ANALYZING INFANTS
One of the most baffling situations the chiropractor meets is in
caring for sick babies. There are several reasons for this: The
baby can give no assistance in the way of subjective symptoms. It
is difficult to nerve trace with any degree of satisfaction and
assurance of accuracy; it is even very difficult to keep the child
still for palpation. Therefore, it becomes necessary to rely largely
upon the objective symptoms and the palpation, with what verification
may be obtained from nerve tracing and the spinograph. However, there
is no class of patients in which the results are so gratifying as
with the babies and small children, for they respond to adjustments
more readily than does the adult.
There is no time in the practice of the chiropractor when he
needs to have better self-control than when he is taking care of
infants. There is great need of every faculty that is employed in
the analyzing and adjusting, especially if the child is seriously
ill. Usually the parents are more or less excited and worried and
are likely to keep urging the chiropractor to do something and thus
unduly influence him unless he is accustomed to such cases. If the
child is in pain and crying it is likely to get on the nerve of every
one present and this will tend to make the chiropractor nervous. He
must be careful that these things do not influence him to act too
hastily before he has had time to make a careful analysis.
History of the Case
Great care must of necessity be exercised in taking the analysis
of the baby and of the small child. A very careful history should
be taken. This, of course, must be obtained from the parents or
nurse. This history should include such points as whether birth
was instrumental or natural, whether it was premature or full term,
whether there were any peculiarities of respiration at birth, whether
there have been any convulsions and what sickness, if any, the child
has suffered with. Inquiry should be made relative to the condition
of the bowels and kidneys, how the child sleeps, and if there is a
tendency to cry out during sleep. If the child refuses to nurse or
nurses with difficulty it may indicate an incoördination of the mouth
or the throat.
Objective Symptoms
In view of the fact that the child can give no aid in the way of
subjective symptoms, it is necessary for the chiropractor to make
most careful observations and substitute, as far as possible, the
objective symptoms for the subjective ones. About the first thing
we see when we begin the analysis is the baby’s face. It may reveal
valuable information. A very careful study should be made of the
facial expression and the condition of the eyes. In the face we take
into consideration the color. We should look for pallor, cyanosis and
jaundice; we notice whether there is perspiration, whether the face
is cold and clammy or warm and moist; also we observe the expression
as to the muscular condition, since there may be muscular spasms
which will produce grimace. This is either the result of pain some
place in the body or an abnormal action of the facial muscles. There
may be a pinched expression or a look of fear or anxiety. In some
severe cases the face will be expressionless, while in others it may
be that of an adult.
The condition of the eyes is important. They may have a dull
expressionless look. The lids may droop and the eyeballs be sunken.
In cerebral incoördinations there may be strabismus, or the eyeballs
may be rolled upward and inward. These symptoms are significant and
should all be very carefully noted, for, as has been stated, there
will be no chance to profit by subjective symptoms.
After a careful observation of the face and facial expression has
been made, the child should be undressed and placed in a convenient
position for further observation. Before the clothing is removed the
room must be heated to a proper temperature so the infant will not
take cold or be exposed to an atmosphere that will be distressing.
A temperature suitable for the bath will be satisfactory. The child
should be placed on his back and every movement of the body observed.
Such movements as the flexing of the thighs on the abdomen, as in
abdominal pain, may lead the chiropractor to a conclusion on the zone
involved.
The general appearance of the child must be carefully considered,
whether the child is properly developed and whether or not there
are any deformities. The chiropractor should look for dyspnea and
other objective symptoms. A very careful inspection should be made
of the spine to determine any malformations or marked curvatures.
The character of the cry is sometimes important, as for instance in
pneumonia or bronchitis there is a short, catchy cry; the cry of
laryngitis and croup will be hoarse. In extreme prostration, as in
many cases of malnutrition, the cry will be very feeble.
