Published Mar 13, 2018
Christian Fludder Braden Keil


Introduction: Behaviours and signs of infants presenting for assessment are varied and many. This study aims to determine if there is a difference in presentation based on the location of joint dysfunction.  Methods: Data were collated from 195 cases under 12 months of age attending a paediatric chiropractic clinic in 2010. Information included behavioural presentations and passive range of motion assessment of spine and extremity joints.Results: 70.7% presented with unsettled behaviour, 48.7% with breastfeeding difficulty, 61.5% with Vagus nerve signs, 32.8% with positional preference, 26.1% with bowel signs and 5.1% with developmental delay. Four infants presented without any abnormal behaviour (2.0%). Conclusion: There may be association of certain presentations with particular joint dysfunction locations, particularly unsettled behaviour, Vagus nerve dysfunction and breastfeeding difficulty. Further research is needed to further define the association between infant presentations and spinal and extremity joint dysfunction.
Abstract 138 | PDF Downloads 100



Behaviour, Infants, Joint Dysfunction

1. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health, Task Force on Pain in Infants, Children, and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. PEDIATRICS2001;108:793-7.
2. Anand KJ, International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. 2001. pages 173-80.
3. Stevens BJ, Gibbins S, Yamada J, Dionne K, Lee G, Johnston C, et al. The premature infant pain profile-revised (PIPP-R): initial validation and feasibility. Clin J Pain 2014;30:238-43.
4. Stevens B, Johnston C, Petryshen P, Taddio A. Premature Infant Pain Profile: development and initial validation. Clin J Pain 1996;12:13-22.
5. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw 1993;12:59-66.
6. Hudson-Barr D, Capper-Michel B, Lambert S, Palermo TM, Morbeto K, Lombardo S. Validation of the Pain Assessment in Neonates (PAIN) scale with the Neonatal Infant Pain Scale (NIPS). Neonatal Netw 2002;21:15-21.
7. Gallo A-M. The fifth vital sign: implementation of the Neonatal Infant Pain Scale. J Obstet Gynecol Neonatal Nurs 2003;32:199-206.
8. Buchholz M, Karl HW, Pomietto M, Lynn A. Pain scores in infants: a modified infant pain scale versus visual analogue. J Pain Symptom Manage 1998;15:117-24.
9. Knutson GA, Owens EF. Active and passive characteristics of muscle tone and their relationship to models of subluxation/joint dysfunction: Part I. J Can Chiropr Assoc 2003;47:168-79.
10. Knutson GA. Active and passive characteristics of muscle tone and their relationship to models of subluxation/joint dysfunction: Part II. J Canadian Chiropr Assoc 2003;47:269-83.
11. Apps JR, Beattie RM. Cow's milk allergy in children. BMJ 2009;339:b2275.
12. Stringer MD, Pablot SM, Brereton RJ. Paediatric intussusception. BJS 1992;79:867-76.
13. Loening-Baucke V. Prevalence, symptoms and outcome of constipation in infants and toddlers. J Pediatrics 2005;146:359-63.
14. Stewart A. Paediatric chiropractic and infant breastfeeding difficulties: A pilot case series study involving 19 cases. Chiropr J Aust 2012;42:98-107.
15. Murgia M, Venditto T, Paoloni M, Hodo B, Alcuri R, Bernetti A, et al. Assessing the Cervical Range of Motion in Infants With Positional Plagiocephaly. J Craniofacial Surg 2016;27:1060-4.
16. O'Shea JE, Foster JP, O'Donnell CP, Breathnach D, Jacobs SE, Todd DA, et al. Frenotomy for tongue-tie in newborn infants. Cochrane Database Syst Rev 2017;3:CD011065.
