Last week we discussed the consultation for an infant patient, that has to be done correctly so the patient’s parents know you are the expert and have put in the time and effort to be the best pediatric chiropractor possible. It isn’t about having a slick comment or phrase, it IS about being completely connected with the parents and knowing what they are going through and what they want.
Parents want a healthy, vibrant, thriving baby and child. Parents want to connect with their baby and want to do the very best for them. Parents will do anything to ensure their child is the healthiest and happiest. You need to know that these parents have spent hours online researching their baby’s health and condition and they expect you to know MORE than they do…that is why you are the expert, so you better be!
Let’s start this exam. First thing you need to do is to LOOK at the baby and show and tell what you see:
Look for facial symmetry and balance: compare the forehead and cheeks and show and tell the parents what you see, if one side is anterior then expect the opposite side occiput to be posterior-check that. Measure the cranium and then each side from EOP to glabella for symmetry. If that measurement is more than 5mm different there is significant cranial asymmetry which indicates cranial fixation. If you don’t do cranial work already then look into the programs taught by Roger Turner or Martin Rosen or Carol Phillips…they all offer amazing programs and I feel these courses are essential when specializing in the pediatric population.
Look for head and/or neck tilt and/or rotation, check to see if baby can turn their head from side to side. If baby fights turning to one side or lifts their body as you turn their head that is not OK and a sign of an upper cervical subluxation. While you turn their head check for ATNR, which means that the baby’s arms will move with their head (the arm you turn the head to will extend and the opposing arm will flex).
This is also a good time to check for rooting and sucking reflex as well as acoustic blink. If you’re allowed to go into baby’s mouth now is a perfect time to check the latch and suck. Offer baby your clean finger or gloved finger, baby should immediately suck on your finger by pulling your finger to the roof of their mouth. The suck should be rhythmic and smooth, there shouldn’t be a tongue thrust but the tongue should wrap around your finger on each side, assess to make sure one side doesn’t “give out” after a few sucks. Palpate the midline palate, it should be smooth and arched, if it is tented or like an M that is a sign of palate fixation. Look at the underside of the lip and assess for a lip tie. As baby “talks” look for a tongue tie, if the tongue forms a heart shape then that is a severe tongue tie and should be referred to an IBCLC and a provider who can perform a revision.
Next palpate the belly for softness and tone, then palpate the hips and check for popping or clicking, which can be a sign of hip dysplasia or subluxation.
All of these tests can be performed with baby laying on the exam table, in a pregnancy pillow or laying in the parents arms…your job is to gain trust so accommodate them and baby appropriately.
Now lift up the baby and lay them on their belly. (Great way to assess Startle and Parachutes reflex) Watch to see how comfortable baby is laying on their belly. Check Gallants and gluteal crease, palpate the the spine for subluxation (remember Gonstead and that most vertebrae will subluxate posterior prior to rotation). Look at the erectors for tone and symmetry, also check the skin folds in the thighs for symmetry.
If the parents are ok with it I recommend that you invert the baby, (you may have to explain why you are doing this…that is totally ok…again you’re gaining trust) Remember the baby was inverted for months so they are totally ok in that position. A healthy baby will be relaxed in an inverted position and look both ways with ease. Any sign of torsion or arching is not normal. If baby is stuck looking one way see if you can get them to look the other direction by having Mom or Dad talk to them from that side or by bending the ipsilateral knee. Look for head tilt or extension. This test will show you indications for upper cervical subluxations and dural torsion and tension. Gather all this information.
I also recommend utilize scanning technology to asses their nervous system further. This examination is meant to test their nervous system and push it to it’s limit…if at any point you “blow out” their nervous system then you may have to finish the exam for that day. It is totally OK to delay the testing to another time. This new patient visit does not have to be completed on day one, you DO NOT have to adjust this baby on day one either…remember you are preparing this family for a lifelong relationship…right? What is your mission…or deal in crisis mode or grow healthy families? So take your time, do these tests slowly and properly so you gain the right information and assess their nervous system completely and accurately. This exam is meant to show you (and the parents) function and malfunction, this exam is for you, the parents and the baby.
So….now what? What do you do with all this incredible information? How do you craft a care plan to correct subluxation, not simply adjust subluxation? How do you explain your findings and your recommendations so the parents track with you? Let’s dive into that topic next time!
I hope these emails are making you think and making you “up your game” and skills. That is what Practice Evolution is all about, building the best doctors, period. I don’t teach marketing or salesmanship or anything like that. I teach how to be incredible at what you do, I teach you to be the best doctor ever, to work harder, to train more, to learn more. Because that is what your patients deserve…especially these young ones. When you’re ready to raise your game, work harder and dive deeper and become the best doctor you can be then we should talk. I am a tough coach, I will push you to exceed and expect more, my job is to get you to your best. I start my next training module August 4-6…if you’re really ready then it’s time we connect. Fill out my Practice Health Mini Check Up and I’ll take it from there, let’s do this and let’s change the health of your community!