Norsk Forening for Kvinnehelse Barnekiropraktikk

NFKB er en faggruppe for medlemmer av Norsk Kiropraktorforening (NKF) med særlig engasjement innen utredning og behandling av kvinner og barn fra et kiropraktisk ståsted.

NFBK sine formål

  • Å øke vår profesjons interesse for barnekiropraktikk
  • Å bidra til økt kompetanse innen utredning og behandling av barn
  • Å arbeide for gode videre- og etterutdanningstilbud innen barnekiropraktikk
  • Å arbeide for økt tverrfaglig samarbeid og bedre samhandling med andre helseprofesjoner og faggrupper
  • Å stimulere til økt interesse for forskning innenfor barnekiropraktikk
  • Å stimulere til mer fysisk aktivitet hos barn
  • Å gi publikum oversikt over medlemmer i NFBK

​Norsk Forening For Barnekiropraktikk ble etablert på sensommeren 2013.

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Kiropraktikk i Norge har en lang historie, og den første kiropraktoren i Norge startet rundt 1915. Det var liten tilgang på nye Den delen av helseprofesjonen kiropraktikk som befatter seg med diagnostikk, behandling og forebygging av biomekaniske funksjonsforstyrrelser hos barn og unge i alderen 0-18 år. Kiropraktoren undersøker og behandler ut fra et muskel-skjelettperspektiv, og fokuserer på nedsatt bevegelighet og økte spenninger i ledd og muskulatur. Behandlingen baseres på manuelle teknikker tilpasset barnets alder og tilstand. Man bruker milde behandlingsteknikker, og det er ingen risiko for alvorlige bivirkninger forbundet med denne type behandling.

Behandling av barn har alltid vært en del av kiropraktikken og ble første gang beskrevet i litteraturen i 1906. Sent på 80-tallet ble det oprettet flere videreutdanninger innen pediatrisk kiropraktikk. I 2002 ble det igangsatt mastergradutdanning innen pediatrisk muskelskjeletthelse ved Anglo-European Collage of Chiropractic i England.

​Kiropraktisk behandling av barn er en trygg behandlingsform og ingen alvorlige bivirkninger er registrert. Nyere forskning viser også at det ikke er registrert en eneste klagesak i forbindelse med kiropraktorbehandling av barn hverken i Danmark eller Norge fra 2004-2012 (Jevne, Hartvigsen, Wulff Christensen, 2014).

De vanligste årsakene til at foreldre tar med barna sine til kiropraktor er

Idrettskader

Gråt/urolighet som følge av muskel- og skjelettplager

Nakkeskjevheter/favorittside/tvangsside

Assymmetrier

Muskel- og skjelettplager/smerter

Hodepine

Konklusjon: Muskel- og skjelettlidelser utgjorde den vanligste primære plagen for barn og ungdom som oppsøkte kiropraktor i Norge. En betydelig andel av barna ble negativt påvirket av sine plager i form av dårlig humør og begrensninger i daglige aktiviteter. Langvarige eller kroniske plager var ikke uvanlig. Det lave antallet utvalgsstørrelse i denne undersøkelsen, både blant pasienter og kiropraktorer, krever at resultatene tolkes med forsiktighet.

Sammendrag av masteroppgaver

Her finnes sammendrag av masteroppgaver til kiropraktorer i Norge som har gjennomført studie innen pediatrisk muskel-skjeletthelse (MSc Advanced Professional Practice Paediatric Muscoloskeletal Health), ved Anglo-European College of Chiropractic.

A cross-sectional questionnaire survey administered to children in a Norwegian school-setting.

​Elisabeth Gløersen Prøsch, 2017

Objectives: First, it investigated a population of Norwegian school-aged children from 9 years of age to 16 years of age to see how much physical activity and sedentary behaviour they engaged in daily and weekly. Second, it considered potential differences between the ages and genders. Third, it explored a possible association between the level of PA and SB to neck pain or back pain.

