I know it is pathetic, but I can’t wait to have grandkids. I look forward to spoiling them rotten, doing all the things I didn’t want my parents to do!  Things like baking chocolate chip biscuits and eating ice-cream for afternoon tea.

I am also excited to share with them what I loved doing with my own kids. Like dancing like maniacs to ABBA! and most of all, reading lots and lots of books. That feeling of being tucked up in a corner of the couch or the bed with a kid on either side and getting lost in the simple adventures of little people. And reading the same book over and over and over – I am sure I could still recite many of them if I gave it a go. 

That reading aloud to children is good for them (and us) is a well-known fact. The number of kids books in the home is the number one predictor of later school success (1).  Shared reading has been shown to foster early literacy skills (2), improve listening skills (3), vocabulary (4), reading comprehension (5) and spelling (5).  Story time helps a child’s cognitive development (6) and creates a positive relationship with reading (7) which becomes more apparent the older the child gets.

A recent study even found that children who were regularly read to from baby age and on had improved behaviour and less hyperactivity at 4.5 year of age as they started school (8). Another important factor in reading rituals is the time spent bonding with the parent, enjoying some quiet time with focused interaction. Reading aloud to children has a positive impact on sleep routine, peer relationships, self-esteem and resilience (2).

Interestingly, recent research argues that a book is not just any book. A study released this week highlighted the differences in positive outcomes between reading aloud to children from a printed book and one from a screen (9). According to this study the e-book just doesn’t cut the mustard. One of the benefits from reading a book together is the child-centred conversation that the book stimulates. It offers an opportunity to engage the child by making comments about what is happening in the story and asking questions that revolves around the child and his/her life experience:

What colour is the big ball in the picture? What colour is your ball? Do you remember when we walked to the duck pond to feed the ducks?  What sound does a duck make?  Open ended questions about how the child feels about the story or what s/he thinks is going to happen next stimulates the child’s imagination as well as comprehension. It is primarily this dialogue that makes reading so beneficial for brain development.  

This study found that this type of conversation was significantly less when reading a book on a screen.  Parents were more likely to ‘just get the job done’ without asking and commenting on the story. The verbal exchanges that did take place were more likely to be directions about the device, such as not to pushing the buttons or changing the volume.

The researchers were careful to point out the small study size and basic e-book app used. They acknowledged the need for further study and stressed that if parents were aware to increase their communication with their children while reading the e-book, it would be as beneficial as the old print book.  Wusses! They know it will never be the same as the old dog-eared, crayon decorated and torn up print versions of the past!

References:

1. Family scholarly culture and educational success: Books and schooling in 27 nations M.D.R.Evans https://www.sciencedirect.com/science/article/pii/S0276562410000090
2. Reading aloud to children: the evidence E Duursma https://adc.bmj.com/content/93/7/554.short
3. Parental Involvement in the Development of Children’s Reading Skill: A Five‐Year Longitudinal Study Monique Sénéchal
4. Early vocabulary development: The importance of joint attention and parent-child book reading Brad M Farrant https://journals.sagepub.com/doi/abs/10.1177/0142723711422626
5. To Read or Not to Read: A Meta-Analysis of Print Exposure From Infancy to Early Adulthood Suzanne Mol https://www.researchgate.net/publication/49740676_To_Read_or_Not_to_Read_A_Meta-Analysis_of_Print_Exposure_From_Infancy_to_Early_Adulthood
6. Reading to young children: A head-start in life? Guyonne Kalb https://www.sciencedirect.com/science/article/abs/pii/S0272775714000156
7. The Association Between Parental Involvement in Reading and Schooling and Children’s Reading Engagement in Latino Families Gustavo Loera https://www.tandfonline.com/doi/abs/10.1080/19388071003731554
8. Reading Aloud, Play, and Social-Emotional Development Alan L. Mendelsohn, MD https://pediatrics.aappublications.org/content/141/5/e20173393
9. Differences in Parent-Toddler Interactions With Electronic Versus Print Books Tiffany  Munzer https://pediatrics.aappublications.org/content/143/4/e20182012

In my book for parents ‘Switched-on Kids, the natural way to raise healthy children’ I write about the importance of unstructured outdoor play for children, to foster a sense of connection to who we really are, to provide the opportunity to explore and being creative as well as facilitating that feeling of ‘There’s no place I need to be, nothing I need to do’.

