Tonal Pediatrics Outline with Dr. Kristina Stitcher
Kristina Stitcher, D.C.
Kristina Stitcher, D.C. 801-281-1688 office [email protected]
Tonal Pediatrics and Pregnancy Kristina Stitcher, D.C.
Mindset and Office Set Up
What do I believe about chiropractic?
What do I know about the power of an adjustment?
What is your rationale for seeing a symptom free infant or child? Who is my ideal patient?
What does my ideal balance and ‘work’ day/week look like? How long do you plan on actively seeing patients? And WHY?
Family Wellness Office Set Up Suggestions:
Kid space with toys and space to make some noise Pictures of kids throughout the office
Bathroom supplies
Pads for new moms
Step stool for kids Changing station and supplies
Snacks
Outlet covers
Nursing support for moms
Special room or dedicated space Kid gowns
Baby doll
Infant toggle headpiece Measuring tape Pregnancy pillows Stickers
Treasure chest
Kids adjusting table Stuffed animals
Lots of patience
Extra shirts for the doctor and team
An environment where all patients understand WHY you see infants and kids.
Kids
Why do you want to see kids in your practice?
It all begins on the phone!
“is this appointment for you or your child?”
New Patient Procedures
Consultation Strategies
● Talk to the child first, they are the patient; ask their permission
to talk with mom about their pregnancy and birth.
● Talk with the child about why they are there, rephrase if necessary and remove labels that the child has been given or adopted.
- ● “Power On” demonstration to explain subluxation
- ● Reinforce “we don’t treat”
Examination
● Mom/Dad does the exam
- ● Posture check and explanation
- ● Function tests
Gillet test Scanning Technology
X-Rays
● What age are x-rays appropriate?
Primitive Reflexes Neurological Testing
Display and explain function or lack of function ● Pelvic Distortion Subluxation Complex
When should you take them?
Wrap Up
● Do you adjust the first visit or not?
● Preparation for the ROF
Report of Findings
● Who is it for?
● Schedule recommendations
● Special Considerations
Enuresis
Double check C0/1/2, L3/5, S3, coccyx
Nutritional Support for Kids
Vitamin D, essential fatty acids, probiotics
Double dose Fish Oil
Attention, concentration, hyperactivity, dyslexia
Ear Infections C1/2
Foods to avoid:
Soy, GMO, Corn, Sugar, Aspartame, Dairy, Wheat
Neurologically Stimulation/Balancing Games ▪ Think Gravity
▪ ▪
Use function tests as a guide Textures, colors, sounds, taste
Adjusting Kids Tonally
Check domination of one side of NS Balance NS focus
C1/2, coccyx
Fish Oil
Adjust ears
Dairy issues Immune compromise
Upper c/s Probiotics, Vit D
Rules
Think globally not locally
Think care plan instead of this visit
Think repetition for development and growth Prioritize and Emphasize
Utilize MC2 for all kids who can follow directions
Adjust with pressure or integrator or vibration, limit diversified moves while kiddos young….slow down your hands.
Pregnancy Care
Why do you want to see pregnant women?
Why are pregnant women as patients frustrating? Anatomy of the pregnant woman:
You must be willing to assess and work on the supporting tissue of the pregnant belly.
� The Webster protocol is a specific chiropractic sacral analysis and diversified adjustment. The goal of the adjustment is to reduce the effects of sacral subluxation/SI joint dysfunction. In so doing neuro-biomechanical function in the pelvis is improved.
Adjusting during pregnancy:
Think plan, don’t try to do everything in one visit.
Cervical spine
● Assess with MC2 for UC involvement
While patient supine check pubis
● Have patient squeeze knees together into your fist
● Shortened leg is side of anterior/superior pubis
● Side of pubis subluxation often side of round ligament tautness
Adjust pubis
● Activator or drop
● LOD is A-P and S-I
● Recheck leg squeeze mm test Check round ligament for tautness
● Webster RL hold
Assess softness and balance of the uterus Assess the psoas for unequal contracture
Sacrum
● Lateral or posterior
● Base anterior/posterior
● Adjust with drops, Logan, SOT blocks (ask)
Coccyx
● Have patient squeeze buttocks, side of shortened leg is side to adjust Lumbar Spine
Hips
● Especially L5/S1 ● L3
● Bend knee; rotate foot out, check; then rotate foot in, check
● Can be performed prone or supine (both test and adjustment)
Thoracic/ribs
● Try to avoid if close to due date or breech baby…unless it is a primary subluxation then it is contributing to the issues.
