Wellness Care For Children

By Maxine McMullen, D.C.
Credit: Streams From The Fountainhead (Pages 19-21)

“Children are not merely “little people.” They are dynamic, ever-changing beings that are in a constant state of adapting to new environments as their immature nervous systems develop billions of new pathways.”

During the first eight years of their existence, they are literally “programming” their brains with trillions of pieces of information that will allow them to function at their optimum potential.

As individuals who know and understand the importance of a subluxation-free state to enable this process to proceed as efficiently as possible, we need to be monitoring these individuals from pregnancy through adolescence to ensure that it does!

Checking For Subluxations

This is a relatively easy task for those of us who have obtained a chiropractic degree. The same tools available to check an adult may be utilized, including but not limited to, instrumentation, palpation, and X-rays.

It is also important to listen to the story related to you by the child’s parents. Discussion with the mother or father may reveal events that the child has encountered that may have led to the creation of a specific lesion (subluxation), such as intrauterine constraint (pelvis), breech presentation (sacrum) or forceps delivery (double AS occiput). Physical evaluations further appraise neurological development and occasionally indicate areas of probable subluxation (e.g., C5-6 with Erb’s palsy).

Adjusting Regimen

The choice of technique is an extremely personal one. They all appear to have merit when accurately applied. What we may need to modify is the contact point (to ensure that it is as specific as possible), and the amount of force required to achieve our goal. Newborns, with their immature muscle control and the still-present effects of maternal hormones, need only a few ounces of pressure to accomplish the task, while the speed of the thrust is of essence when dealing with the wiggling toddler. Once children get accustomed to the routine of an office, they are generally quite malleable and frequently scramble onto the adjusting table well before being invited. Immature infants or extremely sick children are often best left in the arms of their caregiver. There is no “magic” in the equipment. As children generally have an insatiable appetite for new experiences, varying techniques slightly and utilizing sensory distracters (such as hand puppets) keeps them interested and more relaxed during their procedures.

Frequency of Care

There are two major influences in this equation: Where the child falls within the health care paradigm (i.e., acute, prevention or wellness care) and the age of the child.

Acute care is when the child presents with a specific problem that needs to be immediately addressed. The “symptom-oriented” state may well be the reason for the parents making the initial contact with your office. Because there was some reason that this child got subluxated in the first place, one needs to assess the probable time frame that this lesion has been in existence and how serious the child’s present state is in order to create a reasonable care plan.

Long-standing problems take a little longer to reverse as the developing brain has probably programmed misinformation into its data banks, while short-term lesions may remiss within one or two adjustments. This frequently depends on the age of the child.

It is of primary importance that the chiropractor understand that the symptoms are generally the last thing to manifest and the first thing to remiss, or they will abandon the care program once the symptoms have improved while the underlying lesion has not yet been completely addressed. Children in this group may need to be checked on a once or twice daily basis for a week (or less) and then moved into one of the next two groups, depending on the initial evaluation, overall health status and age of the child.

Preventative/maintenance care usually includes chronically ill children who have difficulty maintaining an adjustment due to their environmental status, or those with special needs (e.g., Down’s syndrome, cerebral palsy or scoliosis). This phase of care requires less frequent visits, buy more “educational” time as we endeavor to remove the offending stressors and reverse any previously encounter problems. In this group, teaching the parents about the importance of a healthy lifestyle (e.g., proper diet, exercise and rest) are frequently required, along with paraprofessional support in those cases where special needs exist.

Generally speaking, when moving from intensive, acute-type care wherein the child is seen frequently (even twice daily in the first week to twice weekly for two to three weeks), the child may now be seen once a week. I emphasize that “seen” does not mean adjusted once a week. Once the child holds the adjustment for three weeks to a month, every other-week visits can be arranged for a two-month period of time. Once the patient is clear of nerve interference we move to a wellness profile of care for the patient.

Wellness care includes all asymptomatic children that are being monitored to ensure that their nervous system is free to develop to its greatest potential. Children in this group are commonly in a family system that is cognizant of maintaining a healthy lifestyle. The frequency of care varies only with age factors and acute incidents that may occur.

Active, athletic children and those in gymnastics, ballet, and contact sports often need to be checked twice a month or more. Parents are advised to have their children checked after games in all sports such as football and rugby. For the average child, however, a once-a-month visit to the chiropractor is adequate.

