The chiropractic examination of an infant, as do the adjustments, look quite different than what is done for adults. The spine is at a developmental stage where most structures are still cartilaginous ( although a very firm type of cartilage), and the development of the curves has not yet occurred ( the spine is still largely in a long C-shape curve for the first 8 weeks). The vast majority of issues we are going to find will be in the cervical and cranial areas. The only exception to that being C-section births, where pretty much anything can happen depending upon how the baby was retrieved.Just plain visualization of the infant laying on their back in the car seat alone can give you some clues: is the head always turned to one side, extended, is there a large asymmetrical bald spot, does the shape of the head look asymmetrical ? Palpation has to be very delicate in that age group, too much pressure will cause of flinch response and mask the more subtle soft tissue findings. There are some tests that are very specific for the newborns, including the inversion test: the baby is held upside down by their ankles, facing away from the doctor. An uncompromised baby will show relaxed arms and hips, neutral head without rotation and extension. The fencer's test done in the inverted position taps into the primitive reflex of protectively turning your head and reaching out your arm out on the side of "free fall" ( when the doctor decreases the hold on one of the ankles). It is a great way to pick up rotational problems in the upper cervical spine, as babies will only be able to turn their head and reach their arm to one side. It is also a good tool to monitor improvement. Jaw alignment issues can be palpated while the child is sucking on a pacifier, but most often I will have to insert my gloved pinkie in the mouth to really feel the movement pattern of the jaw. Children who have started to gain head control will transition out of the inversion test and into upright testing such as the head righting reflexes and standard motion palpation.Children are naturally creatures of movement and comfort, so assessing a baby over 12 weeks does require a bit of creativity on behalf of the chiropractor. My rule of thumb has always been to follow the child where they go if feasible and palpate them while they are comfortably occupied doing what they want and where they want. To that effect we try to have the parents bring in the favorite toy, book for distraction, and I have been known to crouch in a corner of the room behind a child who is tinkering with a toy or laying on my gym ball, but most often we are successful if I can assess a child when they are laying on a parent's lap or belly.