Methods: The subjects were 125 males and 105 females, a total of 230 school-aged children, from 9-16 years of age, located at Bjørnsletta school in Norway. The subjects completed a questionnaire by themselves. The questionnaire was adapted to meet the exact needs of the research questions, and to ensure that the subjects understood exactly what they were being asked. The questionnaire included items that investigated the subjects´ physical activity, sedentary behaviour and the frequency of any experienced neck or back pain during the last 6 months. The children were given multiple choices for each question.

Results: On average, 9-, 13-, 14- and 16- year olds spent 4 hours daily of physical activity, 10 year olds were active 4 hours daily and 15 year olds 3 hours daily. For sedentary behaviour, 9 year olds spent on average 5 hours sedentary daily, 10 year olds spent 6 hours sedentary daily and 14-16 year olds devoted 7 hours daily sedentary. It was no statistical significant difference in the physical activity level nor the level of sedentary behaviour among the ages and genders in the sample. The prevalence of neck pain and/or back pain among the subjects was high. The odds ratio for sedentary behaviour and neck pain was 2.79, indicating that the odds of neck pain is higher for children who are sedentary more than 6 hours per day than those who are not. The odds ratio for SB and back pain was 2.75, indicating that the odds of back pain is higher for children who are sedentary more than 6 hours per day than those who are not. Both reached statistical significance. The association between neck – and back pain level of physical activity did not reach statistical significance.

Conclusion: School-aged children between 9-16 years of age followed the daily recommendation of 60 minutes daily PA, but exceeded the recommended level of SB by a threefold to what is recommended. This study showed no statistical significant difference in the sedentary level or activity level between the ages or genders. Neck pain and back pain was prevalent in school-aged children. A high level of SB (> 6 hours per day) was shown, with statistical significance, to have an association to both self-reported neck pain and back pain among school-aged children from 9-16 yea

In 2015 The Norwegian Physiotherapy Association requested Norwegian health authorities to construct clinical guidelines regarding examination and treatment of infants, aged 0-6 months within private healthcare.

​Kristin Lo Nystrøm, 2017

Background: In 2015 The Norwegian Physiotherapy Association requested Norwegian health authorities to construct clinical guidelines regarding examination and treatment of infants, aged 0-6 months within private healthcare.

Objectives: To explore and analyze National Health Insurance data regarding the current practice of infant pediatric patient care amongst chiropractors and other manual-therapists in Norway.

Setting: Data pertains to chiropractic and other manual therapy practices in Norway

Subjects: Infants (0-6 months) consulting authorized chiropractors and manual therapists in Norway in 2010 and 2015.

Method: The study design chosen was a quantitative cross sectional health service analysis using retrospectively collected health insurance data. All reimbursement claims from authorized chiropractors and manual-therapists in Norway, regarding examination and treatment of infant pediatric patients (0-6months) in 2010 and 2015.

Results: 20% the infant pediatric population in Norway seeks help from private musculoskeletal health care practitioners. The infants are brought in mostly prior to their third or fourth month of life and there is a slight predominance towards male babies. They receive generally a modest amount of treatment slightly above 3 treatments in average, and most infants receive less than five treatments in total. The diagnoses used are musculoskeletal around the spine and non-musculoskeletal like infantile colic and excessive crying, and are significantly different in the two professions, indicating either heterogeneity in their patient group, or a traditional or cultural difference in diagnostic practice.

Anna Allen, 2016

Bakgrunn: Ideen om kiropraktorbehandling for barn er kontroversielt, men likevel er det mange foreldre som oppsøker denne type behandling til barna sine. Årsakene til dette er ikke godt dokumentert. Del en av denne studien forsøkte å dokumentere profilen til alle pediatriske pasienter som oppsøkte Norske kiropraktorer i 2013 ved hjelp av National Health Insurance data (NHI), med hensyn til alder, kjønn og primære klager. Del to hadde som mål å gi en mer detaljert beskrivelse av disse pasientene i form av en beskrivende, papir-basert undersøkelse.

