Obtaining a clinical history of a child with a disability can be its own challenge because there may previously have been extensive medical intervention. For a complete view into this child’s history, the doctor must allow adequate time for a thorough interview with the parents or caretaker and the child (if possible). Questions should be asked that will allow the chiropractor to get a complete understanding of what the child can do, what they cannot do, and what they may be able to do. Obtain all medical records when possible, but be careful not to be biased by them. It is important to ask your own questions and take your own measures.

A thorough pediatric history should include prenatal, perinatal, and postnatal development. This includes questioning the mother about the length of the pregnancy, complications, infections, and drug intake. Understanding the perinatal period should include questions about the type of delivery, duration of labor, medications, anesthesia, use of assisted devices (forceps, vacuum), and fetal presentation. The history should also contain postnatal information such as birth weight, gestational age, Apgar scores, and complications after birth. In a child with a disability, it is important to expand questioning to include all hospitalizations, childhood illnesses, surgeries, traumas, medications, allergies, and nutritional status. Many children who later show delayed development and disabilities often display feeding problems early in life, including reflux, excessive colic, and formula changes. Sleeping habits can also be altered in many children who later display developmental disabilities, so a thorough history must include deliberate questions about these areas (1). Further questions about the child’s growth and developmental progress, including gross and fine motor milestones, social behavior, speech and language development, school performance, and hearing and vision outcomes should be included. The doctor can gain a vast amount of knowledge about the child by having the child, parent, or caretaker give a description of a “typical day” for the child. Include questions about temperament, eating patterns, discipline problems, and interactive skills. The demands on a family with a disabled child are great, so a detailed social history should be taken. Ascertain who the primary care giver is and what the challenges are in the home both physically and socially for this child and the family. Because many physical disabilities are permanent, it also is important to define the family’s expectations of the chiropractic care.

As with any patient, cooperation is essential in obtaining accurate findings. The order of the examination can be flexible. Knowing what to expect in the broad clinical picture can alleviate much of the apprehension about working with these special children. Keep in mind that
this child most likely has been examined by individuals of multiple disciplines. A fearful child must be put at ease before any examination can begin. Take care to direct as much verbal interaction as possible to the child, even if they do not seem to understand. Never underestimate how much language a child can comprehend. Some nonverbal children use computer-assisted communication devices but they may not have the vocabulary to be specific when relaying their problems. Having pain charts with faces that range from smiles to frowns or a childfriendly picture available that allows the child to point to specific anatomy can facilitate communication and assist in future assessments. Although you may want to focus on their disability, begin by looking at the whole child and note their general appearance, nutritional status, ability to move, alertness, interest in their surroundings, playfulness, distress, and vocalizations. All of these impressions are judgments used to recognize the progress or deterioration of the child’s condition and should be very carefully and specifically documented. The physical examination of a child is already challenging, but it can be overwhelming in a patient who is nonverbal and nonambulatory with athetoid body movements. Some conditions may require the clinician to perform an examination that is normally done on a thin, slippery exam table to modify the procedures to be done in a seated position, lying across a lap, or with an air mattress on the floor. Doing a thorough and reproducible examination is important to document the effects of chiropractic intervention. After a thorough history, take the time to organize your thoughts and plan the exam. In some cases, this can mean a subsequent office visit.

In the following section, two physical disabilities of childhood will be used to highlight the differences in chiropractic analysis and care for conditions that are present with hypertonia or hypotonia. It would be beyond the scope of this textbook to discuss all possible physical conditions and how they might alter chiropractic analysis and management. Though it is important to understand the exact presentation of each child’s physical
disability, many conditions that alter tone require similar modification to chiropractic analysis and management.