Discuss health, normal function and what happens during pregnancy. Make sure you emphasize that pregnancy and birth is normal, natural and efficient when the body is working at its best.
Report of Findings
Discuss post natal work…if you don’t talk about it then they will see you as their “pregnant chiropractor” and only come when they are pregnant…you are a family wellness chiropractor!
Minimum care schedule: follow the birth provider’s schedule, stay away from corrective care plans, which can overwhelm, but find a balance so you’re adjusting them to be healthy
Schedules of care
not simply stay ahead of their symptoms.
Trained surgeon and Birth natural process
Not a midwife
Ob/Gyn Midwives
Doulas
| ●pathologist looking forproblems ● Trained to followtimetable ● Taught that birth can gowrong and they must intervene to support healthy outcome● Delivering baby by whatever means possible will save the baby’s life and is medically necessary | ● ● Patient must qualify formidwifery care ● Midwife must transferhigh risk patients● Hospital CNM● Birthing Center CNM orLDEM or DEM ● Home birth midwifeLDEM or DEM | ● ● Not a replacement forthe spouse/partner ● Trained birthassistant ● Experience andknowledge of normal natural birth and ways to support mom through this process● Can help a mom in the hospital or at home● Advocate for the birthing mom |
Utilize mindset of pregnancy adjusting
Cushion mom with pillows for breasts and tender abdomen and pelvis
Post Delivery Adjustment
Communicate health, function and wellness with your adjustments. Talk about what the patients will gain by getting adjusted and having their babies adjusted.
Infants
Average pull on a newborn’s cervical spine is 60-90lbs
Cardinal signs of subluxation from birth or intrauterine constraint are (KISS):
Birth Trauma
First Visit
● Difficulty breathing at birth (low APGAR score for respirations)
● Difficulty nursing, especially when nursing poor on one side
● Crying spells and difficulty sleeping
● Arching of the back
● Head tilt
● Flattening of back of head or bald patch on one spot ● Asymmetric skull
● Difficulty swallowing and tendency to spit up
● Child does not like to be cuddled
If left untreated, subluxations or KISS can lead to: ● Problems with balance
● Poor posture
● Walking on tiptoe
● Tiredness
● Atypical stomach ache
● Sleep problems
● Headaches
● Changes in behavior
● Growing pains
● Delay in learning words
● Changes in behavior: easily discouraged, temper tantrums, demanding
attention, nervousness
Paperwork with questions about pregnancy, birth, ultrasounds, APGAR score, vaccines, nursing etc.
Consultation
Review and ask about the birth, pregnancy, and feedings, sleep habits etc. Discuss your purpose and explain what a subluxation is
Discuss what you do and don’t do
Explain the amount of pressure you use to check and examine the baby as
Examination Who is it for? Check cranials
well as when you adjust.
Check primitive reflexes Check jaw and latch
Belly should be soft and pliable Palpate hips for popping/motion Lateral Bend
Palpate the spine completely Gluteal Fold Deviation
Scans Inversion
Watch for over stimulation
1st adjustment
2 mindsets:
Separate from the exam with explanation and preamble Physically make it separate if doing it this way…. Leave the room for a little while, have mom dress baby first, etc.
Part of the exam with explanation and preamble
Schedules of care support
- ● NO COOKBOOK! You’re the doctor!
- ● Wellness every 2 weeks
- ● Torticollis 3x a week to start; prep family for 4-8 weeks.
- ● Torticollis with plageocephaly 3×6-8 to start.
