Blog, Live Events August 9, 2022

Disruptive Pediatrics presents: Pediatric Examination Basics

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This is Dr. Drew Rubin. I am so excited to bring you ChiroSecure’s, Disruptive Pediatrics. Thank you so much for ChiroSecure for having us with you guys. Pediatrics, I think is the wave of the future. What I have noticed in my office since the pandemic, we’re seeing more kids than ever before and more kids that are what we would call a neurodivergent more kids with autism.

ADHD, Learning disorders, other kinds of things. So today I wanted to do something. I want to go back to basics instead of doing these interviews, which I’ve been enjoying, but I want to go back to basics and make sure we all know some very simple, basic neurological exams to do on all these different kids.

So I’m going to fly through. Today, but I think it’s going to be so important for you to understand that when we’re looking at these neurodivergent kids, we have to look at neurology. It’s not just about looking at their posture. It’s not just feeling their spine. That’s all important stuff is all chiropractic stuff, but it’s.

It, we have to take it one step further and go into their neurology and check what their nerve system is doing because that nerve system tells us where they’re at, where their brain is at, how their nervous system is functioning. So let’s go to the slides. Thank you. And I am super stoked to talk to you about what.

The three keys or their core prim pupils and primitive reflexes. These three keys are the things we need to be looking at when we’re talking about looking at neurology. Now there’s so many more tests. There’s so many more things that we can cover. I’m only going to cover some basic basics because I want to give you a taste of this.

And then once you really get into this, then you can start discovering more and more. But the core is absolutely critically important because the core. If you’ve got a kid as an example who has hypotonia and they’re very weak and they can hold the hold their heads up.

It’s not just because their head is weak. It’s because their whole core is weak. And part of the core is the occiput part of the core. In my opinion, as the way I look at it is how are they able to hold themselves up like this? So we need to look at the core and we’re going to examine not.

Their stomach, right muscles and how the core isn’t just the stomach. The core is really like the spine and all the central stuff in the middle. So we need to examine their core and see how well they’re doing. And I’ll show you how to to test for that. The pupils critically important that the eyes probably are something like 50% of the brain, at least from what I, my research 50% of the brainpower has to do is something to do with the eyes.

So we’ve got to look at kids’ eyes as one of the big missing links to that. In chiropractic pediatrics, that a lot of people don’t look at kids’ eyes. And number three is reflexes printed reflexes, critical stuff that Dr. Malillo really first introduced me to. And Dr. Monica Berger talks about quite a bit, one of our, another ChiroSecure people.

So primitive reflexes are important because in the beginning, when a baby is a little bitty munchkin, a couple of weeks old, I just saw a three day old baby yesterday was so cute. These kids have all their pin reflexes, but then they go away. They get tamped down as the brain kind of starts serving and growing up like this top-down regulation starts and tamps them down.

But what happens if they don’t? What happens if those reflexes don’t get tamped down? I saw a kid yesterday on the spectrum. Every one of the prem reflexes we’re going to go over today was positive and he’s six years old. And having trouble speaking and having trouble walking with balance issues, absolutely critical for this kind of stuff.

So that’s what we’re really going to talk about right now. So let’s talk about, let’s get to the, let’s get to the meat of this core. My favorite thing is doing a pull to sit test. So yeah. Hold on to there, how the child lied down at whatever age and having to grab onto your fingers and then lift them up.

Now, a little baby, a little newborn, you do this. They head’s going to go back an older kid from six months old. And on the older kids should have, they should lead with their chin. They should lead with their chin. What you’ll see, we had this kid yesterday, another one who was on the spectrum and he’s four and a half years old.

And we did this exam with him and he led with, instead of leading with chin, he led backwards. So we pulled them up and his head went backwards instead of coming up like this he’s head went back like this. And as you see there on the bottom of the PowerPoint slide, when you’re your, if your head doesn’t go forward like this, when you pull to sit, this indicates not just a weak core, but also a weak occiput a week proprioceptive input in that upper cervical area.

So that’s the first thing we want to do is check this, pull to sit. That’s a great way to test for infants and for older kids for four year olds for ten-year-olds I’ve even tested. 20 year old adult, a couple of weeks ago, who’s adult person on the spectrum. And he has issues with this instead of pulling up like, this is how I went backwards.

And this is what it looks like is when does it, we core the head. We’ll go backwards like this, or there’s going to be a push like this from one side or push like this outside, or they use their arms to sit up. That’s how, the core is weak pupils. I cannot begin to tell you how important peoples are.

