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Neurodevelopment in Paediatrics with Dr Damian Kristof and Dr Genevieve Keating

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Neurodevelopment in Paediatrics with Dr Damian Kristof and Dr Genevieve Keating

What do screen time, tummy time and pureed food all have in common? They can drastically affect a child’s neurodevelopmental milestones.

In this episode Dr. Damian Kristof and Chiropractor and PhD Researcher in Early Childhood Development Dr. Genevieve Keating dive deep into how we can optimise healthy neurodevelopment in children through facilitating a strong body-brain connection. They discuss topics such as the importance of introducing solid foods at the right time for oral muscle development, how screen time affects posture, breathing and self-regulation, and why it’s important that practitioners of different modalities work together to be able to support healthy development in children.

Covered in this episode

[00:39] Welcoming Dr. Genevieve Keating
[01:27] Gen’s background
[03:02] Why are we seeing neurological issues in children now?
[04:16] How postural changes affect neurodevelopment
[06:39] The problem with pureed food
[09:47] The detrimental affects of screen time on children’s posture and self-regulation
[16:32] The importance of tummy time
[20:35] Regulating the nervous system
[24:39] Should kids be sleeping on their back?
[29:14] Chiropractics for children
[36:40] A multi-pronged approach to children’s healthcare
[38:35] Thanking Genevieve and final remarks

Resources Discussed in this Episode

Gen's website: Dynamic Neurodevelopment

Gen's courses:

Inspiral Resources

Diplomate in Chiropractic Neurodevelopmental Paediatrics

American Paediatric Association 'Back to Sleep' Campaign
Study: The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system (Porges, 2009)
Study: Long-term developmental outcomes in patients with deformational plagiocephaly (Miller & Clarren, 2000)
Study: Case-Control Study of Neurodevelopment in Deformational Plagiocephaly (Speltz, et al. 2010)

Damian: This is FX Medicine bringing you the latest in evidence-based integrative, functional and complementary medicine. I'm Dr. Damian Kristof, a Melbourne-based chiropractor, and naturopath. Joining us on the line today is Dr. Genevieve Keating. Gen Keating is a highly skilled and Ph.D. awarded chiropractor, and researcher with a special interest in paediatric care. Her particular focus is the neurological development of the child.

Dr. Gen runs educational courses in paediatric neurological development and delivers Diploma-level accredited courses worldwide to help educate practitioners about children and neurological development. Gen has a keen interest in the facilitation of shared care and the advancement of paediatric care to assist in the proper neurological advancement of the paediatric patient. It's a real pleasure to have you joining us today, Gen.

Genevieve: Thanks, Damian. Pleasure to be here.

Damian: Gen, I'd love to start by asking you some questions, please, about how and why you became so interested in this field? How did you get here?

Genevieve: Oh, a long story. I've been in practice for 35 years and really the beginning of it was I had a head injury from diving into a pool when I was 12. And I hit my head on the bottom and suffered a concussion, not that it was diagnosed that way. And really my life, I wasn't well, I had shocking migraines, and I got help with a chiropractor. And from then I got really interested in what's going on here. So I worked there part-time as a high school student and then studied Chiropractic. But I've always been fascinated about, child development, and how do we support healthy development for families and communities. And that's what drives me.

Damian: Yeah, I think that's such a common thing within our fields of care whether it be Naturopathy, which you know, I'm a naturopath and nutritionist. And also as a chiropractor, it all came from our own experience, didn't it? And a lot of people experienced it, because we - for whatever reason - we all were thrusted into a particular model of care as children growing up. And then, as we maybe find a different path or see a different avenue, we can often take that.

And I found that too within chiropractic, when I was experienced to chiropractic, I thought, "Oh, maybe I want to be a chiropractor." But then when you see people like yourself and other great chiropractors doing great things, I then became interested in doing it. But even from a naturopathic perspective, before I was a chiropractor, looking in at what you were doing and what other chiropractors were doing, I was blown away.