Metode: Del en var basert på Norske NHI data fra 2013. Del to besto av en ettåring, papirbasert undersøkelse. Kiropraktorer registrert i Norsk Kiropraktisk Forening (NKF) ble invitert til å delta via e-post. Deltakende kiropraktorer ble tildelt en tilfeldig måned for å samle inn data. Alle pediatriske pasienter (eller deres foreldre) ble bedt om å fullføre spørreskjemaer som inneholdte informasjon om hovedplagen, konsekvenser av denne plagen, alder, og måten de ble henvist på.

Resultat: Generelt var det godt samsvar mellom del en og to av studien i form av alder, kjønn og hovedplage. De yngste barna utgjorde den største barnegruppen i norsk kiropraktisk praksis. Muskel- og skjelettlidelser var den vanligste årsaken til barn som besøkte en kiropraktor i alle alderskategorier, ifølge NHI data. Del to av studien fant at en tredjedel av unge skolebarn og ungdom rapporterte smerte som varte lenger enn ett år. Elleve prosent av barn mente at deres plage hadde sterkt påvirket humøret, og 22% mente at deres aktivitetsnivå hadde vært svært begrenset på grunn av tilstanden. Henvisninger fra helsepersonell var uvanlig. Resultatene fra undersøkelsen var basert på 161 utfylte spørreskjemaer, mottatt fra 15% av medlemmene i NKF.

Konklusjon: Muskel- og skjelettlidelser utgjorde den vanligste primære plagen for barn og ungdom som oppsøkte kiropraktor i Norge. En betydelig andel av barna ble negativt påvirket av sine plager i form av dårlig humør og begrensninger i daglige aktiviteter. Langvarige eller kroniske plager var ikke uvanlig. Det lave antallet utvalgsstørrelse i denne undersøkelsen, både blant pasienter og kiropraktorer, krever at resultatene tolkes med forsiktighet.

Marit Jansen Sundmoen, 2016

Background: Musculoskeletal issues are very common and costly complaints in the Norwegian society. Problems that start at an early age is likely to continue throughout adulthood. It is therefore important to investigate the extent of the problem to be able to deal with these issues at an early age to help prevent further exacerbation.

Objectives: This study intended to investigate the prevalence of spinal pain and headaches amongst students attending their first year at Malakoff School, and to see whether there is any association between the pain and gender and BMI.

Study design and setting: This study was a cross sectional observational study conducted at Malakoff Advanced Level School in Moss, Norway.

Methods: A questionnaire of 9 questions were distributed to 219 first year students at Malakoff School. Inclusion criteria were that the students were first year students and 16 or 17 years of age. There were no exclusion criteria.

Results: 206 participants were included in the data analysis, 44% female. The point prevalence for any pain was 55% with the distribution being 27% headache, 26% NP, 14% MBP and 24% LBP. The 1-month prevalence for any pain was 83% with the distribution being 51%, 43%, 25% and 42% respectively. During the 1-month period prevalence half of the subjects had pain in >1 of the different areas.

50% had pain on a daily or weekly basis with an average of 4.8 points on the NRS scale. There was no association between pain and BMI. Females were 3.5 times more likely to report pain. 12% had not participated in PE, 18% reported school absenteeism.

Conclusion: Spinal pain and headaches are common complaints among 16-17 year olds at Malakoff School. Although there was a high prevalence of pain, the pain did not seem to alter daily participation in school activities for the students.

Cathrin Alvestad Slettebø 2015

Background: Musculoskeletal injuries are common though considered under-recognized at birth. Little is understood about whether such birth traumas could affect activities of daily living of the newborn, but it is known to affect at least breastfeeding and excessive crying. There are no gold standard routines for examination of the musculoskeletal system in infants, and even very little research that investigates clinical examination and MSK findings in infants under the age of six months.

​Objectives: To determine the prevalence of neck dysfunction, postural spine problems, and their possible association with parent reported behavioural problems such as suboptimal breastfeeding in infants younger than six months of age. The aim of this study is to observe any associations between MSK problems of infancy and common behavioural and public health issues such as breastfeeding and supine sleep.

