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Original Contribution  |   March 2020
Characteristics and Treatment of Pediatric Patients in an Osteopathic Manipulative Medicine Clinic
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Emergency Medicine / Neuromusculoskeletal Disorders / Pediatrics
Original Contribution   |   March 2020
Characteristics and Treatment of Pediatric Patients in an Osteopathic Manipulative Medicine Clinic
The Journal of the American Osteopathic Association, March 2020, Vol. 120, e1-e7. doi:
The Journal of the American Osteopathic Association, March 2020, Vol. 120, e1-e7. doi:
eAppendix 1.
All Reported Presenting Complaints Treated with Osteopathic Manipulative Medicine in an Outpatient Clinical Setting by Patient Encounter for Pediatric Patients by Defined Age Categories
Age Categorya No. (%)
Category 1 (n=54)
 Feeding difficulties 27 (50.0)
 Misshapen head 18 (33.3)
 Nonspecific head complaints 3 (5.6)
 Abnormal head and neck position 2 (3.7)
 Gastrointestinal complaints 2 (3.7)
 Nonspecific complaints 2 (3.7)
Category 2 (n=307)
 Misshapen head 133 (43.3)
 Feeding difficulties 27 (8.8)
 Colic 26 (8.5)
 Reflux 22 (7.2)
 Abnormal head and neck position 22 (7.2)
 Constipation 19 (6.2)
 Nonspecific complaints 15 (4.9)
 Nonspecific head complaints 13 (4.2)
 Gastrointestinal complaints 8 (2.6)
 Erb's palsy 6 (2.0)
 Respiratory problems 7 (2.3)
 Other musculoskeletal complaints 5 (1.6)
 Other cervical complaints 4 (1.3)
Category 3 (n=34)
 Misshapen head 14 (41.2)
 Ear complaints 10 (29.4)
 Other musculoskeletal complaints 4 (11.8)
 Gastrointestinal complaints 2 (5.9)
 Insomnia 2 (5.9)
 Headache 1 (2.9)
 Colic 1 (2.9)
Category 4 (n=76)
 Lower extremity complaints 18 (23.7)
 Neurological/psychological complaints 14 (18.4)
 Back pain 6 (7.9)
 Respiratory complaints 6 (7.9)
 Cervical complaints 5 (6.6)
 Constipation 5 (6.6)
 Misshapen head 5 (6.6)
 Headache 4 (5.3)
 Ear complaints 3 (3.9)
 Other musculoskeletal complaints 3 (3.9)
 Upper extremity complaints 3 (3.9)
 Nonspecific complaints 2 (2.6)
 Other head complaints 2 (2.6)
Category 5 (n=168)
 Headache 39 (23.2)
 Back pain 28 (16.7)
 Cervical complaints 27 (16.1)
 Lower extremity complaints 16 (9.5)
 Psychological complaints 15 (8.9)
 Nonspecific complaints 11 (6.5)
 Other musculoskeletal complaints 5 (3.0)
 Visual disturbances 5 (3.0)
 Nonspecific head complaints 4 (2.4)
 Upper extremity complaints 4 (2.4)
 Gait abnormality 3 (1.8)
 Speech difficulties 3 (1.8)
 Gastrointestinal complaints 2 (1.2)
 Other gastrointestinal complaints 2 (1.2)
 Constipation 1 (0.6)
 Ear pain 1 (0.6)
 Hip pain 1 (0.6)
 Neurological complaints 1 (0.6)
Category 6 (n=1037)
 Back pain 475 (45.8)
 Headache 155 (14.9)
 Cervical complaints 82 (7.9)
 Lower extremity complaints 70 (6.8)
 Dizziness 51 (4.9)
 Upper extremity complaints 45 (4.3)
 Hip/pelvic pain 44 (4.2)
 Rib complaints 35 (3.4)
 Nonspecific complaints 22 (2.1)
 Neurological complaints 21 (2.0)
 Other head complaints 16 (1.5)
 Other musculoskeletal complaints 13 (1.3)
 Gastrointestinal complaints 4 (0.4)
 Respiratory complaints 3 (0.3)
 Psychological complaints 1 (0.1)
Category 7 (n=582)
 Back pain 278 (47.8)
 Neck pain 65 (11.2)
 Headache 54 (9.3)
 Upper extremity complaints 47 (8.1)
 Lower extremity complaints 40 (6.9)
 Hip/pelvic pain 29 (5.0)
 Rib pain 23 (4.0)
 Neurological complaints 15 (2.6)
 Nonspecific complaints 11 (1.9)
 Nonspecific head complaints 8 (1.4)
 Gastrointestinal complaints 6 (1.0)
 Other musculoskeletal complaints 4 (0.7)
 Respiratory complaints 2 (0.3)

aAge categories: 1, term neonatal (birth-27 days); 2, infancy (28 days-12 months); 3, toddler (13-23 months); 4, early childhood (2-5 years); 5, middle childhood (6-11 years); 6, early adolescence (12-18 years); 7, late adolescence (19-21 years).

eAppendix 1.
