Children’s sleep is one of the most common concerns mentioned by parents in my practice.  31% of ‘normal’ school children aged 6-13 are reported as having disorders of initiating and maintaining sleep, and 41% of parents feel their children (aged 2-14 years) suffer insomnia (1). The amount of sleep required by children obviously varies depending on age, as well as from child to child.  Be aware that school kids aged 6-12 years old still need 9-12 hours of sleep every night (2).

Sleep is required for growth, immune function, healing, learning and memory formation. A recent study found that children who sleep too little may suffer depression, anxiety and impulsive behaviour, and have poor cognitive performance.  The effect on depression may last up to 12 months after the period of sleep issues (2).

In my book ‘Switched-on Kids – the natural way to help kids be their best’, I write about the importance of establishing a set and calming routine to prepare for bed. Here are some helpful hints to discuss with parents when talking about children’s sleep:

Start slowing down activities one to two hours before bed.  Take a relaxing, soothing bath or shower and do quiet activities together such as reading books, telling stories, drawing, breathing exercises, meditation, doing craft or a puzzle in the time before bed.  A cup of chamomile tea or warm milk can be very calming.  Avoid adding sweetener, as that may increase activity levels in the short term.  It is best to not eat a lot just before bed, as digestion may interfere with sleep.  If the child is hungry, offer a light snack, ideally a food containing tryptophan to help produce melatonin (chicken, eggs, cheese, fish, peanuts, pumpkin and sesame seeds, milk and turkey).  Avoid caffeinated drinks for several hours prior to bedtime.

If a child has trouble sleeping due to anxiety, or tends to wake from nightmares, it is important to talk about it, but earlier in the day.  Just before bedtime it is better to chat about happy places and things to encourage a relaxed state conducive for sleep.

In the pre-sleep time, preferably at least one hour before bedtime, it is important not to use screens such as TV, computer, iPad or phones.  The blue light emitted by these devices stimulates the brain and keeps it active, which is what we do not want at this time.  Also avoid TV’s and computers in the child’s bedroom, as we want the brain to associate the bed with sleep, not with game playing and socialising.

Try to keep the child’s bedroom free of toys and clutter to minimise the inspiration to play at this time.  Keep the room dark, cool and comfortable.  A nightlight may help with this. At the end of the day it about ensuring the kid feels safe, loved and relaxed to help the whole family sleep well and be their best.

• Prevalence and Course of Sleep Problems in Childhood Leonie Fricke-Oerkermann, Sleep Oct 2007
• ‘Sleep duration, brain structure, and psychiatric and cognitive problems in children, Wei Cheng, Molecular Psychiatry 2020

1 – ‘Effect of Sunscreen Application on Plasma Concentration of Sunscreen Active Ingredients
A Randomized Clinical Trial’ Murali K. Matta, JAMA. 2020;323(3):256-267. doi:10.1001/jama.2019.20747
2 – https://www.ewg.org/sunscreen/report/the-trouble-with-sunscreen-chemicals/
3 – https://phys.org/news/2019-03-beaches-sunscreens-coral-reefs.html
4 – https://www.fda.gov/media/124654/download

Now, I am no expert in communicable diseases, nor is this meant to be an opinion or advice about travelling or transmission prevention.  What I do know is that we have entered a phase of global hysteria, a state of deep-seated and unresolving fear, which will have a profound impact on our communities’ health both physically and emotionally for the foreseeable future. 

This state of perpetual fear facilitates a dangerous state of dis-ease, activating our HPA axis, decreasing vagal tone, lowering our immune response, slows our healing and damages our interpersonal relationships.
 
I also know that families are functionally connected units where the emotional state of each person is picked up, assessed and reacted to by the other family members:  Babies struggle to settle and feed when mum’s under stress.  Toddlers don’t sleep well and act up to regain parents’ attention. Children struggle to concentrate and learn as they suffer in fight-flight mode.  And everyone is more susceptible to immune challenges, whatever they are. 

The fact is that we are all under considerable stress in our everyday lives full of work, house duties, chauffeuring kids, finances, time pressures as well as global warming, pollution, pesticides, 5G, nano particles…….  The list is endless.

