Pediatrics


Informed Choice in the Chiropractic Family Practice
Pediatrics
Written by Jeanne Ohm, D.C.   
Monday, 27 March 2006 02:22

icpaParents today appreciate knowledge. As practitioners working with parents, it is important that we provide resources for them to make informed choices for their families’ health and well being. Questions about pregnancy, birth options, breastfeeding, medical treatment, nutrition are just some of the concerns parents are actively seeking answers to. When we provide them with the information to answer their concerns, we are offering a valuable service toward promoting the chiropractic family wellness lifestyle.

In our office, we have an extensive lending library with many books, videos and DVD’s. Throughout the 23 years we have been in practice, many patients have commented on this wonderful resource of information not available elsewhere. True, we have to replace books more often then I would like to; however the replacement fee is small compared to the benefit I know people are getting from the materials we make available. Let’s say, just one mother avoided the Rhogam shot during pregnancy when it contained the harmful preservative thimerosal, or perhaps another chose to change birth providers and avoided a c-section or another parent choose the watch-and-wait approach for their child’s ear infections and also avoided the adverse effects of antibiotics and tubal surgery on their child—well, then the maintenance and replenishing of our library was worth every cent.

Most recently, we are sending every patient who comes in to the I.C.P.A. public website: www.icpa4kids.org. This informative site was designed to provide parents with numerous articles, research references and commentaries about the many issues parents face when making informed health care choices for their families. The “search” option allows them to access many family-related topics.

The I.C.P.A. offers “referral cards,” so doctors can hand them out in their practices and neighborhood family centers throughout their communities. There is a place on the card to personalize it with your center’s name and contact info as well. Parents in your community become aware of you as a doctor providing the resources they are looking for.

Additionally, we carry bulk copies of the I.C.P.A.’s new public magazine, Pathways. This full color magazine is beautifully laid out and gives chiropractic the professional presentation it deserves.  The thought-provoking articles in Pathways are core to providing parents with credible information supportive of the wellness lifestyle.

Become a resource center in your office and community and begin  providing parents with the information they are actively seeking. Offering parents these sought out materials establishes your credibility and defines you as the family provider respectful of their right to make choices for their families’ lives and well being.

Dr. Jeanne Ohm instructs internationally on the topic “Chiropractic Care for Pregnant Women and Children.” She is executive coordinator of the International Chiropractic Pediatric Association and can be reached via their website at www.icpa4kids.com.

 
Breastfeeding Difficulties and Chiropractic
Pediatrics
Written by Jeanne Ohm, D.C.   
Monday, 27 February 2006 01:24

breastfeedingbaby

M
odern birthing procedures—even those with seemingly minimal intervention—are known to cause trauma and stress to the infant’s cranium and spine. In Biedermann’s text, Manual Therapy in Children, author R. Sacher tells us, “When considering injuries and dysfunctions of the spine and its associated structures, the significance of birth trauma is often underestimated, and the resulting symptoms frequently misinterpreted.” In the case of difficulty breastfeeding, as with many childhood disorders, the cause of the problem often traces back to undetected biomechanical injuries to the spine and cranium at birth. The failure to recognize these biomechanical injuries and their relationship to difficulty in breastfeeding leads to incorrect conclusions and, therefore, inadequate recommendations and treatments. Without real solutions, mothers become discouraged, successful breastfeeding is not achieved and women abandon the practice out of frustration.

 

Breastfeeding is, by far, the best choice for infant feeding for numerous reasons. Significant research shows that, from a nutritional, immunological, digestive, neurological, developmental, mental, psychological and emotional standpoint, there is no replacement.  Today, more and more women are choosing the healthy, natural benefits of breastfeeding. Exclusive breastfeeding is the optimal feeding mode for an infant’s first six months of life. Many women initially plan to breastfeed for that length of time, yet fall short because of difficulties that seem to have no solution. Many of the care providers they consult are unaware of the biomechanical disorders in the infant’s spines and craniums, which cause the difficulty in breastfeeding. This lack of knowledge leads to ineffective recommendations with poor results. Unless the biomechanical cause of these difficulties is addressed, women may become frustrated and abandon their original intent to breastfeed their babies.  In these instances, it is imperative that family chiropractors offer mothers and their infants care appropriate to their needs.