All Reported Presenting Complaints Treated with Osteopathic Manipulative Medicine in an Outpatient Clinical Setting by Patient Encounter for Pediatric Patients by Defined Age Categories
Age Categorya No. (%)
Category 1 (n=54)
 Feeding difficulties 27 (50.0)
 Misshapen head 18 (33.3)
 Nonspecific head complaints 3 (5.6)
 Abnormal head and neck position 2 (3.7)
 Gastrointestinal complaints 2 (3.7)
 Nonspecific complaints 2 (3.7)
Category 2 (n=307)
 Misshapen head 133 (43.3)
 Feeding difficulties 27 (8.8)
 Colic 26 (8.5)
 Reflux 22 (7.2)
 Abnormal head and neck position 22 (7.2)
 Constipation 19 (6.2)
 Nonspecific complaints 15 (4.9)
 Nonspecific head complaints 13 (4.2)
 Gastrointestinal complaints 8 (2.6)
 Erb's palsy 6 (2.0)
 Respiratory problems 7 (2.3)
 Other musculoskeletal complaints 5 (1.6)
 Other cervical complaints 4 (1.3)
Category 3 (n=34)
 Misshapen head 14 (41.2)
 Ear complaints 10 (29.4)
 Other musculoskeletal complaints 4 (11.8)
 Gastrointestinal complaints 2 (5.9)
 Insomnia 2 (5.9)
 Headache 1 (2.9)
 Colic 1 (2.9)
Category 4 (n=76)
 Lower extremity complaints 18 (23.7)
 Neurological/psychological complaints 14 (18.4)
 Back pain 6 (7.9)
 Respiratory complaints 6 (7.9)
 Cervical complaints 5 (6.6)
 Constipation 5 (6.6)
 Misshapen head 5 (6.6)
 Headache 4 (5.3)
 Ear complaints 3 (3.9)
 Other musculoskeletal complaints 3 (3.9)
 Upper extremity complaints 3 (3.9)
 Nonspecific complaints 2 (2.6)
 Other head complaints 2 (2.6)
Category 5 (n=168)
 Headache 39 (23.2)
 Back pain 28 (16.7)
 Cervical complaints 27 (16.1)
 Lower extremity complaints 16 (9.5)
 Psychological complaints 15 (8.9)
 Nonspecific complaints 11 (6.5)
 Other musculoskeletal complaints 5 (3.0)
 Visual disturbances 5 (3.0)
 Nonspecific head complaints 4 (2.4)
 Upper extremity complaints 4 (2.4)
 Gait abnormality 3 (1.8)
 Speech difficulties 3 (1.8)
 Gastrointestinal complaints 2 (1.2)
 Other gastrointestinal complaints 2 (1.2)
 Constipation 1 (0.6)
 Ear pain 1 (0.6)
 Hip pain 1 (0.6)
 Neurological complaints 1 (0.6)
Category 6 (n=1037)
 Back pain 475 (45.8)
 Headache 155 (14.9)
 Cervical complaints 82 (7.9)
 Lower extremity complaints 70 (6.8)
 Dizziness 51 (4.9)
 Upper extremity complaints 45 (4.3)
 Hip/pelvic pain 44 (4.2)
 Rib complaints 35 (3.4)
 Nonspecific complaints 22 (2.1)
 Neurological complaints 21 (2.0)
 Other head complaints 16 (1.5)
 Other musculoskeletal complaints 13 (1.3)
 Gastrointestinal complaints 4 (0.4)
 Respiratory complaints 3 (0.3)
 Psychological complaints 1 (0.1)
Category 7 (n=582)
 Back pain 278 (47.8)
 Neck pain 65 (11.2)
 Headache 54 (9.3)
 Upper extremity complaints 47 (8.1)
 Lower extremity complaints 40 (6.9)
 Hip/pelvic pain 29 (5.0)
 Rib pain 23 (4.0)
 Neurological complaints 15 (2.6)
 Nonspecific complaints 11 (1.9)
 Nonspecific head complaints 8 (1.4)
 Gastrointestinal complaints 6 (1.0)
 Other musculoskeletal complaints 4 (0.7)
 Respiratory complaints 2 (0.3)

aAge categories: 1, term neonatal (birth-27 days); 2, infancy (28 days-12 months); 3, toddler (13-23 months); 4, early childhood (2-5 years); 5, middle childhood (6-11 years); 6, early adolescence (12-18 years); 7, late adolescence (19-21 years).

×
eAppendix 2.
All Reported Clinical Assessments Treated with Osteopathic Manipulative Medicine in an Outpatient Clinical Setting and Defined by the International Classification of Disease, Tenth Revision by Patient Encounter for Pediatric Patients by Defined Age Categories
Age Categorya No. (%)
Category 1 (n=67)
 Feeding difficulty (R63.3, P92.8, P92.9, F98.29) 26 (38.8)
 Plagiocephaly/cranial molding (Q67.3, M95.2) 13 (19.4)
 Abnormalities of skull and/or face bones (Q75.9) 7 (10.4)
 Cephalhematoma due to birth injury (P12.0) 4 (6.0)
 Torticollis (M43.6) 3 (4.5)
 Caput succedaneum (P12.81) 3 (4.5)
 Gastroesophageal reflux disease (GERD) (K21.9) 2 (3.0)
 Birthmark not otherwise specified (Q82.5) 1 (1.5)
 Constipation (K59.00) 1 (1.5)
 Contracture of left hip (M24.552) 1 (1.5)
 Failure to thrive (R62.51) 1 (1.5)
 Neonatal obstruction of right nasolacrimal duct (H04.531) 1 (1.5)
 Other congenital deformities of chest (Q67.8) 1 (1.5)
 Other injuries to skeleton due to birth trauma (P13.9) 1 (1.5)
 Perinatal jaundice from other excessive hemolysis (P58.8) 1 (1.5)
 Temporomandibular joint (TMJ) disorder (M26.609) 1 (1.5)
Category 2 (n=350)
 Plagiocephaly (Q67.3) 100 (28.6)
 Abnormalities of skull and/or face bones (Q75.9) 47 (13.4)
