Pediatrics

From the time your child is born to the time he or she takes the first step numerous physiological and neurological developments will take place. As a parent you have an endless number of concerns and questions? Should I breastfeed? What brand of formula do I choose? Is my child suffering from colic? What is dimersol? How can I alter the vaccination schedule to reduce potential side effects? What childhood diseases should I be concerned with? Is there any disease at a high prevalence within my city? Is my child growing at a normal rate? Is my child deficient in vitamin D? What products do I use? Etc.

As a father himself and a member of the i.c.p.a. (International Chiropractic Pediatric Association) Dr. Khanjian offers a wide variety of services for infants such as motor neurological testing, screenings for scoliosis, torticollis, gait alteration, Genu Varum (bow leggedness),Genu Valgus (knock knees),Club foot, Pectus excavatum/carinatum (chest deformities), scapular deviations and Rickets. Dr. Khanjian will monitor your child for proper weight, height and head progression. Cranial screening will also be performed in making sure all lobes of the skull are developing evenly. To ensure your child’s nervous system is functioning and well, Dr Khanjian will assess your child for any present subluxations. Your child’s nervous system much like the adult nervous system can be depressed and insufficient when subluxations are present.

The potential to correcting physical deficiencies in a child are much greater when detected and treated at an early age than of those addressed later. With proper care, timing and attention, concerning issues can be addressed, altered and corrected for life with chiropractic care.


Spinal Development

The primary and secondary curves of the spine refer to the kyphotic and lordotic curves of the vertebrae. Lordotic curves are concave curves seen when looking at the side profile of a normal spine. The lordotic curve can be seen within the cervical and lumbar regions of the spine. kyphotic curves are convex curves which constitute the thoracic and sacral regions of the spine. The significance of these curves in an adult can alter many factors such as weight distribution and postural imbalance. In the infant however, the development of the primary and secondary curves are detrimental for a child’s ability to hold the head upright, crawl, creep or even walk.

Upon birth and throughout the period of time spent within the womb, an infant has what is referred to as a “C” shaped vertebrae, as one can imagine this curled formation would be advantageous and accommodating for a neonate who will be residing in a womb for nine months. However, when an infant is born gravitational forces are applied despite the numerous undeveloped muscles and ligaments surrounding the cervical region. Due to the circumstance it is crucial for the parents to be extra cautious in supporting the infants neck and back. Unfortunately, from the time of labor to the point an infant is able to support his or her head marks the most vulnerable period for sprains and strains of the cervical muscles and ligaments. Quiet often sprains and strains of the neck muscles become apparent when an infant suddenly begins to favor a head tilt either side of their shoulder, this condition may result from a single incident or may result from various situational causes such as improper sleeping positions.

An infant may begin to hold the head upright during the 3rd to 5th month of life. This physical ability marks the development of the primary curve. Biomechanically, this means the cervical spine now has developed enough curvature (arch) to sustain the weight of the head. This is a significant milestone, especially when considering that the head of an infant is ¼ in ratio to the body, as compared to the adult in which the head comprises 1/8 in comparison.

Secondary curves of the spine (kyphotic curves) seen in the thoracic and sacral regions develop within 7 to 12 months. The stages and degree of development can be observed as your child will progress from sitting on their own without back support to crawling and eventually walking. Biomechanically this signifies that both primary and secondary curves have been developed allowing the head of the infant to be centered over the pelvis as such creating balance for motion.

As a parent there are many ways to encourage the healthy development of the primary and secondary curves in your infant. “Tummy time” referred to as prone position (stomach down) lying of an infant is recommended for 5-15 minutes a day. This exercise should be performed under the supervision of the parent while your child is awake. This position helps encourage the baby to lift his or head and arch the low back actively. Your child may not be very responsive to this activity at first, in some instances this exercise may even cause frustration. However, as parents you may have to take extra steps in creating stimulants during this activity such as television, radio or simply placing their favorite toy in front of your infant as he or she performs tummy time.

Another key in guiding your child to the development of healthy primary and secondary curves of the vertebrae is encouraging your child to crawl or creep (elbow crawling). Crawling or creeping with help of the extremities (hands, elbows and knees) helps stimulate your child in arching the back thus actively defining the kyphotic and lordotic curves. Unfortunately, many parents fall under the notion that they must encourage their child to walk far beyond their expected stage. This wrongful notion may also be accommodated with the usages of carriers and walkers, both of which place your child in a vertical upright posture producing harmful unwanted weight on your infant’s spine. This undesirable axial load not only decreases your child’s vertebral development but may also reverse its growth by developing lumbar kyphosis (reversal of curve). Car seats, walkers and vertical carriers all promote the “c” shaped positioning of your child’s vertebrae, these accessories are not very helpful when your infant is striving to develop healthy primary and secondary curves. Although circumstances may limit our options with the usage of accessories such as a car seat, we can however be more conscious with the duration of time our child is placed in an unfavorable ergonomic position and provide more breaks during a long car trip.


