The purpose of this paper is to familiarize the reader with the science and philosophy of pediatric chiropractic care, while detailing what conditions may improve under chiropractic care and how to recognize those infants who may benefit from such care. Chiropractic treatment will be discussed, including specific techniques employed by the chiropractor.
'Kevin' was four weeks old when first seen by his chiropractor. He came accompanied by his mother and her lactation consultant. He had been unable to latch onto the breast, despite four weeks of diligent effort, which included finger-feeding, cup-feeding and the use of a nipple shield, an SNS apparatus and a Habermann bottle. On examination, the infant was found to have joint restrictions in his spine and cranium that were corrected using chiropractic manipulative therapy and craniosacral therapy. Immediately following the chiropractic adjustments, Kevin latched onto his mother's breast and nursed for thirty minutes. He received two follow-up visits over the next two weeks and went on to nurse successfully for a full year.
CHIROPRACTIC SCIENCE/ PHILOSOPHY
Chiropractic care is poorly understood since it differs in theory from conventional (or allopathic) medicine. Chiropractic is based on the construct that physiological dysfunction may be secondary to restriction in the joints of the spine and/or cranium, which may disrupt optimal nervous system function. This altered neurological input results in dysfunction at the nerve's end organ, creating symptoms and disease. By correcting the structural joint dysfunction, the chiropractor seeks to normalize function of both the nervous system and its end organs (Anrig and Plaugher 1998).
This joint dysfunction has been named the Vertebral Cranial Subluxation Complex (VCSC). A subluxation is defined as '...a motion segment in which alignment, movement integrity, and/or physiological function are altered although contact between joint surfaces remains intact' (Gatterman 1995). A motion segment is 'a functional unit made up of the two adjacent articulating surfaces and the connecting tissues binding them to each other' (Gatterman 1995).
A VCSC may lead to symptoms and disease by creating kinesiopathophysiology, myopathophysiology, neuropathophysiology, histopathophysiology, and/or pathophysiology. In other words, a subluxation may negatively impact segmental motion, as well as related muscle, nerve, and cellular functions. Pathophysiology refers to the long-term impact of these altered functions on the structural tissues of the affected motion segment. When neurological and cellular functions are altered, disease may result.
CONDITIONS THAT RESPOND TO CHIROPRACTIC CARE
Because the nervous system is integral to all body systems, a subluxation can create a wide range of symptoms and dysfunction. Subluxations in the upper cervical spine or posterior cranium may interfere with the function of the hypoglossal nerve (CN XII), as in the case example of Kevin. The resultant abnormal tongue motion gives rise to dysfunctional nursing (Hewitt 1999). Similarly, the vagus nerve (CN X) provides motor and sensory control to the digestive tract. Hence, dysfunction in this nerve secondary to a subluxation can create gastric reflux or chronic constipation, or can negatively impact nutrient absorption, contributing to failure to thrive.
Colic, hyperirritability and poor sleep may also be secondary to a VCSC. Both cervical and cranial subluxations have been shown to create headaches (Nilsson and Christensen 1997); Lord and Barnsley 1996; Haldeman 1995). Irritability, an inability to fall into a deep sleep, and the need for constant comfort may be signs of an infant with a severe headache. One uncontrolled prospective study of 316 infants with colic treated in fifty chiropractic offices throughout Denmark showed a 94% resolution of colic following an average of three chiropractic treatments over a two-week period (Klougart, Nilsson and Jacobsen 1989).
The sternocleidomastoid muscle (scm) receives its nerve supply from the second cervical nerve. Functional interference with this nerve secondary to an upper cervical subluxation may cause hypertonicity of the scm muscle, resulting in congenital torticollis. Chronic otitis media can follow a VCSC when the joint dysfunction disrupts the trigeminal nerve (CN V) that supplies motor control to the tensor veli palatini muscle surrounding the eustachian tube. The resultant eustachian tube occlusion may result in fluid retention in the middle ear with subsequent pathogenic invasion (Fallon 1997).
In general, correction of the offending subluxation restores optimal neurological function, thereby restoring a newborn's ability to nurse or to absorb nutrients, and resolving the infant's reflux, constipation, colic, torticollis, or chronic otitis media.
CAUSES OF A SUBLUXATION
In general, neonates acquire a VCSC in one of two ways: either from in utero malposition or from birth trauma. Any abnormal in utero position (such as occiput posterior), presentation (such as breech) or lie (such as transverse), or the presence of multiple fetuses, may put excess stress on the elements of the fetal spine or cranium. Such excess stress may create a spinal or cranial subluxation in the fetus.
