parent, so be it. If he/she prefers to be sitting, or on the floor, we can adapt to that too. We know how difficult it is to check ranges of motion in a tense child having a full-blown temper tantrum, or to gain a pediatric reflex at any time. We also recognize some findings may be “off” due to a child’s temporary behaviour. For example, a screaming child may have a reddened injected tympanic membrane, elevated respiration and heart rate. You can still gain much data but miss oth-er elements. So come back to these at another time. Also, as a rule of thumb, a well-fed, satiated infant is usually more compliant whereas a hungry infant is alert but per-haps more labile. An infant ready for a nap may be sleepy whereas one waking up may be cranky. A take-home lesson here is for us to be flexible to adapt to them, to meet them were they are at. mEASURING OUTCOmES I recommend “cycles of care” when there comes a time to reassess the progress of the child in comparison to where they were and to re-establish new goals or changes for their care. It keeps us mov-ing forward, looking for new issues that might have cropped up and measures the status of the child. It keeps us from dictating care based solely on the pres-ence or absence of pain/symptoms, so care is based on clinical findings. The time to reassess may be dictated upon a visible change, either positive or nega-tive, in clinical status; when thinking about changing technique, frequency of visits, etc; and when thinking about adding something else to the program of care, if there is information regarding new complaints/trauma or based on cer-tain time frames. The purpose, of course, is to globally document how the child is progressing. The reassessment, if comparing to the initial assessment, should retest the same components. I personally look at the health status from a global perspective – osseous, muscular, soft tissue, neurologi-cal function, growth and development. Basic physiological tests such as vitals are also helpful to recheck. In addition, I utilize forms that par-ents complete at each reassessment. These forms address their observations and offer scales for them to rank how their child is doing in 12 areas of life. Forms also allow them to complete lifestyle questions regarding the child’s stress, nutrition, and any traumas that have occurred, either previous to, or during, the time of treatment. From a standpoint of gaining information and addressing any unanswered questions, these forms are invaluable and, again, add to my certainty regarding care strategies for the patient. The idea behind all of this is to ad-dress the clinical question of why the child is attending for care. Gathering evi-dence through the history and examina-tion, arriving at a hypothesis – diagnosis – delivering care and then measuring the outcome is the living application of the scientific method. • In part 2, I will address how to main-tain the conversation within the chiropractic scope of practice. While deviating into other areas may be of utility to you as a clini-cian, if misinterpreted this may confuse the patient and parents regarding what we do, as well as be misconstrued as delivering care in areas outside our scope. I will also address the safety record of infant care and chiropractic. 28 • CANADIAN CHIROPRACTOR | MAY 2012 www.canadianchiropractor.ca
Chiropractic + Naturopathic Doctor May 2012: Page 28