 Torticollis (M43.6, Q68.0) 42 (12.0)
 Colic/fussy infant (R10.83, R68.12) 34 (9.7)
 Feeding difficulty (P92.9, R63.3) 27 (7.7)
 Constipation (K59.00) 25 (7.1)
 GERD (K21.9) 23 (6.6)
 Injury to brachial plexus due to birth trauma (P14.3) 6 (1.7)
 Otitis media (H65.00, H65.499, H66.90) 5 (1.4)
 Ear pain (H92.09) 4 (1.1)
 Hip pain/dysfunction (M25.552, M25.651, M25.652) 3 (0.9)
 Spasm of muscle (M62.4) 3 (0.9)
 Down's syndrome (Q90.9) 3 (0.9)
 Cough (R05) 3 (0.9)
 Gas pain (R14.1) 3 (0.9)
 Upper respiratory infection (J06.9) 2 (0.6)
 Genu varum of knee (M21.161, M21.162) 2 (0.6)
 Other vomiting of newborn (P92.09) 2 (0.6)
 Congenital facial asymmetry (Q67.0) 2 (0.6)
 Hiccups (R06.6) 2 (0.6)
 Cervical strain (S13.4) 2 (0.6)
 Problems with head (V48.8) 2 (0.6)
 Oral thrush (B37.9) 1 (0.3)
 Nasolacrimal duct obstruction (H04.559) 1 (0.3)
 Dermatitis due to food taken internally (L27.2) 1 (0.3)
 TMJ disorder (M26.6) 1 (0.3)
 Other congenital deformities of chest (Q67.8) 1 (0.3)
 Bowing of leg (Q68.5) 1 (0.3)
 Congenital deformity of ankle (Q74.2) 1 (0.3)
 Strain of fascia at shoulder level of left arm, initial encounter (S46.912A) 1 (0.3)
Category 3 (n=36)
 Plagiocephaly (Q67.3) 14 (38.9)
 Otitis media (H65.91, H66.90, H66.91) 9 (25.0)
 Colic/fussy infant (R10.83, R68.12) 4 (11.1)
 TMJ disorder (M26.60) 2 (5.6)
 Abnormal posture (R29.3) 2 (5.6)
 Insomnia (G47.00) 1 (2.8)
 Otalgia, unspecified ear (H92.09) 1 (2.8)
 Torticollis (M43.6) 1 (2.8)
 Abnormality of gait (R26.9) 1 (2.8)
 Headache (R51) 1 (2.8)
Category 4 (n=81)
 Congenital anomaly of lower extremity (Q74.9, Q66.22, Q66.4) 11 (13.6)
 Lower extremity pain/sprain or strain (M25.579, M79.609, S86.919A) 8 (9.9)
 Abnormal involuntary movements (R25.9) 7 (8.6)
 Plagiocephaly (Q67.3) 6 (7.4)
 Headache (G44.209, R51) 5 (6.2)
 Neck pain/sprain or strain (M54.2, S13.4XXA) 5 (6.2)
 Back pain (M54.9) 5 (6.2)
 Constipation (K59.00) 4 (4.9)
 Attention deficit disorder of childhood with hyperactivity (F90.1) 3 (3.7)
 Dystonia (F24.9) 3 (3.7)
 Other seizures (G40.89) 3 (3.7)
 Otitis media (H65.00, H65.499) 3 (3.7)
 Cough (R05) 3 (3.7)
 Developmental speech articulation disorder (F80.0) 2 (2.5)
 Pharyngitis, acute (J02.9) 2 (2.5)
 Allergic rhinitis, cause unspecified (J30.9) 2 (2.5)
 Hip pain (M25.559) 2 (2.5)
 Difficulty in walking (R26.2) 2 (2.5)
 Other specific developmental learning difficulties (F81.89) 1 (1.2)
 Enuresis (F98.0) 1 (1.2)
 Acute upper respiratory infection, unspecified (J06.9) 1 (1.2)
 Wrist pain (M25.539) 1 (1.2)
 Low back pain (M54.5) 1 (1.2)
Category 5 (n=192)
 Headache (R51, G43.0, G43.009, G43.909, G44.1, G44.209, G44.219, G44.329, G44.89) 45 (23.4)
 Neck pain/strain/sprain (M54.2, S13.4XXA) 27 (14.1)
 Back pain/dorsalgia/thoracic pain (M54.9, M54.6) 18 (9.4)
 Leg/ankle/foot/limb pain (M25.5, M25.579, M79.606, M79.609, M25.561, M25.569, M25.571) 16 (8.3)
 Low back pain/strain (M54.5, S33.5XXA) 12 (6.3)
 Autism (F84.0) 10 (5.2)
 Chromosomal abnormality (Q99.9) 9 (4.7)
 Tourette syndrome (F95.2) 5 (2.6)
 Torticollis, unspecified (M43.6) 5 (2.6)
 Gait abnormality (R26.9) 5 (2.6)
 Enuresis (F98.0) 3 (1.6)
 Disturbances of vision (H53.16) 3 (1.6)
 Constipation (K59.0, K59.04) 3 (1.6)
 Strabismus (H50.9) 3 (1.6)
 TMJ disorder (M26.6, M26.629) 3 (1.6)
 Speech abnormality (R47.02) 3 (1.6)
 Attention-deficit/hyperactivity disorder (ADHD) of childhood (F90.9) 2 (1.0)
 Inguinal hernia (K40.90) 2 (1.0)
 Spasm of muscle (M62.4) 2 (1.0)
 Allergy to milk products/other foods (Z91.001, Z91.018) 2 (1.0)
 Hip/pelvis pain (M25.559, R10.2) 2 (1.0)
 Arm pain (M25.532, M79.602) 2 (1.0)
 Insomnia, unspecified (G47.00) 1 (0.5)
 Chondritis of external ear, bilateral (H61.033) 1 (0.5)
 Allergic rhinitis (J30.9) 1 (0.5)
 Epidermal cyst (L72.0) 1 (0.5)
 Disorders of sacrum (M53.3) 1 (0.5)
 Generalized abdominal pain (R10.84) 1 (0.5)
 Scoliosis (and kyphoscoliosis), idiopathic (M41.2) 1 (0.5)
 Sacroiliac pain (M53.88) 1 (0.5)
 Occipital neuralgia (M54.81) 1 (0.5)
 Jaw strain (S03.40XA) 1 (0.5)
Category 6 (n=1724)
 Low back pain/lumbar sprain/strain (M54.5, S33.5XXA, S33.5XXD, S33.8XXA, S33.9XXA, S39.012A) 331 (19.2)
 Back pain/dorsalgia/thoracic pain/sprain/strain (M54.6, M54.89, M54.9, S23.3XXA) 274 (15.9)
 Neck pain/strain/sprain (M53.82, M54.2, S13.4XXA, S19.9XXA) 258 (15.0)
 Lower extremity/knee/ankle/foot pain (M25.561, M25.562, M25.569, M25.571, M25.572, M25.579, M72.2, S86.919A) 163 (9.5)