Some of the most common indicators of difficulty with breastfeeding are:

• Babies who cannot latch firmly
• Babies who can latch and not sustain sucking
• Babies who are unable to smoothly coordinate suckling, swallowing and breathing
• Babies who can feed in only one position or postural
• Babies who seem dissatisfied when nursing and who remain fussy and distressed throughout the day
• Babies who chew and damage the mother’s nipples
• Babies who may not feed any better from other devices
• Babies who have the need to suck 24/7

It has been my experience of 24 years in practice that, when infants presented in our office with the above signs, once evaluated and adjusted accordingly, they responded favorably with chiropractic care. Normal function in the infant was restored and breastfeeding continued without further complications and hindrances. Providing the mother with effective solutions allows the mother and child to continue to benefit from this superior practice of bonding and feeding.

As doctors of chiropractic, it is our responsibility to inform parents about the importance of chiropractic care right from birth. Among other numerous benefits of chiropractic care for infants, the ability to successfully breastfeed has life long consequences for the baby’s future health potential. A chiropractic evaluation should be included as a standard of care for all infants. Offering care for newborns may very well be one of the most important contributions chiropractic brings to the wellness lifestyle.

Dr. Jeanne Ohm instructs internationally on the topic “Chiropractic Care for Pregnant Women and Children.” She is executive coordinator of the International Chiropractic Pediatric Association and can be reached via their website at www.icpa4kids.com.

 
"Experimental and Investigational"
Pediatrics
Written by Jeanne Ohm, D.C.   
Tuesday, 27 December 2005 00:00

Around the country, Blue Cross Blue Shield policies are denying chiropractic care for children under the age of 12. Labeling chiropractic care for children as "experimental and investigational," BC/BS is seeking to intimidate parents into believing that chiropractic care is not safe or effective for children.

Reality

Doctors of Chiropractic have been adjusting children for over 100 years. The reported incidence of malpractice with children is extremely minimal. As one chiropractic insurance claims adjuster told me, "In fifteen years, I have seen maybe five cases of malpractice involving children. Most of them had to do with the child tripping over the adjusting table or some similar type equipment related injury."

The current attempt by BC/BS to intimidate parent's right to choose is absurd, considering all of the on-going treatments their policies cover without question. Listed below are just a few current scenarios where questionable treatment protocols for our country’s children were established by conventional medicine without the sufficient documentation to substantiate their safety and efficacy. These services were accepted and covered without a blink and now current, published research studies are revealing the danger and ineffectiveness of these "approved" treatments." To add insult to injury to the consumer, these experimental treatments are still covered by insurance policies in spite of the new findings!

If your patients are faced with this apparent dichotomy in insurance policy coverage, their insurance companies need to know they are not willing to have their intelligence insulted and their right to choose denied. Change will come with consumer demand.

Unquestioned, routine procedures

The following scenarios are just a few examples where this double standard in health care coverage is revealed…

Unnecessary flu shots: Last year there was a huge push for flu shots for infants. There was no data to substantiate it. Now, a new study, published in “The Lancet”, found that flu shots don't really work in children younger than two years of age. In addition, the scientists said they "recorded no convincing evidence that vaccines can reduce mortality, hospital admissions, serious complications and community transmission of influenza" in young kids.

The interesting point to note here is that without any scientific data for efficacy, the flu shot was recommended and paid for. Interesting to note is that the flu shot, like all vaccines, is considered "preventative medicine" and frequently chiropractic care is denied because it is preventative care.

Leading Drug Company Deceives Parents: It was bad enough that the toxic substance thimerosal was ever put into vaccines without even testing its effects, however what is even worse is when it was finally exposed that it may be having adverse effects on children, a leading drug company continued to supply the infant hepatitis B vaccine, still contaminated with thimerosal, for two years after announcing that it had eliminated the toxin from the vaccine.

It was September 1999, in the midst of concerns about the risks of mercury in childhood vaccines, when Merck stated that the FDA had approved a preservative-free version of the vaccine. Despite Merck's news release that stated, "Now, Merck's infant vaccine line is free of all preservatives," the company still distributed the vaccine containing thimerosal until October 2001.

