Bringing Pediatric Care Into Your Practice
By Ramon G. McLeod, Editor-in-Chief
The statistics say it all: More than 2 million children received "manipulative or body-based therapies" by chiropractors or osteopaths in 2007, according to the National Center for Health Statistics.1 Yet, as impressive as these numbers are, they are well below what they could be, according to Dr. Jeanne Ohm, Executive Coordinator coordinator for the International Chiropractic Pediatric Association.
"There is the huge void, an unmet need," she said. "Some of it has to do with practitioners' habits and the fact that they simply haven't worked with kids before, [which causes] some doctors to hesitate. And there are some differences in treating children."
"For example, with an adult you can expect very direct responses to your treatment ... We're used to that and expect it," she said. "Communication with a child, particularly young ones, can be somewhat different. When palpating a 6-year-old, you will get some response, but you have to listen very carefully because they won't be able to articulate like an adult, obviously. With newborns and infants, you have to be ready to be very sensitive to their physical reactions. But this is something most doctors are extremely capable of ... it's not a terribly difficult skill to learn."
Meet the Parents
The federal report found that the overwhelming majority of children treated with "manipulative therapies" have parents who are familiar with and have used complementary and alternative health care. But if you want a viable practice that includes pediatric care, don't assume for a moment that parents, including existing patients, are sold on bringing their children in as well.
The obvious first step is to educate the parents, including those with experience with chiropractic, that the purpose of all chiropractic procedures is to reduce interference to the nervous system, Ohm said.
Dr. Elise Hewitt, president of the American Chiropractic Association's (ACA) Pediatrics Council, gave an example of how she connects the dots for parents between nervous system interference and feeding issues, which is a common problem in the infants she sees:
"As one example of the kind of conversation I'll have, I will explain to the parents that if the joints in the cranium get locked up, which can happen during traumatic birth, this can irritate the nervous system," she said. "If the nerves to the tongue are irritated, the baby can't suck properly because there is a communication problem between the brain and tongue. ... And so I explain that by relieving that irritation, we can improve the child's sucking reflex. Most of the time that seems to make sense to people."
The bottom line, according to Hewitt, is to keep explanations of your diagnosis simple but accurate.
Pain and Safety
Parents, including those with experience receiving chiropractic care, will ask you about treatment pain and the safety of pediatric chiropractic, Hewitt said.
"I think the best way to explain is to show them what you will do. The treatment itself is very gentle, quite different than an adult would receive. ... I give a little gentle push with my thumb ... and I'll show them, demonstrate it on them, so they can feel how gentle it really is and so they'll know what an adjustment will feel like," she said.
Ohm said that one recent study on pediatric chiropractic found just a handful of instances in which the child experienced discomfort.2 "And all of the parents continued care," she added.
Hewitt said that one of the most gratifying aspects of pediatric care is that children, including infants, can respond very quickly to chiropractic care. "For babies with nursing issues, they'll get better pretty quickly. We'll usually go with treatments twice a week for a week or two, then once a week for a week or two, and then generally we're done."
Hewitt said that chiropractic treatment can be very effective for infants with classic problems such as feeding issues, constipation, sleep issues, colic and general irritability. These are exactly the kind of common problems that can drive parents crazy. In toddlers, chiropractic care has been found effective for treating another very common problem: chronic ear infections. "What happens is that the middle ear is supposed to drain into the Eustachian tube, but if there is interference in the nervous system, the muscle that controls that can spasm, and if it spasms it can't drain the fluid," Hewitt explained. "Typically, a pediatrician will use antibiotics to kill the virus, but that doesn't get to what is causing the problem in the first place ... the fluid still can't get out. And if you think about it, getting to the real cause, not just the symptom, is what chiropractic is truly about."
Both Ohm and Hewitt said that doctors who want to extend their care to children should get additional training before adding children, particularly infants, to their practice. A great way to start, Hewitt said, is to team up with a doctor who is already working with kids to find out if this type of practice meshes well with your personal style.
There are also numerous training programs available through the ICPA (http://icpa4kids.com/contact.htm) and the International Chiropractors Association Council on Chiropractic Pediatrics (www.icapediatrics.com), which sponsors a Diplomate in Clinical Chiropractic Pediatrics (DICCP). This is a board-certified credential in pediatrics for doctors of chiropractic. Check your local state association for training opportunities as well.
Elise G. Hewitt, DC, CST, DICCP, is board-certified in chiropractic pediatrics. She practices in Portland, OR and has written extensively on chiropractic care and children.
Jeanne Ohm, DC, is certified in the Principles and Practices of Chiropractic Pediatrics and is an instructor in ICPA's pediatrics diplomate program. She practices in Pennsylvania.