 Cluster/tension/posttraumatic/other headache (G44.021, G44.029, G44.201, G44.209, G44.221, G44.229, G44.311, G44.319, G44.329, R51) 133 (7.7)
 Vertigo (H81.311, H81.319, R42) 86 (5.0)
 Pain/sprain in upper extremity (M25.51, M25.539, M75.50, M75.80, M77.00, M79.603, M79.641, M79.642, M79.644, S43.491S, S63.502A, S63.681S) 72 (4.2)
 Migraine (G43.001, G43.009, G43.10, G43.109, G43.111, G43.909) 55 (3.2)
 Rib/chest wall pain/strain/sprain/costochondritis (M94.0, R07.81, R07.89, R07.9, S23.41XA) 52 (3.0)
 Back muscle spasm (M62.40, M62.459, M62.830, M62.838) 46 (2.7)
 Hip/pelvic pain/sprain (M25.551, M25.552, M25.559, M70.60, R10.2, S73.109A) 40 (2.3)
 Scoliosis (M41.124, M41.30, M41.9) 26 (1.5)
 TMJ disorder/abnormal jaw closure (M26.51, M26.60) 22 (1.3)
 Sacroiliitis/sacroiliac/sacrococcygeal pain (M46.1, M53.3) 15 (0.9)
 Pregnant state, incidental (V22.2, Z33.1) 14 (0.8)
 Torticollis (M43.6) 10 (0.6)
 Unequal leg length (M21.70, Q72.811, Q72.812) 10 (0.6)
 Epilepsy (G40.90) 7 (0.4)
 Nausea and vomiting (R11.2) 7 (0.4)
 ADHD (F90.0, F90.2, F90.9) 6 (0.3)
 Pain in unspecified joint(s) (M25.50) 6 (0.3)
 Nocturnal enuresis (N39.44) 6 (0.3)
 Obesity (E66.01, E66.9) 5 (0.3)
 Atypical facial pain (G50.1) 5 (0.3)
 Connective tissue disease (M35.9) 5 (0.3)
 Spondylosis/spondylolisthesis (M43.06, M43.16) 5 (0.3)
 Occipital neuralgia (M54.81) 5 (0.3)
 Abnormal posture (R29.3) 4 (0.2)
 Skull fracture (S02.2XXS, S02.91XS) 4 (0.2)
 Dislocated TMJ (S03.0XXA, S03.0XXD) 4 (0.2)
 Autism spectrum disorder (F84.0) 3 (0.2)
 Upper respiratory infection/pneumonia/upper respiratory disease (J06.9, J18.9, J39.9) 3 (0.2)
 Myalgia (M79.1) 3 (0.2)
 Driver injured in collision with other motor vehicles (V43.62XS, V49.49XA, V49.49XD) 3 (0.2)
 Tourette's disorder (F95.2) 2 (0.1)
 Asthma (J45.90, J45.909) 2 (0.1)
 Acne vulgaris (L70.0) 2 (0.1)
 Menstrual cramps (N94.6) 2 (0.1)
 Epigastric pain (R10.13) 2 (0.1)
 Generalized pain (R52) 2 (0.1)
 Postconcussion syndrome (F07.81) 1 (0.1)
 Tobacco abuse (F17.200) 1 (0.1)
 Thoracic outlet syndrome (G54.0) 1 (0.1)
 Other localized visual field defect (H53.452) 1 (0.1)
 Chronic nonsuppurative otitis media (H65.499) 1 (0.1)
 Perforation of tympanic membrane (H72.00) 1 (0.1)
 Acute maxillary sinusitis (J01.00) 1 (0.1)
 Chronic adenotonsillitis (J35.03) 1 (0.1)
 Constipation, unspecified (K59.00) 1 (0.1)
 Rib stiffness (M25.60) 1 (0.1)
 Postural kyphosis, thoracic region (M40.04) 1 (0.1)
 Other spondylosis with myelopathy, lumbar region (M47.16) 1 (0.1)
 Radiculitis, thoracic or lumbar (M54.15) 1 (0.1)
 Other synovitis and tenosynovitis (M65.80) 1 (0.1)
 Pyelonephritis (N12) 1 (0.1)
 Urinary tract infection (N39.0) 1 (0.1)
 Ehlers-Danlos syndrome (Q79.6) 1 (0.1)
 Dysphagia (R13.10) 1 (0.1)
 Rash and other nonspecific skin eruption (R21) 1 (0.1)
 Muscle fasciculation (R25.3) 1 (0.1)
 Fever (R50.9) 1 (0.1)
 Concussion (S06.0) 1 (0.1)
 Other complications due to other internal prosthetic device, implant, and graft (T85.898A) 1 (0.1)
 Unspecified fall, initial encounter (W19.XXXA) 1 (0.1)
a a
 Low back pain/lumbar sprain/strain (M53.87, M54.16, M54.30, M54.5, S33.9XXA) 186 (21.5)
 Neck pain/strain/sprain (M54.12, M54.2, S13.4XXA) 120 (13.9)
 Back pain/dorsalgia/thoracic pain/sprain/strain (M54.6, M54.89, M54.9, S23.3XXA) 113 (13.1)
 Tension/spinal/epidural/other headaches (G44.201, G44.209, G44.221, G44.229, G44.52, O29.4, O89.4, R51) 59 (6.8)
 Pregnancy (O00.0, O00.01, V22.1, V22.2, Z33.1, Z3A.28, Z3A.35) 58 (6.7)
 Chest discomfort/rib pain/costochodritis (M94.0, R07.89, R07.9, S23.41XA) 45 (5.2)
 Lower extremity pain/strain/sprain (M25.561, M25.562, M25.569, M25.579) 42 (4.9)
 Pain/sprain in upper extremity (M25.51, M25.539, M25.549, M75.50, S43.439A, S43.80XA, S46.912A, S63.8X9A, S66.811A) 40 (4.6)
 Hip/pelvis pain (M25.552, M25.559, M70.60, R10.2) 21 (2.4)
 Migraine (G43.009, G43.019, G43.10, G43.109, G43.909) 19 (2.2)
 Scoliosis (M41.115, M41.125, M41.129, M41.20. M41.9) 18 (2.1)
 Muscle spasm (M62.40, M62.838) 16 (1.9)
 Torticollis (M43.6) 14 (1.6)
 Pain/strain or sprain of sacrococcyx (M46.1, M53.3, M53.88, S33.8XXA) 14 (1.6)
 Thoracic outlet syndrome (G54.0) 12 (1.4)
 TMJ disorder (M26.60, M26.602) 9 (1.0)
 Car passenger injured in vehicle collision (V43.62XS) 9 (1.0)
 Spondylolisthesis/intervertebral disk disorder of lumbar region (M43.16, M51.06, M51.1, M51.36, M51.86) 8 (0.9)
 Numbness/paresthesia (R20.2, R20.9) 5 (0.6)
 Obesity (E66.01, E66.9, O99.212) 4 (0.5)
 Light-headedness (R42) 4 (0.5)
