Numera finns det inga restriktioner för en Leg. Kiropraktor att behandla barn, men man ska välja en Kiropraktor som har utbildat sig utomlands och studerat vidare i området (Pediatrics). Rektorn av den Svenska Kiropraktor skolan har nu uttalat sig i bohusläns tidningen (Nov, 2019). Hon är tydlig med att kiropraktorer utbildade i Sverige har ingen utbildning eller kompetens att behandla barn under 12 år. Därför avråder hon Svenska utbildade kiropraktorer starkt att ta mot barn.
I Sverige, har Sue Weber den längsta högskola utbildningen (utomlands) och mest erfarenhet när det gäller undersökning, diagnostik (vad är problemet) samt behandling av barn. Hon undervisar andra kiropraktorer i undersökning och behandling av barn. Välkomna!
Den nyaste forskning visar tydlig att kiropraktisk behandling av spädbarn minskar antal timmar av gråtande, är mycket säkert och att föräldrar är mycket nöjda (99.7%). Det visar sig att kiropraktisk behandling har bättre effekt än akupunktur. Rapporten nu avråder akupunktur på spädbarn. (An overview of systematic reviews of complementary and alternative therapies for infantile colic, Perry, 2019).
Det finns bevis att barn som gråter mycket och samtidigt har problem med ryggens leder kan behandlas effektivt med kiropraktik (många har fått diagnosen spädbarns kolik). Behandlingen är anpassad för barnens ålder och är mjuk och försiktig. Spädbarns behandling hos en Kiropraktor är vanlig i många länder och har visat sig vara ofarlig samt 97% av föräldrarna var mycket nöjda med behandlingen. Bieffekterna har studerats och det vanligaste är att barnet sover bättre. Lä mera på följande länken. Colic (kolik) and Chiropractic
Hur får ett spädbarn problem med nacke eller rygg?
Att förlösas med instrument, sugklocka eller tång, att dras
ut eller tryckas ut ovanifrån är andra vanliga orsaker till varför barnet kan må mindre bra efter födseln. En onormal kroppsställning hos det nyfödda barnet kan reflektera hur barnet legat i livmodern eller en traumatisk födsel. Dessa barn har ofta en böjd presentation (favorit sida) i nacken och eller kroppen efter födseln. Alla dessa olika scenarier kan leda till en stor belastning på nacken, kraniet och/eller ryggen samt kan orsaka besvär för barnet. De tre första veckorna efter födseln har barnet normalt en hopkrupen hållning, fosterställning (från livmodern). Barnet ska inte ha en favorit hållning efter tre veckor. Andra tecken kan vara att barnet sover inte djup, vill inte ligga ner själv och måste bäras hela tiden, barnet är ofta känslig för beröring kring nacken, den är svårt att trösta och kan även drar/river sig i ansiktet eller huvudet. En del barn som inte mår bra har ett enormt behov av att suga.
Varför skall ett spädbarn behandlas av en kiropraktor?
Det finns flera orsaker till att ett spädbarn kan behöva kiropraktisk vård. Den mekaniska belastningen vid en normal födsel leder vanligtvis inte till några problem. Om förlossningen är ovanligt lång eller alldeles för snabb eller om fostret har en mindre fördelaktig position vid förlossning (ansiktet först till exempel) kan det uppstå en överbelastning av nacken hos spädbarnet. Särskilt stora barn eller tvillingar kan ha haft det trångt i livmodern under den sista delen av graviditeten. Det kan innebära att fostret kan ha legat i en sned ställning under en period utan att kunna röra sig fritt. Barn som ligger i sätes en längre tid får enormt tryck på huvudet och ofta har ont. Detta kan skapa ett tillstånd som kan liknas vid nackspärr. När barnet har smärta under en längre tid kan hjärnan tolka andra intryck, till exempel beröring, som smärta. Detta överkänslighet eller misstolkning av vad som är smärta har man med sig om inte man får hjälp.
Behandling i ett tidigt skede ökar livskvaliteten för hela familjen och ger barnet bästa förutsättning att nå sin optimala kapacitet. Forskning har visat att de mjukare teknikerna är ofarliga för barn.
Hur behandlar man små barn?
Man använder inte samma behandlingstekniker för spädbarn som används för vuxna. De tekniker som används för spädbarn är ”touch and hold” och kranial-sakral terapi (craniosacral therapy). Behandlings tekniken är anpassad för ålder och utveckling, men är överlag mycket mjuka. De flesta fall behöver mellan 3-6 behandlingar beroende på vad problemet är och hur länge barnet har haft problemet. Behandling i ett tidigt skede ökar livskvaliteten för hela familjen och ger barnet bästa förutsättning att nå sin optimala kapacitet.