Outdoor play for children has sadly decreased considerably over the past 20 years, despite being so essential for children’s health and wellbeing. The average child now spends less than thirty minutes a day enjoying unstructured outdoor play (1). This trend is at least partly to blame for the huge increase in overweight and obese children, along with the associated health risks, we are experiencing in the Western world (2).

Outdoor play for children improves their levels of vitamin D, which will increase the bone density and decrease the risk of future heart disease and diabetes (3). Playing out of doors helps exercise the eyes by making them to change focus frequently and this appears to decrease the occurrence near-sightedness (4). Children diagnosed with ADHD experience improvement in their behaviour from being in nature (5) and it also helps sleep (6).

Research has shown that outdoor play for children taking place in natural surroundings, such as parks, gardens and school recreational areas, which has dirt, rocks, trees, shrubs and water such as creeks, lakes and oceans, improves their strength, flexibility and coordination and reduces their stress levels and inattention.  It also fosters supportive peer relationships and feelings of competence (7).

According to Karen Malone from University of Wollongong (8) who wrote ‘Every Experience Matters’: An evidence-based review on the role of Learning Outside the Classroom for children’s whole development from birth to eighteen years:

• Outdoor play for children helps them achieve higher results in the knowledge and skill acquisition;
• Increase their physical health and motor skills;     
• Socialise and interact in new and different ways with their peers and adults;     
• Show improved attention, enhanced self-concept, self-esteem and mental health;  
• Change their environmental behaviours for the positive, as do their values and attitudes and their resilience to be able to respond to changing conditions in their environment

What we as chiropractors can do to foster outdoor play for children

With this in mind, I frequently have conversations with parents about what after-school activities are essential for a child.  Of course, they need to exercise, but no-one ever stipulated that exercise had to be organised by coaches in 60 minute time slots.  Riding bikes around the oval, climbing trees and doing scary stunts at the skate park all counts as exercise, plus it is self-directed, outdoors and fun. 

The safe green spaces and quiet streets that we may have enjoyed when we were kids may not be available for our children, but taking a bunch of neighbourhood kids to the park for them to play while we parents chat, read a book or get our exercise by walking the perimeter is much better for all than being locked inside with a device in our hands.

As chiropractors we can do a lot to inspire parents to actively slow down the manic speed of everyday life by encouraging them not to get caught up in the ‘must do activities’ and the perceived expectations of a successful childhood. The benefits of saying ‘No’ can be liberating and exhilarating for the whole family.

References:

(1) Li Ming Wen et al, ‘Time spent playing outdoors after school and its relationship with independent mobility: a cross-sectional survey of children aged 10–12 years in Sydney, Australia’ International Journal of Behavioral Nutrition and Physical Activity 2009, 6 

(2) Trost S et al. ‘Physical activity and determinants of physical activity in obese and non-obese children’. Int J Obes 2001

(3) American Academy of Pediatrics. ‘Many Children have suboptimal Vitamin D Levels’ Pediatrics. October 26, 2009

(4) Kathryn A. Rose, Ian G. Morgan et al. Myopia, Lifestyle, and Schooling in Students of Chinese Ethnicity in Singapore and Sydney.  Arch Ophthalmol. 2008;126

(5) Wells, N.M. ‘At Home with Nature: Effects of “greenness” on children’s cognitive functioning.’ Environment and Behavior November 2000 vol. 32.

(6) National Wildlife Federation 

(7) Louise Chawla, Kelly Keena et al. ’Green schoolyards as havens from stress and resources for resilience in childhood and adolescence.’ Health & Place, Volume 28, July 2014, 

(8) Dr Karen Martin. ‘Putting Nature back into Nurture: The Benefits of Nature for Children. A Literature Review’ The University of Western Australia

According to the Royal Children’s Hospital in Melbourne (1) 30% of four-year olds wet the bed. At this age, it is considered normal.  A diagnosis of ‘Nocturnal Enuresis’ is given if it affects a child over five years old.  15% of five-year olds wet the bed, 5% of 10 year olds, and 2% of 15 year olds.  These statistics are surprisingly similar all over the world (2). It affects twice as many boys as girls (3).  20% of the kids with nocturnal enuresis also have daytime accidents and 15% have bowel accidents (3). There is a strong genetic association, with 75% of children whose parents both wet the bed suffer with enuresis, and 50% if only one parent did (3).

Theories abound for the cause of nocturnal enuresis. If the child has never been dry at night, he will have what is called primary enuresis, whereas secondary enuresis means the child has had at least six months of being dry at night.