 Postconcussion syndrome (F07.81) 3 (0.3)
 Bell's palsy (G51.0) 3 (0.3)
 Carpal tunnel (G56.00, G56.01, G56.02) 3 (0.3)
 Occipital neuralgia (M54.81) 3 (0.3)
 Menstrual problems (N92.1, N94.3, N94.4) 3 (0.3)
 Postpartum blues/depression (O90.6) 3 (0.3)
 Abdominal pain/strain (R10.31, R10.9, S39.011S) 3 (0.3)
 Idiopathic thrombocytopenic purpura (D69.3) 2 (0.2)
 Upper respiratory infection/bronchitis (J06.9, J40) 2 (0.2)
 Pneumonia (J18.9) 2 (0.2)
 Anosmia (R43.0) 2 (0.2)
 Lipoma, unspecified site (D17.9) 1 (0.1)
 Entrapment of lateral cutaneous nerve of thigh (G57.10) 1 (0.1)
 Chronic pain due to trauma (G89.21) 1 (0.1)
 Aural vertigo (H81.319) 1 (0.1)
 Pharyngitis, acute (J02.9) 1 (0.1)
 Constipation (K59.00) 1 (0.1)
 Unequal leg length (M21.70) 1 (0.1)
 Pain in joint involving multiple sites (M25.50) 1 (0.1)
 Neuralgia and neuritis, unspecified (M79.2) 1 (0.1)
 Maternal care for breech presentation (O32.1XX0) 1 (0.1)
 Mild or unspecified preeclampsia (O14.0) 1 (0.1)
 Edema or excessive weight gain in pregnancy (O26.00) 1 (0.1)
 Heartburn (R12) 1 (0.1)
 Abnormal posture (R29.3) 1 (0.1)
 Seizure (R56.9) 1 (0.1)
 Brachial plexus lesions (S14.3XXA) 1 (0.1)
 Muscle strain (T14.90XA) 1 (0.1)
 Other specified complication of medical care, sequela (T88.8XXS) 1 (0.1)
 History of traumatic fracture (V15.51) 1 (0.1)

aAge categories: 1, term neonatal (birth-27 days); 2, infancy (28 days-12 months); 3, toddler (13-23 months); 4, early childhood (2-5 years); 5, middle childhood (6-11 years); 6, early adolescence (12-18 years); 7, late adolescence (19-21 years).

eAppendix 2.
All Reported Clinical Assessments Treated with Osteopathic Manipulative Medicine in an Outpatient Clinical Setting and Defined by the International Classification of Disease, Tenth Revision by Patient Encounter for Pediatric Patients by Defined Age Categories
Age Categorya No. (%)
Category 1 (n=67)
 Feeding difficulty (R63.3, P92.8, P92.9, F98.29) 26 (38.8)
 Plagiocephaly/cranial molding (Q67.3, M95.2) 13 (19.4)
 Abnormalities of skull and/or face bones (Q75.9) 7 (10.4)
 Cephalhematoma due to birth injury (P12.0) 4 (6.0)
 Torticollis (M43.6) 3 (4.5)
 Caput succedaneum (P12.81) 3 (4.5)
 Gastroesophageal reflux disease (GERD) (K21.9) 2 (3.0)
 Birthmark not otherwise specified (Q82.5) 1 (1.5)
 Constipation (K59.00) 1 (1.5)
 Contracture of left hip (M24.552) 1 (1.5)
 Failure to thrive (R62.51) 1 (1.5)
 Neonatal obstruction of right nasolacrimal duct (H04.531) 1 (1.5)
 Other congenital deformities of chest (Q67.8) 1 (1.5)
 Other injuries to skeleton due to birth trauma (P13.9) 1 (1.5)
 Perinatal jaundice from other excessive hemolysis (P58.8) 1 (1.5)
 Temporomandibular joint (TMJ) disorder (M26.609) 1 (1.5)
Category 2 (n=350)
 Plagiocephaly (Q67.3) 100 (28.6)
 Abnormalities of skull and/or face bones (Q75.9) 47 (13.4)
 Torticollis (M43.6, Q68.0) 42 (12.0)
 Colic/fussy infant (R10.83, R68.12) 34 (9.7)
 Feeding difficulty (P92.9, R63.3) 27 (7.7)
 Constipation (K59.00) 25 (7.1)
 GERD (K21.9) 23 (6.6)
 Injury to brachial plexus due to birth trauma (P14.3) 6 (1.7)
 Otitis media (H65.00, H65.499, H66.90) 5 (1.4)
 Ear pain (H92.09) 4 (1.1)
 Hip pain/dysfunction (M25.552, M25.651, M25.652) 3 (0.9)
 Spasm of muscle (M62.4) 3 (0.9)
 Down's syndrome (Q90.9) 3 (0.9)
 Cough (R05) 3 (0.9)
 Gas pain (R14.1) 3 (0.9)
 Upper respiratory infection (J06.9) 2 (0.6)
 Genu varum of knee (M21.161, M21.162) 2 (0.6)
 Other vomiting of newborn (P92.09) 2 (0.6)
 Congenital facial asymmetry (Q67.0) 2 (0.6)
 Hiccups (R06.6) 2 (0.6)
 Cervical strain (S13.4) 2 (0.6)
 Problems with head (V48.8) 2 (0.6)
 Oral thrush (B37.9) 1 (0.3)
 Nasolacrimal duct obstruction (H04.559) 1 (0.3)
 Dermatitis due to food taken internally (L27.2) 1 (0.3)
 TMJ disorder (M26.6) 1 (0.3)
 Other congenital deformities of chest (Q67.8) 1 (0.3)
 Bowing of leg (Q68.5) 1 (0.3)
 Congenital deformity of ankle (Q74.2) 1 (0.3)
 Strain of fascia at shoulder level of left arm, initial encounter (S46.912A) 1 (0.3)
Category 3 (n=36)
 Plagiocephaly (Q67.3) 14 (38.9)
 Otitis media (H65.91, H66.90, H66.91) 9 (25.0)
 Colic/fussy infant (R10.83, R68.12) 4 (11.1)
 TMJ disorder (M26.60) 2 (5.6)
 Abnormal posture (R29.3) 2 (5.6)
 Insomnia (G47.00) 1 (2.8)
 Otalgia, unspecified ear (H92.09) 1 (2.8)
 Torticollis (M43.6) 1 (2.8)
 Abnormality of gait (R26.9) 1 (2.8)
 Headache (R51) 1 (2.8)
Category 4 (n=81)
 Congenital anomaly of lower extremity (Q74.9, Q66.22, Q66.4) 11 (13.6)