Almost every single kid who comes in with some neuro diversion issue, whether it’s autism or learning disorders or whatever, it happens to be ticks seizures instead of their eyes being like this. Turned in, use your phone. What I’ll do is I’ll go like this. I’ll bring my phone in the new patient exam and I’ll put it onto my, the camera app and I’ll take a picture of it.

And I could show you hundreds of kids’ pictures in my phone, where you’ll see, instead of their eyes being like this, you’ll see that. One of their pupils is in, they call it esotropia when one pupil is turned in a little bit, what does that mean? It means their eyes are not tracking perfectly the same.

So number one, we’d take a picture with our phone. Number two is we test tracking. We hold up some object like here’s a paper, we hold up an object and hold their chin and say, watch this, and then go like this and see what happens. See if they’re able to track with their eyes or if they, their eyes bounce around or they closed.

Oh, they go this is all kinds of fascinating things that you’re going to see. Not necessarily just the stigmas, but you’re going to see some kind of that is average that is not able to track. Number three is convergence. So once again to hold their chins, and then we bring the object in and we go like this and we’ll bring it close to their notes.

Not all the way to their nose, because that’s what make their eyes cross. We bring it about maybe six inches from their nose like this, and then go out and we want to watch do both eyes convert. Equally at the same speed and all looking at the same thing. I’ll see this a lot where kids one, I will converge in one.

I will not it when I look for versus slower or I’ve even seen it where last week we saw one kid when I converged and when I went out that a right, that’s called convergence insufficiency. So these are the kinds of things we need to test because nobody’s testing these things. Nobody’s testing these things.

Cause tracking if you’ve got tracking issues, this could cause amongst other things, if you’ve got tracking issues, it can have dyslexia or dyslexia like issue, because now the words are jumping on the page instead of being nice and straight across, like you see there on the bottom, convergence issues will also cause problems because if you’re supposed to, if you want focus, right?

When you converge, you focus on something closer to you, if you can’t, then things are out of focus, it makes it harder. So I’ll let you have to ask these kids do you have any, do you like reading is one of my favorite questions and a lot of these kids will say no. And if you have a kid who says, no, they don’t like reading, you got to ask the question, the further questions are let’s try.

Let’s do you mind if we track to check your tracking and and convergency mind if I take a picture of your eyes, et cetera, and then reflexes pin reflectors. I call this the big five. You got rooting Palmer Gualapa Biscayne, ATNR asymmetric tonic neck. Must be tested on every kid in your practice.

At least do the big five rooting reflex. As you might remember when this is obviously a baby picture or baby cartoon picture, you’re going to test from the lip to the ear like this from the lip to the ear on both sides. When you’re doing a baby, you’re using your finger like this, when you’re doing an older.

Who’s a year older, you’re going to use the paintbrush. You’re going to use a reflex hammer. You’re going to use some other object other than your finger, because the finger might be misconstrued as something tickling. So use the paintbrush use use a reflex hammer, use a tongue depressor, use anything other than your.

And you’re going to test it bilaterally, and you want to see symmetry in, in these reflexes. You want to see them not there at all right in a little baby. You want to see it there in a older kid or adult on the spectrum of adult age, you don’t want to see it at all. Number two is they instead of six best because that was the, from the, these cute little cartoons is the Palmer grass, but the grass reflects.

Once again, you’re going to use a paintbrush or some other kind of objects, and you’re going to go from the bottom of the wrist, to the fingers, to bottom of the fingers, from the risk to the fingers, from the risk to the fingers like this, testing it on both sides. You should see nothing, nothing should be happening, but if they start to move or wiggle, that is a positive, they call that retained primitive reflex number three, but basically.

So you’re going to test, and obviously this isn’t a foot, this is a hand, but just make believe this is a foot. So the, and this would be the heel and this would be your pinky toe. And you would go from the pinky toe side and it. The toes like this, either with their paintbrush or reflux hammer, et cetera, and you should see nothing.

And sometimes the kids will go like this and sometimes the kids would go like this. Sometimes the whole Lego pullback that is a positive, a retained primitive reflex, the asymmetric tonic neck reflex. When they’re a little baby you’re going to have, they would lie down and you turn their head to one side, turn their head to the other side.

There’s a perimeter of rolling. With an older kid or adult, you’re going to have them stand to do this. If possible, if they can’t stand, you’re going to have them lying down and ask them to stand up with their hands out in front of them like this and the eyes closed, and then you go behind them and it turn out.

