sincerity, on the part of the chiropractors attending these classes, in reaching out to pediatric patients. We all want to be of service to this population. That being said, many DCs are still nervous about seeing children in their practices. What are the concerns expressed that hold my colleagues back from seeing children? How does one deal with these concerns? QUESTIONS REGARDING PEDIATRIC PATIENTS The top concerns I hear from DCs re-garding treating pediatric patients are: • • What if I miss something? How do I obtain a thorough his-tory on someone who cannot speak to me? How do I organize an examina-tion, especially if dealing with a difficult case [read: infant temper tantrum]?; What outcomes do I use? How do I explain what I am see-ing from a chiropractic perspec-tive and remind the parent(s) I am not treating “x” condition but rather allowing the body to self-regulate and improve its own function? What is the safety record? tests, chart the results and move for-ward. I usually handle this with a com-ment along the lines of “I want to add a few more tests that I did not perform on the initial” or “ upon review, I realized I wanted more complete information on…” or “I was unable to obtain good information on this test on the initial so I wish to replicate that to determine accurate findings.” • • • • These are all good questions. Below, I will offer some points to address them. DUE DIlIGENCE As with anyone serving in the health-care arena, we chiropractors have to consider the possibility of “missing something.” Despite systematic differential diagno-ses, it is always possible to misdiagnose or delay a diagnosis of “something else,” regardless of what type of practitioner one is. In the pediatric population, seri-ous health issues can go “bad” quite rap-idly. We know this and are taught this. However, that being said, knowing the acceptable standards for normal, being diligent in your history and examination – that is, not taking shortcuts, putting it all together while considering differen-tials and seriousness – you should end up with a solid working impression. My rule of thumb is to keep asking questions, using observation, physical examination, and our exceptional palpa-tion skills, which, with appropriate test-26 • CANADIAN CHIROPRACTOR | MAY 2012 ing if warranted, provides us with the necessary tools to make a solid diagnosis and formulate a plan. At the end of the day, if a child is your patient, you need to care for him/ her however you feel most appropriate. It goes without saying that if the child presents in a way that suggests there is an impending emergency, care for it as such and refer. If it is something out-side our scope, yet there are chiropractic considerations, then refer to co-manage the patient. Keep to what we do best – let others do what they do best and follow up. If you wish to gain more diagnostic testing beyond what we chiropractors can do, co-manage the patient with an-other health-care professional. Write a clinic note, to explain your findings and thoughts on what might benefit the child for further testing. Forward it to the ap-propriate professional and, then, follow up. I have done this when requesting genetic testing, advanced imaging (brain MRI, CT’s, ultrasounds) blood work, hearing, sight and dental tests, to name a few. Another challenge faced is, “What if realize later that I’ve missed a test I should have done or should add to the arsenal of examination?” While it is best to know and remember your procedures so well that they are automatic, this does happen – often when you are distracted by questions from a parent or upon re-flection of the file. Don’t despair – you can and should perform the tests on the next visit. Simply inform the parent at the report of findings that you are add-ing a couple of tests. Then, perform the ASk All THE RIGHT QUESTIONS Pediatrics can be challenging in that gain-ing information is done through the third party of the parent or guardian. In addi-tion to the usual questions and systems review, I find an additional review of how this child is interacting and adapting in his/her environment helpful. Adding in age-appropriate questions on prenatal maternal health, birth, APGARs, feeding/ appetite/nutrition, digestion/bowel func-tion, urination, sleep cycles, milestones, social interaction with others, response, attention, activity, co-ordination, energy levels, style of care giving (home care, day care), among others, is very helpful in gaining an understanding of the child’s quality of life and fills in the blanks in building a good picture of the child’s his-tory. This is an art but is learned through practice. kIDS WIll BE kIDS On occasion you may experience dif-ficulty in completing your evaluation of a child. When this happens, it helps to know you have choices. Work through that visit as best you can and have the parent bring him/her back to complete the remainder of the examination at a different time or on a different day. I en-courage chiropractors to meet the child where the child is at, not where we are at. This means we need to be flexible to adapt to the child at that time. If the child prefers to be examined while lying on the www.canadianchiropractor.ca
Chiropractic + Naturopathic Doctor May 2012: Page 26