 Lower extremity pain/sprain or strain (M25.579, M79.609, S86.919A) 8 (9.9)
 Abnormal involuntary movements (R25.9) 7 (8.6)
 Plagiocephaly (Q67.3) 6 (7.4)
 Headache (G44.209, R51) 5 (6.2)
 Neck pain/sprain or strain (M54.2, S13.4XXA) 5 (6.2)
 Back pain (M54.9) 5 (6.2)
 Constipation (K59.00) 4 (4.9)
 Attention deficit disorder of childhood with hyperactivity (F90.1) 3 (3.7)
 Dystonia (F24.9) 3 (3.7)
 Other seizures (G40.89) 3 (3.7)
 Otitis media (H65.00, H65.499) 3 (3.7)
 Cough (R05) 3 (3.7)
 Developmental speech articulation disorder (F80.0) 2 (2.5)
 Pharyngitis, acute (J02.9) 2 (2.5)
 Allergic rhinitis, cause unspecified (J30.9) 2 (2.5)
 Hip pain (M25.559) 2 (2.5)
 Difficulty in walking (R26.2) 2 (2.5)
 Other specific developmental learning difficulties (F81.89) 1 (1.2)
 Enuresis (F98.0) 1 (1.2)
 Acute upper respiratory infection, unspecified (J06.9) 1 (1.2)
 Wrist pain (M25.539) 1 (1.2)
 Low back pain (M54.5) 1 (1.2)
Category 5 (n=192)
 Headache (R51, G43.0, G43.009, G43.909, G44.1, G44.209, G44.219, G44.329, G44.89) 45 (23.4)
 Neck pain/strain/sprain (M54.2, S13.4XXA) 27 (14.1)
 Back pain/dorsalgia/thoracic pain (M54.9, M54.6) 18 (9.4)
 Leg/ankle/foot/limb pain (M25.5, M25.579, M79.606, M79.609, M25.561, M25.569, M25.571) 16 (8.3)
 Low back pain/strain (M54.5, S33.5XXA) 12 (6.3)
 Autism (F84.0) 10 (5.2)
 Chromosomal abnormality (Q99.9) 9 (4.7)
 Tourette syndrome (F95.2) 5 (2.6)
 Torticollis, unspecified (M43.6) 5 (2.6)
 Gait abnormality (R26.9) 5 (2.6)
 Enuresis (F98.0) 3 (1.6)
 Disturbances of vision (H53.16) 3 (1.6)
 Constipation (K59.0, K59.04) 3 (1.6)
 Strabismus (H50.9) 3 (1.6)
 TMJ disorder (M26.6, M26.629) 3 (1.6)
 Speech abnormality (R47.02) 3 (1.6)
 Attention-deficit/hyperactivity disorder (ADHD) of childhood (F90.9) 2 (1.0)
 Inguinal hernia (K40.90) 2 (1.0)
 Spasm of muscle (M62.4) 2 (1.0)
 Allergy to milk products/other foods (Z91.001, Z91.018) 2 (1.0)
 Hip/pelvis pain (M25.559, R10.2) 2 (1.0)
 Arm pain (M25.532, M79.602) 2 (1.0)
 Insomnia, unspecified (G47.00) 1 (0.5)
 Chondritis of external ear, bilateral (H61.033) 1 (0.5)
 Allergic rhinitis (J30.9) 1 (0.5)
 Epidermal cyst (L72.0) 1 (0.5)
 Disorders of sacrum (M53.3) 1 (0.5)
 Generalized abdominal pain (R10.84) 1 (0.5)
 Scoliosis (and kyphoscoliosis), idiopathic (M41.2) 1 (0.5)
 Sacroiliac pain (M53.88) 1 (0.5)
 Occipital neuralgia (M54.81) 1 (0.5)
 Jaw strain (S03.40XA) 1 (0.5)
Category 6 (n=1724)
 Low back pain/lumbar sprain/strain (M54.5, S33.5XXA, S33.5XXD, S33.8XXA, S33.9XXA, S39.012A) 331 (19.2)
 Back pain/dorsalgia/thoracic pain/sprain/strain (M54.6, M54.89, M54.9, S23.3XXA) 274 (15.9)
 Neck pain/strain/sprain (M53.82, M54.2, S13.4XXA, S19.9XXA) 258 (15.0)
 Lower extremity/knee/ankle/foot pain (M25.561, M25.562, M25.569, M25.571, M25.572, M25.579, M72.2, S86.919A) 163 (9.5)
 Cluster/tension/posttraumatic/other headache (G44.021, G44.029, G44.201, G44.209, G44.221, G44.229, G44.311, G44.319, G44.329, R51) 133 (7.7)
 Vertigo (H81.311, H81.319, R42) 86 (5.0)
 Pain/sprain in upper extremity (M25.51, M25.539, M75.50, M75.80, M77.00, M79.603, M79.641, M79.642, M79.644, S43.491S, S63.502A, S63.681S) 72 (4.2)
 Migraine (G43.001, G43.009, G43.10, G43.109, G43.111, G43.909) 55 (3.2)
 Rib/chest wall pain/strain/sprain/costochondritis (M94.0, R07.81, R07.89, R07.9, S23.41XA) 52 (3.0)
 Back muscle spasm (M62.40, M62.459, M62.830, M62.838) 46 (2.7)
 Hip/pelvic pain/sprain (M25.551, M25.552, M25.559, M70.60, R10.2, S73.109A) 40 (2.3)
 Scoliosis (M41.124, M41.30, M41.9) 26 (1.5)
 TMJ disorder/abnormal jaw closure (M26.51, M26.60) 22 (1.3)
 Sacroiliitis/sacroiliac/sacrococcygeal pain (M46.1, M53.3) 15 (0.9)
 Pregnant state, incidental (V22.2, Z33.1) 14 (0.8)
 Torticollis (M43.6) 10 (0.6)
 Unequal leg length (M21.70, Q72.811, Q72.812) 10 (0.6)
 Epilepsy (G40.90) 7 (0.4)
 Nausea and vomiting (R11.2) 7 (0.4)
 ADHD (F90.0, F90.2, F90.9) 6 (0.3)
 Pain in unspecified joint(s) (M25.50) 6 (0.3)
 Nocturnal enuresis (N39.44) 6 (0.3)
 Obesity (E66.01, E66.9) 5 (0.3)
 Atypical facial pain (G50.1) 5 (0.3)
 Connective tissue disease (M35.9) 5 (0.3)
 Spondylosis/spondylolisthesis (M43.06, M43.16) 5 (0.3)
 Occipital neuralgia (M54.81) 5 (0.3)
 Abnormal posture (R29.3) 4 (0.2)
 Skull fracture (S02.2XXS, S02.91XS) 4 (0.2)
 Dislocated TMJ (S03.0XXA, S03.0XXD) 4 (0.2)
 Autism spectrum disorder (F84.0) 3 (0.2)
 Upper respiratory infection/pneumonia/upper respiratory disease (J06.9, J18.9, J39.9) 3 (0.2)