Behandling för dessa barn av en kiropraktor med pediatrikutbildning (barnbehandlingsutbildning) skiljer sig i inriktning från en barnbehandlande sjukgymnast. Kiropraktisk behandling riktar sig mot ledernas funktion i kroppen samt kraniet. Tekniken som används för de minsta barnen handlar om ett mjukt tryck som har visat sig vara både effektivt och ofarligt. Studier utförda med spädbarn som var svåra att trösta fann positiva korttids- och långtidseffekter av kiropraktisk behandling. De barn som fick kiropraktisk behandling lugnade sig snabbare och sov bättre direkt efter behandling. De barnen mådde också bättre än kontrollgruppen ett år efter behandlingen.
Kiropraktisk behandling för dessa barn är ett bra alternativ eftersom de mediciner som ofta skrivs ut kan ha allvarliga biverkningar på grund av att de ofta påverkar andningen.
Det är dock inte bara mekaniska problem som kan vara orsak till ovan nämnda symptom hos barn. Barn som är svåra att trösta kan också ha allergiska besvär eller vara överkänsliga mot vissa födoämnen. Den reaktionen som uppstår kan orsaka besvär. Mjölkprotein, soya protein, vete, ägg, nötter och fisk är det vanligaste allergener, fast det finns andra produkter som barn kan reagera på. Om barnet har en överkänslighet eller är allergisk är det viktigt att mamman undviker produkter som orsakar problem under tiden som hon ammar. Förutom vissa vanliga allergener finns det också krossallergener. Vi kan reagera mot dem också. Titta under näring och hälsa för att se vilka de är.
Chiropractic care for infants with difficulty breastfeeding
Read below about tongue-tie and the chiropractors role in understanding why the infant has difficulty breastfeeding comfortably and efficiently.
Infant Sucking Disorders (Amnings- och sugsvårigheter)
Headaches in Infants and Toddlers
Infants can have headaches following complications around or during delivery. A long, difficult or very fast delivery and particularly one where the infant is pulled or pushed out are reasons why an infant can have a headache and be irritable. An acute cesarean section where the baby has descended in the canal and is pulled back up is traumatic for the head and neck. We understand an infant has a headache based on the history around delivery and their behavior. Holding their heads, scratching their face, pulling their hair and/or holding their eyes shut are common signs of a headache in an infant. Infants with difficulty feeding and sleeping may have a headache. Toddlers display headaches by head banging, holding their heads, turning away from light and/or seeking a quiet and dark room.
Hur vet jag att mitt barn har ett problem som kan behandlas med kiropraktik?
Tecken på att barnet kan behöva behandling är att barnet ligger gärna på ett visst sätt, att de inte rör sig liksidigt. Både armar och ben ska rör sig ungefär lika mycket. Barnet ska inte ligga i en båge, eller vänder sig hela tiden tillbaka till ena sida. Om barnet inte är bekväm att ligga själv på mage eller rygg är det tecken på ett problem och dessutom viktig för utveckling. Barnet ska kunna ligga stabil på magen och rygg och inte välta sig över. Om nacken gör ont kan det vara strulig med amning eller kan barnet upplevas som otröstlig framförallt på kvällen. En del kan även få magbesvär. Andra tecken kan vara att barnet drar eller river sig i ansiktet eller huvudet. En del barn som inte mår bra har ett enormt behov av att suga och de vill amma eller suga konstant, och detta kan berör på att det ända som ger tröst är amning . Läs mer om amning och sugsvårigheter här.
Dessa mekaniska störningar kan ge upphov till en mängd andra symtom hos barnet. T.ex. barnet är svårt att trösta, barnet vill inte ligga på rygg eller på mage, barnet vaknar skrikande och/eller barnet sover oregelbundet. Dessa barn får ofta diagnosen spädbarnskolik. Tecken att det kan vara mekaniska orsaker till besvären är att barnet är sned i nacken (torticollis), huvudet är snett (plagiocephaly) eller kroppen är sned (barnet ligger gärna i en båge). En del barn kan ha KISS syndrom. KISS beskriver barn som har mekaniska besvär med den översta delen av nacken vilket leder till en sned hållning. IISMO (Irritable infant syndrome of musculoskeletal origin) beskriver spädbarn med mekaniska besvär som kan vara i andra leder än just översta halsryggen. Klicka här för mer information om KISS och IISMO på engelska. Man kan behandla dessa spädbarn på ett mjukt och försiktigt sätt med goda resultat. När spädbarnet mår dåligt, påverkar detta hela familjen. Förutom att mamman blir stressad, kan anknytningen mellan barnet och mamman riskera att utebli. Detta kan få långvariga konsekvenser för både barnet och mamman. I situationer där man under lång tid inte kan trösta sitt barn, kan det uppstå en enorm frustration och känsla av att man inte räcker till. Det är en viktig anledning till att man ska försöka undvika att situationen uppstår på grund av ett problem med kroppens leder. I vissa fall kan det leda till att föräldern tappar tålamodet och skakar barnet. Detta kan vara en farlig situation för barnet. Det är en viktig anledning att få hjälp, att utesluta problem som uppstår på grund av ett problem med kroppens leder.