17. Wiberg JM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther 1999;22:517-22.
18. Hipperson AJ. Chiropractic management of infantile colic. Clin Chiropr 2004;7:180-6.
19. Miller J. Cry babies: A framework for chiropractic care. Clin Chiropr 2007;10:139-46.
20. Miller JE, Newell D, Bolton JE. Efficacy of chiropractic manual therapy on infant colic: a pragmatic single-blind, randomized controlled trial. J Manipulative Physiol Ther 2012;35:600-7.
21. Alcantara J, Alcantara JD, Alcantara J. The chiropractic care of infants with breastfeeding difficulties. EXPLORE: The Journal of Science and Healing 2017;:1-19.
22. Annique C Holleman DC M, DC JN, Simone F C Knaap DC MF. Chiropractic management of breast-feeding difficulties: a case report. Journal of Chiropractic Medicine 2011;10:199-203.
23. Dobson D, Lucassen PLBJ, Miller JJ, Vlieger AM, Prescott P, Lewith G. Manipulative therapies for infantile colic. Cochrane Database Syst Rev 2012;12:CD004796.
24. Hawk C, Schneider MJ, Vallone S, Hewitt EG. Best Practices for Chiropractic Care of Children: A Consensus Update. J Manipulative Physiol Ther 2016;39:158-68.
25. Davies NJ, Fallon JM. Chiropractic Pediatrics. Churchill Livingstone; 2010.
26. McLain RF, Raiszadeh K. Mechanoreceptor endings of the cervical, thoracic, and lumbar spine. Iowa Orthop J 1995;15:147-55.
27. Fludder CJ, Keil BG. The prevalence of extremity joint dysfunction in neonates and infants within a paediatric chiropractic clinic. Chiropr J Aust 2017;45:360-7.
28. Anand KJS, Aranda JV, Berde CB, Buckman S, Capparelli EV, Carlo W, et al. Summary Proceedings From the Neonatal Pain-Control Group. PEDIATRICS 2011;117:S9-S22.
29. Craig KD, Whitfield MF, Grunau RV, Linton J, Hadjistavropoulos HD. Pain in the preterm neonate: behavioural and physiological indices. Pain 1993;52:287-99.
30. Goksan S, Hartley C, Emery F, Cockrill N, Poorun R, Moultrie F, et al. fMRI reveals neural activity overlap between adult and infant pain. Elife 2015;4:1321.
31. Hartley C, Duff EP, Green G, Mellado GS, Worley A, Rogers R, et al. Nociceptive brain activity as a measure of analgesic efficacy in infants. Sci Transl Med 2017;9:eaah6122.
32. Herr K, Coyne PJ, Key T, Manworren R, McCaffery M, Merkel S, et al. Pain Assessment in the Nonverbal Patient: Position Statement with Clinical Practice Recommendations. Pain Management Nursing 2006;7:44-52.
33. Maitre NL, Stark AR, McCoy Menser CC, Chorna OD, France DJ, Key AF, et al. Cry presence and amplitude do not reflect cortical processing of painful stimuli in newborns with distinct responses to touch or cold. Archives of Disease in Childhood - Fetal and Neonatal Edition 2017;102:F428-33.
34. Maxwell LG, Malavolta CP, Fraga MV. Assessment of pain in the neonate. Clinics in Perinatology 2013;40:457-69.
35. Lee SJ, Ralston HJP, Drey EA, Partridge JC, Rosen MA. Fetal pain: a systematic multidisciplinary review of the evidence. JAMA 2005;294:947-54.
36. Slater R, Cantarella A, Gallella S, Worley A, Boyd S, Meek J, et al. Cortical pain responses in human infants. J. Neurosci. 2006;26:3662-6.
37. Slater R, Cantarella A, Franck L, Meek J, Fitzgerald M. How well do clinical pain assessment tools reflect pain in infants? PLoS Med. 2008;5:e129.
38. Rodkey EN, Pillai Riddell R. The infancy of infant pain research: the experimental origins of infant pain denial. J Pain 2013;14:338-50.
