Chiroblog

Attention-Deficit/Hyperactivity Disorder (ADHD) is on the rise, with more children being diagnosed each year. According to recent studies, nearly one in ten children in the United States is diagnosed with ADHD, making it the most common mental health condition among children. This recent increase may be in part due to better awareness and diagnosis, but we cannot discount the potential of environmental and dietary concerns. Common treatments for ADHD often involve medication and behavioral therapy, but worries about side effects and long-term use have made many parents explore alternative options.

One such option is pediatric chiropractic care, which offers a natural, non-invasive approach to improving nerve system function. A pilot study found that chiropractic care, when combined with usual care, showed improvements in ADHD symptoms in children. Pediatric chiropractic care provides a promising complementary approach for parents seeking holistic solutions for ADHD.  We have seen many children who were having significant difficulties in school becoming straight A students because their ability to focus increased, reading grade levels jumped significantly, and overall behavior improved. 

References:

What’s behind the increase in ADHD?
The effects of chiropractic adjustment on inattention, hyperactivity, and impulsivity in children with attention deficit hyperactivity disorder: a pilot RCT

The Polyvagal Theory, developed by Dr. Stephen Porges, explains how our nervous system responds to stress and safety through three levels: social engagement, fight/flight, and freeze. The social engagement system, governed by a part of the cranial nerves called the Ventral Vagus, helps us connect with others and feel safe. When we feel threatened, our sympathetic nervous system activates the fight/flight response, preparing us to either confront or escape danger. If the threat is overwhelming, the dorsal portion of the vagus nerve triggers the freeze response, causing us to shut down and conserve energy[1][2].

When working with children with autism, having an understanding of these levels can be insightful. Many children on the spectrum may have a heightened sensitivity to their environment, causing their nervous system to frequently shift into fight, flight or freeze. This can manifest as anxiety, avoidance, or turn into them shutting down. When you recognize these responses as natural reactions to perceived threats, caregivers and educators can create more supportive environments, which helps to promote feelings of safety and social engagement. This approach can help children with autism feel more secure and connected, ultimately enhancing their ability to interact and learn[3][4].  That is why in designing our office we structurally took into account the Polyvagal perspective to prepare the environment that is more suitable to children with autism, and also changed the way we approach our examinations and adjustments based on making the best possible experience for someone who is neurodivergent.

References

[1] What is Polyvagal Theory? - Polyvagal Institute

[2] The polyvagal perspective - University of Arizona

[3] International Journal of Psychophysiology

[4] How the Polyvagal Theory Inspired My Parenting - Psychology Today

Infantile colic is a common condition in otherwise healthy babies that cry for long periods, often intensely. It affects up to 40% of infants and typically peaks around six weeks of age[2]. While this can be distressing for both babies and parents, some researchers believe it could be linked to an immature nervous system. The nervous system plays a key role in controlling a baby’s digestive system and how they react to different stimuli[1]. If the nervous system isn’t fully developed, it can lead to digestive issues or discomfort, which may explain the excessive crying.

One theory behind colic is that the baby’s nervous system is overwhelmed, which can also lead to gastrointestinal problems. Signs of this include babies arching their backs and clenching their fists, which suggest they’re experiencing neurospinal tension[1]. This tension can be caused by misalignments or stress in the nervous system, such as from birth trauma or even the mother’s stress during pregnancy[1].  A recent study of 120 colicky babies indicated that there might some neurological dysregulation in these infants that leads to their not being able to easily digest food [3].

Understanding colic as a neurological issue opens up new ways to manage it. For example, gentle chiropractic care can help relieve the neurospinal tension by addressing the underlying cause, not just the crying[1]. This approach focuses on easing the root problem, which may offer relief for some babies.

References:

[1] What is a Colic Baby? Understanding the Signs and Root Causes of Colic

[2] Infantile Colic: Recognition and Treatment - AAFP

[3] Clinical Evidence of Vestibular Dysregulation in Colicky Babies Before and After Chiropractic Treatment vs. Non-colicky Babies

Children with autism often have retained primitive reflexes, which are automatic movements that babies typically outgrow as they develop. These reflexes, such as the Moro reflex (startle response) and the palmar grasp reflex (grabbing with the hand), are essential for early development but should go away as the brain matures. However, in children with autism, these reflexes can stick around, potentially causing issues with their motor skills, coordination, and even cognitive functions[1]. Studies have shown that retained primitive reflexes can cause trouble when it comes to a child's ability to perform everyday tasks and may lead to difficulties in social interactions and learning[2].