Secondary enuresis can be caused by psychological stress such as a new baby in the family, changing schools, moving house or similar. It can also be related to a UTI or constipation, diabetes, sleep apnea or obesity (2).

Primary enuresis is thought to be caused by having a smaller bladder, producing more urine at night, bladder muscle (Detrusor) overactivity, poor sleep pattern, global maturation delays and poor brain bladder connection (3).  Research has shown that children with ADHD have a higher incidence of bedwetting (4).  

Being a chiropractor will invariably involve providing chiropractic treatment for bedwetting

Common advice for bedwetting includes sticker charts and prizes and ‘lifting’ – waking the child to go to the bathroom at night. According to one study ‘lifting’ over a six month period improved symptoms significantly in 37% of the kids, whereas the positive reward did nothing (5).

Bedwetting alarms are a popular approach to nocturnal enuresis, according to Glazener helping almost half the kids studied to stay dry (6). Another increasingly common medical treatment is the prescription of Desmopressin, a synthetic Anti-Diuretic Hormone mimicking the effect of vasopressin normally increasing at night to decrease urinary output from the kidneys.  According to the literature this fixes bedwetting completely in 30% of kids with another 40% experiencing improvement.  However, there is a 70% recurrence once medication is stopped (3).

Although clinical trials (7), and maybe personal experience have shown that chiropractic treatment for bedwetting is not totally successful, I think there are important thoughts to be had about chiropractic on this topic.  Even if it is just that we know from Heidi Haavik’s research that chiropractic adjustments impact the function of the prefrontal cortex (8), and we know that the prefrontal cortex oversees the function of the lower brain functions such as the brainstem which controls micturition (9).  

LeBoeuf’s study from 1991 (10) found that the 170 children aged 4-15 years experienced an average decrease in bedwetting (from 7 to 5.6 nights per week), just from showing up in the chiropractic office – no care provided.  This number was reduced to four nights per week after receiving chiropractic treatment for bedwetting.  I reckon a 43% improvement from a non-invasive approach is not too bad.

Although, as far as I know, all adjustments stimulate the prefrontal cortex equally, I usually pay more attention to the parasympathetic levels when adjusting: Keeping in mind that the individual sacral bones fuse at 18-30 years of age (11), check sacrum, upper cervicals and cranials.  Also assess pubic bones and pelvic floor muscles and fascia.

Some things to consider when caring for a kid with Nocturnal Enuresis:

Constipation is an important factor in enuresis and should be discussed in detail. A child over five years will usually take care of all toileting himself.  Constipation may cause ‘overflow’ movements, resulting in ‘loose’ stool, faecal material which has squeezed around compacted faecal material.  This may cause ‘skiddies’ or accidents, or that the child thinks he has had a bowel movement. A food diary should be kept, and a keen eye kept on the amount of fibre and fluids consumed, as well as potential food intolerances.  Lack of physical activity can be involved in constipation and potentially irritate the bladder.

Sometimes parents are very vigilant when it comes to decreasing fluid intake later in the day.  Although it makes sense to decrease drinking for an hour or so prior to bedtime, limiting fluids may increase the concentration of the urine, irritating the bladder lining and exacerbating the poor bladder control at night.  Point out that coffee, tea and soft drinks are diuretics.

Research has shown that pelvic floor exercises are not effective as a treatment for nocturnal enuresis (12).  Overall muscle tone is though, as it stimulates brain function and brain-body connection, and the child should be encouraged to keep physically active in sport and play.

In my experience ‘stressing’ the bladder can be a good way to connect the brain and the bladder.  I usually suggest the whole family participates, so as not to single out anyone: Drink a huge amount of water, and then try not to go to the bathroom. Hang on, hang on, curl the toes, squeeze the knees…..  Only go when it is impossible to hang on anymore.  This will help stretch the detrusor muscle and ‘wake up’ the sensory nerves to sensitize the brain to the sensation of a full bladder.  Jumping and running with a full bladder will have a similar effect. 