Respiration
Since the chiropractor must depend almost entirely upon objective
symptoms and upon the palpation of the infant in determining the
character of the incoördination he should be thoroughly familiar with
the characteristics of the normal child. The rate of respiration
of the infant, especially during sleep, is of some importance. The
following table is given by Holt and Howland and indicates the normal
rate of respiration at different ages:
At birth 35 per minute
At the end of the first year 27 ” ”
At two years 25 ” ”
At six years 22 ” ”
At twelve years 20 ” ”
Respiration is very much faster than this when the child is awake. If
the child is at all active it may be twice as fast. It is advisable
to observe the respiration to determine whether it is normal or
labored, shallow or deep, regular or irregular.
Irregularity of respiration in infants is characteristic and must not
be mistaken for indications of incoördination. The least excitement
will disturb the rhythm; as a matter of fact, the only time there
will be perfect rhythm is during sleep. In observing infants it will
be found that the lungs sometimes do not expand equally. This is due
to the delicate muscular walls of the thorax and does not necessarily
indicate incoördination. It is well to take this into consideration
when observing the infant. This must be very carefully considered
when incoördinations of the lungs are suspected. Placed in certain
positions one lung may expand very much more than the other in
normal respiration; or in some positions, and sometimes for unknown
reasons, there may be practically no expansion in one lung for a
short time. This peculiarity is due to the inability of Innate to
maintain adaptation through the delicate structures of the thorax to
the atmospheric pressure. This might be very misleading and result in
the conclusion that one lung was badly affected when there would be
nothing at all wrong. However, if there are symptoms which indicate
an incoördination in the lungs there should be a very careful
palpation made of the upper dorsal region to locate the subluxation
and the hot box.
In infants the respiration is altogether diaphragmatic; it is
irregular at times; it may be superficial for a time and then
deep. This irregularity continues in the child more or less until
the seventh year. After this such an irregularity indicates some
disturbance and should receive consideration.
The muscular walls of the thorax are very feebly developed and are
therefore very soft and yielding; a slight obstruction in respiration
will result in a marked sinking of the thorax from the normal
atmospheric air pressure.
Pulse Rate
It is not necessary to take the pulse of the infant, but it might be
well to know what the normal pulse rate is at different ages. The
following table will give the desired information:
At birth the pulse rate is from 130 to 150 per minute
One month of age 120 to 130 ” ”
One year of age 108 to 120 ” ”
Two years of age 90 to 108 ” ”
Three years of age 80 to 90 ” ”
Seven years of age 72 ” ”
Very slight disturbances will often increase the pulse rate out of
all proportion to the severity of the condition. The heart will beat
very much faster just from the handling of the child in making the
analysis, or as a result of any excitement or crying. It may be very
difficult to count the pulse because of its rapidity.
Often a very moderate incoördination will result in a marked increase
in the pulse rate and especially is this true in cases in which there
is slight fever.
An increase of the heart action does not, necessarily, mean that
heart place should be adjusted. This increased action may be due to
the natural adaptation because of handling or to nervousness at the
presence of strangers. Especially is this likely to be true of the
child that is old enough to notice things. It is not uncommon to have
the pulse beat increased as much as 25 beats per minute in this way.
During sleep the pulse may be slightly irregular, even when the
child is normal. In cerebral disturbances it will be slow and
irregular. In cerebral tumor it may be as slow as 40 or 50 beats
per minute. In acute incoördinations the pulse rate may be very
greatly increased. With incoördinations in such families as the
poison, fever, degeneration, and some incoördinations in the spasms
family, the pulse rate may be very high, even when the condition
is not at all alarming. It is well to take this into consideration
when observing a case so that the chiropractor will not be misled
in making the analysis and that the objective symptoms may be of
greatest value to him.
Zones Involved
In analyzing an infant it is well to keep in mind the zones in which
incoördination is most commonly found. In the majority of cases these
zones will include the gastro-intestinal tract, the respiratory
tract, the kidney zones and the brain. Very frequently there will be
incoördinations of the pharynx, tonsils and mouth.
