One of the areas many chiropractors find frustrating is controlling the children who enter their offices. Unfortunately, this becomes a roadblock to chiropractors seeing more kids. It all has much to do with the lack of etiquette they are taught and the poor role models they have in our often rough-and-tumble society. Teaching kids to be kind and polite during their office visits is perpetually a problem, but there are easy solutions.

Kids can be encouraged to behave if you set the rules from the beginning. Right from the first visit, the staff should introduce the rules and manners which are expected. Prior to their first adjustment, children must receive verbal instructions (in front of their parents) from the chiropractic assistant or the doctor. These instructions cover what is expected of both child and parent during each office visit and include, but are not limited to:

-- where they wait prior to their adjustment

-- which table(s) they use for their adjustment

-- where the patient's chart is left, and whether or not the child is capable of carrying his or her own patient chart.

Additionally, children must be told how to wait on the table to get adjusted (seated or lying down) and how to act while getting checked. The latter is most easily accomplished by having them watch other children. You can also let children know they have a special job while getting adjusted, such as throwing away the face paper at the end of their visit.

Different ages will respond to various types of encouragement. While dealing with infants, you will need to address all of these issues with the parents.

If you need the parents to bring a receiving blanket to lay the child on during the exam or daily office visit, let them know. You may also want them to bring a cloth diaper to lie down on for each visit, rather than scratchy face paper.

Your office may have a special area available for breast feeding and changing children, along with a diaper pail (rather than placing smelly diapers in the regular bathroom trash). Your office rules must be addressed from the start. If they are not, you cannot expect people to follow them.

Many offices suffer the woes of undisciplined children because they simply haven't let the kids know how they are expected to behave. Parents also need to be instructed so they are better able to monitor their children. If you give kids free reign, they will take advantage of it. Solving this problem can be as simple as providing a special place in the office just for them (i.e., a Kid's Corner).

Toddlers are notoriously self-centered, but can be taught to consider the feelings of others. This happens predominately through their parents' example. However, the doctor and staff should also encourage these young children to say "hello," "please" and "thank you" when appropriate.

Let them see their actions have consequences. At one and two years of age, they can't be expected to be very good at sharing, or aware of the concepts of give and take. If they are overtired, hungry, or sick, do your best for them while they are on the adjusting table, but don't expect them to be too cooperative.

Preschoolers are very impulsive and apt to say or do whatever comes into their minds. These three to five year-olds are also eager to please and learn. It's important, however, that they are taught the right way. You'll get further by praising good behavior. They may be too fidgety to endure a long examination (so move quickly) but they should be well behaved during their daily visits.

Elementary aged children range in age from six to ten. These are the prime years for learning manners and the age for developing empathy for others. Still, kids in this age group may act rudely just to see how far they can push you.

It's important from the first visit forward that you let the child and the parent know you won't tolerate disrespect for any reason.

Encourage them to act responsibly and do what is expected of them upon each visit. Explain to them what language is appropriate in the office and encourage them to use words such as "subluxation" and "adjustment," and not to use words like "crack."

Illustrate the subluxation with 3-D models such as a plastic spine and teach them the responsibility of being consistent with their visit schedule. Have them attend a pediatric health care class and encourage them to bring their friends. Offer to visit their school and let them act as your assistant in presenting a chiropractic lesson in their classroom. If encouraged to act with proper etiquette right from the start, children of this age can be a joy to work with.

Preteens and early teens can be difficult, even if they have been well-behaved patients for years. Many adolescents go through a period where they act as though they just don't care. Thus, teaching them to model considerate behavior at this age is crucial. Pointing out to them examples of kind behavior can make all the difference. Reinforcing positive examples leaves more of an impression than endless nagging ever will.

If you remember some of these simple rules and apply them with consistency, your office will be filled with the laughter of children rather than with their shrieks and cries. Practice will be a joy and you will love caring for the children as much as they will love their adjustments.