References:

1. https://www.rch.org.au/kidsinfo/fact_sheets/bedwetting/
2. https://www.parentingscience.com/bed-wetting.html
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4251068/
4. https://www.ncbi.nlm.nih.gov/pubmed/19096296
5. https://www.sciencedirect.com/science/article/pii/S0022347608010688
6. https://www.ncbi.nlm.nih.gov/pubmed/15846643
7. https://www.ncbi.nlm.nih.gov/books/NBK62701/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800094/
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5714479/
10. https://www.ncbi.nlm.nih.gov/pubmed/2019820
11. https://www.ajronline.org/doi/10.2214/ajr.170.4.9530059
12. https://www.ncbi.nlm.nih.gov/pubmed/19695646

It’s that time of year again, where life just speeds up to almost manic proportions. Everyone wants everything finished before the big day, everyone wants to catch up before the end of the year, everyone wants to leave an empty in-tray for the holidays. There are umpteen end-of-year concerts, get-togethers, performances, tests and reviews.  There is so much fun and excitement that it all just spills over into one word: Busy.

There is nothing wrong with ‘Busy’ as such. It just means we have full lives; that we choose to participate and go all in.  However, it seems that lately being insanely busy has become almost a prerequisite to fit in to our Western lifestyle. To the extent that I have noticed people in Australia have changed the way they greet each other.

It used to be: “How are you going?” and then without waiting for an answer they would follow with another question: “Good?”. Now they ask: “How are you going? Busy?” As if being good and busy are synonymous.  Which, of course, we all know they are not. I’m not telling you anything new when quoting stats from beyondblue:

• 45% of Australians will suffer mental illness in their lifetime,
• In any one year 1 million Australians suffer depression
• 2 million suffer anxiety

According to a Medibank survey from December 2017, the number of people reporting they suffer with stress have increased by 30% in the past decade, now affecting almost 5 million Australians.

These problems are becoming so much more prevalent in our children as well.  It is estimated that 14% of children between 4-17 years suffer mental health problems.

Meditation as mediator for all ages

Now, we know what to do to tackle the busy-ness: We can make conscious decisions to say No Thank You, we can practice being present and participate in yoga, mindfulness and meditation. These are no longer fringe approaches written about in women’s magazines. They are recommended by the medical establishment as well as chiros and spiritual healers.

Little Nick, a 5 year old Kindergarten kid with ADHD, highlighted just how far we have come on this path. As I was adjusting him this week, we chatted about what the best part of his school-day had been.  “My meditations” he said without hesitation.  “We meditate for 5 minutes when we come back into the classroom after recess and lunch”. Then I asked him a really intelligent question: “So what do you do when you meditate?”, to which Nick answered: “We breathe. Just breathe. The teacher says ‘Breathe in……… Breathe out…..’ And that’s what we do”.

How insightful from that little man! In my book Switched-on Kids – The natural way for children to be their best, there are several strategies for parents to help their children improve their mental and emotional health through breathing and meditating.

An important point about this though is, that this practice really has to start with us; their parents.  We tend to get caught up with the Must Do’s on our to do lists: work, kids’ activities, cleaning, canteen, social engagements, news watching, exercise, P&C meetings, healthy food preparation, podcasts etc.  However, for our children to have the best opportunity to not end up in a busy and disconnected lifestyle, we want to be their role models.  Which means choosing to take some time out of our busy lives to meditate and breathe, just like Nick.

So, as this is also the season for giving, I want to thank you for being part of the Switched-on Kids Community this year by giving you a little gift. Whether you receive this as a chiropractor or a parent doesn’t matter, this is to help you slow down and connect with yourself on a daily basis. Research shows that practicing ‘presence of mind’ for just 10 minutes a day has long lasting effects on brain circuitry and connection, helping us feel calmer and more centred.  It helps us change our subconscious behaviour patterns and our bodies to function and heal.

This little gift comes from an expert in the mindfulness world who understands the importance of incorporating presence into all areas of our lives. Charlotte Thaarup from the Mindfulness Clinic has over 20 years experience in facilitating positive change in our personal and interpersonal lives.  The gift is access to nine guided meditation which you can download and play whenever; for example if someone cancels their appointment, or, even better, you come in 15 minutes early and choose to use this time for you to become more connected with yourself and present in your life.

You can find the meditation at:
https://themindfulnessclinic.com.au/mindfulness-practice-free-audios/  
Password: tmcfreeaudio

Enjoy!

It is getting to that time of year when the primary schools here in NSW invite their prospective Kindergarten students for special visits to ‘Big School’.  This is to help the kids familiarise themselves with the school environment, surroundings and routines and prepare them for this exciting milestone early next year.  Although it is only a small group of children who fit in to the birthdate window giving them a choice between starting young this coming year or being one of the older kids the following, it is a very common question from parents in my office: What is the best option in children’s learning experience?