We have one antidote – human touch.  It causes a release of oxytocin, increases parasympathetic activation, improves immune function, mood and brain function.  It is free, widely available and very effective.  Let us, at least at this point in Australia, not become hostages to our fear, nor to the media, which is having a heyday playing with our emotions. Rather, let us take a deep breath, cuddle our children, get into nature, kiss our partner, relax, be mindful, embrace our parents, eat well, get adjusted, hug our friends, exercise, enjoy some sunshine.  And for goodness sakes – turn off the news!

From the Department of Health ‘Coronavirus (COVID-19) health alert’ www.health.gov.au: As at 06:30 hrs on 29 February 2020, we have 25 confirmed cases of coronavirus (COVID-19) in Australia. 15 of these cases are reported to have recovered. The remaining cases are in a stable condition. 

From the Department of Health ‘A Summary of Influenza Surveillance Systems in Australia, 2015’: In Australia, it has been estimated that influenza is associated with 366 respiratory and 1,400 all-cause deaths.

In the world of chiropractic practice, people come and people go. Although I envision lifetime care, some people leave because they feel better, or because they don’t, because they prioritise their finances differently or whatever other reason.  I am fine with that.  What I am not so good with, is if they perceive I haven’t done my job properly and leave cranky, disappointed or sad.

Some years ago, I had a very unhappy experience involving a wellness family who I had cared for over a period of several years.  The daughter of the family, Amanda, was brought in to see me when she was eight years old as she struggled with attention resulting in school learning delays and self-confidence issues.  She was also quite uncoordinated and chose more ‘sedentary’ pastimes such as craft and colouring in rather than moving.  Thankfully Amanda responded very well to chiropractic care and soon the whole family was under care.

Time flies and suddenly it was time for high school for Amanda. Mum brought her in for a thorough check up a few weeks before school started and insisted on having this assessment include X-rays.  I generally do not X-ray children unless absolutely necessary, but Mum was adamant, so I gave in.

The X-rays came back as expected: unremarkable, except for a lack of cervical lordosis.  Mum knew of the importance of having proper spinal curves from her own images and wanted to know why Amanda didn’t have one. My understanding at the time was that a lack of cervical lordosis in children who are developing and healthy is not typically normal.

I had learnt that cervical lordosis is the first spinal curve to develop in young babies as they learn to lift their head up and hold it there while on their stomachs.  I had learnt that the cervical curve functions to ‘neutralise’ the thoracic kyphosis we are born with, enabling us to keep our head upright with the eyes forward and horizontal. Normal was to have a cervical lordosis.

The only cause I could think of for Amanda’s lack of cervical lordosis was too much time sitting with the neck and spine in a flexed position and mentioned the dreaded tech neck (or book neck) as a possible cause.  Mum exclaimed that Amanda had very limited screen time!  Therefore, she could only conclude that my chiropractic care had been inadequate in providing the appropriate bone and soft tissue development and curvature.

I was very sad and upset as Amanda and her family marched out of the practice with Mum swearing she would never return. And I have to admit that, although I have never thought, intended or claimed that the care I provide creates or restores curves, I was very disappointed in my ability to ensure Amanda developed at her best.

The Shocking Fact: The Lack of Cervical Lordosis in Children is Normal!

Fast forward many years, and here I am in 2019 doing the second year of my Masters in Paediatrics enjoying the company of the legendary Dr. Lindsay Rowe on a video going through ‘Normal and variant radiological anatomy of the paediatric patient’. I almost fell off my chair when he stated that a lack of cervical lordosis in children is normal (WHAT!!).  That the cervical curve commonly doesn’t form till the end of adolescence at 14-16 years old.

As chiropractors, we could argue what ‘normal’ is. However, if the curve does develop at 14-16 years old maybe it is a sign of structural maturity, increasing core and postural strength, better coordination of the spinal muscles and/or developing neural integrity….  The point is: it is not just a sign of subluxation or poor posture.

It is obviously too late for Amanda.  However, for the rest of the families in our practices and communities, it is wonderful to know that we chiropractors have all this extra time to facilitate the development of the proper cervical curve through our adjustments, advise on movement, exercise and proper posture as well as encouraging limiting sitting and screen time.  And encourage chiropractic care for a lifetime!

References:

• Rowe LR. (2005) Normal and Variant Radiological Anatomy of the Paediatric Patient. Kiro Kids p/l, Adelaide South Australia
• https://www.ncbi.nlm.nih.gov/pubmed/24395005
• https://pubs.rsna.org/doi/10.1148/rg.233025121#REF3

Here we go again – another Christmas is upon us.  Whether that means cold and dark or hot and sunny, it seems that both the little and the big people in our practices are tired and on edge, ready for a break.  The kiddies are super-excited about the big guy in the red suit visiting, while their parents are worried about what that means in time, financial strain and socialising with loved – and maybe not so loved – ones. 