Methods:  A cross sectional questionnaire based observational study in a clinical population. Mothers of infants presented to chiropractic clinics in Norway filled in a questionnaire on the first visit, and this was followed by a clinical examination and questionnaire completed by the chiropractor on the same day. Eleven chiropractors enrolled or graduated from a Masters program in musculoskeletal health of paediatrics participated in this data collection. There were no interventions and the study was observational in nature.

Results:  In total, 90 infants enrolled in the study.  A total of 56 infants (66%) had postural problems. Favourite side (N=41; 75%) was the most common dysfunction in supine lying. Neck hyperextension was present in 21 infants (38%).  The inability to rotate their head equally side to side was present in 49 children (54%).   In total 22 (24%) of the infants did not have the ability to sleep or lie comfortably supine.  Suboptimal breastfeeding was reported by 22 (25%) parents, and 10(12%)of the mothers reported pain during feeding.   TMJ imbalance was identified in 16 infants (19 %). There were statistically significant associations between suboptimal breastfeeding and TMJ imbalance, suboptimal rooting/sucking reflexes, inability of full cervical rotation and painful breastfeeding, respectively.

Conclusion:  Parents reported several MSK problems in infants along with suboptimal breastfeeding and other ADLs, which were corroborated and specified by the clinical examination.  More study is needed to determine a gold standard reference for infant musculoskeletal examinations along with the importance in improving activities of daily living and public health.

Thorleif Henning Monsen, 2016

Background: Breastfeeding is the superior method of infant feeding; clinicians have the important role of supporting measures that promote breastfeeding. Breastfeeding promotes the infant health benefits of ideal nutritional content, better absorption, fewer food-related allergies, improved psychological development, and better immunological defences, as well as substantial economic advantages for the family and society. Ankyloglossia has been identified as a barrier to breastfeeding. Surgical correction of ankyloglossia with frenectomy (also referred to as frenomy, frenotomy, frenulotomy, or simple release) is rapid and low risk, yet experts have not reached a consensus regarding indications for the procedure.

Objective: In this study, data from the frenectomy service at Poole Hospital for the past decade was examined to elucidate the profile of infants receiving frenectomy, complications during the procedure, and immediate outcomes reported by mothers. The findings were used to evaluate current clinical evidence regarding the indications for frenectomy in new-borns and infants with ankyloglossia with the aim of further informing this type of practice.

Setting: A health services evaluation based on a retrospective quantitative review of medical records using data from the frenectomy service at Poole Hospital for the past decade.

Subjects: Infants presenting at the frenectomy service at Poole Hospital since 2005.

Method: A health service evaluation reporting form was designed and used to gather data from existing patient records. The collected data were analysed using Excel and SPSS.

Results: In total, 1038 forms were randomly selected from over 6000 total, with 952 forms used in the final analysis. 86 forms in total were excluded, 59 (5.8%) forms for the reason “Did not arrive”, and 27 (2.6%) forms due to illegibility. Most patients (69.3%, n=660) were in the 0–3 weeks age group, while 278 (9.2 %) were in the age group 4-6 weeks, and 14 (1.5%) patients were in the age group 7–12 weeks. 570 (59.9%) were male and 382 (40.1 %) female. The mean number of problems for each subject was 3.16, with “problems latching” (69%, n=655) and “sore nipples” (59%, n=557) being the most common reasons for seeking help. The problems of “weight loss” and “colic” were experienced by 166 (17%) and 439 (46%) of subjects, respectively. 108 (1%) of the subjects sought medical attention without stating any symptoms. 709 (74.5%) of the patients had frenectomy performed with 673 (94.9%) of the mothers reporting improvements after the procedure. Out of the 709 (74.5%) who had the procedure, 480 (67.7%) reported minimal blood loss with just a few drops. Another 88 (12.4%) reported no blood loss at all after the procedure while 141 (19.9 %) reported that pressure needed to be applied to the patient to stop the bleeding.