När börjar barnet visa symtom på att något är fel?
Beroende på förlossningens förlopp kan det ta några veckor innan barnet visar att det inte mår bra. Ett av de första tecknen kan vara att barnet har svårt att komma till ro.
Många av dessa barn har svårt att sova. Ni kan ha svårt att trösta dem. Många kallar detta för spädbarnskolik. Oftast visar de tydliga tecken att de inte är nöjda, men en del barn visar inte oro, men kroppen är sned. Det finns många fler anledningar än tarmproblem till att ett barn gråter mycket. Som en kiropraktor med kompetens att ta emot spädbarn, har man kunskaper att diagnostera om problemet härstammar från lederna i kroppen eller från något annat, t ex allergi.
Om orsaken till besväret är biomekanisk är målet är att minska smärtan som uppstår från de leder som inte fungerar normalt. De barn som har kvar en annorlunda kroppshållning (sned kropp eller nacke) efter tre veckor bör undersökas och behandlas av en kiropraktor som har specialiserat sig på behandling av barn. En icke symmetrisk hållning påverkar utveckling av barnet. Det märks mest på balansen och den motorisk utveckling. Både är enormt viktig i utveckling av en stark rygg och smidig balans.
Training for infants with plagiocephaly or torticollis (English)
Klick on the link below to read the text.
Training for infants (English)
For Swedish, klick on the following link: Träning for spädbarn även asymmetri
Plagiocephaly – Wonky head shape Plagiocephaly
Some babies are at a risk for unusally cramped space while developing inutero. This effects how the body and head are formed and this is evident for the keen observer at birth. The head and or face can be asymmetrical, the head can be tipped, the body can be curved like a banana. The feet may be excessively turned in. Babies who have been in a breech or transverse position are especially crowded (not to mention the twin babies).
It is not uncommon that babies who have been abnormally compressed have pain. They show it by being cranky and difficult to console, they may hold their bodies in a favorite position, or dislike being touched where it hurts. Some babies who are in pain may not make eye contact as early as expected.
Babies that are difficult to console are at high risk for being shaken. Addressing these biomechanical dysfunctions early is important so the infant does not become pain sensitive. It is important to find a chiropractor specialized in the evaluation, differential diagnosis and treatment skills for the pediatric patient. Manual treatment for the pediatric patient has been shown to be both safe and effective.
Some babies have plenty of space inutero, but have a difficult delivery. This can be a delivery that takes a long time, or a delivery that is very quick. Babies that need assistance to be delivered, that is, pulled out, pushed out or emergency c-section have a very high risk of injury. When an infant has pain after delivery they may choose a favorite position because it is less painful. These babies may have difficulty feeding if the jaw is affected or it hurts to lie in the breastfeeding positon. This may in turn cause pressure on the head which leads to an abnormal head shape (plagiocephaly). Klick on the link to read more about what effect this has on the infants development.
Träning för barn med torticollis och plagiocephaly(English) Klick on the link below to read the text.
Training for infants (English)
For Swedish, klick on the following link: Träning for spädbarn även asymmetri
Amning och Kiropraktik?
Det är inte helt ovanligt att barn som har haft det trångt så positionen inte är optimalt eller har haft en traumatisk förlossning får problem med amningen. En stor studie, publicerad i 2016 visar hur kiropraktisk behandling var effektivt i behandling av barn med amningssvårigheter. Vid undersökning kan man komma fram till om problemet är i käken, tungan, “posterior tongue tie” eller nacken. Om käken är ett problem, har barnet ofta svårt att öppna munnen helt, de kan också vara skev i munnen (tittar på nappen!). När man återställa normal funktion i nacken och/eller käken svarar barnen snabbt på behandling. Behandling kan också rikta sig mot tungan i många fall med god resultat.