The upcoming festive season can be a challenging time in the practice as well, as we mentally and physically wind down; maybe not sticking as diligently to best procedures and letting things slide. Unfortunately, speaking from my own hard-earned experience, this can result in a slow start to the new year as it takes a while to get everything cleaned back up and running again.

2-step guide for chiropractors

So, what can be done to help keep our families sane during this busy season and prioritise their health, including keeping their chiropractic care going? There are probably many answers to that, but two springs immediately to mind:  

• Plan ahead 
• Remind them that you exist.

Plan ahead

Planning ahead involves organising themes, events and marketing for next year well in advance of the big day.  Advertising your ‘Back to school’ backpack and shoe assessment or a posture screening now will make people know you are open and ready for them in January. 

 In my practice, we like the ‘New Year – New You’ event: cardboards on the walls ready for people to write their New Year resolutions on.  The kids love sharing their thoughts or just having the opportunity to draw on a wall!  The grown-ups often decide they want to get fit and healthy starting in the new year, so maybe have exercise posters, hand-outs and challenges ready as well as offering the opportunity for a chiropractic check-up.

Remind them you exists

Christmas really is a time to enjoy, relax and reconnect, so the reminder that you exist could be a hand-out or social media posts providing families with fun ways to do things together.

Here are some suggestions, but obviously be as creative as you please. 

You could provide:

• A recipe for a healthy Christmas treat (or a seriously sinful one) that the family can make together.
• Prioritise outdoor time – go for walks, go to the park and/or the beach.  We all know how much better we feel once we are actually up off the couch and moving no matter what the weather.
• Make food art competition: Who can make the best Santa from fruit and vegetables?

Games like:

• Dance-offs – Take turns choosing the best dance music and each family member shows off their best/worst moves.  Alternatively, make a family choreographed dance performance to show off when the relatives arrive.
• Parcel wrapping game: Two people link arms, so only one free hand is available from each person.  They then work together to wrap a box in wrapping paper with sticky tape and pretty ribbons.
• Bauble competition – See who can balance the most Christmas baubles on a ruler balanced on a 30-40 cm tower of blocks/Duplo/LEGO in 1 minute.
• Christmas card frisbee:  Pull the back off last year’s Christmas cards and have a competition about who can throw the most into a box from 1 metre away. 

This is all about us connecting with the families in our practices, let them know we care, and for us to all lighten up as we step back and fully enjoy Christmas for what it is:  a time to step out of our daily routines and celebrate life with our loved ones.

I hope this guide for chiropractors was useful and upon that I wish you a very Merry Christmas and all the best for the New Year.

Brexting, Bracebooking and Brinstagramming may be new terms in my vocabulary, but unfortunately the concept is not.  I have been worrying about feeding Mummas in my reception for years – whether this is breast or bottle – gazing lovingly into the screen of their phone rather than their baby’s eyes.  I used to have a sign on the front door of my practice saying “Please turn off your mobile devices”, due to the sensitive developing brains present, but as you can imagine, my success rate was close to zero.

Now, although I am so old that I didn’t even have a computer when my children were little, I perfectly understand the need to have a break, to keep in touch with friends, to feel ‘normal’. And I recognise that feeding time seems to be the perfect opportunity to multi-task when baby is otherwise gainfully engaged. However, it is important that mothers understand what happens at feeding time other than the transfer of nutrients, to facilitate informed decisions about when to use their devices.

Brexting: what it does

First and foremost is the question of eye contact. From birth, human babies have been found to show preference for looking at faces, focusing particularly on the eyes. Even tiny infants can detect and understand emotional states of others by looking into their eyes, and this has been found to be involved in social connection and development later in life (2).

Also, while baby appears to stare vacantly at mum while feeding, she/he is actually busy mapping out mum’s face in her/his little brain.  This results in early face recognition (baby recognises mum’s face from four days old), increased interaction and connection with mum, oxytocin reward for both resulting in that all-important ingredient for secure attachment: bonding (2).