Research suggests that addressing these retained reflexes through specific therapies can help improve the symptoms of autism. For example, modalities like sensory stimulation and physical exercises aimed at reducing these reflexes have shown good results, especially when coupled with gentle, brain-based chiropractic care [3]. Combining therapies (such as chiropractic) with neurological exercises can boost brain connectivity and improve cognitive and motor functions in children with autism[1][2]. By focusing on these underlying neurological issues, it is possible to give better overall development and quality of life for children with autism.

References

[1] Identification and reduction of retained primitive reflexes by sensory ...

[2] Retained Primitive Reflexes and Potential for Intervention in Autistic ...

[3] Combining Chiropractic Care with Extinguishing of Primitive Reflexes: A Case Series of 8 Children

Interoception, the sense of internal body signals such as hunger, thirst, and heartbeat, plays a crucial role in self-regulation and emotional awareness. For children with autism, improving interoception can significantly enhance their ability to understand and respond to their body's needs. One effective strategy is engaging in interoceptive awareness activities. For example, the "Feel Your Heartbeat" challenge involves children performing physical activities like jumping jacks and then pausing to notice their heartbeat. This helps them become more attuned to their internal signals[1]. Additionally, mindfulness exercises such as deep breathing and body scans (such as fully describing a painful sensation) can help children recognize and interpret various bodily sensations, promoting better self-regulation and emotional control[2].

Another approach is incorporating sensory activities that stimulate interoceptive awareness. Activities like playing with textured materials, engaging in yoga, or using weighted blankets can help children with autism become more aware of their internal states[3]. By consistently practicing these strategies, children can develop a stronger connection between their internal signals and their emotional responses, leading to improved self-awareness and overall well-being[4]. Supporting children in this journey not only enhances their daily functioning but also empowers them to navigate their emotions and physical needs more effectively.  For example, a mom of a child with autism recently told me after several chiropractic adjustments that their child is now more open to describing when they are hungry and is more open to trying new foods (since textures and smells are often significant detractors).  Pediatric, brain-based chiropractic can be helpful for kids (and adults) with autism.  

References

[1] How to Improve Interoception: 5 Proven Strategies for your Child

[2] Interoception: Knowing Yourself Inside and Out - Reframing Autism

[3] Strategies to improve interoception in autistic individuals

[4] Interoception and mental wellbeing in autistic people

[5] A Systematic Review of Associations Between Interoception, Vagal Tone, and Emotional Regulation: Potential Applications for Mental Health, Wellbeing, Psychological Flexibility, and Chronic Conditions, Pinna T & Edwards D, https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2020.01792/full

A study in 2015 discussed the link of trigeminal neuralgia (TN) with dysfunction of the autonomic nervous system. ¹
Method: 12 patients with classical TN and 12 healthy control patients. Patients are asked to submerge right arm for 5 into 10*C water to trigger pain. Patients rated their pain every 30 seconds on a 0-100 scale. Electrocardiograms were taken before and during experimental pain test. Heart rate was also analyzed in frequency domain, differentiating low frequency components ( HR fluctuations in the LF range reflect baroreflex-mediated sympathetic activity associated with Mayer waves of blood pressure) and high frequency components (HRV in the HF range is generated by respiratory sinus arrhythmia and
constitutes a sensitive measure of cardiac vagal parasympathetic activity).

Result: No difference in pain perception or heart rate between TN group and control group. No one in TN group experienced facial pain. All patients experienced an increase in low frequency oscillations (increased sympathetic activity) and decrease in high frequency (decrease in parasympathetic activity), but the changes were more pronounced in the TN group.

Conclusions: “Results indicate that TN patients and healthy controls have comparable
autonomic cardiac responses at rest, but that in response to a tonic experimental pain challenge, TN patients show greater sympathetic arousal and parasympathetic withdrawal than healthy controls.” “The exact reason for the negative association between sympathetic reactivity and the number of pain paroxysms experienced by TN patients remains unclear and surely merits future attention.”

The Vagus nerve has clear parasympathetic connections, but the jury is still out on the trigeminal nerve. However, one thing noticed frequently in chiropractic practices is how the temporomandibular joint (TMJ), when not functioning, will usually be associated with increased tension in that person, whether they are a child or an adult ².  Reducing the alignment issues in the TMJ often reduces that person’s stress as well.

