Developing an adjusting schedule for pediatric patients is very important. Unfortunately, most chiropractors do not have a system for creating one.

This is a rather large void in our profession. Children need to be taken care of as real patients. A proper pediatric history has to be obtained from their parents (who fill out a pediatric history form), and follow up must occur with the proper consultation.

Of course this precedes the chiropractic examination, in which the chiropractor detects vertebral subluxation. From that, an adjusting schedule is developed, to which strict adherence is necessary, followed by regular re-examinations to monitor and update the correction of the vertebral subluxation.

When it comes to developing a pediatric adjusting schedule, every child needs to be taken care of as an individual. There is no "one size fits all" adjusting schedule or recipe technique. A chiropractor has to evaluate the needs of every individual child.

One thing that must never, ever be done is to develop an adjusting schedule based on a child's symptoms or condition. If we try to do that, we will have an incomplete correction of the child's spinal problems.

I can remember an example of a doctor from Hawaii who consulted with me on one of his patients. He described a 13 month-old child who was learning to walk. The child had an internally rotated foot, and kept tripping over himself.

When I inquired about his history, the doctor revealed that the child had first come in at four months of age with ear infections. After two or three adjustments, the ear infection cleared up and the chiropractor dismissed the patient. Nine months later, the patient was back with problems.

I would contend that because the chiropractor dismissed the child when the symptoms cleared up, he never fully addressed the child's vertebral subluxation. This condition progressed over the ensuing nine months, resulting in a new problem.

The lesson here is, we don't want to set an adjusting schedule based on the symptoms or condition. Instead, the adjusting schedule must be based on several important factors: Severity of the vertebral subluxation complex; the chronicity of the vertebral subluxation; and the child's lifestyle and how he or she responds to care.

These factors are determined by preparing a thorough history and performing a thorough examination on the patient.

The examination includes motion palpation, static palpation, postural analysis, surface EMG, infrared thermal scanning, leg checks and other analytical procedures. Depending on the objective findings from those tests, the chiropractor will compare them to his or her experience and determine the appropriate adjusting schedule.

For some children it might be twice a day, for others it could be once every two weeks. Everything depends on the examination. It is not some arbitrary, fictitious decision. It is based on objective findings founded on the initial examination.

You might have an infant who is very subluxated from inutero constraint, stresses, and birth trauma. On the other hand, you could have children who made it through all that relatively easily, who are not all that subluxated. There is no average. It is all based on the needs of each individual child.

Depending on the technique with which you are most familiar, you'll want to schedule a progress exam. Most techniques will require one within 13-15 visits. At the progress exam, you will repeat all of the initial exam procedures done on the first visit. On the re-exam, they all become outcome parameters. With this information you will be able to measure the changes in that child's spine, from visit one to visit 13.

You will be able to see, for example, the EMG is showing the muscles are pulling 70% more on one side than the other in the first visit, as opposed to them pulling only 30% on the 13th visit. The infrared thermal scan was three standard deviations above normal on the first visit, as opposed to two on the second exam. The areas of fixation in the spine were locked up in many directions, now have improved. And so on.

You go down each of the exam findings and finally you can reveal to the parent that, based on all objective improvements in each of these tests, the child may be graduated from five days a week to four days a week, or three times a week to two times a week, followed by another re-exam in 13 visits.

The parents, who may have an understanding that the nervous system and healing is something abstract or fictitious, now see there is an objective, rational basis for why the adjusting schedule is being changed. It is best to always update the adjusting schedule following a re-examination.

The process is repeated every 13-15 visits until maximum improvement is attained -- that is, the most correction in the spine that can be measured. At that point, you may want to recommend a wellness schedule.

Having an adjusting schedule that is rational and logical endows the chiropractor with the confidence to know everything possible is being done to correct a child's vertebral subluxations. When children have the opportunity to have their subluxations fully adjusted, their nervous systems will work optimally, helping them to reach their own genetic potential at every level of existence, and allowing their body to regulate and heal itself up to an ever-higher capacity.

(Drs. Stuart and Theresa Warner, whose New Jersey practice is comprised of 70% young children and pregnant woman, have brought chiropractic pediatrics to the forefront of the profession. Their company Future Perfect, which has publishing, consulting, product and seminar divisions, presents around 100 pediatric programs a year including the certification program. The Warners are founders of "Kids Day America," and the World Children's Wellness Foundation and the Children's Wellness Newsletter. Comments or questions can be directed to DrsWarner@chiropediatrics.com or by phone at 732/295-5437.