Conclusion: The results of the study add the growing evidence base that frenectomy performed by a trained clinician is a safe procedure resulting in high rates of immediate maternal parent-reported improvement. Nevertheless, additional study is needed to further elucidate the significance of this condition as it pertains to breastfeeding, and to clarify the appropriateness and proper timing of the corrective procedure.

Gyda Thorsen Nervik, 2015

Background: Recent research shows an increase in paediatric musculoskeletal (pMSK) problems. Public health nurses (PHNs) in Norway meet almost all infants through the public health clinics and there is little information available on their procedures with regards to musculoskeletal problems in infants.

Objectives: The aim of this study was to investigate the procedures of PHNs working in public health clinics in Norway when recognising musculoskeletal problems in infants. PHNs and parents presenting their child to chiropractic clinics in Norway were asked questions about public health nurses’ recognition, recommendations and referrals with regards to pMSK problems.

Design: Cross-sectional study design.

Methods: An online questionnaire was created using the Survey Monkey website and was sent to public health nurses working in public health clinics throughout Norway. A paper-based questionnaire was handed out to parents presenting their infant to four chiropractic clinics in Norway. Data were analysed using Survey Monkey and Microsoft Excel for descriptive statistics.

Subjects: 231 out of 475 responses were received from the public health nurse survey. Of these, 225 worked as public health nurses. 58 parent questionnaires were collected.

Results: The response rate for the public health nurse survey was 48.6%. Most PHNs were between 50-59 years (37.9%) or 40-49 years (36.2%) and the majority of respondents worked in the Eastern part (30.5%) and Northern part (23.3%) of Norway. 93% of PHNs recognised a musculoskeletal problem when the infant prefers to look/sleep to one particular side, and 80.4% recognise breastfeeding difficulties (particularly on one breast) as a MSK problem. The majority of PHNs recommend counter-positioning to parents whose infant has a MSK problem (87.7%); just over half recommend tummy time (58.8%). 42.1% of PHNs replied that they do not know whether there they see an association between assisted births and paediatric MSK problems. 46.7% often refer pMSK cases to specialists, while 48.1% refer depending on the critical nature of the problem. The majority of PHNs refer pMSK cases to physiotherapists (61.9%), 1.9% refer to chiropractors. Most PHNs never (40.4%) or rarely (37.5%) use the KISS/KIDD diagnosis when explaining pMSK problems to parents. Parents participating in the parent survey were mainly from the Western (48.3%) or Eastern (39.7%) parts of Norway. The majority of infants presenting to chiropractic clinics in Norway were in the 0-3 months age group (62.1%). 55.2% of parents reported that their child had a MSK problem and 51.4% answered that the PHN had not recognised this problem in their child. 44.8% of parents had not received any advice for MSK problems from the PHN, however 31% were advised to practice counter-positioning. Half of the parents had sought help for the MSK problem without being referred from the PHN or doctor, and 14.6% had been referred by the PHN. Of these, 41.7% had been referred to a chiropractor.

Conclusion: PHNs in Norway readily recognise MSK problems in infants, give advice about counter-positioning and often refer pMSK cases to physiotherapists. These findings are not completely supported by parents, as the majority reported that they had not been referred to a specialist by the PHN, had not received any advice and the PHN did not recognise the MSK problem in their infant. However, the results were not ideal for comparison due to low response in the parent survey.

Cathrine Herneblad-Due, 2014

​Background: Musculoskeletal complaints are common in children and research indicates that childhood complaints are on the increase and can be a predictor of pain later in life. However, the complaints and prevalence rates are reported with great variations in the literature.

​Objectives: To determine the prevalence rates of musculoskeletal complaints of headache, migraine, neck pain and back pain in Norwegian 9-11 year old school children through a cross-sectional survey.

​Subjects: 638 questionnaires were handed out and 317 were collected (49.7 % response rate). Randomized primary schools in the areas of Akershus, Østfold and Sør- Trøndelag (Norway) were invited to participate.

​Methods: A cross sectional questionnaire based study

​Results: It was as common to experience pain as not in this study population. Headache and “other complaint” (foot/ heel complaints) were the most common when assessing ‘period prevalence’ of six months as well as ‘point prevalence today’ or this week. Headache, migraine, neck pain and back pain were most common at an interval of every three months, while lower limb complaints were most common at a weekly basis. No gender differences were found in this study and there were found minor association to trauma.