So these days, we see issues with kids that we've never seen before. We see autism, we see ADD, we're seeing Asperger's, we're seeing all kinds of neurological issues. What do you think's going on at the moment? Why is this happening right now?

Genevieve: You know, there's been a rapid increase, and some people say “Is it just down to improved diagnostic criteria?” because we know that early intervention for some of these neurodevelopment, well, all neurodevelopmental disorders is really important. So there is a push to diagnose earlier. But the improvement in diagnosis doesn't cover it.

And there's an argument to say toxicity and chemical toxicity in our environment has increased. And children are more susceptible because of their rapidly growing brain and nervous system and their immature detoxification organs so that they're more susceptible. And there was an argument to say, with the change in our food and the change in our environment, and medications for children have increased. And so there's an argument to say that that could be a component of how development is changing.

But the other thing, of course, Damian, that we're seeing is - and particularly with changes to a lot of online stuff over the last couple of years - we are seeing that real change in posture with children, that head forward posture and that internal rotation in the shoulders, and that sort of forward into the thoracic spine. 

And that's significant for a couple of reasons. It's not only about posture, but that affects airway; as the head comes forward, and the jaw comes down, the tongue sits lower in the mouth. We don't get that good lip seal, good muscle use for that breath-suck-swallow cycle, and that affects oxygenation. As does the lack of ribcage movement, as the thoracic spine comes forward and the shoulders internally rotate, we decrease the ability of the lungs to take a good deep breath in.

And that oxygenation is really important for all of us, but particularly for kids because their brain is, as I said, still developing. So when we get that change in the airway, the change in the posture, the increase in tension in the neck with that head forward posture, that has dramatic impacts on children's growth and development and their health and their well-being.

If we're not breathing well, swallowing well, chewing food well, and using all those muscles well, then nutrition and gut are impacted. The nutrition to the system, but also the way the gut functions is impacted because of that sort of mechanical change with what's going on in the airway.

We see so many kids that really struggle with textures of foods, they just want those bland foods, but they want that sort of easy to chew texture. And don't get me started on the squeegee packs that parents squeeze pre-mashed up food, pureed food into kids mess, we won't go there. But that whole movement of the mouth and the saliva and the swallowing, they're really important to stimulate all those branchial arch nerves into the brainstem, and for development.

I think kids are really babies, particularly in young children, they're very brainstem and diencephalon driven creatures. We don't have a highly developed upper cortex yet, when we're born, and that happens over those coming years. And I think it's really incredibly important that we get good movement and good extension tone into there to help them fire and wire the brain.

Damian: This is so great, Gen, I'll tell you, but I have to tell you, and like so many other people who are into food right now, people are going to go, "What do you mean, squeegee packs? What's wrong with squeegee packs?" So I'm going to take you back there because I know you said you don't want to get into it, but I do want to get into it.

Genevieve: Okay, great. I'm happy to go there.

Damian: Are they really that bad? What's the story there?

Genevieve: Well, I think they are because texture is really important when babies move from hopefully breastfeeding, or formula feeding if breastfeeding, let's be open-minded about things people choose. But we know that people, there's not enough support for women to breastfeed in a lot of quarters. And if we can get that breathe-suck-swallow and get feeding happening well, then that's an important early start.

But as we move on to solid foods, the whole thing about child development is, I think of it as scaffolding. They might start on a bit of puree stuff, and they might have a bit of experience of sucking on fruit or veggies themselves and getting into that whole experience of it. But over time, we should be able to increase the texture so that they can get those muscles working.

The oral function is really important. And if we're on squeegee really highly pureed foods all the time, children don't get that sensory experience of the hands, and the mouth, and the face, and the mess. But they're also not getting to use those muscles as they should bit by bit. And the muscles that we use to manage food are the same muscles that we use for talking. So we're seeing lots of speech and language delays.

And although that's not my primary area, of course, as a chiropractor, my Ph.D. is in early childhood development. And I'm particularly interested in how do we work in an interdisciplinary collaborative way, because none of us have all the answers. It takes a team approach, even for typically developing children for health care, but particularly for children that have higher needs. So I'm particularly interested in that speech and language development and how do we get that whole breathing coordination going for language, and that comes from chewing your food as well.

