Treating injured pediatric patients with instrument adjusting

Given the growing number of baby boomers and early Gen Xers who are living longer, there is certainly increased interest in chiropractic care for geriatric patients.¹ However, if we are considering the benefits of chiropractic care for geriatric patients, we must also remember those at the other end of the spectrum—pediatric patients. Parents are increasingly seeking chiropractic care for their children.² 

Of course, in the case of injured pediatric patients (particularly infants and toddlers), extra care must be taken when performing an instrument adjustment.

Preparing the pediatric patient for an adjustment

Aside from the obvious need to take care with any injured patient, there are some specific considerations that must be made when adjusting children. While older teens can, in almost all cases, be treated similarly as to young adults, younger children, particularly infants and toddlers, are smaller and still growing. In their 1997 paper, Plaugher and Alcantara suggest when preparing for juvenile adjustments, “consider some force modification, table positioning, and clinician contact points.”³

If the patient is verbal, explain the procedure to the child to prepare them for the adjustment. DCs don’t have this luxury with a pre-verbal child who may already be tense and upset due to pain from the injury. In their 1997 paper, Plaugher and Alcantara suggest that some spinal adjustments, particularly to the atlas, can be done with the child on a parent’s lap, which may help reduce anxiety and relax muscles for a safe adjustment.³

Conversely, older children can be shown the adjusting instrument and how it works. The DC may even consider performing a quick adjustment on the parent, under the notion that if it is safe for mommy or daddy, then it will be safe for the child.³

Considerations of instrument adjusting for injured children

It goes without saying that less force must be applied to injured children as compared to adults. Given this, an instrument assisted adjustment can provide the same amount of pressure on the joints that is necessary, but with less force.³ The benefits for infants and toddlers from instrument adjusting in this regard should be self-evident. An instrument assisted adjustment can help young patients heal without running the risk of further injury due to excessive force used during the adjustment.

Another consideration is that of the size of the pediatric vertebrae. Points of contact for younger pediatric patients must be very specific, lest hypermobility be introduced into the surrounding vertebrae.³

While it may be possible for a DC with very small hands and thin fingers to accomplish this manually, it can be all but impossible for DCs with larger hands. Again, an adjusting instrument is well suited to compensate for this because it already has a very small point of contact for the affected joints. This will remove the possibility of making the injury worse by lessening the stability of surrounding joints.

Calm before treatment

An injured child, particularly one who is not old enough to verbally communicate, will likely be very scared and anxious, not only due to pain but also due to not understanding how chiropractic care works. A few extra minutes to calm a child, combined with instrument assisted adjustments may not remove all of the fear, but it will go a long way toward helping the child heal from injuries.

References

¹ Dougherty PE, Hawk C, Weiner DK, et al. The role of chiropractic care in older adults. Chiropr Man Therap. 2012;20:3.

² American Chiropractic Association. Increasing number of children receive pediatric chiropractic care. Published January 2009. Accessed July 2015.

³ Plaugher G, Alcantara J. Adjusting the pediatric spine. Topics in Clinical Chiropractic 1997;4(4):59–69.