The incoördinations found in the digestive tract will include all
forms of indigestion and dysentery. Such incoördinations as pneumonia
and bronchitis will involve the respiratory tract. From the kidneys
there are the various conditions involving the poison family due
to improper elimination. Meningitis and all forms of cerebral
incoördinations as well as conditions of the eyes and ears are common
to infancy and childhood.
It must be remembered that with an infant grave symptoms may develop
in a very short time, likewise recovery may take place very quickly
following even the most alarming symptoms. However, no chances
should be taken for it is not uncommon for an infant previously in
good health to become sick very suddenly and die within a few hours.
Therefore, in handling children most careful attention should be
given and conditions should always be regarded more or less serious
until developments prove otherwise. The chiropractor must realize
that his success in handling infants does not depend entirely upon
his observations of the case, for with every patient there must be
a thorough and complete analysis of the spine. The only value to be
received from the observations is that they may lead him to specific
regions of the spine.
The Child’s Cry
It is not uncommon for an infant to cry with no apparent localized
cause. This crying may continue for hours with no other symptoms.
There will be no indication of colic or other symptoms to denote
the seat of the pain. The crying is constant and, while in some
cases may be quite violent, yet there are no paroxysmal attacks;
this indicates that the pain is constant. It is easily distinguished
from a hunger cry in that the child usually refuses to nurse. If the
crying persists for hours there will be more or less exhaustion.
Such cases are very pitiful and draw heavily upon the sympathies of
the chiropractor as well as upon other attendants. In such cases
the first thing to do is to strip the infant of all clothing and
look for open safety pins, rough places in the clothing, such as
folds or wrinkles; foreign objects, as small buttons, for example.
Usually, however, this will be done before the chiropractor is
called. It may be an advantage for the chiropractor to observe the
infant very carefully for a few minutes after the clothing has been
removed, in an effort to locate the seat of the pain. However, this
is not so very important because first, in most of these cases it is
practically impossible to determine the location of pain, and second,
because a very careful palpation of the child will always reveal the
causative subluxation. In making the analysis the chiropractor should
give himself plenty of time to make a thorough palpation. He should
not be in too great a hurry to adjust the child merely because of
his anxiety to relieve the crying. He must not allow the incessant
crying of the child to work upon his nerve and destroy his efficiency
in caring for the patient. In these cases the subluxation may be
located in any part of the spine, although it is less often found
in the cervical region. If there is a subluxation in the cervical
region, great enough to produce this constant crying, there is very
likely to be cerebral symptoms. In these cases the subluxations are
usually quite exaggerated and very often the hot box becomes the
determining factor.
In a case recently an infant three weeks old had been crying
constantly for several hours. The clothing had been removed and
the child very carefully bathed and powdered; then instead of the
clothing being replaced the child was wrapped in a blanket. Still the
crying persisted. A very careful observation of the patient gave no
information whatsoever as to the possible location of the cause for
the crying. There was nothing that would quiet the child. He finally
grew so exhausted that the cry became little more than a whimper,
beads of perspiration standing out over the entire body. There were
no signs of colic or tympanites. A careful palpation revealed the
sixth dorsal very badly subluxated and a slight subluxation of the
first lumbar. These were adjusted and the child stopped crying almost
instantly and in less than ten minutes was sleeping normally. There
was no return of the abnormal crying and the child had no further
adjustments.
We have many such cases on record, but the citation of this one is
sufficient to illustrate the results that are obtained in such cases.