Damian: This is so profound, that a simple little thing I mean, I'm not going to make this too basic, because it's not basic, it's complicated, it's multi-levelled. It's multi-levels of the scaffolding, as you would say, Gen. But it seems that much of the neurological development of the paediatric patient falls apart or falls away in those early months, when people are trying to determine “How do I breastfeed? Can I breastfeed? Is there a mid-suck? Am I getting the nipple to the back of the throat? Is the baby gulping air? Is there reflux? Am I using medication?” Then we move on to food at four months now, the recommendation for children to be getting solid four months, I don't know where that came from but maybe we could talk…

Genevieve: Well the World Health Organization still says exclusive breast or formula feeding till six months. And that's really reassuring Damian for patients to hear because there is that little bit of a push to go early, go early. But the gut’s immature, the system to handle that is immature and there's really not a need for it so.

Damian: Yeah, we could go on for years or days at least, trying to find out why that is the recommendation. But I do think that there's this speed of things that happens these days, Gen. That there's an urgency about getting things done, everything's really, really quick. So it's “Quick, eat your meal. Quick, cook it up. Quick, we've got to get to here. Quick, get this done.” 

Back in my day, Gen, maybe I'm sounding old when I say things like that but the most digital thing that we ever had was Donkey Kong Jr. And you play that on your little Nintendo. You get bored of that because you got sick of jumping over barrels. But these days, people or kids are playing games for a long period of time. I used to read a lot. And I don't recall my neck posture being better or worse than kids that are on games or screens all the time. What's the difference between reading a book and playing a game?

Genevieve: You know, my Ph.D. thesis was nearly going to be on the parental rationale for early screen time in very young children, but I changed that over and I'll talk about what it was in a minute. But I've been really concerned about the shifts that I've seen to children, really young children, 2, 3, 4, 5 months old even, being given phones and iPads to entertain them. So there's the postural component to that and you see that every day. And we all see that as kids kind of slump right forward. And we talked about that, that increase in tension in the neck and the difficulty with breathing.

But the other component of that is the eye movements that we use when we're looking at a small screen. So if we think about when we're changing focal distance in a normal environment, and we're maybe looking at a book, we might change that focal distance. But what happens when we're looking at a small screen, and I'm not talking so much about TV, but I'm talking about screens closer than that.

We use saccadic eye movements. Saccadic movements to the eyes are those short, sharp movements. And they're driven by an area in the prefrontal cortex in we're going into the area, their frontal driven eye movement, and their short and sharp movements. And there's some really interesting research coming out about that hyper-plasticity of the frontal driven saccadic movements as compared to the slower pursuit movements which come from the parietal area, and they drive those slower, longer movements of the eyes.

So I think there's something interesting that happens in that screen refresh rate with games, and all kids TV now. They looked at early TV for kids, and that was shot in one long scene, there wasn't that rapid screen refresh changing rate. And so there is some arguments about “Are we training short attention spans, and a lot of stimulation needed to hold attention?” And that does worry me with what I'm seeing with kids today, as well. So I think there's that product, the visual type of activity that we're doing when we're on screens a lot.

But there's also that whole thing of self-regulation. We used to talk about executive function with kids, or adults as well, a bit like air traffic control, holding ideas and what's incoming, and where do I put that piece of information? And how do I plan for something? And how do I pay attention? They're all the prefrontal cortex executive functions, but really, now we think of it as self-regulation. How do I stay calm and present, and be able to soothe and settle myself, so that I can pay attention to what I need to pay attention to? Or think through an idea, or plan an activity, or hold a goal in mind.

And, of course, when we think of self-regulation it’s all the things that get in the way of that. Things like, from the biological domain of uncomfortability in the body, muscle tension, inability to sit still. And then there's over sensory stimulation for sights and sounds. And all of that richness of sensory information, there’s all of the emotional feelings when children are upset about something. If they're hungry, if they're feeling uncomfortable, if their gut’s sending that sort of interoceptive discomfort, that’s all a barrage of sensory information that comes into the thalamus and up into the cortex. And it's got to be dealt with by the brain and choose what we pay attention to. 

