The current study analyzed the characteristics of pediatric patients for whom OMM was used as an adjunctive medical approach. We found sex variations in the use of OMM in a pediatric population and age-related variations in presenting complaints, clinical assessments, and type of OMT technique used. Boys accounted for the majority of encounters for patients younger than 2 years. Furthermore, feeding difficulties and plagiocephaly were the most frequently documented presenting complaints and clinical assessments for patients younger than 2 years. This finding was consistent with a study by Lund and Carreiro,
8 which reported torticollis and skull or face deformity as the leading assessments for OMM in pediatric patients aged from birth to 11 months. Our finding also correlated with the documented prevalence of plagiocephaly in an infant population.
27 Although the current study did not assess sex-related differences in the types of presenting complaints or clinical assessments, the larger number of clinical encounters for boys younger than 2 years is consistent with plagiocephaly being more common in that group.
28-30
The current study found that girls accounted for the majority of encounters for patients aged 2 years and older and for more patients and encounters overall. The early adolescence age category had the largest number of patients, encounters, and mean number of encounters per patient. This age category also had the largest number of female patients, encounters for girls, and mean number of encounters for girls. The current study did not differentiate clinical assessments based on sex, but the female predominance in the older age categories may be related to the increased frequency of specific musculoskeletal complaints. For example, we identified headache as the most common assessment (23.4%) in the middle childhood age category (6-11 years). Similarly, a study by Lund and Carreiro
8 reported a headache prevalence of 13.6% in children aged 5 to 12 years. The predominance of girls within this age category may be related to findings of other studies, which reported that headaches are more common in female pediatric patients.
31,32
The frequency of musculoskeletal presenting complaints and clinical assessments increased with patient age in the current study. Black et al
1 suggested that musculoskeletal conditions are common reasons for children seeking out adjunctive medical approaches. Low back pain/lumbar sprain/strain was the most frequently documented clinical assessment for the early and late adolescence age categories (12-21 years) in the current study. MacDonald et al
33 reported a growing incidence of low back pain in school-aged children beginning around 10 years that steadily increased throughout adolescence; by 18 years, the prevalence approached that documented in adults. Being female has been reported as a risk factor for back pain in school-aged children.
9 A study by Ramirez et al
34 found the average age for pediatric patients to present with back pain was 14.8 years, and girls accounted for 68% of their pediatric back pain population. The increased frequency of back pain observed during adolescence in conjunction with the greater number of female patient encounters may represent a future area of study for adjunctive medical approaches in the pediatric population.
The thoracic, head, and cervical body regions were the most common body regions of somatic dysfunction assessed in the current study. Myofascial release, muscle energy, and osteopathic cranial manipulative medicine were the most commonly used OMT techniques. In a study by Snider et al,
35 myofascial release, balanced ligamentous tension, and muscle energy were the most commonly used OMT techniques in the inpatient setting across all age ranges. In the current study, we found differences in OMT techniques based on age category. Term neonatal, infancy, and toddler age categories (birth to 23 months) most commonly received osteopathic cranial manipulative medicine, myofascial release, balanced ligamentous tension, and soft tissue. Middle childhood and early and late adolescence age categories (6-21 years) most commonly received myofascial release, muscle energy, and high-velocity, low-amplitude. We observed that from birth to 18 years, osteopathic cranial manipulative medicine was among the 5 most commonly used techniques. This finding may reflect a 2003 study by Johnson and Kurtz,
36 which reported osteopathic cranial manipulative medicine was ranked last in a list of 11 OMT techniques used by 955 contemporary osteopathic physicians in a clinical setting. However, OMT specialists were significantly more likely to use osteopathic cranial manipulative medicine than were family practitioners.
36 The current study occurred within an NMM/OMM specialty clinic where medical students and residents are trained in osteopathic cranial manipulative medicine as part of a wide variety of OMT techniques. The data presented in the current study may also reflect variations between physicians. Specifically, the current study pooled treatment data from 11 attending physicians and 24 resident physicians, but physicians within an individual group practice may have similar practice patterns that differ from physicians outside of that group practice.
The current study had several limitations. We had a low number of patients and encounters for the term neonatal, toddler, early childhood, and middle childhood age categories. These low numbers limit the conclusions that can be made for those age categories. Race was not studied as a demographic variable because a large number of patients did not have race indicated in the EHR. Another limitation was that our data were obtained from a single OMM outpatient clinic. This clinic may not be representative of OMM clinics in other geographic regions or of how pediatric patients present to other OMM clinics. Furthermore, because our patients were treated in an NMM/OMM specialty clinic, our results may not reflect the presentation of patients or the approach taken by osteopathic pediatricians or other osteopathic primary care physicians in a non-NMM/OMM specialty setting. One notable difference in the current study was the inclusion of data from patients seen by NMM/OMM residents. In a previous pediatric study,
8 only data from attending physicians were used. Last, encounters involving self-pay patients had significantly less somatic dysfunction assessments than encounters with patients using private insurance or Medicaid payment methods. This difference is challenging to interpret given that self-pay accounted for only 4.2% of encounters. As such, the difference may be due to the sampling bias of a small sample size or due to the insurance-based fee structure of the studied clinic. Therefore, this finding may not reflect OMM clinics with a cash-based fee structure.