A text-book on hygiene and pediatrics from a chiropractic standpoint

by J. H. Craven

Palpating the Infant

In palpating an infant the first thing to look for is the hot box. It may be possible to locate it very easily and if this is so it then becomes necessary only to list the direction in which the vertebra is subluxated. In looking for the hot box it is necessary to use care so as not to be misled by the difference in the temperature of the back due to some article of clothing being in contact with the back and raising the temperature in that region. Notice that there has not been some woolen garment, such as the band, pressing against the spine. To eliminate the possibility of thus being misled the entire back should be exposed to the atmosphere a sufficient length of time to allow the back to become influenced alike to the temperature of the air. The majority of incoördinations of infancy are acute, therefore the hot box is present. After the hot box is located then a very careful palpation should be made to determine the direction in which the vertebra is subluxated. It is not sufficient to consider that because the patient is an infant all that is necessary is to list the vertebra straight posterior and adjust it accordingly. Laterality, superiority and inferiority are quite as essential, and the chiropractor should not be satisfied until he has convinced himself on the question of these directions. If there is no laterality, superiority or inferiority then the adjustment should be given straight toward the anterior.

In palpating an infant it is usually best to place the child on the knees of an adult in the position for an adjustment. The child will be almost constantly on the move. It will therefore be necessary for the chiropractor to adapt himself to this constant moving. The child should be placed in as many different positions as possible to make the palpation. He may be held up over the shoulder of the mother or nurse; first on one side, then on the other, this giving opportunity to palpate with both hands and make comparisons.

No effort should be made to force the child to be still. It is a good policy to hold the palpating fingers on the spine and let the child wiggle and squirm all he wants to, moving the spine beneath the palpating fingers of the chiropractor. In this way a comparison may be made of what is felt under the fingers while the child is moving.

It is quite difficult to nerve trace an infant in any measure of accuracy because the infant can not coöperate to any degree of satisfaction. In some, however, nerve tracing may be used to a certain extent by producing slight pressure and noticing whether or not the child flinches.

It is very much more difficult to palpate the cervical vertebrae of an infant than it is those of the dorsal and lumbar regions. The same technique and tactics are used, however. It is sometimes an advantage to place the child on the mother’s lap in such a way that the head will be unsupported by the lap. One hand should support the child’s forehead, while the other hand palpates or it may be necessary to place the infant in some other position. The chiropractor should be sufficiently resourceful to find a way to get an accurate palpation of the cervical region. Here, again, he will meet with the difficulty of keeping the child still. This makes it necessary that he be very alert and at the instant it is possible to feel the vertebra to be ready to make his comparisons quickly and decide the direction in which it is subluxated.

The cervical vertebrae of an infant are very hard to feel, but if one of the segments is subluxated sufficiently to cause pressure on a nerve that segment will be easier to feel because it is out of the median line; especially will it be easier to feel if it is subluxated posteriorly. Every possible means must be used to make an accurate palpation. If there is a subluxation in the cervical region there will very likely be symptoms which will indicate it. Subluxations are not as commonly found in the cervical region as in the other regions of the spine.

In making an analysis of the infant the importance of the sacrum must not be overlooked. It will be remembered that the segments of the child’s sacrum are separated with cartilage and are subject to being subluxated. These segments coalesce later in adolescence and form the sacrum into one solid bone. Therefore it is highly important that the subluxations that may exist between the segments be adjusted before this process takes place.

The tubercular ridge formed by the rudimentary spinous process in the median line of the posterior surface of the sacrum is of very little value in palpating the segments of the sacrum. It is best to palpate the articular crest on each side of the tubercular ridge. In this way it is possible to determine if one segment is more prominent on one side than on the other. This should be done very carefully and if a subluxation is found it should be adjusted on the side that is most prominent. The contact is on the articular ridge and the thumb may be used for nail point the same as in the dorsal region; or if the child is large enough nail point one may be used.

Whenever possible a spinograph should be made of the child. This may not always be possible with the small child and with the very young infant it may be very difficult. In many acute incoördinations it is impracticable to try to get a spinograph, not because the spinograph would not be of value, but because it is difficult to get to the office to take it. In the chronic cases a spinograph should by all means be taken. Every possible means should be used to verify the palpation.

CHAPTER IV
ADJUSTING INFANTS

CHAPTER IV

ADJUSTING INFANTS

The recoil is used in adjusting a child the same as in adjusting an adult. The young infant can be placed upon the knees of the mother or nurse instead of being placed on an adjusting table. The ordinary adjusting table will be too large for the real small infant. Care must be used that the child is placed in the correct position for the adjustment and that the neck and head are properly supported. Placing the child on a pillow on the lap of an adult is not satisfactory because the pillow is too soft and makes it more difficult to move the vertebrae. If the child is adjusted on the mother’s lap care must be exercised that the mother’s skirt is not drawn tightly for it is best to leave the infant’s abdomen unsupported or at least not to have too solid a support.

