Blog, Live Events, Pediatrics February 9, 2020

Improve Infant Adjusting & Communicating

Now, here’s today’s host, Dr. Erik Kowalke.

Hey, hey, welcome back to the Look to the Children series, first Thursday of every month. My name is Dr. Erik Kowalke. I own and run a practice in Grand Rapids, Michigan, Higher Health Chiropractic. But thank you to Dr. Stu Hoffman and ChiroSecure for hosting and just sponsoring these, and they’ve been doing it for a long time and they’re a huge supporter of Principle Chiropractic, and so super thankful for them. And I got to do another one of these couple of weeks ago and it was super fun. So if you haven’t seen Dr. Monica’s show, make sure you check that out as well. I think hers is the third Thursday of every month.

Yeah. So my name is Dr. Erik Kowalke. I see lots of kids in our office. Our office has grown a lot. We opened in 2011 and now we have five docs and myself, and 16 adjusting tables and eight adjusting rooms, and we see 1,200 or so a week with 35 to 40% of those, kids. So we see a lot of kids. And my goal for you out of this show is if you’re a chiropractor and you’re watching, that you get something that you can take and take action and take back to your practice and implement.

So today I want to talk about some techniques stuff, actually, adjusting kids, and then some more connection stuff, some ideas that we’ve come up with recently that we think are going to be really great to connect and educate parents even better than before. So, yeah. So let’s get started.

When you’re adjusting an infant or a baby, I was checking a little baby yesterday and this was like a four to seven month old, maybe seven months old, and you know when you’re adjusting a baby, they’re not laying perfectly still for you, so they’re always like moving around. And if you’re a student or you’re a recent graduate, I remember one of my biggest fears was, “Well, how am I ever going to find a subluxation when I’m trying to motion palpate somebody and they’re moving around and their muscles are contracting, in like how the heck do you feel anything?” And it just takes a lot of practice and skill.

But what I was noticing there, I was thinking about this show as I was doing it, I was like, “I wonder how I could explain how this is happening.” And when I was checking C1, you can feel the muscles tightening, but the baby’s never in one position for a long period of time. So they’re always moving and they’re contracting, even if they’re not really moving, they’re contracting their head and their muscles are contracting. So just feeling and keeping your hands in the right position and letting the baby move where the baby wants to move, and then you’re feeling and you’re checking for misalignments in between contracting [inaudible 00:03:33], and so it’s almost like a dance with the baby. Letting the baby do what it wants to do, at the same time you’re checking what you want to do. So you have to have patience.

Something that might take you 10 seconds to check or less on a person that’s cooperative and listening to you might take you a minute to check on an infant and you just have to be patient. Because the downside is if you’re not patient and you try to force it, the baby will sense that and then they’ll start screaming and they’ll start losing their mind and then everything’s out the window. So be patient, let the baby do what it wants to do. Your facial expression is going to determine whether that is going to be any success at all or not, because the baby’s looking at you probably, and if you’re smiling and happy and reading the expression on the baby, you’re connecting with that baby, the baby’s trusting you in that process. But you got to read the facial expression.

So that’s the other thing that we train a lot on and we do a lot in our office is the baby tells you they are going to cry before they’re going to cry. So if you have kids and they start going, and then they’re like, “Oh, I’m going to cry.” So you got to switch it up right before they cry to be proactive and usually you can break their concentration and they don’t end up freaking out. And sometimes that’s changing your facial expression, sometimes that’s changing your position. Maybe you’re too close to them, maybe you need to move farther away, maybe you need to be down the table from them a little bit more.

And so the quicker you can respond to that, the faster. So if you’re moving and they’re not responding then maybe need to pick the baby up and start checking them on your shoulder or something else and just totally switch positions. Whatever it takes to break that concentration of the baby and why they’re crying and why they’re scared, because once they go down that road and they start screaming, it’s really hard to get them to come back. So stay focused, be sure of your intent and you’re looking at the baby the whole time. Let the baby work with you and don’t work against it. So this isn’t typically like you find a misalignment in one direction and you’re putting it back in place in the other way, let the baby help you adjust.

So what’s great about kids, especially little kids, is they have a lot of unconscious movements and muscle control. So that means when a baby’s going like this, they’re not thinking, “Oh, I’m going to turn my head all over the place right now. I’m going to look to the left.” I mean, a lot of it is unconscious. Their body’s just reacting. When you hold the baby up and you tilt them this way, they’re not thinking, “Oh, I’m going to put my head this way.” It just happens.