You can picture that five-year-old sitting on the mat in class. And there's all of the kid next to him wriggling and somebody rattling paper and the boy’s hungry and the teachers coming in. And there's a lot going on, all the stuff flapping around in the classroom. And that's a lot for child to try and contain and concentrate on instructions from the teacher and just learn and put their ideas together. And because that brain is immature, young children don't have good self-regulatory capacity, it's really about co-regulation.

When we're born, our cortex, as I said, is so immature, that we need a significant caregiver to help us calm and regulate and feed and warm and comfort. And over time that transitions over into children being able to take more of those care activities on themselves. And there is an argument to say that the better that the mother or caregiver provides that co-regulation the better the child can learn to do it themselves.
And so I think we're seeing an epidemic of dysregulated children that don't have that ability to kind of settle and calm and soothe themselves. And I think screen time is used - to come back to the screen time part of it - screen time is used to calm a child, but it actually doesn't calm a child, it quietens the child for now, it occupies them.

And there's all that sort of overstimulation of the dopamine reward pathways. Kids get quite addicted, if I can use that terminology, to their games or to what they want to play. And the tantrums and frustration that comes from that I see every day in practice in different ways. And I think as society, as parents, as therapists, as practitioners, it is our job to support families to how to help their children in their regulation capacities. Their self-regulatory capacities, and build up for them over time.

Damian: This is so good, Gen. And I'm glad you brought up the bit about the addiction component. And it's fair to use that because we'll be interviewing Dr Wayne Warburton, I'm not sure if you've met Wayne before.

Genevieve: I know Wayne well, I had him speak at one of our conferences a few years ago, his work is quite outstanding. And I've shared that with a lot of our families in our practice and it really does help them to understand what's going on there. Wayne's fabulous.

Damian: Yeah, he is fantastic. I interviewed him on the Wellness Guys many years ago. And I saw him in New Zealand at the NZCC event that they were holding. And the research he presented was just mind-blowing, I can't wait to share that with everybody listening to this. 

But I think it is really important and to think about the ways in which we used to self-regulate. It would be, if I was roughing up my brother or I was just getting a little bit persnickety or narc-y mum would say, "Go outside, throw the ball at a cricket stump or go climb a tree." Or teaching me other activities that are outside of blue light stimulation, because we didn't really watch television back then and you weren't looking at screens because there's no mobile phones. And there's only so long you look at a phone with a dial on it isn't it? You know, like around diagonally played patterns. 

So being able to go outside, or ride your bike by yourself not having to have a conversation with other people. Kids these days feel like they got to be surrounded by people. So giving people that time, giving kids time to just down tools, I think it's a really important thing. What else could they be doing?

Genevieve: Well, I think that moment thing and that outside, we know the calming… the Japanese have the whole thing of forest bathing. And we know that outside activities are really important for kids to just get their body moving. I often think about, we spend a lot of time in flexed forward postures, whether we're on screens, whether it's schoolwork. 

I see so many - as you know, Damian I work with babies right - I have a lot of referrals from maternal and child health nurses and paediatricians and GPs for babies with say, asymmetrical patterns or tension in their system or inability to turn their head one way. And they're really important because if we don't have that symmetry in the system. And maybe it comes from the way we give birth these days, and the move towards medical intervention in birth. And there's a time and a place for that. 

But the percentages of epidurals and Caesars are way higher than what would be normally expected in our society. But when we have children that have difficulty with extension tone, even that baby lying on their tummy and lifting the head up. Because we put babies on their back to sleep since the 1992 American Paediatric Association Back to Sleep campaign, babies sleep on their back.

And a lot of babies don't like tummy time, and parents get nervous of tummy time with young babies. But it's critically important that babies get lots of episodes, it doesn't have to be a long time. Lots of episodes of tummy time to start to lift that head and get that extension tone through the neck. That's what fires midline cerebellar pathways and that's what starts to develop that postural tone that comes in over those next months and months as the baby learns to crawl and sit up and then to walk.