Milestones (Motor development guideline)

The following motor development guidelines are general. Your child may or may not exhibit with different stages of development. Theses actions and impulses vary among children and the stages of developments you may initially observe them within.


1 month:
-Most actions reflexive; chin quivers, hands tremble, startles easily
-Jerky movements smooth as nervous system matures, muscle control improves; toward the end of this period, may lift head briefly when lying on the stomach


2-3 months:
-Reflexive movements begin to fade and intentional actions become more frequent
-Neck strength improves; should raise head 45 degrees while lying on the stomach
-legs straighten and may push down when placed on surface
-As flexibility in knee and hip joints develop, kicks gain force
-Brings hands together
-grasp objects placed in hand
-swipes at dangling objects


4 months:
-Raises head 90 degrees while lying on stomach
-Holds head steady when held upright
-Supports upper body with arms when lying on stomach
-Rolls over one way
-Reaches for object
-Grasps rattle and brings to mouth


5 months:
-Holds head steady when held upright
-Rolls over one way
-Pushes up with the arms and arches back to lift chest
-Rocks on stomach, kicks legs, “swim” with arms
-Grabs feet and brings to mouth when resting on back
-Grasps and reaches for objects


6 months:
-Keeps head level when pulled to sitting
-Sits upright, with help
-Transfers objects from hand to hand, turns them from side to side, twsit them from upside down


7 months:
-Sits up without support
-Rolls over in both directions
-Self feeding more established
-Reaches out when sitting with a claw-like grip or raking motion
-Moves forward on the stomach to get a toy out of reach
-Bears some weight on legs when held upright


8 months:
-Supports entire weight on legs; likes to bounce
-When sitting, pivots to look for dropped objects
-Gets into sitting position using arms
-Passes an object from one hand to the other
-Rakes small objects and picks them up with a fist
-Picks up small objects with thumb and forefinger.


9 months:
-Works to get objects out of reach
-Pulls up to the standing position from sitting
-Stands holding onto something
-Learns to open fingers and drop objects
-Plays peek-a-boo


10 months:
-“Cruises”-walks holding on to furniture
-Momentarily stands unassisted
-Interested in tiny things
-Enjoys toys with moving parts such as levers and wheels that spin


11 months:
-Gets into a sitting position from stomach
-pincer grasp established
-Holds crayon and tries to scribble
-Plays patty-cake and waves bye-bye


12 months:
-Assisted walking more established
-Begins walking without support
-Picks up tiny objects neatly
-Stacks blocks and builds towers


13 months:
-Stands alone momentarily
-Walking better established
-Playing patty cake, waving bye-bye established
-Starts to drink from a cup


14 months:
-Walks well, about 2 steps
-Stoops to pick up toy
-Turns a container over to dump contents
*** When other development is normal, late walking is unlikely to be a cause for concern


16 months:
-Drinks from a cup
-Points to desired objects
-Enjoys scribbling with crayons


18 months:
-Runs
-Rather push carriage than sit in it
-Uses fork and spoon
-Unzips zipper
-Sorts shapes and drops them into matching holes
-Takes toys apart and puts them back together


20 months:
-Walks up steps
-Throws a ball overhand
-Becomes curious about objects/places
-“Feeds” a doll
-Builds a tower of four cubes
-Enjoys finger painting


24 months:
-Moves with greater efficiency
-Kicks ball forward
-Takes off some clothing, may also put some on
-Dance to music
-Brushes teeth with help
-Builds a tower of six cubes
-Shows hand preference

Expecting Mothers

As an expecting mother in your early or late stages of pregnancy, you may experience the many symptoms of postural imbalance as your center of gravity shifts forward due to your protruding midsection. Along with a shift in balance and normal weight gain you may experience pressure on your joints, pelvis, back and neck. The duration of your pregnancy along with increasing factors of weight, fluid retention and postural imbalance may produce pain with muscles, ligaments, adhesions, cramps, swelling and not to mention subluxations. With the inability to turn to medications for the sanctity of you and your child, you will begin to appreciate the conservative approach our clinic can offer to soothe your symptoms in maintaining a healthier pregnancy. With the combination of his academic course work, participation in Bradley courses and vast training of specific spinal adjusting for expecting mothers, Dr. Khanjian can help re-establish pelvic balance simultaneously optimizing space within the pelvic region for your infant.

In addition to adjustments, our office provides pre-natal massage therapy for expecting mothers. Conducted by a licensed therapist, the massage will not only help you relax, but will address possible adhesions, increase blood flow and help relieve aches and pains. In addition, Dr. Khanjian offers pre-natal consultations on nutrition, labor, exercise and all up to date information for you and your baby’s health.