Obviously, each child is different; their social skills, maturity, independence, interest in learning etc. and the child’s preschool will have invaluable advice to give in this matter.  The individual families and their values and circumstances also vary greatly, so it is impossible for us to give a definite answer.  However, we can provide some information that may stimulate some food for thought.

Compared to the rest of the developed world Australian children start school quite young at 4.5 to 6 years of age. The top three countries with regards to children’s literacy: Singapore, Shanghai and Finland, start their kids’ schooling at age seven years or older (1).  This provides them with important time to play and learn on their own terms, which in turn makes the children’s learning experience happier and more successful.  These are the words of David Whitebread, an expert in paediatric cognitive development from Cambridge University.

A Danish study demonstrated that delaying children’s school start by one year (start by age seven) decreases their risk of inattention and hyperactivity at the age of eleven by 73% (2).

Another study showed that children who were allowed to play while in preschool had better grades by year six (twelve years old) than peers who were introduced to formal learning earlier (3).

Studies have also shown that eleven year old children have the same reading ability whether they start formal learning by five or seven years of age (4). However, children who started learning younger had poorer reading comprehension and enjoyment of reading.

The improvement in children’s learning experience, behaviour and emotional health is attributed to longer time to play – a time where they foster movement, creativity, interpersonal relationships, language skills, communication, both verbal and non-verbal and building resilience.  The importance of play is increasingly being recognised by researchers and policy makers as essential for a child’s emotional and intellectual development.

From a slightly different angle, Malcolm Gladwell in his book ‘Outliers’ talks about the successful lives that children experience throughout their entire lives, just because they started out being a little bit older, bigger, faster, smarter and more mature than their younger peers.

We should never tell families what to do, but ‘Real Life’ really starts soon enough….. ?

I love this chiropractic stuff! I fully embrace the chiropractic values, live the chiropractic lifestyle and have total faith, confidence and belief in what we do.  The joy it brings to bear witness to the power of chiropractic: a non-verbal autistic child that speaks, a colicky baby that stops crying, the dyslexic kid that starts to read and the families whose lifestyles and connections improve.  All by removing the nervous system interference to allow them to express their optimum potential.

Why chiropractic research is evermore important

However, the more experience I get in chiropractic, the more I realise that we are on our own.  No other profession has faith, confidence and belief in chiropractic or in healing for that matter.  Regardless of how much we say: “Look at my results.  The people I see are happy, healthy and they keep coming back”, we are judged as something like ‘conniving faith-healers’.  No-one understands that we don’t treat symptoms, or what we could actually be doing if we are not treating symptoms.  It doesn’t help that we are not always very good at communicating this so the people we serve understand this concept.  Often even they think we are treating them for something or preventing something.

The common language used in healthcare is research.  The holy grail of the double blind randomised controlled trials for every possible treatment.  Exactly this is the crux of our challenge.  To stay true to our truth, that whole setup is not going to work for chiropractic. We are, per definition, not a treatment for anything, LBP or otherwise.  We remove interference to the brain and nervous system, allowing the body to heal and function as it is designed.  We don’t own the outcome.

That doesn’t mean we shouldn’t focus on chiropractic research.  We have tried to play our own game parallel to the rest of the healthcare professions, but that hasn’t really served us well.  There are many, many more chiropractors practicing today than when I graduated, but we are serving less of our community.  To connect and be relevant in our communities’ health we need to be able to demonstrate objectively that what we do positively impacts lives.  And the only way to do this is through chiropractic research.  Ethical and appropriate research that answers chiropractic questions:  What do we do?  How does what we do work?

This is where the Kids’ Summit comes in. The purpose of the Kids’ Summit is to raise much needed capital to fund the outrageously expensive studies into the effects of subluxations and adjustments on a little person.  This year’s big fundraising event is happening in Chicago September 29-30.  We have world class speakers from all over the globe volunteering their wisdom and experience for us to donate the profits of the event straight into research on chiropractic care for kids.

If you are the least bit interested in kids chiropractic, you will know the superb expertise of these people:

• Steve Williams
• Julie Uren
• Claudia Anrig
• Joyce Miller
• Martin Rosen
• Janine Kinahan
• Monika Buerger
• and myself (Dorte Bladt).

I encourage you to come along.  Not only because it’s going to an amazing event with a tremendous amount of knowledge being shared, hands-on skills being taught and friendships to be made.  Chicago is beautiful in September, and always a fun and lively place to visit.  More importantly is the fact that you invest in your future.  In this age of instant results and gratification, we need to become a respected alternative force in the healthcare field.  Not by trying to fit in to someone else’s model, but by objectively defining who we are and what we do through our philosophy, art and science.