Dysfunctional bonding is associated with increased risk of future depression, anxiety, learning difficulties and challenges with memory. Bonding is worth working hard to achieve!  In their article ‘The importance of early bonding on the long-term mental health and resilience of children’ Winston and Chicot talk about how to support pregnant mums and new mothers with practical skills to help them bond with their baby. They suggest skin to skin contact, early breast feeding, cuddling and lots of face to face time with baby to establish non-verbal communication(3).

Eye contact also causes mum’s and baby’s brain waves to synchronise, stimulating baby’s vocalisation and communication and helping to build baby’s social neural networks (4).  Studies have shown that babies as young as two days old can differentiate between direct and averted gaze and that the electrical activity in babies’ brains is increased with direct gaze (5).  Research has also showed that eye contact and joint gaze is involved in language development (6).

On another note, if mum is breast-feeding, being distracted while feeding can interfere with the let-down. Obviously, distractions can come in many shapes: toddlers, partners, the weather as well as screens. Some can be managed, and some can’t. Studies have shown that exposure to distressing or worrying screen content is more likely to cause feeding difficulties (1).

What new mums need more than anything is love, support and understanding, as well as a helping hand with cooking, cleaning and rocking baby. I want to emphasize here, that my intent is not to encourage chiropractors to bash new mothers with more Do’s and Don’ts. A gentle enquiry into how she is going may lead to a considerate and empathetic conversation, giving her facts that help her decision about when to use her device.

References:

1 http://medicalrepublic.com.au/brexting-can-smartphone-addiction-hurt-babies/15329
2 https://www.psypost.org/2017/07/learn-read-anothers-mind-looking-eyes-49330
3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330336/
4 https://www.biorxiv.org/content/10.1101/108878v3
5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC123187/
6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3434454/

I recently had the great honour of being interviewed by the awesome Monika Buerger from Intersect 4 Life.  She is doing a series of interviews on chiropractic care for children for ChiroSecure, an American risk management group.  

In this interview I share my secret weapon for managing the toddlers in your practice, and no, it does not involve sitting on them!  I share some powerful communication strategies to help families understand the chiropractic message and to inspire them to take an active role in their child’s care. We also squeezed in an interesting discussion about kids’ development, chiropractic research and how we can best care for this age group.

Monika has been a wonderful supporter of  the Kids’ Summit since the start and has helped raise a significant amount for vital research into chiropractic care for children. 

Have a look at the interview here:

References:

1. https://academic.oup.com/toxsci/article-abstract/163/2/490/4921230
2. Malo, J; Chan-Yeung, M; Bernstein, D I (2013). Asthma in the Workplace (4, illustrated, revised ed.). CRC Press. p. 198
3. https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+hsdb:@term+@DOCNO+234
4. https://www.ncbi.nlm.nih.gov/pubmed/23924280
5. Casas, L., et al.  Domestic use of bleach and infections in children: a multicentre cross-sectional study. Occup Environ Med, (2015) April

Maybe this time would be well spent on some quiet self-reflection?  

How did we end up in this situation where our profession is questioned at such a basic level? Should we have seen this coming? How well did we handle the events that lead to this?  Did we, by being quiet and respectful, allow forces around us to define who we are and what we do?  Did we, by so bitterly fighting each other, neglect to address where the real threat was coming from? 

You may or may not see a lot of children in your practice.  The point here is that, in my opinion, what we are facing at the moment is not about the safety and efficacy of chiropractic care for children. It is about chiropractic. Who we are and what we do.  We need to define this, individually and collectively, and share this with our community, other health care providers and policymakers alike.

Why we need to define chiropractic care for children

Children are humans.  Children have nervous systems and spines.  Those are not something we magically grow when we are 12 years old.  Children get subluxations, stuck joints or whatever you want to call them, just like big people. And due to the development patterns in children, these are much more detrimental to future health and function than in adults.
 
If we survive this external review, are you ready to provide superb chiropractic care for the 18.8% of the Australian population who are kids? Children are definitely not little adults, they require specialised, age appropriate approaches.  Do you feel that you can provide the best possible assessment and chiropractic care for children under 12? ‘Best practice’ changes over time. Are your skills up to date?  Do you know as much about caring for young people in your practice as the adult?

Now is the time to take this seriously:  

• Know who you are and what you do.  
• Connect with and support your tribe. 
• Upgrade your knowledge and expertise. 

 
For the sake of the children in your practice and your community as well as for the sake of your profession.