Post Natal

Congratulations, you are a mother now, whether it’s your first child or your third, you’ve come to understand the labor of love that comes with a child. Your infant will present physical challenges your body must meet. You will carry your infant throughout most of the day, not to mention the baby bags, assembling de-assembling of the stroller and the usage with the car seat. There is a toll on your spine and it may be felt at any point of the day. Unlike the pre-natal back pain experienced generally in the lower lumbar and pelvic region, post-natal back pain will more commonly occur within the mid-thoracic region. The reasoning behind the difference is due to the point of stress the spine experiences on the gravitational center in perspective to your body. During your pregnancy your neonate was positioned centrally within your lumbo-pelvic region creating a protuberance in your abdominal region. Biomechanically this would allow the point of stress to be in the lower lumbar and pelvic region. However, In your post natal stage you externally carry your child to either the left or right side of your upper body thus shifting your center of gravity and causing stress within your thoracic region. As your child gains weight your vertebra can be prone to even more stress. Patterns of rolling your shoulders in, over utilizing your trapezius muscles and anterior head carriage are all common tendencies in compensating for weight carriage. With every inch of forward head and upper body posture producing 10lbs of pressure on the corresponding segment within the spine, one can only estimate the toll and pressure exerted on the disc of a mother carrying a 9lb child.

Our clinic will not only address symptoms of your back pain, but as well help strengthen the musculoskeletal system surrounding your spine to increase its integrity within the clinic and as well with home care exercises. In addition, we will provide ergonomic skills, techniques and accessories to help reduce your back pain throughout your post-natal stage.


Q’s and A’s
Question: What is the normal weight gain during pregnancy?
Answer: Although there may be many factors to weight gain during your pregnancy, one must always consider the dietary nutritional value during the full nine months. An unnecessary increase in weight can occur with the consumption of fats, but this gain in weight would have no nutritional value to you and your child. With nutritional status taken into consideration along with pre-pregnant weight and stature, normal healthy weight gain can range from 18-40 pounds throughout your pregnancy.


Question: How many grams of protein do I need during my pregnancy?
Answer: 75 grams of protein per day.


Question: What is Elastin?
Answer: A pregnancy hormone that helps loosen the ligaments attached to the pelvic bone.


Question: What are Kegel exercise’s?
Answer: Exercises designed to help strengthen the integrity of the pubococcygeus muscle which helps supports the uterus and the abdominal organs


Question: What is “Dilation” and how is measured?
Answer: Dilation is the opening up of the cervix and is measured in centimeters. A fingertip dilated means about 1 centimeter dilated. Full dilation is 10 centimeters. Once full dilation occurs, the cervix is completely gone over the baby’s head and the mother may push the baby out to be born.


Question: What is Effacement?
Answer: Effacement is the thinning and softening of the cervix and is measured in percentages. Usually, the cervix is long, hard and closed. With contractions, the cervix starts the effacement process. As it continues to soften, it starts to dilate, as well.


Question: What is Preterm labor?
Answer: Labor that begins before the 36th week of pregnancy.


Question: What is normal amniotic fluid pressure?
Answer: The AFI (amniotic fluid index) is utilized to determine your amniotic pressure standing. Normal can range anywhere between a 7 and 23.


Question: What are the common prenatal supplements utilized as against deficiencies in pregnancy?
Answer: Iron, folic acid, zinc, copper, magnesium and pantothenic acid.


Question: What is the recommended daily intake for calcium during pregnancy
Answer: 1200mg


Question: How can Anemia be prevented during pregnancy?
Answer: Anemia can become prevented by dietary consideration emphasizing on raw fruits and vegetables that are rich in iron such as: watercress, green onions, kale, broccoli, chard, okra, squash, carrots, radishes, yams, tomatoes, potatoes (with jackets). Iron rich fruits such as: bananas, apples, dark grapes, apricots, plums, raisins, strawberries. Other iron rich food are: sunflower seeds, crude blackstrap molasses, black beans, sesame seeds (Tahini), peas, egg yolks and honey. In addition, the diet should include whole grains, such as whole wheat, whole rice, buckwheat, beans, soybeans and millet. It is beneficial to avoid tea and coffee, caffeine based substances interfere with iron absorption in the body.


Question: What is Hypovolemia?
Answer: An insufficiency in blood volume level for the demand of pregnancy.


Question: How can hypovolemia be prevented?
Answer: Hypovolemia can become prevented with adequate consumption of proteins, calories, salt, and other essential nutrients.


Question: What is the single most important factor influencing the baby’s weight at birth?
Answer: Maternal nutrition.


Question: What is considered “low birth weight”
Answer: under 5.5 lbs.


Question: What can help the mother and child gain the right amount of weight, protects against gestational diabetes, reduces stress and aids in digestion?
Answer: Exercise (accordingly by keeping your pulse and core temperature in the normal range).


Question: What are some things that might harm your baby?
Answer: Drugs, smoking, alcohol, aluminum, mercury, chemicals, pesticides, caffeine, artificial sweeteners, junk foods, processed foods and excess sugar.