The First Years of Life

At birth the average newborn weighs around seven pounds, at six months they will double that and by 12 months their weight should be at least triple their birth-weight! The average newborn is approximately 20 inches long; by 12 months it will have increased its growth by at least 50 percent of that length. The newborn brain weights approximately 350 grams, and by the end of the first year it will triple its weight to over 1,000 grams. This is due to the incredible increase in the number and size of cells, formation of branches and connections, insulation with myelin and massive glial cell increase. At no other time in our existence will our growth ever be this accelerated again!

The nervous system is constantly absorbing, storing, and analyzing every event and experience. A single neuron may make 6,000 to 20,000 connections with other neurons in various parts of the brain. The number of these synapses appears to be more important to the emotional and intellectual quotient than the total number of neurons created.

During the first year the brain demands 60 percent of the total energy absorbed and 50 percent of those calories must come from fat (EFA). At rest, the brain uses 20 percent of all the oxygen in the blood and in excess of 25 percent of the available glucose. This is a major reason why all mothers should be encouraged to breast-feed, as breast milk is the only “whole” nutrient that meets all of these needs completely.

During the first few months the primitive, protective reflexes are dominant as the pons and homolateral functions develop. This process is also enhanced by breast feeding. As the central and peripheral systems integrate, the infant will begin to lose these automatisms and deep tendon responses become remarkable.

From six to 12 months midbrain organization is reinforced by quadruped activity as the infant begins to crawl. Binaural and binocular maturation, along with improved hand- eye coordination occurs in concert with this activity, and stabilization of the secondary spinal curves is also dependent on adequate utilization of quadruped motion. Biped activity should not be encouraged until well after the 10th month of age. It should be noted that ossification of the femur head does not occur until approximately 12 months of age and thus should also be protected from early exposure of the excessive gravitational forces created when assuming a biped posture.

With all of these amazing feats occurring during the first year, careful monitoring of the structure and development by a trained chiropractor should occur at least once every four weeks even though there may not be outward manifestation of dis-ease. Incoming information from the child’s own system, especially proprioceptive data, needs to be precise. Inaccurate feedback from subluxated areas will become the “norm,” making all subsequent information pertinent to it “false.” For this reason alone we should ensure that all newborns are evaluated as soon after birth as possible. (“As the twig is bent, so grows the tree.”) It also gives some degree of reason as to why we are inclined to resubluxate at the same level of the spine even after an apparent correction has been made.

Second Through Fifth Year

The infant brain continues to constantly grow, reorganize and renew its “wiring” in an attempt to adapt to new conditions and the flood of incoming data through the first three years. During this time early cortical function and organization is predominant, biped motion is perfected and bilateral integration continues. At age three the brain begins to develop cortical hemispheric dominance, beginning with the hand then followed by the eye, foot and ear. Between ages three and five children “lose” brain cells that are not being used, thus the importance of healthy, continuous stimulus prior to entering school and receiving a “formal” education.

Overall physical growth has slowed down significantly and will continue to decelerate in comparison to the first few months and years until they reach the “pubertal growth spurt.” Maintaining a monthly “watchful eye” on spinal development and nervous system function through this era is reasonable. If no adjustment is required, that gives reason to celebrate and keeps parents satisfied that they are “on the right track” regarding their parenting responsibilities. Each child is an individual and responds uniquely to the challenges of his or her daily environment.

School-Age Children

By age six most children have acquired all of their gross motor skills and high percentage of their fine motor development. This era is a time for perfecting them and developing “higher centers” of psychosocial skills and integration. At this time the frequency of visits may be reduced to around six times per year for the children who appear to be maintaining their adjustments for reasonable intervals. Children exposed to stressors such as problems with school or family dynamics, increased physical challenges of contact sport activities, or toxic environmental exposure will most likely require more frequent evaluations.

It is important to remember that pain is usually one of the last symptoms to manifest as a spinal complain in early childhood. The degenerative changes noted in the adult spine have generally taken at least 10 years to become evident on radiographic study and are frequently the result of unresolved insults that occurred during childhood. Structure and function of the spine and the nervous system it protects are uniquely and exquisitely interrelated. By closely monitoring them for any lesion (namely the ubiquitous subluxation) we can prevent many problems from manifesting, but more importantly allow children to reach their greatest possible potential as human beings.

The cost of preventative health care is a few hundred dollars a year.

The cost of well-being? PRICELESS!

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