I realise that it may be a challenge for you to join us in Chicago.  You are still able to help support the tireless effort of the Kids’ Summit and thereby kids chiropractic research by making a donation – all profits going directly to chiropractic research for the future of our profession and the health of our community.
www.thekidssummit.com

News about the escalating number of children suffering with learning difficulties and various diagnoses are a common depressing read in the Australian press. The economic burden on society is often mentioned, highlighting that this is a problem that affects us all. Figures from USA estimates the combined annual national cost of learning disabilities, autism and ADHD to be US$ 193 billion!(1) Although we can’t extrapolate these figures to Australia, the fact is: it’s costly. More importantly though, is the worry, pain and stress the individual child and their families suffer when they are not performing at optimum.

To ensure the best outcomes for these children, an early diagnosis is essential. Health professionals’ ability to diagnose learning difficulties, ASD and ADHD have improved significantly over the recent years and this helps the child receive the support she/he requires.

A recent study (2) draws our attention to the possibility of early screening to pick up the potential strugglers before actual challenges manifest in the child. In this study they used the presence of three primitive reflexes in pre-school aged children to measure psycho-motor function of the child and compared this to a standardised assessment for this age group called MOT 4-6.

Primitive reflexes are commonly used by many health professionals to assess integrity of a baby’s nervous system and track the baby’s development as the reflexes normally integrate. The reflexes are replaced over the first year of life by more mature motor responses: postural reflexes and voluntary movements in gravity.  Zafeiriou (3) mentions that babies with 5 or more abnormal postural reactions, as in non-integrated primitive reflexes, have either developed cerebral palsy or developmental retardation.

Sally Goddard and many others have demonstrated that retained primitive reflexes beyond the first 12 months of life is indicative of decreased brain efficiency in processing sensory information. This will interfere with gross motor function, balance, coordination, learning and behaviour – ‘minimal brain disorder’ (2).

The physiotherapists who conducted this study assessed the presence of the asymmetrical tonic neck reflex (ATNR), symmetrical tonic neck reflex (STNR) and tonic labyrinthine reflex (TLR) in 35 healthy, typically developing pre-schoolers (4-6 yrs old).  They then conducted a Motor Proficiency Test for children between 4 and 6 years old, MOT 4-6, a validated test for stability, locomotion, object control and fine movement skills in this age group.  The 18 standardised movements included jumping sideways, throwing at a target and standing on 1 leg.

The researchers then compared their results, and they were very interesting!  Out of the 35 normal, healthy, well-functioning children 89% had at least one retained primitive reflex, although most at a very residual level.  69% of the girls and 63 % of boys had good or complete integration. The MOT 4-6 showed 63% of the girls and 60% of the boys showed very good or normal development.

The results of the two tests correlated: The children who had better motor function also had fewer retained primitive reflexes. So as a screening method the 3 reflex tests showed the same results as the 18 motor proficiency tests.  This could save significant time and effort in highlighting children who may benefit from a little extra attention.

So what does all this mean for us?  It is obviously a very small study group, and I don’t know much about the lifestyle of families living in Gdansk.  However – if we generalise – about 40% of preschool kids, who have not been flagged as needing special attention, are actually functioning below their potential.

Given Heidi Haavik’s research on the effect of the adjustment on sensory motor integration and pre-frontal cortex function, does chiropractic have a role to play here?   Research has shown that sequential brain-based movement patterns can help stimulate reflex integration and improve brain function (4).  And we know how to asses a child for primitive reflexes and provide appropriate exercises, don’t we?  If not, maybe it’s time to learn so we can play an active role in children living healthier, happier (and cheaper) lives.

References:

1. https://www.socialworkdegreeguide.com/autism/
2. Persistence of primitive reflexes and associated motor problems in healthy preschool children Ewa Z. Gieysztor Arch Med Sci. 2018 Jan; 14(1): 167–173.
3. Primitive Reflexes and Postural Reactions in the Neurodevelopmental Examination Dimitrios I. Zafeiriou, Pediatr Neurol. 2004 Jul;31(1):1-8.
4. Prevalence of Persistent Primary Reflexes and Motor Problems in Children with Reading Difficulties M. McPhillips and N. Sheehy Dyslexia. 2004 Nov;10(4):316-38.

