Shared by: DrsWarner@chiropediatrics.com Drs. Theresa & Stuart Warner welcome you to grow your pediatric practice with the following list. The Famous ChiroPediatric Top 7 The Top Seven New Patient Exam Procedures For A Child Every child on their first visit needs to have a comprehensive chiropractic pediatric exam performed, not a medical exam. Most children have already had a medical exam so a chiropractor should not have to repeat it, plus you probably are not as proficient at a medical exam as a pediatrician. Another concern is, "Do you want the responsibility of making a medical diagnosis?" In addition, and most importantly, a medical exam does not detect vertebral subluxation in the pediatric patient. If you are relying on orthopedic and neurological tests to document the necessity of chiropractic care for a pediatric patient there will be a lot of subluxated children not benefiting from adjustments in your office, because most children do not have positive orthopedic and neurological tests. A properly performed chiropractic examination will document the need for chiropractic care, locate the areas of primary, secondary and tertiary subluxations in the child's spine as well determining the severity and chroncity of the subluxation complex. The comprehensive chiropractic pediatric exam also adds credibility to chiropractic and starts the chiropractic/patient relationship off on the right foot. A clinically competent exam is not limited just by the top seven list below but the list will get you off to a great start. 1. Full Spine Motion Palpation Analysis Motion palpation will determine if each motion unit in the spine is moving normally, hypo mobile or hyper mobile. This analysis will also reveal the direction and severity of abnormal movement in the spine. A child's spine should be free to move normally in each of the planes of movement throughout the spine. If a joint fixation is present, meaning a hypo mobile movement has been determined, it needs to be properly documented in the patient's notes. Any pathomechanics in the spine will alter nerve function as well as other concerns in the spine. Motion palpation may reveal the location that needs to be adjusted as well as monitor the progress of ongoing care. 2. Surface Electromyography Surface electromyography (SEMG) should be performed on every new pediatric patient as well as on progress exams. The surface electrodes of the SEMG help measure the electrical activity of postural muscles in the neutral position of the patient. It measures the muscle activity in microvolts and the higher the muscle contraction the higher the reading. Children's SEMG signals are higher than adults because they do not have as much adipose tissue between the muscle and the skin so the symmetry of muscle activity from the left side of the spine to the right side is more valuable for clinical practice as well as for patient education. Parents understand the need to have balance in their child's spine. SEMG is a very objective assessment tool to document vertebral subluxation in the child and to monitor and update the correction of the subluxation. 3. Posture Analysis Posture Analysis can be performed many different ways today. It can be done visually just by eye or manually with a plum line. There are more sophisticated systems today that document postural deviations with digital photography. Posture need to be assessed differently in a newborn versus a teenager. A child's posture should be looked at from the anterior, posterior and laterally. All postural distortions should be properly documented in the patient's notes including translations, rotations, tilts and elevations as well as other abnormal findings. A posture exam is a valuable method to document the effects of the subluxation as well as to monitor the patient's progress. 4. Infrared Thermal Scanning Infrared thermal scanning measures the temperature patterns of the spine in the pediatric patient. The autonomic nervous system controls the skin temperature as well as important functions of organs and the immune system. Therefore if you uncover abnormal skin temperature patterns you can deduct that there can be interference in the nervous system and immune function. Infrared thermal scanning can also monitor and update the effectiveness of the adjustment as well as the progress of the subluxation correction. 5. X-ray Exam X-ray has been widely used in the chiropractic profession as an analysis of the spine and to rule out pathology. If there has been trauma or there is clinical reason to take x-rays, proper shielding, collimation and other methods should be used to reduce exposure. If your technique is dependent on x-ray to locate subluxation you will probably take x-rays on all of your patients. However if your adjusting technique does not rely on x-ray you may only take x-rays on very few patients when clinically indicated. 6. Somatic Respiratory Movement Observing the depth and pattern of movement of the breath throughout the child's spine, such as taught in network spinal analysis, is extremely helpful. The integration of the breath and spinal alignment are essential to the healing process. The breath, movement, and touch are all interconnected in the health and healing of the child. This should be observed during your examination process and noted on the patient's exam card. 7. Leg Checks Leg checks are used by many chiropractic techniques. Leg checks can help document the effects of vertebral subluxation in children. The legs of children can grow at different rates so it is important to use consistent landmarks while observing the changes in the legs length when using challenges, head rotations and other analysis. Facilitated nerves can alter leg lengths and help document subluxation patterns in the child's spine. Make sure to record leg length findings in the patient's file. It is important to become competent in performing and documenting the results of your chiropractic examination for a child. It is essential to have good records on your pediatric patients to show rational for continued chiropractic care as well as for legal cases, third party reimbursement and state board issues. If you only learned how to perform a medical exam in school you may consider taking postgraduate courses in pediatric exam procedures to enhance your skills and competency.