Support for the Breastfeeding Baby: The Chiropractor’s Role
Joyce Miller, BSc, DC, PhD
Associate Professor, Anglo-European College of Chiropractic Clinic (AECC); Bournemouth BH5 2DF
Little is more important to the long-term health of the newborn baby than breastfeeding. All health care professionals must use their individual skills to assist the mother and baby to achieve a successful breastfeeding dyad.
Mechanical forces during intra-uterine life and during birth may negatively affect the oral-motor function of the newborn. Although it is difficult (if not impossible) to precisely establish exact reasons for these problems, assisted births such as forceps, vacuum extraction and cesarean sections have been implicated.
It is the job of the chiropractor, who provides manual therapy for structural problems in the human skeleton, to detect these physical problems and to work to maximize their functional effectiveness. An examination of the infant must be performed to detect any musculoskeletal problems that may affect the infant’s feeding efficiency. A common example is an injury to the sterno-cleido-mastoid muscle either due to restricted intra-uterine position or to minor injury during birth. This may result in a head tilt seen in the child as well as reticence to feed on the “uncomfortable” side.
The chiropractor is one of the many professionals ready to support and assist the breast feeding dyad toward success so that the child may continue to feed in the long term. In a recent study of infants referred to chiropractic clinic for treatment of sub-optimal breastfeeding, most children improved and were able to go on to exclusive breastfeeding. The role of chiropractic care is to examine for and treat biomechanical problems implicated in suboptimal breastfeeding.
Chiropractic care of infants is gentle and well accepted by both infant and parents. It has been shown to have high satisfaction rates by parents.
Infant sucking disorders (Amnings svårigheter)
The anatomy of the infant is designed to breastfeed, to suck. The structure of the mouth and throat are adapted to allow both swallowing and breathing at the same time. There is coordination between the muscles of the mouth, the functioning of the jaw and tongue, and the ability to breathe through the nose which allows for sucking, swallowing and breathing. This should occur in a smooth rhythmic tempo.
Some infants have difficulty with breastfeeding and are unable to effectively feed without pulling off the breast, coughing, choking and preferring one breast. It is not uncommon for infants who have had a traumatic birth or assistance during delivery to have difficulty feeding. Premature infants have the highest risk for feeding difficulties as they may not have developed adequately to master the skills necessary to successfully feed. Some infant have an abnormal head position during delivery which creates excessive forces on protruding parts, like the nose and the jaw. This can be both painful and interfere breastfeeding. Trauma to the nose interferes with ease of breathing through the nose. The infant is an obligate nose breather, the mouth is used for feeding not breathing, so when nose breathing is suboptimal, it can affect feeding. The jaw and the tongue together are used to express milk from the breast. If the jaw is injured, the mouth is usually not straight, it may be more diagonal. When the jaw does not function properly the result is usually inefficient, painful feeding for both the mother and the infant.
Infants that are not initially united with their mothers may have missed a critical window for optimal breastfeeding. With successful breastfeeding the mother produces a hormone, oxytocin. This is an important hormone which is involved with bonding between the mother and infant. Successful breastfeeding allows for optimal nutrition, successful bonding between the mother and baby and training of the structures in the mouth and throat. There are primitive reflexes in place which help the neonate to find the breast and to suck.Unsuccessful sucking may be an early sign of neurological compromise.
It is important to understand what the problem is so treatment can be directed at the appropriate structures. There is no other specialist who focuses on the mechanical treatment of the infant with sucking dysfunction. If there has been trauma to the nose or the jaw during delivery, this can affect the infants’ ability to effectively suck. The muscles in the tongue and the mouth need to function properly to coordinate the action of sucking and swallowing while breathing. The nerves which supply the tongue, the face, the back of the throat and the neck can be affected with certain procedures during delivery which cause bruising and/or torquing of the cranium. Treatment is gentle with a goal of improving function of the structures involved. The earlier the infant is treated, the easier it is to establish effective feeding. Proper sucking is important not only for successful breastfeeding but for training the muscles of the mouth which later are used in speech and articulation.
