Introduction to Management of Children

Question 1

Describe the common musculoskeletal complaints in paediatric primary care and their epidemiology.

Answer 1

Conditions commonly seen in a chiropractic paediatric practice include:
- Low back pain:
- Thoracic spine pain:
- Scheuermann’s disease: majority of a 13% abnormality findings for 14 year old school children had these changes.
- Neck pain:
- Scoliosis:
- Headache:

Question 2

Spinal Pain in Children/Adolescents epidemiology

Answer 2

• 3-4/10 have LBP.
• 1/3-1/2 have pain persisting >3mths affecting daily tasks
• Prevalence increases with age

Question 3

Radiographic findings with back pain in Children/Adolescents

Answer 3

• No link between imaging and LBP
• Scheuermann’s changes have been seen, but unable to distinguish between LBP and non-LBP

Question 4

Safety of chiropractic for children

Answer 4

• No paediatric deaths from manual therapy alone
• MSK treatment shows little risk of harm
• Underlying pre-existing pathology has been associated with 3 recorded deaths, none of which were from chiropractic treatment

Question 5

Reported Concerns

Answer 5

• Cervical manipulation: A case of quadriplegia, child had spinal cord astrocytoma
• Repeated radiographic examinations
• Paediatrician concern delay or prevent appropriate medical diagnosis and treatment

Question 6

Allowing chiropractic for children

Answer 6

• There is controversy
• Scope of complaints differs for each age, and management strategy will have to be adapted for the individual, but this is not specific for children.
• When treating children MSK disorders there is no controversy that exists

Question 7

Murdoch Stance on paediatric care

Answer 7

• Taught to exam infants-teenagers to appropriately manage and co-manage or refer
• Multi-modal practitioner: Taught tools available for MSK which are safe and evidence based
• Selected neurological disorders are introduced for evaluation of unsettled child but not management
• Safe/EB approach, effective and supports continued learning in student clinic

Question 8

Condition parameters for murdoch and treating children

Answer 8

Only MSK can be treated at Murdoch
- Advice given on potential non-MSK conditions such as colic, asthma, bed wetting, and otitis media
- Best available evidence is inconclusive or doesn’t support manual therapy for treatment of non-MSK conditions, therefore advice should only occur after consultation and written approval from respective medial practitioner
- AGE: No HVLA techniques utilised for under 6. No cervical under 12.
- Treatment: Mobilisations of cervical, thoracic, lumbar/pelvic and extremities, soft tissue therapy, stretching and advise