References 

1. Léonard, G., Chalaye, P., Goffaux, P., Mathieu, D., Gaumond, I., & Marchand, S. (2015). Altered
Autonomic Nervous System Reactivity to Pain in Trigeminal Neuralgia. Canadian Journal of
Neurological Sciences / Journal Canadien Des Sciences Neurologiques, 42(2), 125-131.
doi:10.1017/cjn.2015.10

2. Santos, E. et al.  (2022). Association between temporomandibular disorders and anxiety: A systematic review. Frontiers in Psychiatry.  https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.990430/full 

Diagnosis and referral for surgical treatment of ankyloglossia, commonly referred to as a tongue-tie, has been on the rise over the past 25 years.^1-5 Breastfeeding difficulties such as poor latch, painful latch, poor infant weight gain, and long duration of feeding are most often attributed to tongue-ties. Interestingly, the highest rate of surgical intervention referrals occurs in male infants with private insurance from affluent regions of the United States.¹ However, there is a paucity of data to support that surgical interventions provide meaningful changes in breastfeeding outcomes. There is moderate data to support that mothers report decreased nipple pain but limited overall data to support immediate or long-term breastfeeding success after surgery.^1-5 Unfortunately, this has resulted in a lack of substantiated universal diagnostic and treatment criteria for tongue-ties.^1-5

The apparent lack of clinical consensus leads to confusion among parents regarding the correct course of treatment for their infant. The good news is that healthcare practitioners are starting to investigate surgical alternatives. There is some positive data to support osteopathic, myofunctional, speech language pathology and/or chiropractic therapy for improving sub-optimal infant feeding with or without a tongue-tie.^7-11 In general, the results appear to be amplified when any of the aforementioned therapies are combined with breastfeeding training with Certified Lactation Consultants.^8-10 In short, approximately 60% of patients who take a multi-modal conservative approach to a suspected tongue-tie can avoid surgical intervention.⁴ Results from these interventions can be seen in as little as two weeks.¹⁰ Some severe tongue ties may still require surgery if the degree of restriction could eventually interfere with speaking and/or swallowing solid foods.⁵ It is always recommended to speak to your pediatrician about your infant’s feeding difficulties and determine a care plan, but equally important to realize that not all tongue ties require surgical intervention and might be amenable to alternative care. 

References

1. Walsh J, Links A, Boss E, Tunkel D. Ankyloglossia and lingual frenotomy: National trends in inpatient diagnosis and management in the United States, 1997‐2012. Otolaryngology–Head and Neck Surgery. 2017;156(4):735-740. doi:10.1177/0194599817690135
2. Rosi-Schumacher M, Ma AC, Reese A, et al. Feeding issues in infants referred for frenotomy. Cureus. Published online May 2, 2024. doi:10.7759/cureus.59539
3. O’Shea JE, Foster JP, O’Donnell CP, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database of Systematic Reviews. 2017;2021(6). doi:10.1002/14651858.cd011065.pub2
4. Caloway C, Hersh CJ, Baars R, Sally S, Diercks G, Hartnick CJ. Association of feeding evaluation with frenotomy rates in infants with breastfeeding difficulties. JAMA Otolaryngology–Head & Neck Surgery. 2019;145(9):817. doi:10.1001/jamaoto.2019.1696
5. Frezza A, Ezeddine F, Zuccon A, Gracco A, Bruno G, De Stefani A. Treatment of ankyloglossia: A Review. Children. 2023;10(11):1808. doi:10.3390/children10111808
6. Tomara E, Dagla M, Antoniou E, Iatrakis G. Ankyloglossia as a barrier to breastfeeding: A literature review. Children. 2023;10(12):1902. doi:10.3390/children10121902
7. Chowdhury R, Khoury S, Leroux J, Alsayegh R, Lawlor CM, Graham ME. Alternative therapies for ankyloglossia-associated breastfeeding challenges: A systematic review. Breastfeeding Medicine. 2024;19(7):497-504. doi:10.1089/bfm.2024.0072
8. Herzhaft-Le Roy J, Xhignesse M, Gaboury I. Efficacy of an osteopathic treatment coupled with lactation consultations for infants’ biomechanical sucking difficulties. Journal of Human Lactation. 2016;33(1):165-172. doi:10.1177/0890334416679620
9. Miller JE, Miller L, Sulesund A-K, Yevtushenko A. Contribution of chiropractic therapy to resolving suboptimal breastfeeding: A case series of 114 infants. Journal of Manipulative and Physiological Therapeutics. 2009;32(8):670-674. doi:10.1016/j.jmpt.2009.08.023
10. Vallone, Sharon. Evaluation and treatment of breastfeeding difficulties associated with cervicocranial dysfunction: a chiropractic perspective. Journal of Chiropractic Pediatrics. 2006; 15.
11. González Garrido M del, Garcia-Munoz C, Rodríguez-Huguet M, Martin-Vega FJ, Gonzalez-Medina G, Vinolo-Gil MJ. Effectiveness of myofunctional therapy in ANKYLOGLOSSIA: A systematic review. International Journal of Environmental Research and Public Health. 2022;19(19):12347. doi:10.3390/ijerph191912347

