Every child is unique. They learn and grow at their own pace, they can race ahead in some areas while playing developmental catch up in others. The parameters of ‘normal’ can take on many different forms in a healthy child. Broadly speaking, child development can be divided into four major areas; motor, speech andlanguage, social/emotional, and cognitive. These four domains contribute to our sense of self, and our ability to engage with the world around us. Genuine child development delay can occur in any of these areas, and is usually determined by a child not reaching certain milestones in comparison to their peers ofthe same age.
This is all well and good, but what role could chiropractic care play in the life of the child with developmental delays? At first glance, the question may seem entirely theoretical. We don’t have large studies available to us as yet, so we can’t generalize findings. We can say that we live our lives through our nervous system and thus a well-nurtured and balanced nervous system is likely to do better but that doesn’t give us any specifics, or indeed specific examples. One new case report and selective literature review does though – and it presents some interesting observations.
Developmental disabilities caused by the Central Nervous System are referred to as neurodevelopmental disorders.These children have difficulty with physical, linguistic learning, and behaviour. Delays may be seen in a single area or may appear across multiple areas. Global developmental delay is a term to describe a child with delays noted inat least two areas who is under 5 years of age. Moreover, delays can be classified as mild, moderate, or severedepending on how far below a child’s functional ability is against a benchmark for their age.
Early detection of developmental delay is crucial, as early intervention can prevent or greatly reduce potential flow-on effects in later life, allowing the child the greatest opportunity to thrive.
Research presents some detrimental findings. If a delay is sustained, the child is at a higher likelihood to experience learning difficulties, behavioural issues and functional impairments in later life. Risk factors associatedwith developmental delay include: poor maternal health during pregnancy, infections, birth complications, geneticcharacteristics, trauma, exposure to toxins, maltreatment and possibly low socioeconomic status.
In recent years, there has been a gradual trend upwards in the prevalence of developmental delays. Complementaryand alternative healthcare options may have found a place in this issue, with over 65% of families of children with developmental delay syndromes, reporting current or past use of alternative healthcare. Current literature regarding chiropractic care of children suffering developmental delay is limited, but it is beginning to investigate the role poor muscle tone plays in sensory-motor and coordination disorders, as well as the more established relationship withpostural disorders.
What is the objective of chiropractic care in such cases? Broadly speaking, chiropractic care aims to assessfor and reduce nerve interference caused by vertebral subluxation, and to enhance Nervous System function, and therefore support the optimization of health and well-being
This brings us to the recent case. A female aged three years and four months was brought to the clinic by her mother ,who had concerns about “communication delay and walking delay”. During the initial consultation, issues were noted with learning, achieving milestones, digestion and feeding, general coordination and balance, crawlingand walking, flexibility, and muscle tone. There was also a family history of siblings with autism. The child was co-managed with a general practitioner and a speech pathologist throughout her care.
The case report (referenced below) included an extensive pregnancy and birth history for the child. Findings included a pregnancy history with anxiety, stress at work and home, and fear of labor all rated 4 out of 5, morning sickness and back pain through pregnancy rated 5 out of 5, and a physically active job where the mother could not sit for longer than four hours per day.
The child was the fourth live birth for mother and was born via planned caesarean section. The mother had suffered from hypertension and the baby was in breech and had been engaged low in the pelvis for longer than 3 weeks pre-delivery. While she did cry immediately following delivery, the baby was jaundiced, and remained in hospital for 4 days. She recovered and slept well post-birth. Her muscle tone was reported as average, she regularly arched her back and head, and was diagnosed with “clicky hips”. In addition to these issues, she experienced colic/persistent crying, and constipation with a lot of gas. She didn’t appear to liketummy time and failed to reach milestones at similar times to peers.
The case report noted the following: “She had episodes of ear infections, tonsillitis, 39C plus temperatures, skin rashes, colic/reflux/excessive crying and persistent colds/flus. She began to use words at five and a half months, sat on her own at eight months, began crawling at eight months, and unsteadily walked with a very broad-based gait at three years. She had been diagnosed with global developmental delay with genetic duplications.”
She [the mother] reported the child has quick mood changes, tantrums, easy frustration, shying away from loud sounds. Physically she reported balance problems, walking problems, clumsiness, motion sickness and learning difficulties. Related to her immune system function, she reported the child has had chronic colds and the flu, ear infections/tonsillitis, upper respiratory infections, food sensitivities, and bowel challenges.”
The treating chiropractor used a combination of treatment protocols including ‘touch and hold’, modified diversifiedtechnique, cranial release maneuvers, and home exercises. During clinical assessment, the following was found:
- Subluxations were noted at C0/1, C5, T4, T9, and S1
- Hypertonic erector spinae were present between T9 and T11 on the right, and between T12 and L2 on the left
- Cranial restriction noted at the left frontal, bilateral sphenoid, bilateral parieto-occipital, occipital, and sagittal sutures.
- Muscle stretch reflexes at C5, C6, C7, L4, and S1 were rated a 2/2
- The child was unable to jump with two feet, heel or toe walk, or climb onto the table
- The child was able to walk carrying a toy, but was unable to stand with eyes closed or walk in a straight line
The child attended 2 sessions a week for 3 weeks, and a progress review was completed at visit
Throughout care the mother reported improvements from session to session, noting staff at the early childhood development program noticed significant changes, as well as the speech therapist noticing improved speech. Byvisit 7 the child had jumped for the first time, was picking up sign language more quickly, and was answering more accurately to questions. She was moving her head more freely, bending over and picking things up easily, and herwalking pattern was noticeably better. The mother also reported improved quality of sleep, general mood and behaviour improvements, improved immune system function, and increased general physical resilience.
After a further 6 weeks of weekly visits, there were further improvements noted including improved eye yoking,climbing regularly, and starting to run. At the second review the mother decided to continue care on a twice a month basis.
Could subluxation-based care have been a factor in her improvement?
As defined by ASRF, the subluxation is “a diminished state of being, comprising of a state of reduced coherence, altered biomechanical function, altered neurological function and altered adaptability.” These subluxations, and what they represent, can contribute to maladaptive changes in central neural plasticity, potentially leading to dysfunction. Chiropractic care aims to normalise the altered joint function, and optimise sensory input received and processed by the central nervous system. Overall, it aims to enhance an individual’s ability to engage with and adapt to their external environment. In the context of developmental delays seen in children, this may cause the improvement in motor development, cognitive function, and social interaction.
“It is hypothesized that cranial release techniques both restore optimum cranial motion which encourages normal flow of cerebrospinal fluid whilst simultaneously relieving reciprocal membranous tension.”
While further research is required to confirm the mechanisms behind such improvements, and thus we can only speculate, it is possible that subluxation based care may have helped this child’s nervous system adapt better to the environment around them, and thus be more at ease. But of course we need more research to confirm this.
As a case report, this study has inherent limitations. There was a lack of control group, so improvements cannot bedirectly attributed to the interventions employed. A formal assessment tool was not used to measure clinical assessment and improvements. Rather, improvements were gauged by the treating chiropractor and parent. Although, as there is still only a limited number of case series and reports published on this topic available in the literature, every little bit helps in better understanding the nature of these delays, and how we can best optimisethese kids’ futures.
Doyle, M (2021). Improvements in developmental delay in a female child following chiropractic care: a case report and selective review of the literature. Journal of Clinical Chiropractic Pediatrics. Vol. 20. Iss 2. https://jccponline.com/doyle20-02.pdf