And so when you’re adjusting them, their body is actually helping you. Because if you think about the overarching principle of the human body and our potential to heal, and the innate intelligence, wisdom to allow the body to function as best that it can, it’s not innately going to want subluxations and nerve interference. It doesn’t want that, which is why every time a kid falls, they don’t get a subluxation because their body innately wants to correct it. So if their body can fix it and correct it, it’s going to do that. If it can’t, then it results in a vertebral subluxation complex, which is what we’re fixing so that the body can adapt and function more optimally after we correct that.

So knowing that, the body wants to help fix the vertebral subluxation complex that we’re finding, and with babies, it will help you do that through their movements and however they want to twist or move around as you are applying pressure, or a technique, or an instrument or whatever you use to adjust that subluxation, that baby’s helping you. So let them move, let their body move. You’ve got to kind of go with them when you’re adjusting them, and that really makes the experience so much better and it’s super cool to do that. The smaller babies you get, them more their innate intelligence is helping you, and when they’re really little, like less than two weeks, you often find that they just like totally relax and fall asleep. And so that kind of brings me into less is more.

There’s so much you can do on the infants that you can just way overstimulate their nervous system. So less is more if you adjust a baby and they do that where they’re like totally relaxed. So I’m watching their face and their chest, because a lot of times they’ll change their breathing pattern, they’ll go from like really rapid fast breathing and then they’ll just take a big deep breath in and exhale really slowly and deeply. Usually if I see that, that’s like I’m not going to go any further today. I’m going to let them just process what just happened. And their nervous system just took it huge break and just rested and relaxed and you’ll hear huge changes from that.

So don’t overdo it, which brings you into the next thing about a lot of times, chiropractors, we get caught in a trap of they’re paying for how much and how long we do things and how many things we do, because if we have five different things going on in our office, we’re justifying the value of that visit for all of the things that we’re doing. And it doesn’t work that way with pediatrics because the value isn’t in how long you’re there with them and how many different things you do, it’s the result of what you’re going to get by doing what you do. So if you can remove a subluxation and get a response from the baby and allow that nervous system to function better in two minutes or three minutes, then it doesn’t matter if you spend six minutes. That’s just a mindset thing from chiropractors. Parents don’t really think that or see that, it’s we’re thinking that and seeing that and in turn, because we’re thinking it and feeling that, we’re portraying it unto them and then they have that objection to us.

And so if you’re getting objections from parents, it’s probably you thinking that and you casting that onto them, which makes them say it to you because that really shouldn’t be happening when you build the value of what it is that you’re doing. Which brings me into the next point of just over-communicating. I think typical doctor’s offices, what parents are used to, is it just happens and nobody really explains to them what’s happening. You take your kid in, they’re checking them out, they’re listening to the lungs and the heart and feeling bones and doing all kinds of stuff, a lot of times they’re not saying anything and they don’t even communicate to the parent what’s happening.

I like educating parents, but it’s very effective too to just walk them through what you’re doing and what you’re feeling and what you’re finding. So if you’re checking from a subluxation, let them know, “I’m looking at T3 right now, or I’m checking L5, I’m feeling for the motion between the left part of the sacrum, the S2 and the left ilium, and this is what I’m feeling. This is what I’m feeling on the right side. The right side is a little more [inaudible 00:10:29] than the left side. And so this motion right here, this helps me adjust that.” You’re just walking through that process with them. Basically, you’re explaining everything you’re doing, what you’re feeling, what you’re finding, what you’re sensing, and the parents will just be thrilled that you’re telling them that because they want to know, they want to know what’s wrong with my kid. And so you can walk through that process and give them encouragement and what’s really good too.

So a lot of times you’ll check a kid and there’ll be a lot of stuff that feels great, you don’t need to do anything to it. Communicating that is just as important as communicating the things that you find so it doesn’t become like a fear thing, like, “Oh my gosh, this is so bad.” Every time they come in everything’s so bad. Tell them what’s great. “This is great. That’s great. It’s great that they’re doing this. It’s great that they’re doing that. I see that they’re tilting their head, they’re turning their head, their eye contact is really good.” Parents, especially first time parents with little kids, love when you praise their kid and tell them their kid’s doing great things.

