Why would a baby see a chiropractor?

Why would a baby see a chiropractor?

When most people think about seeing a chiropractor, they think about low back pain
and headaches being treated in adults with some kind of magic that involves pops and twists and pushes (more or less).  It is understandable, if this is your image of chiropractic care, that you would surprised to hear that many families choose to bring their newborn babes in to see a Doctor of Chiropractic. I hope to help answer the question as to why that may be a good idea and dispel some faulty ideas as to what infant musculoskeletal care actually involves. 

There are three big reasons why we tend to see infants in our office: structural asymmetries, movement mishaps and delays, and feeding support (both post-frenectomy and non-surgical).  I like to alliterate, so I will summarize them as follows. 

Supporting Structural Symmetry

Your baby is beautiful and perfect in every way… but they may not be symmetrical. Over 70% of babes are likely to have one or more asymmetry stemming from birth¹⁰.  The most common asymmetries noted are in head shape, facial asymmetry, and head tilt/torticollis (in that order).  

We are not just talking about the funny head shape that babes sometimes get moulded into during delivery.  Those cone h

eads should resolve within 24-48 hours.  It is the persistent and often progressively worsening asymmetries of the head, face, and body that we are paying attention to.  These structural imbalances are not benign, nor are they purely aesthetic.  They can impact feeding and developmental outcomes, so it is important to pay attention to them early and not just wait it out⁸.

If you notice that your babe tends to tilt their head to one side, or that they only like to turn their head to the right, or that one eye always looks larger in all your photos, these are keen observations.  Based on the research on torticollis, earlier interventions will lead to a more complete resolution in a shorter period of time⁷. If in doubt, check it out. 

Certainly, there are lots of little quirks that you may notice with your little one. Some of them, they may grow out of and some of them may not matter at all!   A big part of what we do during our initial exam is assessing what may impact a child’s growth and development and what won’t, and educating parents on the difference.  A thorough musculoskeletal screen for a newborn is a great learning opportunity and good way to ensure care is sought sooner for those who need it and that those who don’t need it are able to rest easy.  

“A musculoskeletal screen may be of benefit to find conditions which might affect discomfort in some positions and pain syndromes of infancy. Furthermore, the musculoskeletal screen can be considered safe for the infant.” – MILLER 2013

Mastering Movement & Milestones

Supporting structural symmetry and mastering movement/milestones tie in together.  During the first few years of life, how our body will grow is heavily influenced by how we use it.  It is much more intricate “function depicts structure” relationship than we have as adults (where our structure largely depicts our function).   Gross motor development and motor milestones that we monitor are a measure of both central nervous system health and physical health.   These predictable patterns will occur automatically in a babe with a healthy nervous system based on “preprogrammed software” (think brainstem reflexes) as long as there are no barriers to their function and they are put in an appropriately stimulating environment.  Our job, as musculoskeletal experts, is to rule out or resolve any physical barriers to those functions.  Your job, as a parent or caregiver, is to create an appropriately simulating environment (although we will definitely coach you through what that means as your child grows). 

Basically, this means how we move matters.  It would not be strange for your chiropractor to do a gait analysis or check your posture to ensure that you are loading your tissues appropriately.  This is basically the baby version of that. 

For example, if your baby HATES tummy time, why? Restrictions in their back or neck extension or low muscle tone could make this task very difficult or even uncomfortable.  Or it may be more of a “fitness” issue, which requires only more practice to develop better stamina.  Similarly, if your child is crawling in a “funny” way (or not at all), is it because there is some limitation in their pelvis or hip movement? Or is because they are not getting enough “floor explore time” due to the living room being a danger zone with older siblings and family pets running amok?  

We can help by screening for and supporting any potential barriers to your child’s success. We can teach you how to create an ideal environments at home (think tummy time, alternating feeding and sleeping positions, proper baby handling, and lots of silly games and songs). 

Just as we noted for structural symmetry, an early and thorough musculoskeletal screen may lead to less intervention required and less developmental impact.  A good example of this is head rotation. One of the more common movement dysfunction in a new born is a preference (rigid or not) to turn their head to one side.  If this is persistent, it is more likely to lead to a flat spot on the back of the head on that side, they are likely to nurse batter on one side than the other, they will stimulate their visual field more on that side, and they will likely preferentially roll to that side as well.  You can see how early movement dysfunction can have ripple effects on physical and motor development.  The good news is, most of these issues are very quick to resolve when addressed early. 

Fantastic Feeding 

There are a myriad of factors that impact feeding success for infants.  A babe must be able to move their head both directions comfortably and fully (as mentioned above), tilt their head back, open their mouth wide and symmetrically, create a seal with their lips and tongue, press their tongue all the way to the palate, and pull down to create a nice suction force, preferably all without pinching mom’s nipple or allowing excess air in that will cause gas discomfort or spit up later on…. easy, right?  It’s amazing that most of the time it actually works out!

Many of those factors are physical and modifiable. Head rotation and mandible (jaw) symmetry can be addressed directly.  Others, like a hypersensitive gag reflex and really tight cheek muscles, are very trainable but take more home-based exercises to clear.  Still others, like restrictive intra-oral tissues (lip or tongue ties), sometimes require less conservative corrections (like frenectomies), but we can still help with the recovery and retraining period. And of course, some factors require good old-fashion time and growth. 