So that extension tone is really important right from very young babies. But kids as well, 2-year-olds, 4-year-old, 6-year-olds, 10-year-olds, that whole how do we train that extension tone? And we do a lot of Superman activities or exercise ball or airplane activities. Or even just as they get older, exercises where they get their shoulders back and lift their chest up so we can really work on that extensor tone. Partly to counteract just the physical counteraction of the flexion that we all sit in. And this applies to adults as well, of course, but also to really stimulate those brain pathways. That movement into extension is such an important thing for kids and adults as well, as I said. 

And then other things like concentrating on breathing, kids do a lot of shallow breathing and mouth breathing. But to really help children with nose breathing, and ribcage movement, and getting that diaphragm moving. That has really powerful regulatory impact on the nervous system because of that, the breath-in to breath-out, the sympathetic to parasympathetic tone. 

And also that physical stimulation of the gut for the diaphragm to move down and really work those abdominal organs. That really helps with digestion and firing of parasympathetic tone for rest, digest and rebuild and recover. So extension tone is really critical in any sort of way. And that can be done really simply right from birth but then, as I said, breathing. 

And of course, nutrition, as we talked a little bit about the texture and the structure of food and chewing. But of course, what the nutritional capacity of our food is - as you said - that fastness, quick meals, hurry up. That chewing and that enjoying the food and the social aspect of food that brings that calming to be able to digest our food. 

We see a lot of kids that don't sleep well. They don't get to bed early enough, they miss their tired point. Then they're firing the sympathetic nervous system again and kids say, "I'm not tired, I lie awake, I need to stay up later." No, they actually need to go to bed earlier to catch that tired point.

We've got that whole families and whole communities that push, push, drive, drive, and stress. Parents really getting frustrated and stressed with kids and coming down really hard on kids. And then kids not feeling calm and safe and comfortable. So then they can't relax as well. We don't digest our food as well, we don't sleep, and that's how we're breeding an epidemic of developmental challenges and ill health in people. And I don't think it's rocket science, if we can all work together different practitioners all work together to be able to support healthy development in children.

And, of course, gut function is a really important part of that. It's all very well to think if we think of the vagal contaminants from the brainstem affecting the vagus. You know, Stephen Porges, work about the myelinated vagus and how that helps calm and regulate. It's really important information for us to understand to support children. It's no point trying to intervene when we have say, depressed teenagers. We've seen an epidemic of stress in teenagers and mental health challenges. And it's not that it's not important to intervene then, it is. But we can set up a robustness earlier as a society, if we do work together, to help prevent a lot of it and help support a lot of the development that encourages children to know how to calm and settle and soothe themselves. And I think it's critical, I think we could be all doing a better job for that for our kids. 

Damian: I agree with you.

Genevieve: Kids are born so developmentally earlier than any other mammal. Our brain, it undergoes secondary altriciality after we're born, that secondary growth. And it means that we have a wonderful opportunity to get things right. And it's not about perfect. There's also a lot of parents that really are trying to get it perfect in and trying to do that they're putting themselves under so much stress and they've made child-rearing a higher cortical event rather than a right brain connecting to your feelings, emotional connection.

And so that right brain to right brain of the parent to the child, to be present, is really important part of development. And because there's all these apps and rules about how you raise a child, it's really become an intellectual event. And I think that does get in the way of just that soon.

Damian: It's become a little bit too cerebral. Yeah, too cerebral, too many spreadsheets. Yeah.

Genevieve: Yeah, that's right.

Damian: There's a couple things that you mentioned earlier on, one was Back to Sleep. And we're going back to that 1992 piece in America, which we tend to adopt everything the Americans say, and then we go, "Oh, my gosh, we're becoming more like America every day." That's because we do what Americans do. So not that it's a bad thing. And that can lead research and understanding and inquiry. But the back to sleep thing, though, it's obviously, was done for a particular reason.