Birth trauma is the other etiological factor in the formation of neonatal subluxations. Babies are designed to pass through the birth canal in the occiput anterior position with the head flexed to protect the cervical spine and the occiput leading to protect the cranium. This position minimizes the risk of trauma. Any deviation from this position may put the fetus at increased risk of subluxation formation. Additionally, both a prolonged and a precipitous labor can lead to trauma to the vertebrae and cranial bones. The increased stress during a prolonged labor is obvious. Less obvious is the precipitous birth, in which the fetus lacks time to adapt to the tremendous forces within the birth canal. In either case, this increased stress can create a VCSC. Finally, an assisted delivery, whether with forceps or vacuum extraction or a cesarean section, also increases the chance of subluxation formation. These tools should not be abolished; rather, following their use, a thorough chiropractic examination should be done to detect and correct any resultant subluxations.
A chiropractor uses the physiological effects of a subluxation to detect its presence. Decreased segmental motion, focal muscle hypertonicity, local erythema and hypersensitivity to touch are all indicators of a subluxated segment.
A chiropractor employs two main techniques to treat an infant with a VCSC. Chiropractic manipulative therapy (CMT) uses a high-velocity, low-amplitude thrust to affect the motion and/or position of the affected spinal segments. CMT restores normal neurophysiology to the motion segment, eliminating the abnormal nerve, muscle and cellular changes associated with the subluxation. The technique is similar to CMT used for adults, though it differs in that the delivery involves a reduction both in force and amplitude combined with an increase in velocity.
The second technique, craniosacral therapy (CST), employs a low-velocity, low-amplitude thrust to restore motion to the cranial bones and their related soft tissues. This technique involves the application of five grams of force or less to the affected cranial bones. Because of the gentle forces involved, a sleeping infant will often remain asleep throughout the application of this technique.
RECOGNIZING THE INFANT WITH A SUBLUXATION
Clues to identifying a newborn who may have a subluxation reside in both the neonatal history and examination. Such clues include a history of prolonged or precipitous labor, breech presentation, assisted delivery, or multiple fetuses. Nursing dysfunction, colic or irritability, constipation, hypersensitivity to light or sound, poor sleep, failure to thrive, or gastric reflux may also indicate the presence of a VCSC.
During examination, the occurrence of a hyperactive moro reflex, hypersensitive gag reflex, weak suck reflex, irritated maternal nipples, or abnormal head posture may all represent physiological alterations secondary to a subluxation. Infants with any of these indicators in the history or examination should be evaluated by a chiropractor.
Chiropractic care, complementary to the allopathic care already provided most infants, addresses symptoms and dysfunction by correcting joint restrictions in the infant's spine and cranium, thereby normalizing function of both the nervous system and its end organs. As in the case example of Kevin, chiropractic provides an effective form of health care that not only addresses immediate health needs, but contributes to the long-term well-being of newborns and their families.
Anrig, C., G. Plaugher, editors. 1998. Pediatric Chiropractic. Philadelphia: Williams & Wilkins.
Fallon, J. 1997. The role of the chiropractic adjustment in the care and treatment of 332 children with otitis media. Journal of Clinical Chiropractic Pediatrics 2, no. 2: 167-183.
Gatterman, M. 1995. Foundations of Chiropractic: Subluxation, p. 475. Portland: Mosby.
Gatterman, M. Foundations, p. 474.
Haldeman, S. 1995. Point of view. Spine 20, no. 23: 2586.
Hewitt, E. G. 1999. Chiropractic care for infants with dysfunctional nursing: A case series. Journal of Clinical Chiropractic Pediatrics 4, no. 1: 245-247.
Klougart, N., N. Nilsson, J. Jacobsen. 1989. Infantile colic treated by chiropractors: A prospective study of 316 cases. journal of Manipulative and Physiological Therapeutics 12, no. 4: 281-8.
Lord, S. M., L. Barnsley, et al. 1996. Chronic zygapophyseal joint pain after whiplash: A placebo-controlled prevalence study. Spine 21, no. 15: 1737-45.
Nilsson, N, H. W. Christensen, et al. 1997. The effects of spinal manipulation in the treatment of cervicogenic headache. Journal of Manipulative and Physiological Therapeutics 20, no. 5: 326-30.
* Elise Hewitt is a board-certified pediatric chiropractor and craniosacral therapist who has been practicing in Portland, Oregon, since 1988. She has published papers and lectures around the country on the applications of chiropractic care and craniosacral therapy for children.