39. Cavanaugh JM, Lu Y, Chen C, Kallakuri S. Pain generation in lumbar and cervical facet joints. J Bone Joint Surg Am 2006;88 Suppl 2:63-7.
40. Smith L. Impact of Birthing Practices on the Breastfeeding Dyad. Journal of Midwifery & Women's Health 2007;52:621-30.
41. Hornby PJ, Abrahams TP. Central control of lower esophageal sphincter relaxation. Am. J. Med. 2000;108 Suppl 4a:90S-98S.
42. Shafiq H, McGregor C, Murphy B. The Impact of Cervical Manipulation on Heart Rate Variability. IEEE; 2014. pages 3406-9.
43. Zhang J, Dean D, Nosco D, Strathopulos D, Floros M. Effect of Chiropractic Care on Heart Rate Variability and Pain in a Multisite Clinical Study. J Manipulative Physiol Ther 2006;29:267-74.
44. Hamunen K, Kontinen V, Hakala E, Talke P, Paloheimo M, Kalso E. Effect of pain on autonomic nervous system indices derived from photoplethysmography in healthy volunteers. Br J Anaesth 2012;108:838-44.
45. Vallone S, Carnegie-Hargreaves F. The infant with dysfunctional feeding patterns - The chiropractic assessment. Journal of Clinical Chiropractic Pediatrics 2016;15:1230-5.
46. Anand KJ, Scalzo FM. Can adverse neonatal experiences alter brain development and subsequent behavior? Biol. Neonate 2000;77:69-82.
47. Nevalainen P, Lauronen L, Pihko E. Development of Human Somatosensory Cortical Functions - What have We Learned from Magnetoencephalography: A Review. Front Hum Neurosci 2014;8:158.
48. Chugani HT. A critical period of brain development: studies of cerebral glucose utilization with PET. Prev Med 1998;27:184-8.
49. Haavik H, Murphy B. The role of spinal manipulation in dressing disordered sensorimotor integration and altered motor control. J Electromyography Kinesiol 2012;22:768-76.
50. Haavik H, Niazi IK, Jochumsen M, Sherwin D, Flavel S, Türker KS. Impact of spinal manipulation on cortical drive to upper and lower limb muscles. Brain Sci 2016;7:2.
51. Lelic D, Niazi IK, Holt K, Jochumsen M, Dremstrup K, Yielder P, et al. Manipulation of dysfunctional spinal joints affects sensorimotor integration in the prefrontal cortex: a brain source localization study. Neural Plasticity 2016;2016:1-9.
52. Hall JE. Guyton and Hall Textbook of Medical Physiology. Elsevier Health Sciences; 2015.
53. Espinosa-Medina I, Saha O, Boismoreau F, Chettouh Z, Rossi F, Richardson WD, et al. The sacral autonomic outflow is sympathetic. Science 2016;354:893-7.
54. Espinosa-Medina I, Saha O, Boismoreau F, Brunet J-F. The "sacral parasympathetic": ontogeny and anatomy of a myth. Clinical Autonomic Research 2017;:1-9.
55. Neuhuber W, Mclachlan E, Jänig W. The Sacral autonomic outflow is spinal, but not "sympathetic." Anat. Rec. 2017;300:1369-70.
56. Jänig W, Keast JR, McLachlan EM, Neuhuber WL, Southard-Smith M. Renaming all spinal autonomic outflows as sympathetic is a mistake. Auton Neurosci 2017;:1-3.
57. Keith R Kamrath DC F. Chiropractic management of a 5-year-old boy with urinary and bowel incontinence. Journal of Chiropractic Medicine 2010;9:28-31.
58. Quist DM, Duray SM. Resolution of symptoms of chronic constipation in an 8-year-old male after chiropractic treatment. J Manipulative Physiol Ther 2007;30:65-8.
59. Alcantara J, Mayer DM. The successful chiropractic care of pediatric patients with chronic constipation: A case series and selective review of the literature. Clinical Chiropractic 2008;11:138-47.