Aurélie M. Marchand, DC, in private practice in Italy, published in the Journal of Manipulative and Physiological Therapeutics in November 2015 what may be the first preliminary model of care for adjusting infants and children.1
Her paper brought attention to the amount of force that may be safe for clinicians to use in children starting at birth to age 18.
Marchand’s efforts are laudable because the extent of force safe to use when adjusting children—especially infants—is extremely important. To really be safe, however, one must precisely measure the amount of peak force used when delivering an adjustment.
At Activator Methods, we have been measuring the force parameters produced by our instruments for years. And, more recently, we have been able to produce an even more accurate testing apparatus.
Michael Liebschner, PhD, at the Bio- Innovations Laboratory at Baylor College of Medicine, built a test setup that is able to precisely measure how much force an adjusting instrument transmits into the patient.2 Prior to this, biomechanical engineers weren’t able to take the flexibility of biological tissue into consideration.
We now not only know the amount of force our instruments produce but also understand how the flexibility of tissue makes a big difference in the amount of force transmitted into the patient. This is especially important when treating the pediatric population.
Another thrust parameter Liebschner measured was the depth of thrust (also called thrust amplitude) on each setting of our instruments. Considering how lax the ligaments of an infant’s cervical spine are, this parameter is just as important as the Newtons (N) of force delivered by an adjustment. The depth of thrust of our instruments ranges from 0.5 to 3 mm.
As a practical overview, consider Marchand’s proposal and my own 50- plus years of adjusting infants and children with no adverse events. It’s evident that both the amount of force and the depth of thrust matter, which is why instrument-assisted adjustments are often preferred by many chiropractors for pediatric patients.
The age you need to be the most careful with are those from 0 to 3 months (neonates). During that period, Marchand proposes that 20 N (approx. 5 lbs.) of force is likely to be safe (and I agree, especially if you are using your hands to manually adjust).
Keeping the depth of thrust as low as possible is important, which is why an adjusting instrument is preferred for young infants.
Marchand goes on to propose that from 3 months to 2 years of age, 50 N (approx. 11 lbs.) of force is safe. From 3 to 8 years of age, 85 N (approx. 20 lbs.) of force is safe. From 8 to 18 years of age, 135 N (approx. 30 lbs.) of force is safe. She concludes her paper by noting that “more research will be needed to confirm the proposed model; thus, this research should be considered preliminary.”
Another consideration is that for pediatric patients, you want an instrument designed so that the lowest setting does not exceed 50 N, as that may cause bradycardia in infants aged 0 to 3 months. In neonates, for added safety, the doctor should dampen the force by putting a thumb between the instrument and the atlas.
If you are using your hands on neonates, there is a technique called “touch and hold.” The doctor palpates the cervical spine and touches and holds the area that is considered subluxated. This will not cause bradycardia in infants, newborn to 3 months.
I hope this gives you more confidence when adjusting the pediatric population, and consider using an instrument so you can know the force you are using.
Arlan W. Fuhr, DC, is the co- founder and CEO of Activator Methods International. A practitioner and researcher for more than 40 years, Fuhr is widely acknowledged for bringing instrument adjusting to the chiropractic profession.
1 Marchand AM. A Proposed Model With Possible Implications for Safety and Technique Adaptations for Chiropractic Spinal Manipulative Therapy for Infants and Children. J Manipulative Physiol Ther. 2015;38(9):713-26.
2 In Vitro Biomechanical Evaluation of Single Impulse and Repetitive Mechanical Shockwave Devices Utilized for Spinal Manipulative Therapy. Ann Biomed Eng. 2014;42(12):2524- 2536.