And so just about every kid you can find something that’s like, “Wow, that’s awesome. This kid can do this already or do that already,” and just communicating that to parents and letting them know and giving them encouragement, I mean, as a mom, dad comes in, most of the time the mom brings the babies in, there’s not a lot of people in their life that are telling them, “Great job. You’re doing a really good job as a mom. Your kid’s doing great. You’re taking care of them, they’re healthy, they’re thriving.” They don’t get told that very often, so if you can give them encouragement in that, lift them up in that, that’ll go a long ways as well because they’ll be very appreciative of that.

Approach slowly to kids, especially if you don’t know them very well. Usually, if you’re moving really quickly, that can startle and scare them. Be proactive with facial expressions. I mentioned that.

So the last thing that we just found out recently, there’s a program on the Internet called loom, L-O-O-M, and we use SKED, which is a technology we created to communicate with patients. So every one of our patients in our office has all their schedule on their phone and they can schedule appointments and reschedule appointments and see their appointments for their kids, and it’s awesome, scanning barcodes with their kids all through their phones, so it saves our office a lot of time. And we get 3,000 summary schedules a month through the app that we don’t have to do anything with. So our team loves it. But in combination with that, we’ve started to use this program called Loom, L-O-O-M, and it lets you record videos on your computer and then send those to people and see if they open them or not.

So when we have a reevaluation or we have a deep conversation with a child, or a parent, or something significant that we just talked about, what we’ll do in the adjusting room is we have a desktop app for Loom and we’ll open that up, and we have a camera on the adjusting room computers, and we’ll open Loom and we’ll start recording, and it’ll screen-share whatever it is that we’re looking at.

So if you want to show them evaluation, or you just want to show them a picture of a spine and a nervous system or a nerve chart or whatever you want, you’re just basically reiterating what you just said, but it gives you a drawing tool on there as well so you can draw, “Hey, this is what we were talking about today. This is what we found when the nerves … well, there’s nerve pressure here, blah, blah, blah, blah,” whatever you want to explain is going on, “This is what we were able to adjust and correct today. I’d expect great results because of this. I look forward to seeing you on Tuesday at 3:00, and your next evaluation is going to be in April or whatever.” So it’s just like 60 to 90 second video you film, you can draw on the screen. As soon as you hit stop, it uploads it to your file and it pulls up a browser and you can send it from there.

So in our offices, everything’s moving really quickly. So we’ll film the video in the adjusting room right after they leave and then we’ll just save it there and then change the title of it, and so the team knows who the video’s for, and then they can copy the link to that and they put it into our SKED message, so we can send onetime messages to any people in our office, and we’ll send it to them by text message, by push notification and by email. And all it is is a link to this video. So if they’re in a meeting or something, they’ll get a push notification which will come through on their lock screen of their phone, they can swipe it and it’ll pull up their app with the link to this video, the SKED app, they can click on it and it pulls up the browser and they can watch the video, they could comment back to you in the video.

And so it’s just a whole nother level of making people’s experience great because no doctor is doing that, right? I mean, they’re communication is so poor everywhere else. You’re over-communicating everything that’s going on, building value and now they leave the office and they remember maybe 20% of what you said and they don’t really understand exactly what you said. So their spouse is like, “Hey, what happened today?” And who knows how they explain it based on what you told them because they don’t understand the sympathetic and parasympathetic and everything you just talked about, an overstimulation and understimulation. Or if you give them at home exercises and you’re like, “Do this, this, this and this with your kid,” film a quick video using Loom. And if you use SKED, shoot it out through the SKED, it’ll go to them in text message too.

So it’s super easy for them to show their spouse or rewatch and be like, “Oh, that’s what she said.” It fixes so many issues of them not really understanding and dropping out of care or not doing their at-home exercises or all the things that we as chiropractors are like, “Man, I wish they would just do this.” Or, “I feel like I didn’t communicate this effectively enough.” They drop out of care, they don’t refer people. Over-communicating through video really helps. And a lot of times they say that you have to hear something seven times to really understand it, so this is just one more way to connect and to communicate with them.

That’s all I got for you today on Look to the Children. Hopefully you guys got something out of that. We’ll be back the first Thursday of March, I guess already, yeah. So have a wonderful Valentine’s day and the month of February. Hopefully you got something, you can take it back to your practice and implement. If you have any questions about that stuff, please reach out to me. I’ll help you any way I can. Technology-wise, and what we do, we do a lot of stuff like that in our office. You can reach me through a comment on this video, or shoot me a message through Facebook, or you can message me through We’ll be at the AMPED conference this weekend too in Atlanta, Georgia, so look forward to seeing you guys soon.

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