Again, it is interesting to note that in spite of the known toxicity of thimerosal and its presence in childhood vaccines, insurance companies continued to cover these contaminated vaccines without any control standards of safety for the covered vaccine.

Ritalin and Cancer Risks: The rise in the use of Ritalin in this country is frightening. In an alarming study conducted at the University of Texas, researchers have discovered that every child they tested who was taking Ritalin (methylphenidate) developed chromosomal aberrations that have been associated with an increased risk of cancer.

The researchers tested 12 children before and three months after beginning a daily Ritalin prescription for treatment of ADHD. Every child experienced an increase in genetic damage that is associated with the development of cancer after taking the drug. In the words of the authors, "In every individual examined, there was a statistically significant increase in every genotoxic endpoint analyzed… for each of the parameters tested."

While there has been significant criticism and cause for alarm in prescribing psychotropic drugs to children, rather than a decrease of use, the amount of children taking these drugs has escalated in the past few years. With all of the literature cautioning its use, how can this be? Perhaps the accessibility of Ritalin and other drugs via "health" insurance coverage may be contributing to its frightening rise? It remains to be seen whether the insurance industry will act on behalf of our children's safety and question their routine coverage for these experimental and investigational substances.

Offer Parents Support

It is through public awareness and consumer demand that double standards are eliminated. The I.C.P.A. and its national public advertising campaign is reaching the consumer in numerous ways. To become involved, please visit our site at: www.icpa4kids.com.

Dr. Jeanne Ohm instructs internationally on the topic "Chiropractic Care for Pregnant Women and Children". She is executive coordinator of the International Chiropractic Pediatric Association and can be reached via their website at www.icpa4kids.com.

 
A Glitch in the Matrix
Pediatrics
Written by Jeanne Ohm, D.C.   
Saturday, 26 November 2005 22:48

A recent paper released by the ICA Pediatric Council and written by Dr. Joan Fallon, “A matrix for chiropractic care” has many family practitioners up in arms about its validity and intent. The following is a brief response from the International Chiropractic Pediatric Association’s Research Director, Dr. Joel Alcantara. It is important to note that the International Chiropractic Pediatric Association (ICPA) is the oldest and largest pediatric organization and is separate and distinct from the ICA Pediatric Council.

The chiropractic care of children has been an integral part of the practice of chiropractic since its inception. However, only relatively recently has pediatric chiropractic been considered a new specialty as highlighted by textbooks, specialized post-graduate programs as those offered by the International Chiropractic Pediatric Association and the publication of a peer-reviewed journal specifically addressing the needs of children. A recent article by Fallon1 published in the Journal of Clinical Chiropractic Pediatric provides a “matrix for chiropractic care” of children. It is important to note that Fallon is associated with the ICA Pediatric Council, which is not affiliated with the International Chiropractic Pediatric Association.

The matrix provides for seven categories of care with specified treatment frequencies. The following is a short critical appraisal of her article.

Similar to all healthcare providers, chiropractors face various clinical decisions to provide the most appropriate care. No more in this true than in the practice of pediatric chiropractic. How much care should children receive? What is too much? What is not enough? What are the limits and what are the needs? What frequency of care should one recommend to parents? Why does the child need care? Such challenging questions give rise to clinical guidelines and as defined by the Institute of Medicine,1 they are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.”

Clinical guidelines have the potential benefit of improving health outcomes in patients and improve the quality/appropriateness of clinical decisions. On the other hand, clinical guidelines have limitations and have potential harms. Herein lies the critique of Fallon’s matrix of care for children. Like Fallon’s matrix of care, guidelines may be wrong. For one, although the scientific inquiry on the chiropractic care of children is in its infancy, a number of research endeavors have been published in scientific journals.  Fallon’s review of the literature to support her matrix of care is lacking, misinterpreted and ultimately, misleading.  Secondly, clinical guidelines are rigorously developed by experts in the field. From what could be discerned, her matrix of care is more of an opinion-piece presumably based on her clinical experience. Fallon’s matrix of care has no clinical rationale from a chiropractic perspective. The categories of care are whimsical and have no clinical precedent from which to provide an authority or judgement with respect to treatment frequencies. They do not take into account the detection and correction of spinal and extra-spinal subluxations. Rather they focus on condition-based care from which treatment frequencies are arbitrarily assigned rather than a rigorous review of all the available literature. Ultimately, Fallon’s matrix provides for suboptimal, ineffective and potentially harmful chiropractic care.