Conclusion: Half the group of the Norwegian school aged children studied suffered from MSK complaints within the last six months and over 40 % suffered ‘today or this week’. The majority suffered from lower limb complaints and headache; these complaints serve as associated factors for MSK complaints in the study population.

Ann Kristin S. Homdrum, 2013

Objectives: The objectives of this survey were to investigate maternal choices to initiate or preserve exclusive breastfeeding and to map out the main domains of problems with feeding in infants in a population of mothers who presented their infant for chiropractic care.

Methods: A cross-sectional survey of parents who presented their infants to a chiropractic teaching clinic. Each form was coded with a number and data entered into an Excel spread sheet. Two main software packages were used to analyze data; Microsoft Excel 2000 spreadsheet/SPSS-17 and GraphPad Instat Statistical analysis software.

Results: In all, 1753 surveys were collected. Most mothers (88%) initiated breastfeeding. The mean age when mothers stopped breastfeeding (was 3 weeks (SD=5.5). Amongst women who stopped breastfeeding (n=502), 197(39%) had routine vaginal births and 305 (61%) had assisted births. There was no statistically significant correlation between type of birth and feeding. There was a significant correlation (0.048) between when the mothers stopped breastfeeding and the lack of satisfaction with the breastfeeding experience. Of those mothers who stopped breastfeeding, mothers who planned to breastfeed whilst pregnant, breastfed for twice as long compared to the women who did not plan to breastfeed (p =.005).

Conclusion: This population was representative of the UK population in that breastfeeding initiation rate was high and there was also significant early discontinuation. Further study is required to determine which factors might work toward helping new mothers continue in order to support public health initiatives to improve the health of mother and infant..

Anja Blikstad, 2014

Background: Recent studies indicate a rise in number of paediatric patients with musculoskeletal (MSK) pain. At the same time, children have increased levels of sedentary behaviour including high levels of screen time.

Objectives: Through the use of a questionnaire handed to children between 9-11years in randomly selected primary schools in Norway, the study hoped to gather information about levels and patterns of physical activity and inactivity. Information about school transportation, hours of PE at school and sports activities outside school was collected, as well as hours and type of screen time per day.

​Design: Cross-sectional questionnaire based study.

​Methods: The data collection took place in February 2014. A questionnaire was handed out to all children in 4thand 5thgrade of 6 randomly chosen primary school in 3 of the most populated counties of Norway. Participation was completely voluntary and parents of the children answered the questionnaire with help from their child, which was optional. Data were plotted and analysed in SPSS.

Subjects: A total of 638 questionnaires were handed out and of these, 317 subjects participated in the study,

Results: The response rate was 49.7%, of which 44% boys and 56% girls. The baseline characteristics were considered equal. Seventy-four percent used active transportation to school. Parents driving was the second most common type of transportation (17%) after walking, which was most common (63%). Almost half of the children who walked lived less than 1 km away. Seventy-five percent of children who were driven to school by their parents lived less than 3 km from school. Most children participated in PE at school (98%), with either 1 (45%) or 2 (47%) hours per week. Results showed that more boys had high levels of activity compared to girls. More than 90% participated in organised sports activities, with 68% having 3 hours or more of activity per week. However, 94% of the participants were in the “low activity” group with regards to hours of PE, and 63% were in the group of “low activity” with regards to organised sports activity. The majority of children spent between 1-2 hours in front of the computer per day (82%), and in front of the TV per day (79%). Fifty-one percent had complained about non-specific MSK pain during the past 6 months, however there was no statistical significance (p>0.05) between hours of physical activity or hours of screen time, and presence of MSK pain.

Conclusion: There was no statistically significant association between level of physical activity or level of screen time, and MSK pain. More boys had high levels of physical activity compared to girls, however consistent with results from other studies, the results showed relatively high levels of screen time compared to national recommendations.