There are many healthcare providers that can diagnose a concussion; however chiropractors are the only healthcare providers trained to address the cervicogenic changes that may be driving a number of your child’s symptoms.⁴ Research is still limited on pediatric concussions in general, but in case studies and case series chiropractic care has demonstrated to assist in a full resolution of the symptoms in 2-8 visits over 2-5 weeks after initial injury.^5-6 It is also important to note that a resolution of symptoms at rest does not mean that your child has completely recovered and full stepwise return-to-play protocol over a minimum of five days is considered the gold standard for safe reintroduction of activity.^2-3 There is always a risk of development of delayed symptoms, particularly in females.⁷ Cognitive rest in the initial period after injury should always be encouraged. You should always work with an experienced healthcare provider in order to determine a safe care plan for your child and sport-certified pediatric chiropractors have the education and experience to help you.⁸

Pediatric and sports chiropractors have been trained to examine children and adults with concussion and often are able to help those people with post-concussion syndrome that we not helped by traditional health care providers.  

References

4. Shannon N, Patricios J. Sports-related concussion: assessing the comprehension, collaboration, and contribution of chiropractors. Chiropractic & Manual Therapies. 2022;30(1):NA–NA. doi:https://doi.org/10.1186/s12998-022-00471-z

5. Journal of Clinical Chiropractic Pediatrics : Editorial. jccponline.com. Accessed March 26, 2023. https://jccponline.com/Concussion-Vol17-01.html

6. Chiropractic management of three young athletes with concussion. Chiropractic Journal of Australia (Online), 46(1), 29–47. https://search.informit.org/doi/10.3316/informit.903767969878389

7. Onicas AI, Deighton S, Keith Owen Yeates, et al. Longitudinal Functional Connectome in Pediatric Concussion: An Advancing Concussion Assessment in Pediatrics Study. Journal of Neurotrauma. Published online August 23, 2023. doi:https://doi.org/10.1089/neu.2023.0183

8.  Moreau WJ, Nabhan DC, Walden T. Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification. Journal of Chiropractic Medicine. 2015;14(3):169-175. doi:https://doi.org/10.1016/j.jcm.2015.08.003

Participating in sports has a significant number of physical, mental, educational, and eventual career benefits.¹  However, there is always a risk of injury with participation. Head injuries leading to concussions is a growing area of concern due to the potential long-term effects. Young children may not have the vocabulary to describe their symptoms to you and therefore, diagnosis relies on a combination of child interview by an experienced practitioner, parent interview, and child evaluation. Current diagnostic criteria for children under the age of 12 has been identified for healthcare providers in the Child Sport Concussion Assessment Tool 5 (Child SCAT-5).² Parents can also access the free Concussion Recognition Tool 5 for a quick reference guide to not only identifying a concussion but identifying an emergency.³

There are a few symptoms that you might want to notice or ask about after a head injury: complaints of headaches, dizziness, feeling like the room is spinning, altered or double vision, and/or nausea. You may also notice other changes like a change in your child’s mood such as unexplained sadness or irritability, trouble falling asleep or staying asleep, excessive tiredness or rapid fatigue, as well as trouble concentrating, following instructions, or completing tasks. While this is not an exhaustive list of symptoms, these are some of the most common. It is important to understand that “just do not feel right” is considered a symptom and is enough to warrant investigation into your child’s condition.^2-3

Dr Rubin is both pediatric and sports certified, so has a unique skill set to help kids with post-concussion syndrome.  Let us know how we can help you and your child get back to school and sports the right way. 