- ● Ear Infections chronic 3x minimum
- ● Nursing issues 3x minimum
- ● Failure to thrive daily
- ● Reflux 3×2-4 to start
- ● Daily checks
Motor Vehicle Crashes
● While the rate of deaths in motor vehicle crashes in children under age 16 has decreased substantially – dropping 45 percent between 1997 and 2009, it is still the leading cause of death for children ages 4 and older. Counting children and teens up to age 21, there are more than 5,000 deaths each year. Fatalities are just the tip of the iceberg; for every fatality, roughly 18 children are hospitalized and more than 400 are injured seriously enough to require medical treatment.
● 5000 deaths means 90,000 hospitalized and 2 million require medical attention!
Car Seats:
In the April issue of Pediatrics, the AAP (American Academy of Pediatrics)
published a new policy statement stressing the fact that one year and 20 pounds is the MINIMUM for forward-facing. Their new statement strongly advises parents to keep their children rear-facing until the age of two, or until they outgrow the height/weight limit for the car seat. Even then, it is advised that convertible car seats, which can accommodate rear-facing up to 35 pounds, be used. Children under 2 are 75% less likely to die or be injured in a crash if rear facing
Cranial Work
Breastfeeding Support
| Lactation ConsultantsSome are in hospital, some are trained nurses (may have never nursed)IBCLC’s have to be trained and certified through International Board of Certified Lactation ConsultantsOthers options are doulas with special training, la leche league | ENTSome will clip or use laser for the revision, must find pediatric and lactation friendly doctor.Can perform the lip tie, tongue tieDentistOften will perform a clip of the tongue in office Some don’t think it’s a big deal unless very seriousprocedurePediatricians |
Lip Tie Tongue Tie
Kristina Stitcher, D.C. 801-281-1688 office [email protected]
● Don’t start introducing foods until baby has a tooth
● Salivary amylase to break down carbs
● Teach mom to allow baby to ‘play’ with food or explore food rather than as
First Solid Foods
only nutrition source.
● Pressure from family and friends
- ● Breast milk is the main nutritional support for the first year of life
- ● First foods
● Avocado is an excellent first food ● Vegetables should be next
● Then fruit
● Lean protein
● Grain, if desired, should wait as long as possible
Vaccines
Do you have a stance on this issue?
Should this be something you discuss in a family wellness practice?
What do you say when a mom asks you?
Structuring your vaccine class
What is the goal? Education
New patients
Piss off MDs Who is your audience?
Existing patients Lay public Medical public
Why are you doing this? Share knowledge
Increase personal understanding and knowledge Stand for healthy families
NOT ANTI-vaccine
Know your scope of practice
Know your state/province or country’s laws on vaccinations so you can speak to those Be aware of any groups (religious, etc.) that are highly influential and have taken a stance in your area.
This can be a great way to build relationships with other chiropractors; medical doctors and birth providers who don’t want to discuss this topic themselves, but would love to refer their patients and clients to a class instead.
Networking
Make sure this is win-win-win (you, them and the patient) to be successful!
Midwives Obstetricians
Doulas
Birth Educators Lactation Consultants Pediatricians Dentists
Naturopaths
Herbalists Acupuncturists
Massage Therapists Cranial Sacral Therapists Energy Workers
Yoga Instructors, especially pre-natal.
Psychologists
And many others….get creative, seek out providers who help you and your family be healthy and network with them.
How Monthly Classes or Workshops Birthing Events
Natural Parenting Events
Referrals
Ask your patients whom they like!
Lunch and learn
Make yourself uncomfortable and get out there!
These can be a slow build, but once the foundation is strong they are easy to maintain at a high level and offer an ongoing referral source of new patients that are qualified in what you do.
Kristina Stitcher, D.C. 801-281-1688 office [email protected]
Further Support and Training:
Practice Evolution-
Personalized coaching with Dr. Kristina!
www.practiceevolution.com 30 Day Creating the Practice of your Dreams program
How to Raise a Healthy Child in a Sick World book or eBook through Amazon
Podcasts:
Chiropractic Evolution
and
Holistic Hive
Kristina Stitcher, D.C. 801-281-1688 office [email protected]