When I put my head backwards, Gen  - and tell me if it's just me - when I put my head backwards, my mouth automatically opens and it feels to me like it's easier to breathe through my mouth. And I wonder whether or not there's something there. That because children spending so much time on their back even when they're asleep or when they're awake. It draws the mouth open so they become mouth breathers.

And I wonder whether or not that's got something to do with tongue position and then breathing, and how that might affect neurodevelopment. The lack of extensor tone, which you talked about, obviously affecting posture. The inability to go outside and hang out, or to perform tasks that would engage proper movement of the body and coordination, and catching a ball and kicking a ball, and all those sort of things. Is this affecting neurodevelopment in children? Is this what we're saying? All of these things together?

Genevieve: Yeah, I think it is. I think it is Damian. I'm not sure that a child's sleeping on their back, I'm not sure that that drives the mouth open. I know it does in adults, if you put it into extension, but with kids, I'm not sure. But what I will tell you is the Back to Sleep, we've seen such an increase in plagiocephaly with children, you know that slash on one side of the head. Because oftentimes, children from birth, they can have an asymmetry due to the torque and the twist in the way they're born, particularly with forceps and ventouse extraction. But even in normal birth and Caesar birth is well, because I see a lot of newborn babies…

And of course, I want to let you know, Damian, this, but I want to let people know, we don't do I don't do spinal manipulation, like a high-velocity adjustment in young babies. 

Damian: Same.

Genevieve: There’s many, many ways that chiropractors and osteopaths work with young babies that don't involve what people might be thinking of is that wrack and crunch or whatever people want to call it. It's a very finessed unwinding of tension. Babies aren't little segmental units, they're a whole body posture that we unwind. So if children have an asymmetry, a head-turning preference, or a torque in their system, and then they sleep on their back… because all back sleepers don't get flat heads and decal fleet.

Damian: That's true.

Genevieve: But babies that are susceptible do because their heads are soft and they're heavy, and they lie in that one position. That's how they get a flat head. And there's an association, not causation necessarily, but an association between the flathead, the plagiocephaly and increase in ear infections, change in muscle development, delayed motor development, and also delayed cognitive development.

In this research, Miller and Clarren did this research back in 2010. And Speltz and Collett have done time one through three from 6 months, 12 months, 18 months, up to three years studies on tracking children that have plagiocephaly and what happens with their development. And there is an association with delayed motor development, delayed meeting, and motor milestones. And also cognitive challenges, increase in ear infections, as I said, changes in peripheral visual field.

So plagiocephaly is not just an aesthetic issue. And that's a big issue from the Back to Sleep campaign. And I'm not saying children shouldn't sleep on their back, of course, it's the advice and I recommend it as well. But what we need to do is deal with the children that have the underlying asymmetries that cause the plagiocephaly, and also really, if we just had a public health campaign around Back to Sleep and Tummy to Play, which they tried to do, but it didn't go well. But those tummy time episodes. And really help parents understand that baby's lifting their head helps their development, and it helps their motor development and their cognitive development. I don't find parents that have trouble doing that once they understand why. We're all better at doing something if we know what's it for, and what's the value in it and how does it tie in with things that matter to us?

But I think there is a big change in development because of all the reasons: nutrition, the way we birth our children, the emotional stress, the lack of co-regulatory capacities, and all of those things that happen. And if we think Damian, evidence-based practice, people think about that as where research evidence. Yes, it is. That's one component.

Damian: Yeah, love to talk about it. Yeah.

Genevieve: But there's clinical experience that is critically important. And there's patient preferences and values. And that matters in evidence-based practice. It's a triad, best available research evidence, clinical experience, patient preferences, and values. And I think person-centred care is critically important. And when you're ready, I'd love to just talk about the government survey that was done if that's okay.

Damian: Yeah, I'd like to talk about that Gen, I think that's really important. You know, there was an issue a couple of years ago that made it, it was on YouTube, that made it to television, and then subsequently people became nervous of chiropractic. Well, there was a perception that people became nervous of chiropractic children. And so this perception that chiropractic may be unsafe for children gained a little bit of traction.