Like this, we did this yesterday with a little kid, four and a half year old and watch this just whole body move side like this. When I was rotating his head significant H asymmetric tonic, neck reflex, or ATNR reflex as a positive under the retained reflex. And the last one is the GLAAD reflects the GLAAD reflection.

You’re going to take your paintbrush and go. I know that this shows in this picture here from the base of the neck, but you’re going to go from that. Let’s say this was a. You’re going to go from the middle part of the back, down on one side and then down on the other side, that’s written. So you’re not gonna go all the way down from the base of the neck down.

You’re gonna go from the middle part of the back, like around T ten-ish, bottom ribs down. And what you’ll see is a lateral flection. If it’s a positive and you don’t want to see. I saw. And sometimes you want to see a lot of reflection like yesterday. I didn’t see it. I just saw like a wiggle. He just wiggled every time I touched this child we a wiggle of wiggling movement as a positive.

So these are the three key things that you want to test when you are doing checking a child and checking their neurology. You’re checking their core. Pull to sit as the basic example, pupils checking, taking a picture of their eyes, checking their tracking, checking their convergence, our reflexes, the.

Rooting Palmer Babinski Golan and ATNR are the big five there’s I know there’s more, there’s so much more but this is a short program. So I’m going to give you a short amount of stuff, but these are the critical things to check. Cause even if here’s why I’m telling you this, let’s say you’re not doing this at all.

Let’s say your typical pediatric exam is, let me look at your posture, lie down. Let me feel your spine. Let me adjust you. That’s great. Chiropractically speaking. How are you measuring it? How are you measuring your success? Most of these kids are coming and feeling like having some issue with pain or something.

So how do you measure your success? If all you say is, okay, your posture is better. Okay. That’s good. And you can use like a posture pros, a great app that we use, but the. It’s insufficient, in my opinion, to really understand, especially the, these kids who are special needs or neurodivergence, we really want to go deeper with these kids.

And this is a great place to start. If you just do these three areas, the core that pupils and the reflexes, you just check those three things. I’m telling you, you’re going to have a world of difference in not just how you measure, but what you’re measuring and what you’re remeasuring at your re-exams.

Cause to me, that’s the key. As an example, we had a mama who came in a couple months ago with her daughter and who’s got some learning issues and after six weeks or so, she said, I’m not really noticing any changes in my daughter. I said it’s time for re exempt six weeks. We did a Rexam we did a re exam and almost all very fluxes are going.

Her core was better. Her pupils were better. She got excited. She’s oh my God, this is great. So we took her from thinking, oh, things aren’t really getting better to it. Yes. Things are absolutely getting better because what are you missing? We are measuring things and creating measurable results.

And that to me makes a much happier mom, dad or caregiver, because we’re not just saying, oh, they they look better. You feel any better? That’s not the question we ask. We say, let’s measure it. You say not doing any, you don’t see any changes let’s measure. And then we can measure the changes and prove the changes.

And now you have a happy mom who recommits to care. Here are the exercises. That you want to give your kiddos, you got the core pull to sit. You just make them lift that and see how the kid is going like this. That’s what we call the headline. We want to do have them do this exercise over and over again, 10 times, a couple of times a day to build that strength so that his chin goes first instead of his in, instead of his head going first, next is the eye exercises you want to do the same things.

The way we tested is the same thing you’re going to do to. To create the the exercise, the way you test is the way you exercise plan reflected. You can use a paintbrush. Like I showed you before you can use a paintbrush. Like I showed you before in terms of using that paintbrush on the feet, on the hands, et cetera.

You can with the Galot reflects you can have them do snow angels with the ATNR reflex. You can have them do a walking like doing, we call it the Michael Jackson. So the thriller movement where it’s lifting on one side lifting on the other side, like this. I love doing this sort of stuff.

If you want to listen to a podcast, I have a phenomenal podcast where I’ve got almost 470 episodes. Now I love to have you listened to it. Next thing we w we want to talk to you about is the art amazing polyvagal informed pediatric chiropractic seminar with Dr. Stephen Porges. Check it out over here. It is the first of its kind working with Dr.

Steven Porsche, who was an amazing author. I speak for the ICPA. If you’d like to check out some of our ICPA talks, here’s some different ICPA talks that we do. We have to protect our kids. We have to adjust more kiddos. Thank you so much for tuning in. Thank you, ChiroSecure for having us. Please let me know if I can help you in any way.

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