References

1. PCSFN Science Board. Benefits of Youth Sports.; 2020. https://health.gov/sites/default/files/2020-09/YSS_Report_OnePager_2020-08-31_web.pdf

2. Davis GA, Purcell L, Schneider KJ, et al. The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5). British Journal of Sports Medicine. Published online April 26, 2017:bjsports-2017-097492. doi:https://doi.org/10.1136/bjsports-2017-097492

3. Concussion recognition tool 5©. British Journal of Sports Medicine. Published online April 26, 2017:bjsports-2017-097508CRT5. doi:https://doi.org/10.1136/bjsports-2017-097508crt5

Down syndrome is a genetic condition resulting from an extra copy of chromosome 21.  The disorder often includes developmental delays, cognitive challenges, and various health concerns, including those affecting the musculoskeletal system¹. While conventional treatments like physical therapy and medical management are well-established, recent studies suggest that chiropractic care might offer additional benefits for children with Down syndrome. Multiple case studies conclude that chiropractic care is a safe and effective treatment option, reporting no adverse side effects but many positive effects². A case report of a 4-year-old patient with Down syndrome concluded that the correction of the first cervical vertebra (atlas) using gentle chiropractic adjustments was responsible for the correction of convergent strabismus³. Another study reported improved breastfeeding patterns, resolution of a chronically blocked nose, and improved sleep and concentration following regular chiropractic care in a 9-year-old Down syndrome patient².

Children with Down syndrome also show distinct physical issues such as hypotonia (decreased muscle tone) and joint laxity. Spinal misalignments such as scoliosis and hip instability are frequently observed due to their unique musculoskeletal structure⁵. Chiropractic care aims to remove subluxations and enhance the body’s physical function by addressing postural imbalances and reducing discomfort associated with spinal misalignments⁷. This could enhance quality of life in patients with Down syndrome, who commonly experience musculoskeletal pain from joint instability and misalignments².

Chiropractic care might also indirectly boost immune function. A review published in the journal Medicina concluded that spinal adjustments may support a healthy immune response by affecting immune mediators in the body⁴.  Given that children with Down syndrome are more susceptible to infections², maintaining a well-functioning immune system could be beneficial. 

Chiropractic care should complement a comprehensive treatment plan tailored to the child’s specific needs. Some Down syndrome patients also fail to develop the transverse ligament, which stabilizes the two first vertebrae of the spine by binding the dens of C2 (Axis)  to the anterior arch of C1 (Atlas). This causes atlanto-axial instability in the upper cervical spine². Choosing a chiropractor experienced in working with children and individuals with developmental disorders is essential. Use of the Activator instrument offers a very gentle adjustment that is both safe and effective for a wide variety of conditions⁸, including Down syndrome⁶.

References:

1. “Down Syndrome: Symptoms & Causes.” Cleveland Clinic, 1 May 2024, my.clevelandclinic.org/health/diseases/17818-down-syndrome. 
2.  Daruwalla, Delsey. “Down Syndrome and Chronic Ear, Nose and Throat Infections: A Case Report.” Journal of CliniCal ChiropraCtiC pediatriCs, vol. 14, no. 1, June 2013, pp. 1088–1092, https://doi.org/https://jccponline.com/jccp_v14_n1.pdf#page=35. 
3. “Chiropractic Care of a Down’s Syndrome Patient with Vertebral Subluxation and Strabismus.” Vertebral Subluxation Research, vertebralsubluxationresearch.com/2017/09/10/chiropractic-care-of-a-downs-syndrome-patient-with-vertebral-subluxation-and-strabismus/. Accessed 18 Sept. 2024. 
4. 4) Haavik, Heidi, et al. “The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A Narrative Review.” MDPI, Multidisciplinary Digital Publishing Institute, 27 May 2021, www.mdpi.com/1648-9144/57/6/536. 
5. 5) Foley, Charlene, and Orla G Killeen. “Musculoskeletal Anomalies in Children with Down Syndrome: An Observational Study.” Archives of Disease in Childhood, U.S. National Library of Medicine, May 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6557226/. 
6. 6) Dyck, V. Gary. “ Upper cervical instability in Down’s syndrome: A Case Report.” Journal of the Canadian Chiropractic Association, vol. 25, no. 2, June 1981. 
7. 7) professional, Cleveland Clinic medical. “Chiropractic Adjustment Care, Treatment & Benefits.” Cleveland Clinic, 27 June 2024, my.clevelandclinic.org/health/treatments/21033-chiropractic-adjustment. 
8. Taylor, Shane H, et al. “A Review of the Literature Pertaining to the Efficacy, Safety, Educational Requirements, Uses and Usage of Mechanical Adjusting Devices: Part 2 of 2.” The Journal of the Canadian Chiropractic Association, U.S. National Library of Medicine, June 2004, www.ncbi.nlm.nih.gov/pmc/articles/PMC1840040/#:~:text=Of%20the%2016%20studies%20that,than%20do%20manual%20HVLA%20procedures.