But you're at the coalface of that, you're at the forefront. And you worked with government in helping them understand how chiropractic can be used in an integrated fashion, integrative model of healthcare using evidence-based practice. And so I'd love you to just shed a little bit of light on what you discovered. Because I think it's important for the practitioners listening to this right now to understand that what the media say may not actually be the truth. It may not.

Genevieve: It was a really big push for then health minister in Victoria, Jenny Mikakos. It was a really big push for some ultra-conservative, small lobby groups that pushed to sell that story that chiropractic was unsafe. And none of the research evidence supports that, not only in research evidence, in insurance claims, in reports to ARPA, there’s no evidence to support that idea of lack of safety. So leave that part off the table.

And I think then the story was, well, there's been no issues and there's no problem as far as safety goes, but oh, well, it could be unsafe in certain circumstances. And there isn't enough robust evidence at a highest level to support chiropractic care. And that's true, the evidence base is developing and because there could be a risk, even though there hasn't been, well, therefore, it shouldn't be done.

But what's interesting is, Venus published a paper in 2020, looking at evidence-based practice across healthcare. And one of the highest evidence-based practices is care in cardiology, and the highest grade one level of evidence for that is only around 60%. And for things like, dementia care, and all sorts of other care, there’s clinical evidence in these clinical practice guidelines and there's lower-level evidence. But in terms of that grade one evidence, it's not there in a lot of areas, not only in the work that chiropractors and osteopaths do.

Damian: And naturopaths. Yes.

Genevieve: But these are very hard things, it's hard to do a randomised control trial and sham therapy and exclude parents from it when it comes to children. There's all the ethical issues of that.

So what I want to come back to with regard to that is, the government decided, it was run by Safer Care Victoria, and they decided to do a survey of the public. It was open for a month, it was hosted through engaged.vic, a government website. And it was all anonymous and de-identified, it was on the government site, and parents could put in or children, if they are older, could put in their experience of chiropractic care.

So there was a stream for those who had access chiropractic care for children under 12 in the last 10 years. And there's a stream for those that had an opinion about chiropractic care but hadn't accessed it for child under 12 in the last 10 years. And in the parent part of that there was over 22,000 responses. And the other part had 4,500. So 26,500 responses in a month is a huge number of responses and…

Damian: That’s huge. It would have almost broken the internet. Crash the internet.

Genevieve: Well, they had to get external companies in to analyse the data, I'll tell you that part. But 26 and a half thousand responses, it’s the largest healthcare survey done as a one-off survey. The NHS in the UK have slightly larger numbers, but theirs has been running 10 years. So it is the largest health provision survey that there is. And what I'll tell you from that is I actually got access to the data and I wrote it up for my thesis. My Ph.D., as I said was early childhood development. It was through coursework and thesis, and my thesis, I got the data.

So a couple of things we know 75% of children that come to chiropractors are under care of another health practitioner, and some up to seven other health practitioners for that same issue. Forty-eight percent of kids come to chiropractors, this is children under 12. Forty-eight percent come for musculoskeletal issues. And 40% come for developmental concerns, whether that's postural concerns, walking, crawling speech and language. We don't treat conditions as chiropractic, as you know, Damian. But we do work with the posture and the neurological integration to help improve body-to-brain back to body nerve pathways and control.

And so a couple of the other things that came out 99.16% of parents were satisfied or very satisfied, and the large majority those were very satisfied. So 99.16% with their involvement in decisions about care. 98.35% of parents said that their child improved after the care was provided. And when I summed across the fields of, “Did you feel involved in the decision making? Was there appropriate consent to care given? Did your child improve?” And I summed across all of those questions, 99.6% of parents said their child benefited from chiropractic care.

They're outstanding results, they're way higher than even I would have thought they would have been. It was well represented right across Australia, each state was well represented. So I just think they're outstanding results. And I think it is important. Parents want access to health care, other than what they might consider a standard medical care. And it's not only our care, it's all sorts of care, as we know. And I think as long as there's robust consent to care, that there's not harm or risk involved, then I think parents should have the right to access the care. And they're experiences that makes a difference.