 Myalgia (M79.1) 3 (0.2)
 Driver injured in collision with other motor vehicles (V43.62XS, V49.49XA, V49.49XD) 3 (0.2)
 Tourette's disorder (F95.2) 2 (0.1)
 Asthma (J45.90, J45.909) 2 (0.1)
 Acne vulgaris (L70.0) 2 (0.1)
 Menstrual cramps (N94.6) 2 (0.1)
 Epigastric pain (R10.13) 2 (0.1)
 Generalized pain (R52) 2 (0.1)
 Postconcussion syndrome (F07.81) 1 (0.1)
 Tobacco abuse (F17.200) 1 (0.1)
 Thoracic outlet syndrome (G54.0) 1 (0.1)
 Other localized visual field defect (H53.452) 1 (0.1)
 Chronic nonsuppurative otitis media (H65.499) 1 (0.1)
 Perforation of tympanic membrane (H72.00) 1 (0.1)
 Acute maxillary sinusitis (J01.00) 1 (0.1)
 Chronic adenotonsillitis (J35.03) 1 (0.1)
 Constipation, unspecified (K59.00) 1 (0.1)
 Rib stiffness (M25.60) 1 (0.1)
 Postural kyphosis, thoracic region (M40.04) 1 (0.1)
 Other spondylosis with myelopathy, lumbar region (M47.16) 1 (0.1)
 Radiculitis, thoracic or lumbar (M54.15) 1 (0.1)
 Other synovitis and tenosynovitis (M65.80) 1 (0.1)
 Pyelonephritis (N12) 1 (0.1)
 Urinary tract infection (N39.0) 1 (0.1)
 Ehlers-Danlos syndrome (Q79.6) 1 (0.1)
 Dysphagia (R13.10) 1 (0.1)
 Rash and other nonspecific skin eruption (R21) 1 (0.1)
 Muscle fasciculation (R25.3) 1 (0.1)
 Fever (R50.9) 1 (0.1)
 Concussion (S06.0) 1 (0.1)
 Other complications due to other internal prosthetic device, implant, and graft (T85.898A) 1 (0.1)
 Unspecified fall, initial encounter (W19.XXXA) 1 (0.1)
a a
 Low back pain/lumbar sprain/strain (M53.87, M54.16, M54.30, M54.5, S33.9XXA) 186 (21.5)
 Neck pain/strain/sprain (M54.12, M54.2, S13.4XXA) 120 (13.9)
 Back pain/dorsalgia/thoracic pain/sprain/strain (M54.6, M54.89, M54.9, S23.3XXA) 113 (13.1)
 Tension/spinal/epidural/other headaches (G44.201, G44.209, G44.221, G44.229, G44.52, O29.4, O89.4, R51) 59 (6.8)
 Pregnancy (O00.0, O00.01, V22.1, V22.2, Z33.1, Z3A.28, Z3A.35) 58 (6.7)
 Chest discomfort/rib pain/costochodritis (M94.0, R07.89, R07.9, S23.41XA) 45 (5.2)
 Lower extremity pain/strain/sprain (M25.561, M25.562, M25.569, M25.579) 42 (4.9)
 Pain/sprain in upper extremity (M25.51, M25.539, M25.549, M75.50, S43.439A, S43.80XA, S46.912A, S63.8X9A, S66.811A) 40 (4.6)
 Hip/pelvis pain (M25.552, M25.559, M70.60, R10.2) 21 (2.4)
 Migraine (G43.009, G43.019, G43.10, G43.109, G43.909) 19 (2.2)
 Scoliosis (M41.115, M41.125, M41.129, M41.20. M41.9) 18 (2.1)
 Muscle spasm (M62.40, M62.838) 16 (1.9)
 Torticollis (M43.6) 14 (1.6)
 Pain/strain or sprain of sacrococcyx (M46.1, M53.3, M53.88, S33.8XXA) 14 (1.6)
 Thoracic outlet syndrome (G54.0) 12 (1.4)
 TMJ disorder (M26.60, M26.602) 9 (1.0)
 Car passenger injured in vehicle collision (V43.62XS) 9 (1.0)
 Spondylolisthesis/intervertebral disk disorder of lumbar region (M43.16, M51.06, M51.1, M51.36, M51.86) 8 (0.9)
 Numbness/paresthesia (R20.2, R20.9) 5 (0.6)
 Obesity (E66.01, E66.9, O99.212) 4 (0.5)
 Light-headedness (R42) 4 (0.5)
 Postconcussion syndrome (F07.81) 3 (0.3)
 Bell's palsy (G51.0) 3 (0.3)
 Carpal tunnel (G56.00, G56.01, G56.02) 3 (0.3)
 Occipital neuralgia (M54.81) 3 (0.3)
 Menstrual problems (N92.1, N94.3, N94.4) 3 (0.3)
 Postpartum blues/depression (O90.6) 3 (0.3)
 Abdominal pain/strain (R10.31, R10.9, S39.011S) 3 (0.3)
 Idiopathic thrombocytopenic purpura (D69.3) 2 (0.2)
 Upper respiratory infection/bronchitis (J06.9, J40) 2 (0.2)
 Pneumonia (J18.9) 2 (0.2)
 Anosmia (R43.0) 2 (0.2)
 Lipoma, unspecified site (D17.9) 1 (0.1)
 Entrapment of lateral cutaneous nerve of thigh (G57.10) 1 (0.1)
 Chronic pain due to trauma (G89.21) 1 (0.1)
 Aural vertigo (H81.319) 1 (0.1)
 Pharyngitis, acute (J02.9) 1 (0.1)
 Constipation (K59.00) 1 (0.1)
 Unequal leg length (M21.70) 1 (0.1)
 Pain in joint involving multiple sites (M25.50) 1 (0.1)
 Neuralgia and neuritis, unspecified (M79.2) 1 (0.1)
 Maternal care for breech presentation (O32.1XX0) 1 (0.1)
 Mild or unspecified preeclampsia (O14.0) 1 (0.1)
 Edema or excessive weight gain in pregnancy (O26.00) 1 (0.1)
 Heartburn (R12) 1 (0.1)
 Abnormal posture (R29.3) 1 (0.1)
 Seizure (R56.9) 1 (0.1)
 Brachial plexus lesions (S14.3XXA) 1 (0.1)
 Muscle strain (T14.90XA) 1 (0.1)
 Other specified complication of medical care, sequela (T88.8XXS) 1 (0.1)
 History of traumatic fracture (V15.51) 1 (0.1)

aAge categories: 1, term neonatal (birth-27 days); 2, infancy (28 days-12 months); 3, toddler (13-23 months); 4, early childhood (2-5 years); 5, middle childhood (6-11 years); 6, early adolescence (12-18 years); 7, late adolescence (19-21 years).

