One of the most frequently asked questions of any chiropractor who has the privilege of serving a large number of children is "How did you get so many kids into your practice in the first place?" Some who have taken the time and effort to update and fine tune their skills in pediatric chiropractic remain frustrated by their inability to attract children to their clinics. What can be done to change this frustrating situation?

After almost three decades in the profession, a few essential thoughts come to mind.

The first is rather obvious. The public -- and here I include existing patients -- must be told about a child's need for chiropractic care and evaluation. All too often practitioners assume that because they know certain facts and skills and have taken certain post graduate courses, their patients will somehow experience by osmosis what it is they want them to know.

This is a foolish non-strategy. I have found that only by being proactively consistent in informing my patients of what I have learned and what I expect of them will I get compliance.

In order to build my children's practice, I had to make children the focus of my clinics. Everything became part of that focus: newsletters, wall posters, "thoughts of the day," expansion of the play area, purchase of a pediatric adjusting table, pictures of children on the bulletin board, sponsoring of children's concerts, etc. All of these proactive endeavors continue to this day.

Such physical or concrete changes made to help staff and patients alike realize children are welcome and expected are absolutely vital to attracting more young people to your office. Once they're made and your clinic is totally child-friendly, you will be able to begin making the other (more demanding) changes necessary for you to become the children's doctor you want to be.

These changes are difficult because they involve altering the core modus operandi of your doctoring. I believe that in the final analysis if certain procedural changes that reflect the realities of a child's world are not addressed, a pediatric practice may never be possible.

Here are some changes I believe are necessary:

1. Slowing down. My experience has taught me that one of the behaviors not conducive to seeing large numbers of children is that of hurrying through interaction with them. Most children take time to become comfortable with a new person and a new environment, and unless they are allowed to set the pace of the familiarization process, they will simply abort it by fussing or perhaps even doing some serious crying.

Once parents perceive that their most precious possession is unhappy being in your presence, there's virtually no chance that a long-term relationship with the child will be possible. Some time-proven strategies for enhancing the doctor's approval rate with very young children include:

*** Allowing the child time to look at your face and, if old enough, make eye contact.

*** Letting the child determine whether he/she feels more secure on mom or dad's lap or yours.

*** Talking to the child in a soft and quiet voice.

*** Using the child's name often in conversing with the child.

*** Remembering that the child is the patient. All the doctor's speaking, visualization, and focus must be on the child, not the parents.

*** Learning in what position the baby feels best. Some children prefer being on their backs and fuss when put face down and some children have the opposite preference.

*** Allowing the mother or father to be an integral part of the examination and correction. Parents can easily have the responsibility of holding or stabilizing the child while the doctor examines and adjusts.

*** Slowing down all hand and body motions so that the child can follow your actions. In early life, the child's eyes are still developing the coordination necessary to track movement.

*** Acting with assurance. All children have a highly sensitive right brain, which picks up on the doctor's insecurity and hesitation.

*** Knowing when the baby nursed or was fed last and never setting the stage for failure by working with a hungry or tired child.

2. While it is the baby or young person who is your patient and to whom all focus and energy must be directed, do bear in mind that the parents must also be not only satisfied but also excited by the prospect of their child regaining/reaching optimal health through chiropractic. The parents are most likely to keep their child under care if the doctor:

*** Takes the time to actually answer the questions asked by parents. In every case, "I don't know" is a perfectly acceptable answer. The parents will more encouraged by an honest answer rather than a lie or by having their questions ignored or belittled.

*** Conveys his/her heartfelt concern for the child's well being. Follow-up telephone calls, seeing the child outside of hours, giving the family the doctor's home/cell phone number - all these are tangible evidence of sincerity.

*** Has a lot of other children under care. It does take time to build a pediatric practice. Such strategies as seeing all of your 'child' patients in the same time frame work well. The presence of a children in a chiropractor's office is novel and parents need the reassurance that they not they only family under care.

*** Has special training in the care of children. This is where such programs as the International Chiropractic Pediatric Association's fellowship program have such value. The doctor learns special skills and the plaque on the wall that says the doctor is certified in pediatric chiropractic and tells the practice about these skills.

This article has briefly and superficially addressed some of the issues of establishing a chiropractic children's practice. For those of us who truly believe that the future of our profession lies in the caring for children, these opinions are not final answers but rather part of a magnificent work in progress.