I am sure you are aware of the information overload we suffer in the Western World.  Research suggests that we take in 174 newspapers worth of information daily (1), obsessively check our phones on average every 12 minutes (2) and have an attention span of about 8 seconds – less than goldfish! (3). We know that to get our message across to people we need to be succinct and to the point. However, it is my experience that we as chiropractors tend to forget this very important knowledge when we get into our practices.

When a family first presents to our office we are keen to make a good impression; we want to make sure that Mum and Dad understand what we are doing, feel comfortable with us and know how much we know.  To this end we often talk and explain the whole first visit away: About retained primitive reflexes, what an AS occiput means, the effect of low muscle tone, what the sacral plexus is involved in, how gluten intolerance can upset nervous system function….  Now, don’t get me wrong!  All this is important information, and definitely what the people who see us need to know and understand.

The problem is that it can be waaayyy too much information for that first impression, potentially causing double trouble: The parents may feel overwhelmed, confused and maybe even a bit concerned whether they have made the right decision bringing their little one to us. Even worse, we may talk ‘over the child’ and not involving him or her in what we are doing, risking that he/she feels bored or ignored.

BRIEF:

Joseph McCormack, author of a book called ‘BRIEF: Making a Bigger Impact by Saying Less’ encourages us to really think about what it is we need and want to get across, and then verbalise that and nothing else.  He suggests using the acronym BRIEF when communicating on a professional level.  For us chiropractors during the first visit, it could look something like this:

B (Background): Provide a quick context:  What is chiropractic?

R (Reason): Why chiropractic?

I (Information): What are the essential 2-3 points you want them to know

E (End): Link their child to what you’ve just talked about

F (Follow-up): Check in that they are OK and ask for permission to proceed to exam.

So, getting back to the picture: Once you have listened carefully to the child and the parents about the concerns that have brought them to you, let your examination do the talking!

Pre-frame your examination using BRIEF communication: what you will be looking for and how the exam will demonstrate this.  Then concentrate solely on connecting and communicating with the child while you let your exam demonstrate both your skills and the child’s underlying problem.  When finished, succinctly state what you found and what it means and what you can do to help.  Some people will want to know more, which is great – you know they are interested, will tune in and remember.  Others will not – and you know they will leave with the knowledge you have chosen to give them.

And if you made it to the end of this – congratulations, you have the attention span of a genius!  I hope you have an opportunity to give BRIEF communication a go today.

References:

1. The Organized Mind: Thinking Straight in the Age of Information Overload by Daniel J. Levitin
2. https://nypost.com/2017/11/08/americans-check-their-phones-80-times-a-day-study/
3. http://time.com/3858309/attention-spans-goldfish/

Advice: how to start tummy time

Advise the parents to start tummy time with just a few minutes whenever given the opportunity: after a bath, dry baby while on her stomach and give her a lovely, gentle back massage while she is there.  Burp baby while prone over parent’s lap and roll her onto her tummy for a stint with every nappy change.  Explain to the parents not to let baby get overtired.  When the head flops down or she starts to fuss, that’s is enough for now.

The long-term aim is to work up to longer sessions, adding up to at least 40-60 minutes per day.

A great way to start tummy time with a newborn is simply to rest on the chest of a reclining parent.  The parent can be more or less horizontal depending on baby’s comfort and tolerance.

Being carried tummy down on a parent’s arm is often very soothing for baby, while still encouraging her to lift her head.

Tummy time can also be done on the parent’s thighs, either across (maybe with one thigh slightly higher than the other the make it a bit easier to lift the head) or along the thighs.  This works particularly well if there is an amazing sibling running around or a doting Nanna that is interesting to observe.

Another great way to play with baby while providing tummy time is placing baby on the parent’s shins.  This is a great opportunity for the parents to do a bit of core exercise too.  It can be done sitting, where the angle of the legs again determines the amount of work required for the baby to lift the head.  The parent now switches on their core and leans back a bit to get a work-out of their own.

It can also be done with the parent supine.  The higher the shins, the more of a work-out for parent and baby.

And don’t forget the ball.  Babies often love the vestibular stimulation of rolling on their tummies on the big ball. Forwards and backwards, and side to side.

Tummy time is important

As baby gets a bit older and stronger she will often be quite happy being on the floor.  Place them on different colours and textures: blankets, sheep skins, towels, fleeces and playmats, to provide interesting and varied sensory experiences. If baby still struggles to lift and control the head, a small rolled up towel placed under the baby’s chest and arms may help.

