One of the biggest challenges of working with young children, especially the very young is that; they can't tell you when they are in pain. Some may cry, but others will simply avoid painful movements and adopt compensations.
Learning to identify these behaviors is a crucial part of your examination and part of your discussion with parents.
You may be working with a family who have noticed certain behaviors or habits, but didnt quite know what they mean. Today's blog is all about introducing parents to the world of understanding body language and habits of children.
We all know that pain makes us feel uncomfortable. It's awful to be in pain every time you make a certain movement; it often makes us feel a little and often frustrated or even scared. Well imagine being in pain and not being able to tell anyone about it. For babies, this can often be a daily reality. Unlike adults; babies are unable to communicate how they're feeling, or what's upsetting them, or even where they are hurting. All they can do is cry, be grumpy or unsettled or change habits and behaviors to adapt to their current situation.
So let's look at some signs you can look out for in your examination to determine if a little one is in pain.
Let's use cervical range of motion as an example:
- Always check that the baby can move their head through the full range of motion, and that both sides are equal. With rotation for example; a baby should be able to get their chin all the way to their shoulder. This freedom of rotation is needed for normal growth and development to be symmetrical.
- If the child is in pain; you will see tightening of the postural muscles, a grimace, or a little abrupt sound or cry as you are testing the movement of their spine. You may also see compensations; a rolling of the shoulders, an avoidance of turning that way or a postural shift so that the rotation is not longer a pure rotation but is coupled with some lateral flexion or extension to make it less painful.
- A great way to get the parents involved is to explain to them what you are watching for when doing particular tests; e.g. When the baby is supine, and you are checking cervical rotation have the parents look out for any lifting of the shoulders off the table as you rotate their baby's head. There is a postural reflex that may kick in so be sure to identify the postural shift as a cervical restriction. Typically if the shoulder lifts-off and there is an additional sign of discomfort as listed above, there is pain or tightness associated with cervical rotation.
Then ask the parent to gently secure the child's torso while you attempt to rotate the baby's head once more. Note the change.
Let's now use a shoulder subluxation as an example:
- A shoulder subluxation is one of the most common peripheral subluxations in children. Both shoulders should have appropriate glide A-P and P-A in an abducted position. If a restriction is noted, it may be problematic for normal dressing and development.
- Ask the parent about the ease of dressing R vs L arm. Is one arm more difficult than the other. Do they seem to 'hate' getting dressed?
- Perhaps the child is at the age of sitting and crawling. Ask the parent if they are using their arms evenly. Do they reach for items the same way for each arm. Do they use avoidance techniques like bottom shuffling to avoid placing too much pressure on the shoulder?
Helping parents connect the dots to what their child is telling them through likes and dislikes, actions, behaviors and avoidances provides a great opportunity to explain to the families that possible spinal or peripheral restrictions may be present, creating inflammation and pain, affecting how they use their child uses their body.
For the first example your conversation may move into asking about postural habits, do they sleep with their head turned to one way? Has asymmetry in the cranial shape been noted? Does the child avoid turning to see the parent if they are on the side of difficulty?
When you are working a baby that appears to be in pain, don't be afraid to let the parents know. Let them see how you came to that conclusion, what signs are present and explain why it may be the case. Explain to them the importance of recognising pain and the role it plays in their body and their child's body, and discuss how you and the family are going to take steps to address it.
The Well Kids Program offers an excellent age specific examination and online platform to track and summarise the changes noted. Our unique reports and care plans have been created to make explaining your findings to parents easy straight forward. To learn more about our program and to book a demonstration click below.
We would love to hear your experiences with this in practice! How do you explain to a parent their baby is in pain, how do you then explain the role of Chiropractic when addressing this? Leave us a comment in the box below.
Have a fantastic day!
From Dr Jacey and the Well Kids team.