Damian: Yeah, that's profound. Those numbers are mind-blowing, Gen.

Genevieve: They are mind-blowing.

Damian: Yeah, it brings me back to the whole chat about shared care, I think this is really important.

Genevieve: So important.

Damian: And a great thing for everybody listening to this podcast is to understand that all practitioners can be involved in the care of a patient and, in particular, paediatric patient. Those numbers, they're talking about up to seven other practitioners involved in the care of a patient. You spoke earlier, about needing a village to help raise a child and, in particular, it becomes more important to have extra minds working with children that have experienced a deficiency of their neurological development. It's going to require more things. So you will need a speech you might need an OT, you probably going to need a chiro, you will need an integrative nutritionist, you got a GP. There's a whole lot of things that you're going to need to help this child catch up and to get back on track. 

So to hear that data should give a lot of people some confidence that chiropractic can be part of, as well as other therapies, osteopathy, physiotherapy. These are all movement-based practices, we can all be involved in the care of the paediatric patient. I think that's really, really important. That's so good Gen.

Genevieve: Critically important. Yep. Critically important. You know, Damian my area isn't nutrition. I've got a very basic understanding. I'm interested in it, but I'm not skilled, I'm not the person with the skill set. I have fabulous people that I work with and refer to, and who referred to me as well, and I think that's it. It does take a multi-pronged approach and if we sit there thinking we've got answers or the answers, I think we're doing a disservice to our kids. We do need to work together.

But we need to understand what each other does as well so we know how to refer and how to look after people. I just want to see more healthy vibrant communities. And I think our profession plays a role in that as many others do. And it's for the good of the outcome for the kids and the families.

Damian: Yeah. Good on you, Gen. 

Gen, it's been absolutely incredible to have you on the podcast with me today. And I'm sure that the thousands of subscribers to FX Medicine will absolutely love this discussion and get a real sense of the importance of shared care for the paediatric patient. And I'm so grateful that you've given me freely your time today to help people understand more about paediatric neurodevelopment. 

Gen, where can people find more about you and your work?

Genevieve: I practice in East Hawthorn, we have a really busy and vibrant practice there. And as you know I teach to chiropractors and some continuing professional development work and I teach a two-year postgraduate program to chiropractors as well. But also I speak for the dentists and the midwives and the lactation consultants, they speak at my seminars, I speak at theirs. I'm in close contact with a lot of integrative GPs and naturopaths, but that's my work. I'm working on writing a book at the moment because I think it is… that’s really actually more for families. But what are the sort of building blocks of healthy development and how do we turn the health of our communities around into a more positive direction.

Damian: Now, that's the greatest. I'll be stuck in that book in my practice, there's no doubt about it. So if you want to find out more about Gen, go to www.dynamicneuro.com or inspiralresources.com. So you can go there and check her out.

Genevieve: Thanks, Damian.

Damian: But thanks, everybody, for listening today. And don't forget that you can find all of the show notes, transcripts, and other resources on the FX Medicine website. I'm Dr Damian Kristof, thanks for joining us.


About Dr Genevieve Keating

Dr Genevieve Keating has spent the last forty years wondering “how we are who we are.” She is passionately interested in developing brains and how we, as a community, can have a guiding hand.

Her study has earned her a Bachelor of Applied Science in Chiropractic (1988), a Diplomate of the American Chiropractic Neurology Board (2004), and a PhD in Early Childhood Development in 2020.

She is an internationally recognised clinician and educator and has designed and taught seminars for more than 25 years. She currently teaches chiropractors and other professionals about child development and health.

She is committed to engaging health practitioners and the community in understanding, assessing, and supporting neurodevelopment, ensuring that babies and children have the best chance for healthy, happy lives.

She has a vibrant family practice in East Hawthorn and is incredibly inspired by the babies, children, and families she works with.


The information provided on FX Medicine is for educational and informational purposes only. The information provided on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health.

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