The important point for parents to realise is that tummy time is not a time to do the dishes.  It is hard work for the baby and will usually go down much better when it involves fun and socialisation.  Encourage the parents to spend this time on their tummies as well, to visually connect with their baby, coo and chat, sing songs and nursery rhymes.  Also use mirrors and interesting colourful toys to keep baby engaged and interested.

The expectations for baby’s tummy time is that she for the first couple of months will lift the head up and turn from cheek to cheek. By 3 months, baby will hold the head up to 45-90 degrees without too much bobbing and hold a bit of weight on the elbows.  The 4 month old will hold the head to 90 degrees for extended periods and lift chest off the floor through their forearms.  They will also lift both arms and legs up and do ‘swimming’ movements.  By the 5th month, the baby will often learn to roll.

This will decrease the amount of time the baby spends on her tummy.  However, it is from here baby will learn to commando crawl and 4 point cross crawl, so encourage the parents to keep putting baby on the stomach and let her do as she pleases from there. Which is what she will end up doing anyway…..

Let us actively work together with our families and communities to promote a stronger and healthier next generation.

Check out my course on baby basics to learn the latest best-practices in how to care for babies.

There are so many benefits of tummy time and it is the number one activity, an absolutely essential for baby’s future health and development.

Benefits of tummy time and prone position for baby:

• stimulates brain development and connectivity
• strengthens and coordinates muscles
• integrates primitive reflexes
• promotes gross motor development such as rolling, sitting, crawling and walking
• develops spinal curves
• stimulates digestion
• encourages eye function for vision, tracking and coordination
• improves capacity for learning and concentration later in life
• helps prevent plagiocephaly

There is a lot of benefits of tummy time to easily gain.

The initial flexed spinal and limb posture of a baby have to go through significant development to end up as a strong and coordinated bipedal, thinking and connecting human being. Developmentally, this happens through the interplay between the developing brain and the control, coordination, flexibility, tone and strength of the muscles of the spine and body.

The prone position for baby requires muscle contraction of the spinal extensors, which stimulates the cerebellum and thereby the rest of the brain. Lifting the head fires the upper cervical proprioceptors, stimulating the brain as well as causing contraction of the core muscles. The more physical/movement stimulation the brain receives, the faster and better it will develop.

Research shows children who spend more time on their bellies achieve their early gross motor milestones earlier (1). Studies have also shown that children who reach their milestones early tend to ‘perform’ better later in life (2). Primitive reflexes are brain stem movements, and integration of these depend on developing coordinated voluntary movements and postural reflexes. These are midbrain and cortical functions and essential for future success with regards to learning, attention and behaviour (3).

So the prone position for baby stimulates the higher centres in the brain by encouraging repeated movement patterns requiring strength and coordination. The prone position also facilitates ‘accidental’ movements, like rolling, and sets the baby up for cross-pattern movements: commando crawling and 4 point crawling, as well as walking.

The gentle pressure on the abdominal organs from the prone position will stimulate and ‘massage’ them, encouraging movement and release of wind. Plagiocephaly (flat head) has been shown repeatedly to be prevented and improved by increasing tummy time (1). The prone position for baby also provides a totally different visual perspective of the world, helps discovering the hands for hand-eye coordination and promotes converging/diverging eye coordination with the change in head position.

The muscle tone required for upright posture has to be developed through body movement and core muscle strength. Put yourself in a baby’s position and imagine yourself lying on your back and moving your arms and legs. Compare the effort of doing this to moving your limbs and head while lying on your tummy. The benefits of tummy time is that it is much harder!

With today’s epidemic of sitting, tech neck and poor posture and the associated health issues of poor breathing capacity, changes in hormone production, blood pressure problems, mood challenges and concentration difficulties (4) it is so important to help families get off to a good start. Next month I will show you some fun ways for parents and babies to enjoy the benefits of tummy time.

References:

1. The Influence of Wakeful Prone Positioning on Motor Development During the Early Life. Kyu, J Dev Behavl Pedia. 2008 Oct
2. Infant motor development is associated with adult cognitive categorisation in a longitudinal birth cohort study. Murray, J Child Psychol Psychiatry. 2006 Jan
3. Primitive Reflexes and their Relationship to Delayed Cortical Maturation, Underconnectivity and Functional Disconnection in Childhood Neurobehavioral Disorders Robert Melillo 2011
4. Switched-on Kids – The natural way for children to be their best Dorte Bladt 2016