Palpating the Infant
In palpating an infant the first thing to look for is the hot box. It
may be possible to locate it very easily and if this is so it then
becomes necessary only to list the direction in which the vertebra
is subluxated. In looking for the hot box it is necessary to use
care so as not to be misled by the difference in the temperature
of the back due to some article of clothing being in contact with
the back and raising the temperature in that region. Notice that
there has not been some woolen garment, such as the band, pressing
against the spine. To eliminate the possibility of thus being misled
the entire back should be exposed to the atmosphere a sufficient
length of time to allow the back to become influenced alike to the
temperature of the air. The majority of incoördinations of infancy
are acute, therefore the hot box is present. After the hot box is
located then a very careful palpation should be made to determine the
direction in which the vertebra is subluxated. It is not sufficient
to consider that because the patient is an infant all that is
necessary is to list the vertebra straight posterior and adjust it
accordingly. Laterality, superiority and inferiority are quite as
essential, and the chiropractor should not be satisfied until he has
convinced himself on the question of these directions. If there is no
laterality, superiority or inferiority then the adjustment should be
given straight toward the anterior.
In palpating an infant it is usually best to place the child on the
knees of an adult in the position for an adjustment. The child will
be almost constantly on the move. It will therefore be necessary for
the chiropractor to adapt himself to this constant moving. The child
should be placed in as many different positions as possible to make
the palpation. He may be held up over the shoulder of the mother or
nurse; first on one side, then on the other, this giving opportunity
to palpate with both hands and make comparisons.
No effort should be made to force the child to be still. It is a
good policy to hold the palpating fingers on the spine and let the
child wiggle and squirm all he wants to, moving the spine beneath the
palpating fingers of the chiropractor. In this way a comparison may
be made of what is felt under the fingers while the child is moving.
It is quite difficult to nerve trace an infant in any measure of
accuracy because the infant can not coöperate to any degree of
satisfaction. In some, however, nerve tracing may be used to a
certain extent by producing slight pressure and noticing whether or
not the child flinches.
It is very much more difficult to palpate the cervical vertebrae of
an infant than it is those of the dorsal and lumbar regions. The same
technique and tactics are used, however. It is sometimes an advantage
to place the child on the mother’s lap in such a way that the head
will be unsupported by the lap. One hand should support the child’s
forehead, while the other hand palpates or it may be necessary to
place the infant in some other position. The chiropractor should be
sufficiently resourceful to find a way to get an accurate palpation
of the cervical region. Here, again, he will meet with the difficulty
of keeping the child still. This makes it necessary that he be very
alert and at the instant it is possible to feel the vertebra to be
ready to make his comparisons quickly and decide the direction in
which it is subluxated.
The cervical vertebrae of an infant are very hard to feel, but if
one of the segments is subluxated sufficiently to cause pressure on
a nerve that segment will be easier to feel because it is out of the
median line; especially will it be easier to feel if it is subluxated
posteriorly. Every possible means must be used to make an accurate
palpation. If there is a subluxation in the cervical region there
will very likely be symptoms which will indicate it. Subluxations are
not as commonly found in the cervical region as in the other regions
of the spine.
In making an analysis of the infant the importance of the sacrum must
not be overlooked. It will be remembered that the segments of the
child’s sacrum are separated with cartilage and are subject to being
subluxated. These segments coalesce later in adolescence and form the
sacrum into one solid bone. Therefore it is highly important that the
subluxations that may exist between the segments be adjusted before
this process takes place.
The tubercular ridge formed by the rudimentary spinous process in the
median line of the posterior surface of the sacrum is of very little
value in palpating the segments of the sacrum. It is best to palpate
the articular crest on each side of the tubercular ridge. In this way
it is possible to determine if one segment is more prominent on one
side than on the other. This should be done very carefully and if a
subluxation is found it should be adjusted on the side that is most
prominent. The contact is on the articular ridge and the thumb may be
used for nail point the same as in the dorsal region; or if the child
is large enough nail point one may be used.
Whenever possible a spinograph should be made of the child. This may
not always be possible with the small child and with the very young
infant it may be very difficult. In many acute incoördinations it is
impracticable to try to get a spinograph, not because the spinograph
would not be of value, but because it is difficult to get to the
office to take it. In the chronic cases a spinograph should by all
means be taken. Every possible means should be used to verify the
palpation.