When the mother holds the babe on her lap there is a tendency for her to raise her heel off the floor so as to make the knee supporting the child’s head higher than the other. When the adjustment is given the knee will not be sufficiently solid to support the child and the vertebra will not move. For this reason the chiropractor must see that the mother’s heels are both placed squarely on the floor. It is a good plan after the contact has been taken and the chiropractor is ready to give the adjustment to ask if both heels are on the floor. Nine times out of ten one heel will be lifted and the toe will be supporting the weight of the child.

In adjusting small infants in the dorsal and lumbar regions the side of the thumb may be used for nail point. In getting the contact one should palpate in the usual manner, find the vertebra that is to be adjusted, remove all fingers except the pointer finger, turn the hand so the finger is parallel with the child’s spine, then instead of placing the pisiform bone of the nail hand, place the side of the thumb in exactly the same manner as if it was nail point one. This being done, remove the pointer finger. Then instead of placing the hammer hand on the nail hand as in using the pisiform bone for nail point, grasp the thumb that is being used for nail point between the thumb and finger of the hammer hand and press the tissues tightly to make the side of the nail thumb firm. The thrust is given with a recoil just the same as in the usual manner.

It is best not to use too much force until it is determined just the amount required to move the vertebra. One will be surprised, however, at the amount of force required to move the vertebrae of a very small infant. It should be remembered that the vertebrae must move if we expect to get results. It must also be remembered that the child is small and that it is necessary to adapt the amount of force used to the size of the patient. It is not possible to injure a child with a chiropractic adjustment, but it is possible to apply an awkward force, supposed to be a corrective force, in such a way that subluxations may be produced.

This method will be used only with the smallest infants. When the child is a few months old the pisiform bone may be used in exactly the same manner as with the adult. The only difference is that the amount of force will be suited to the size of the patient. In case a straight posterior subluxation and a double transverse adjustment is given on a single vertebra the adjuster may use his two fingers, the first and second, to get contact on the transverse processes. The nail hand is then placed across the two fingers and the adjustment is given with the recoil. It will require very little force to move a vertebra of an infant on the transverse processes.

Care must be exercised that the neck is properly supported when an adjustment in the cervical region is given. It is best to place the child on an infant’s adjusting table whenever possible. When this is impracticable the child may be placed on the lap of an adult the same as for an adjustment in the other regions of the spine. If the head is allowed to remain unsupported as is so often the case when larger babies are adjusted in this manner, there is danger of moving something that should not be moved when the adjustment is made. Therefore that part of the neck directly beneath the vertebra to be adjusted must be placed solidly on the mother’s knee. The same technique is used with older patients in that the face is turned in the direction of the laterality of the subluxation to be adjusted.

With the small infant it may be difficult or even impossible to get nail point two in position to adjust, especially in the middle cervical region. In this event the side of the first finger may be used to an advantage. This will be used, however, only with the smallest infants. In using nail point two it will be an advantage to get the contact near the distal end of the fifth metacarpal bone instead of at the center as in using nail point two on an adult. In adjusting the atlas and axis it is very easy to get the contact with nail point two in the usual manner.

The cervical vertebrae of the infant are very small and extreme care must be exercised in adjusting. Sufficient force must be used to move the vertebra.

The importance of proper attention to adjusting the segments of the sacrum of the infant and small child can not be overestimated. During childhood the child is subject to many falls and jars which are likely to be centered upon the sacrum. These segments being separated by cartilage are relatively easily subluxated. If they become subluxated in youth incoördinations may develop, which in later life will result in various degrees of discomfort or even defects which will become permanent and for which nothing can be done. There are many conditions in adult life which are without doubt the result of pressure upon sacral nerve and this pressure can not be released because of the inability to move the subluxated segments after they become coalesced.

Many deformities and incoördinations in these zones could be averted by proper attention to the segments of the sacrum during childhood. When parents realize the importance of this they will take their children to their chiropractor periodically to have the sacrum as well as the rest of the spinal column palpated. Then the subluxations that have been produced will be taken care of before they become chronic and more difficult to correct.

A careful palpation of the segments of the sacrum should be made. The most common subluxation is a rotation resulting in that segment being more prominent on one side than on the other. When a segment is found to be posterior on one side the adjuster should stand on the opposite side and palpate in the usual manner finding the tubercle of the segment subluxated, measuring to a point midway between the tubercle and the ilium with the second finger of the palpating hand. This finger should then be replaced with the second finger of the opposite hand and the pisiform bone of the palpating hand should be used for nail point. If the patient is a very small infant do not change nail hands but use the thumb of the usual nail hand and adjust the same as adjusting a dorsal or lumbar vertebra when using the thumb for nail point.

CHAPTER V
RESPIRATORY SYSTEM

CHAPTER V

RESPIRATORY SYSTEM

Children and infants are subject to the same general class of dis-eases as are adults and there are no dis-eases which are particularly peculiar to childhood. The incoördinations are not peculiar but rather the children as patients are peculiar. The incoördinations of the child’s respiratory system are practically the same as those affecting the respiratory system of the adult but there are certain peculiarities of the patient that should be considered. Our work will be principally the consideration of these peculiarities rather than the incoördinations themselves. It is not our thought to produce a work on symptomatology.