optimal score should be 10. Anything less generally indicates a degree of birth trauma – not a good thing. Most moms will not remember their baby’s exact score – you may need to have the birth records faxed to you from the hospital/birth centre where the child was born.
As well, even if the child is no longer an infant, it is important to ask mom about feeding habits as a baby – bottle fed versus breastfed. If the child is still an infant, explain the benefits of breastfeeding. La Leche League (website, www.llli.org) can help you with this.
Pay attention to any difficulty a mom may have (or have had) with breastfeeding – for example, if the baby is/was being fussy, feeding on one side, etc. This is a huge clue. It means that a baby is uncomfortable turning the head to one side – generally a side-effect of a difficult delivery – and is very important as it indicates the presence of subluxation.
These are some of the things that you want to chat with the mom about – even if the child is not an infant. The reason is that the majority of health problems seen in adults have their origins in childhood.
I really enjoy this aspect of a child’s visit – the emphasis is not on symptoms but on how their body is functioning. Remember you are teaching your patients. The mom should be aware that this is not yet another medical examination. This is different. To this end, don’t use techno-babble moms can’t understand.
Who’s more nervous?
OK. You’ve done the consultation with her child, and mom was cool about the whole thing – even if you’ve been nervous about it. But why are you nervous, now? It’s only a child!
What makes it worse is that the mother of the child you are about to check, appears to be really calm and relaxed – while you are totally embarrassed that you cannot get out the words you want. I mean, here you are, a grownup, with a college education and a degree, and you feel totally intimidated by this very short and cute seven-year-old in front of you.
To make matters worse, she asks straight out; “Why are you sweating?”
Here is where you, a rational-thinking, well-adjusted adult – one who has spent years studying the art and science and philosophy of chiropractic – start to babble effusively. This seems to be a common scenario for many a doctor who is not accustomed to seeing children.
The more children you see, the easier this will become – like anything else!
That is why they call it “practice.”
Your visit with the child
It is best to approach the child with dignity, respect, warmth, and as their equal. Depending on the age of the child, you may want to approach your young munchkin from the perspective of playtime – not cool if the child is over seven years young because you’ll definitely be labelled as uncool.
Have fun with kids – they are generally not as “cerebrally constipated” as adults are. I usually ask a young five- to seven-year-old girl, for example, how many boyfriends she has. You’ll be amazed at the answers you’ll get. This tends to lead to some discussion between the mom and her child – I sit back and enjoy the banter!
Make certain mom and her child understand what you mean by “subluxation.” There are spinal subluxation models that exist for use with kids – you can use these to help with your description. Dr. Jeanne Ohm’s “power-on” and “power-off” analogy works well here! I ask children: “This is power-on and this is power-off. Which is better?” You’ll always get the correct answer! Even two-year-olds get this. What is most amazing though, is that moms will get it also!
The child’s consent
Here is where I ask the child: “I’m going to check you to see if your power is on. Would that be OK?”
It is very important to ask the child for their permission to examine him/her. Remember: respect and dignity are key here. You never, ever, want to force a child to do anything they are uncomfortable with.
Preparing for the examination
Now, you are ready to start the examination. Make certain that you are well equipped to see children. If you use gowns, your little patients should be gowned in their own cool gowns! This speaks well of you and your office!
As well, have a very flexible doll close at hand in case you need to explain what you mean by the forces of delivery, and the role they play in causing vertebral subluxations. This doll is also very handy in showing mom the stresses on the baby in cases of in-utero constraint. Make it as graphic as is needed to make your point without evoking any fear. I’ll hold the doll horizontally, facing the mother for instance, and bend the doll in such a way that it shows a definite spinal curve, in order to explain a “transverse lie” to mom. I haven’t yet met a mother who does not get the idea that to correct a spine that has been trapped in such a position might take a bit of time.
The important thing here is to make mom understand what you see and what you find. We are told that this is a very difficult thing to do. Nonsense. It’s not that difficult at all. All you need to do is place yourself in the shoes of the parent. How would you like to be talked to? As an equal? Absolutely! With techno-babble? No! How would you, as the child, like to be handled? With great respect? Yes! At their level?
I suggested earlier, in this article, that you ask the child permission to examine them right after. Here is what I say: “I’m going to check to see if your power is on. Would that be OK?” The child will most often say “OK” and you can begin.
Notice the words I’ve used. “Most often”. At times, the child will not give consent to be examined. Sometimes you may need to reschedule the exam until he/she is OK with it.
Please remember that the “power on-off” approach works well with two- to 12-year-olds – don’t try it with someone who is 14. You’ll be labelled as a “loser”, and totally uncool – not a good way to build trust!
OK…You are ready to begin….the cute seven-year-old is standing on the floor, in her gown, and her mother and she are waiting for your direction.
Here we go…
Please look for part 2 of “Kids First” in the July/August issue, where Dr. Ressel will continue discussing a child’s first chiropractic examination.
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