During the exam the infant is evaluated to see if they have normal biomechanical functioning. Besides a thorough biomechanical examination, the neck, the cranium and the shoulders are assessed. Injuries to the neck, shoulder or clavicle are common reasons why the infant has pain or discomfort and prefers to feed from one side. These injuries should be evaluated for treatment. It is important that the neck functions properly to avoid plagiocephaly. Plagiocephaly is a flattening of one side of the head which causes displacement of the ears. This has long term consequences and can be treated with good results. The neck can be gently treated so it regains normal functioning and no longer is a source of pain for the baby. The cranium is inspected for injury and symmetry. Injury to the cranium may be a reason why the infant has a preferred position of the head. It may affect nerves leaving the cranium which supply the face, the tongue, the mouth. This can be treated with gentle maneuvers directed towards restoring normal positioning. The mouth and its’ structures are evaluated next. Some infants have a frenulum or tongue band which attaches too far forward and does not allow them to stretch out the tongue far enough to get a good latch on the breast. Left untreated this can later affect their speech. This can be clipped by a pediatrician during a regular visit. This should be done promptly as it causes a painful latch and inefficient feeding. The tongue is further evaluated to determine if the infant can properly to suck. The infant, who is losing milk while feeding or makes a clicking noise while sucking, may have tongue bunching and can be treated so the tongue functions properly. Next, the shape of the palate has an impact on how efficient they can express milk. Having had a nasogastric tube can affect the palate so that breastfeeding is more difficult. After removal, the infants may continue to make movements with the tongue to expel the tube. This movement is counterproductive to breastfeeding and can be addressed through treatment. Many of the mechanical issues around feeding can be addressed with skilled treatment. Parents can be taught how to work with their child so together with appropriate care there are minimal long term effects.
Consultation with the World Health Organization recommending non-pharmacological alternatives for infants and children
As an expert in paediatrics and a faculty member for the European Academy of Chiropractic (EAC) within the European Chiropractic Union (ECU), I have worked to formulate a contribution to the EU consultation on paediatric regulation for the World Health Organization (WHO). The goal is to promote specific research and trials for drugs prescribed for children, rather than, as were the practice, extrapolating data from experiments on adults. Children and particularly infants are not miniature adults; most of the medications prescribed are not adequately researched for them. They differ in anatomy and physiology, so the response to medication depends on the maturity of their developing systems. This is why medication doses cannot just be downsized.
Our contributions have focused on alternative non-pharmacological interventions to be tried before medication is prescribed. We have seen examples of this with exercise being prescribed as medication. Last week the guidelines for physicians were published for treatment of low back pain and the headlines are: non-pharmacological, alternative treatment is recommended for back pain, among which is spinal manipulative therapy or chiropractic care. Chiropractic care is not just a quick maneuver, it is a package of care first assessing the problem as the spinal care specialist; treating biomechanical dysfunctions with any of a variety of techniques; instructing the patient in self-care, proper posture and ergonomics; and instructing in appropriate exercise to stabilize the injury.
This type of approach to a patients’ biomechanical health is appropriate at all ages and is part of the solution to avoiding chronic pain. The infant with a biomechanical problem due to in-utero constraint or a difficult delivery needs this type of early intervention to avoid permanent changes in how the brain interprets pain. For the geriatric patient’s quality of life, they need a biomechanical assessment and treatment to optimize functioning and learn exercises to keep them functional and prevent falling. Optimal biomechanical functioning is important for good health in all age groups.
Some of the suggestions recommended for addressing the cause of the problem and reducing unnecessary medication and the risks for adverse effects for the infant and child are as follows:
• Before pain medication is prescribed for otherwise healthy neonates, infants and children, an assessment by a spinal care expert should be performed to rule out the possibility of pain due to a biomechanical dysfunction that would be amenable to treatment. A short trial of care is appropriate with positive findings.
• For the otherwise healthy neonate, infant or child with persistent crying and/or any of the following symptoms: recurrent vomiting, stomach pain, eczema, audible mucous or coughing during expiration or constipation: a 3 week trial of milk protein free and soy protein free diet (for the breastfeeding mother and/or child).
• These milk, soy and gluten free formulas should be made available for families over the counter and at a comparable price to regular formulas.
For the following conditions:
• Treatment of GORD or reflux in the infant: before a trial of medication with proton pump inhibitor, the infant should have a 2 week trial of milk protein and so protein free diet to see if symptoms resolve.
• For children not meeting their growth curves: A 4 week trial of milk protein and soy protein free diet. For Scandinavian children and children testing positive for HLA-DQ8(2) positive, a 3 month trial of a gluten free diet should be tested.
• Constipation in the infant or child: a 3 week trial of milk protein and soy protein free diet be assessed before prescribing medication.
• In otherwise healthy children, presenting with back pain, neck pain or other joint pain, an assessment by a spinal expert and a trial of chiropractic care should be made available and assessed before prescribing medication.
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