Technique Toolbox: July/August 2009

One of the biggest displays of trust that a patient can demonstrate to
her chiropractor is to entrust that doctor with the care of her child.
Chiropractic care for a pediatric patient is a “hot topic” in our
profession. Many chiropractors would love to adjust pediatric patients,
but, unfortunately, they are hesitant.

A special thank you goes to Dr. Jeanne Ohm and the ICPA for their contributions to this article.

One of the biggest displays of trust that a patient can demonstrate to her chiropractor is to entrust that doctor with the care of her child. Chiropractic care for a pediatric patient is a “hot topic” in our profession. Many chiropractors would love to adjust pediatric patients, but, unfortunately, they are hesitant. For many, this hesitation is due to the inadequate training that was provided to them. Others are hesitant due to fear of hurting the child, and others simply do not know where to begin, or how to adjust a pediatric patient.

Photo1. A 1-2-3 sequence is assessed, in which the inter-transverse spaces increase first between C0-C1 followed by C1-C2, on the opposite side of lateral flexion.

Research indicates that chiropractic care can have a positive effect on the pediatric population.^1,2 Furthermore, the literature indicates that chiropractic care is safe, effective, and necessary for children at any age.³

So, when should you adjust a pediatric patient, and how do you carry out chiropractic care on such a small person? Well, the earlier we can detect and correct subluxations in a child, the more likely we are to prevent future problems in that individual. As a way of introducing “how” to adjust a child,  I will, in this edition of Technique Toolbox,  discuss finding a commonly encountered  atlas subluxation in an infant, and I will demonstrate two methods for correction of this problem – The Infant Toggle Board, and the Sustained Contact Method.  Although this particular article will be specifically geared to adjusting infants, the two techniques that I will be presenting can be applied to toddlers and older children as well.

Before we begin, a proper infant examination must be performed, to determine if any underlying problems are present. If you are not confident in examining a pediatric patient, I highly recommend that you enrol in the courses that are provided by the ICPA. These courses will educate you on how to perform a proper infant examination, and unveil the indications and contra-indications for chiropractic care of a child. Let us assume that a proper exam has been performed, and no contra-indications exist.

Step 1 – Atlas Analysis: 1-2-3 Sequence. (See photo 1)
The doctor will palpate the transverse processes (TVP) of atlas bilaterally to ensure symmetry. Under normal circumstances, motion palpation of the inter-transverse spaces between C0, C1 and C2 should demonstrate a 1-2-3 sequence.

• Patient: supine, in pregnancy pillow.
• Doctor: at the head of the pediatric patient.
• Contact: pinky contact on the inter-transverse joints of C0-C1, then C1-C2.
• Stabilization hand: opposite parietal bone, laterally flexing head.
• Normally: A 1-2-3 sequence indicates that the inter-transverse space increases on the side opposite of lateral flexion between C0-C1 and then C1-C2.
• For example: with left lateral flexion, the space between the occiput and C1 TVPs, followed by the space between the C1 and C2 TVPs will increase on the right.
• When this phenomenon does not occur, it indicates that the atlas has subluxated.

Step 2 – Individual Palpation of the Atlas

• Patient: supine, in pregnancy pillow.
• Doctor: at the head of pediatric patient.
• Contact: pinkie contacts on bilateral TVPs of atlas.
• Analysis: palpation will reveal a prominence on one side. Detailed palpation of lateral flexion, rotation and I-S analysis reveals that the affected side is subluxated lateral, superior and slightly posterior.

Photo 2: A right atlas pediatric subluxation is corrected using the infant toggle board.

Step 3 – Correction: Infant Toggle Board (See Photo 2)

• Patient: seated on parent’s lap.
• Doctor: seated or standing on the same side of lesion.
• Infant toggle board: around parent’s neck. Positioned with infant’s ear on unaffected side, within the ear-slot of the toggle board
• Contact: pinkie contact on lateral tip of C1 TVP, on the affected side.
• LOC: L-M, S-I. Two to six ounces of pressure.

The doctor must note that the pinkie contact should be slightly posterior, because a straight lateral contact and thrust may produce discomfort. The slightly posterior contact will also assist in correcting the posterior component of the atlas subluxation.

To help the infant become familiar with the sight and sound of the toggle board, the doctor should open and close the apparatus several times in front of the infant. This will ensure that the child is accustomed to the device.

As a clinical note, infant toggle board adjustments are not recommended for a child who is suffering from an acute ear infection, simply because the noise of the drop piece mechanism will further irritate the child. When an infant has an atlas subluxation during an acute ear infection, the doctor should implement the sustained contact alternative.

Photo 3: A sustained contact method is used to correct for the atlas subluxation as an alternative to the infant toggle piece.

Step 4 – Sustained Contact Alternative (See photo 3)

• Locate the subluxated atlas as explained previously.
• Pinkie finger contact on the atlas TVP, on the affected side.
• Hold a sustained contact of two to six ounces of pressure in your line of correction.
• The contact should be maintained for approximately 15 seconds, or until a palpable glide of the atlas is achieved.
• The movement from this contact will be more of a seamless glide, rather than an osseous movement.

As you can see, chiropractic analysis and correction of a Pediatric patient is straightforward, once you obtain the knowledge to do so. As usual, I have only scratched the surface with pediatric analysis and adjustments. There are several ways to detect and correct an infant atlas subluxation, as well as subluxations in the entire infant’s spine. If you would like to learn more about adjusting the pediatric population, go to www.icpa4kids.com. Adjusting pediatric patients is the most rewarding work we can do. Helping a child out of pain, or optimizing the child’s health through chiropractic adjustments will touch your soul more than you will ever know. Don’t be hesitant, instead, educate yourself on how to adjust children, and be confident. If you would like to see a specific technique featured in a future edition of Technique Toolbox, contact me at johnminardi@hotmail.com.

Until next time . . . Adjust with confidence! •

References:

1. Vallone, SA. Pediatric chiropractic: Past, present and future. ICA Rev: NOV 2007(63:3): 51-58.
2. Prax, JC. Upper Cervical Chiropractic Care for the Pediatric Patient: A Review of Literature. J. Clin Chiro Ped. 1999 May; 4(1):257-263.
3. Schmidt M. The need for chiropractic in the care for children. JACA. 2001 Jan; 38(1):60.

Dr. John Minardi is a 2001 graduate of Canadian Memorial Chiropractic College. A  Thompson-certified practitioner and instructor, he is the creator of the Thompson Technique Seminar Series and author of The Complete Thompson Textbook – Minardi Integrated Systems. In addition to his busy lecture schedule, Dr. Minardi operates a successful private practice in Oakville, Ontario. E-mail: johnminardi@hotmail.com, or visit www.ThompsonChiropracticTechnique.com .