Question

Besides manipulation, what other aspects of pediatric healthcare are important for chiropractors to address?

Answer 1

Chiropractic (Greek: done by hand) is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. There is an emphasis on manual techniques, including joint adjustment and/or manipulation, with a particular focus on joint subluxation (World Health Organization 2005) or mechanical lesion and restoring function [1]. The chiropractor's role in wellness care, prevention and treatment of injury or illness is based on education in anatomy and physiology, nutrition, exercise and healthy lifestyle counseling as well as referral to other health practitioners. Depending on education, geographic location, scope of practice, as well as consumer preference, chiropractors may assume the role of primary care for families who are pursuing a more natural and holistic approach to healthcare for their families [2]. In this role, they may also provide "well child" care, monitoring growth and development.

The purpose of this paper is to present a perspective on current management of the paediatric patient by members of the chiropractic profession and to make recommendations as to how the profession can safely and effectively manage the paediatric patient.

Discussion

Use of Chiropractic by Children

According to a report published in 2000 by Lee, Li and Kemper, the number of children visiting chiropractors was substantial and increasing [3]. A 2007 study by National Center for Health Statistics showed that the most common provider-based complementary and alternative therapy used by children in the United States was chiropractic or osteopathic manipulation [4]. Other recent studies in the United States show that approximately14% of chiropractic patients are children under 18, and that chiropractors are the most common complementary and alternative medicine (CAM) providers visited by children and adolescents [5]. In 2007, Jean and Cyr, in a survey of paediatric patients in an outpatient facility, found that 19% of the families sought chiropractic care for their children [6]. Carlton, Johnson and Cunliffe reported on the factors influencing parents' decisions to choose chiropractic care by surveying families with children ages 5-11 years in a typical county in the United Kingdom. The results indicated that parents who already used chiropractors were more likely to take their children to the chiropractor, but that the overall utilization of CAM was most influenced by family physician and friends [7].

Chiropractic Education in Pediatrics

Chiropractic college coursework has included paediatrics for the last several decades. In 1998, Coulter stated that the average hours of education in US chiropractic colleges assessed was 15 hours for paediatrics [8] in the total chiropractic curriculum which includes a minimum of 4,200 hours of classroom, laboratory and clinical experience [9,10].

All chiropractic colleges' undergraduate courses in paediatrics recognize the unique anatomy and physiology of the paediatric patient. In turn, they promote the understanding that modification of evaluation and therapeutic techniques is required, thus preparing graduating chiropractors to work with their patient from birth through end of life. Chiropractic clinical education prepares the student to assess and manage (or co-manage as appropriate) the paediatric patient with a musculoskeletal problem.

As the profession grew, specialty interest groups were founded amongst national associations in the US (International Chiropractors Association, ICA, and American Chiropractic Association, ACA) as well as by private individuals [11-13]. Postgraduate education became available in both private entrepreneurial and academic venues. Academic venues offered by or sponsored by chiropractic colleges included individual postgraduate educational seminars and certification courses of approximately 100 to 120 hours. One such certification has, in the past, been offered by both the ICA Council on Chiropractic and the Anglo European Chiropractic College. Currently, this one-year certification program continues to be offered by the privately held International Chiropractic Paediatric Association (ICPA).

This one year certificate program may serve as the first year of study of the more advanced three year programs that confer diplomate status. For example, the International College of Clinical Chiropractic's program [11] offered in conjunction with the post graduate departments of chiropractic colleges like Palmer College of Chiropractic, New York College of Chiropractic and the New Zealand College of Chiropractic, consists of 360 classroom hours and includes required papers and annual exams before the candidates are eligible to sit for the board examination to qualify them for the Diplomate in Clinical Chiropractic Pediatrics. The International Chiropractic Paediatric Association (ICPA) also offers a diplomate program and testing is administered through the Academy of Chiropractic Family Practice [14].

In the European Union, there are currently two institutions offering a Masters in Science (MSc) with a specialty in paediatrics. These are AngloEuropean College of Chiropractic in conjunction with Bournemouth University and McTimoney Chiropractic College in conjunction with the University of Wales

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