As for the publication of Fallon’s article in the Journal of Clinical Chiropractic Pediatric, I question the peer-review process. It is obvious that peer-review was lacking in this case as exemplified by the inclusion of something as simple as “a fall” being denoted as a condition of care. The peer-reviewers should have weighed the harm versus the benefits that such a poorly written article may have on the practice of pediatric chiropractic.

References

1. Field MJ, Lohr KN, eds. Clinical practice guidelines: directions for a new program. Washington, DC: National Academy Press, 1990.

Dr. Jeanne Ohm instructs internationally on the topic "Chiropractic Care for Pregnant Women and Children". She is executive coordinator of the International Chiropractic Pediatric Association and can be reached via their website at www.icpa4kids.com.

 

 
Post Partum Postural Considerations
Pediatrics
Written by Jeanne Ohm, D.C.   
Wednesday, 26 October 2005 22:06

Part One: For the Mother

We can certainly see the need for regular chiropractic care throughout pregnancy—the varied postural distortions with weight gain and an increase in the hormone relaxin bring many mothers-to-be into our offices seeking help for these normal and often uncomfortable adaptations. It is within our scope of practice to assist the mother post partum in regaining spinal stability with the chiropractic adjustment and recommendations for postural positions she will encounter with her new baby.

Carrying the new baby

The first consideration is carrying the baby. Because all the parents are using car seats these days, they have resorted to using these seats as carriers as well. Almos all parents will leave the child in the car seat to carry the baby into the office, store, house, etc. When parents come into your office carrying their child in on eof these carriers, point out the i8mbalances these are causing them by side carrying this heavy load. This constant repetitive distortion of the parent's spine can adversely affect the spine. Usually, the parents carry the infant to one side, causing increased stress to their spinal structures. As a doctor of chiropractic, you will find neck strains, upper thoracic tension and sacral distortions associated with incorrect or repetitive baby carrying.

To help avoid these common discomforts, I suggest to the mother that the car seat is for the car and that they use alternate types of carriers to transport their babies outside of the car. One option is the age-old method of simply carrying the baby in one's arms.  Although most practical and easiest to implement, many mothers will tell you that they  have a tendency to carry their babies on one side or the other because it is simply more comfortable that way. To avoid this one-sided propensity, I offer the options of "body carriers" or "baby wearing". These include a wide variety of carriers: wraps, slings,  pouches, front holders, side holders, back carriers. Whereas most offer numerous benefits to the mother—baby weight balancing, free hands, and slow and consistent adaptation to the baby's weight gain—there still remains the consideration that each individual carrier places the baby in one particular position on the mother and, therefore, has the potential of cumulative repetitive stress on the mother's spine and nervous system. With this important insight in minde, I offer parents the knowledge of various baby carriers available and that they purchase serveral variations of carriers to accomodate their child's needs to be held as often as possible.

Breastfeeding postures

Another source of spinal stress in the new mother is compromised breastfeeding postures. In addition to lying down with the baby, the most common posture for breastfeeding is in the mother's arms with a tendency to slump forward. This distorted posture for the mother may cause upper thoracic sprain/strain, cervical and lumbar stiffness and resulting curve compensations for all areas. The best solution to avoid these repetitive postural distortions is to advise the mother to purchase a breastfeeding support pillow and use it as often as possible.

To find out more about choosing carriers and breastfeeding support pillows, visit www.icpa4kids.org/research/children/babywearing.htm.

Dr. Jeanne Ohm instructs internationally on the topic "Chiropractic Care for Pregnant Women and Children" She is executive coordinatior of the International Chiropractic Pediatric Association and can be reached via their website at www.icpa4kids.com.

 
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