Nursing is a physical skill. It takes practice and there is more than one way to get it done.  A chiropractor with feeding experience can help make sure all the physical and modifiable factors are working with you rather than against you.  This does not replace lactation support!  A lactation consultant, speech language pathologist, or other feeding expert will help guide you through techniques and other modifications.  We facilitate your success as you train in those new techniques^3,11.  Sometimes, it takes a team (or a village). 

In our office, we use the newly developed Musculoskeletal Infant Breastfeeding Assessment Questionnaire (MIBAQ)⁵ to monitor progress within the first few weeks of care. This is part of our commitment to ongoing high-standard of care and it allows you to track success as well. 

Other Stuff

There are a few studies out there looking at other observations that parents and practitioners see in their infants after care, such as less time crying, more time sleeping, and a reduction in functional GI disorders^1,2,9, but we do not have enough bulk of quality studies to make any claims there.  For now, we will focus on the pure structural and movement dysfunctions and enjoy these other potential benefits as happy side effects of manual therapy for infants. 

We also do “damage control”.  This means checking on those sketchy falls, traumas, dislocating elbows, and other random occurrences that tend to come up when caring for a little person in a big world.

A Quick Note on Safety of Chiropractic Care for Infants

Musculoskeletal and manual therapy for infants looks very different than it does for adults^4,13. Their bodies are different. In some ways, this makes them more resilient and in others, it makes them more vulnerable. Our care for them must be modified based on their physical needs and developmental stage.  

We chose gentle techniques, like fascial and soft tissue stretches, craniosacral therapy, and modified sustained-hold adjustments.  There are no cavitation (pop noises) or quick pushes.  These techniques are safe.  There have been several studies and reviews looking at the safety of manual therapy for infants^1,3,12.  In everything we do, we want you to feel 100% confident and informed. 

Of course, our care at AltaVie Health is not manual therapy only (although we are very good at that).  Much of our time is spent educating and coaching parents and teaching home exercise plans.  We love guiding you through infant handling, developmental norms and expectations, and ways to set both you and babe up for success is these amazing early years. 

I hope that this blog helps broaden your perspectives on movement-based and manual therapy, especially for our youngest patients.  They have bodies that are accomplishing tremendous feats and they deserve to be treated well.  

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References

1. Carnes D, Plunkett A, Ellwood J, Miles C. Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses. BMJ Open. 2018;8:e019040. 
2. Dobson D, Lucassen PL, Miller JJ, Vlieger AM, Prescott P, Lewith G. Manipulative therapies for infantile colic. Cochrane Database of Systematic Reviews. 2012(12).
3. Hawk C, Minkalis A, Webb C, Hogan O, Vallone S. Manual interventions for musculoskeletal factors in infants with suboptimal breastfeeding: a scoping review. Journal of Evidence-Based Integrative Medicine. 2018 Dec 11;23:2515690X18816971.
4. Hawk C, Schneider MJ, Vallone S, Hewitt EG. Best practices for chiropractic care of children: a consensus update. J Manipulative Physiol Ther. 2016;39:158-168. 
5. Hawk C, Vallone S, Young J, Lavigne V. Development of an outcome assessment instrument for suboptimal breastfeeding in infants with musculoskeletal dysfunction. Journal of Clinical Chiropractic Pediatrics. Journal of Clinical Chiropractic Pediatrics. 2020;19(1):1621-1628.
6. Herzhaft-Le Roy J, Xhignesse M, Gaboury I. Efficacy of OMT with lactation consultations for biomechanical sucking difficulties. J Hum Lact. 2017;33(1):165-172.
7. Kaplan SL, Coulter C, Sargent B. Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy. Pediatr Phys Ther 2018; 30:240.
8. Keklicek H, Uygur F. A randomized controlled study on the efficiency of soft tissue mobilization in babies with congenital muscular torticollis. Journal of Back and Musculoskeletal Rehabilitation. 2018 Jan 1;31(2):315-21.
9. Miller JE, Newell D, Bolton JE. Efficacy of chiropractic manual therapy on infant colic: a pragmatic single-blind, randomized controlled trial. Journal of manipulative and physiological therapeutics. 2012 Oct 1;35(8):600-7.
10. Miller J, Fontana M, Jernlås K, Olofsson H, Verwijst I. Risks and rewards of early musculoskeletal assessment: An evidence-based case report. British Journal of Midwifery. 2013 Oct;21(10):736-43.
11. Stewart A. Paediatric chiropractic and infant breastfeeding difficulties: A pilot case series study involving 19 cases. Chiropractic Journal of Australia. 2012 Sep;42(3):98.
12. Todd AJ, Carroll MT, Robinson A, Mitchell EK. Adverse events due to chiropractic and other manual therapies for infants and children: a review of the literature. J Manipulative Physiol Ther. 2015;38:699-712. 
13. Triano JJ, Lester S, Starmer D, Hewitt EG. Manipulation peak forces across spinal regions for children using mannequin simu- lators. J Manipulative Physiol Ther. 2017;40:139-146.
14. Young MD, Young JL. Conservative Care of Pediatric Acquired Torticollis: A Report of 2 Cases. J Chiropr Med. 2017 Sep;16(3):252-256. doi: 10.1016/j.jcm.2017.03.003. Epub 2017 Sep 22. PMID: 29097957; PMCID: PMC5659806.