×
eAppendix 1.
All Reported Presenting Complaints Treated with Osteopathic Manipulative Medicine in an Outpatient Clinical Setting by Patient Encounter for Pediatric Patients by Defined Age Categories
Age Categorya No. (%)
Category 1 (n=54)
 Feeding difficulties 27 (50.0)
 Misshapen head 18 (33.3)
 Nonspecific head complaints 3 (5.6)
 Abnormal head and neck position 2 (3.7)
 Gastrointestinal complaints 2 (3.7)
 Nonspecific complaints 2 (3.7)
Category 2 (n=307)
 Misshapen head 133 (43.3)
 Feeding difficulties 27 (8.8)
 Colic 26 (8.5)
 Reflux 22 (7.2)
 Abnormal head and neck position 22 (7.2)
 Constipation 19 (6.2)
 Nonspecific complaints 15 (4.9)
 Nonspecific head complaints 13 (4.2)
 Gastrointestinal complaints 8 (2.6)
 Erb's palsy 6 (2.0)
 Respiratory problems 7 (2.3)
 Other musculoskeletal complaints 5 (1.6)
 Other cervical complaints 4 (1.3)
Category 3 (n=34)
 Misshapen head 14 (41.2)
 Ear complaints 10 (29.4)
 Other musculoskeletal complaints 4 (11.8)
 Gastrointestinal complaints 2 (5.9)
 Insomnia 2 (5.9)
 Headache 1 (2.9)
 Colic 1 (2.9)
Category 4 (n=76)
 Lower extremity complaints 18 (23.7)
 Neurological/psychological complaints 14 (18.4)
 Back pain 6 (7.9)
 Respiratory complaints 6 (7.9)
 Cervical complaints 5 (6.6)
 Constipation 5 (6.6)
 Misshapen head 5 (6.6)
 Headache 4 (5.3)
 Ear complaints 3 (3.9)
 Other musculoskeletal complaints 3 (3.9)
 Upper extremity complaints 3 (3.9)
 Nonspecific complaints 2 (2.6)
 Other head complaints 2 (2.6)
Category 5 (n=168)
 Headache 39 (23.2)
 Back pain 28 (16.7)
 Cervical complaints 27 (16.1)
 Lower extremity complaints 16 (9.5)
 Psychological complaints 15 (8.9)
 Nonspecific complaints 11 (6.5)
 Other musculoskeletal complaints 5 (3.0)
 Visual disturbances 5 (3.0)
 Nonspecific head complaints 4 (2.4)
 Upper extremity complaints 4 (2.4)
 Gait abnormality 3 (1.8)
 Speech difficulties 3 (1.8)
 Gastrointestinal complaints 2 (1.2)
 Other gastrointestinal complaints 2 (1.2)
 Constipation 1 (0.6)
 Ear pain 1 (0.6)
 Hip pain 1 (0.6)
 Neurological complaints 1 (0.6)
Category 6 (n=1037)
 Back pain 475 (45.8)
 Headache 155 (14.9)
 Cervical complaints 82 (7.9)
 Lower extremity complaints 70 (6.8)
 Dizziness 51 (4.9)
 Upper extremity complaints 45 (4.3)
 Hip/pelvic pain 44 (4.2)
 Rib complaints 35 (3.4)
 Nonspecific complaints 22 (2.1)
 Neurological complaints 21 (2.0)
 Other head complaints 16 (1.5)
 Other musculoskeletal complaints 13 (1.3)
 Gastrointestinal complaints 4 (0.4)
 Respiratory complaints 3 (0.3)
 Psychological complaints 1 (0.1)
Category 7 (n=582)
 Back pain 278 (47.8)
 Neck pain 65 (11.2)
 Headache 54 (9.3)
 Upper extremity complaints 47 (8.1)
 Lower extremity complaints 40 (6.9)
 Hip/pelvic pain 29 (5.0)
 Rib pain 23 (4.0)
 Neurological complaints 15 (2.6)
 Nonspecific complaints 11 (1.9)
 Nonspecific head complaints 8 (1.4)
 Gastrointestinal complaints 6 (1.0)
 Other musculoskeletal complaints 4 (0.7)
 Respiratory complaints 2 (0.3)

aAge categories: 1, term neonatal (birth-27 days); 2, infancy (28 days-12 months); 3, toddler (13-23 months); 4, early childhood (2-5 years); 5, middle childhood (6-11 years); 6, early adolescence (12-18 years); 7, late adolescence (19-21 years).

eAppendix 1.
All Reported Presenting Complaints Treated with Osteopathic Manipulative Medicine in an Outpatient Clinical Setting by Patient Encounter for Pediatric Patients by Defined Age Categories
Age Categorya No. (%)
Category 1 (n=54)
 Feeding difficulties 27 (50.0)
 Misshapen head 18 (33.3)
 Nonspecific head complaints 3 (5.6)
 Abnormal head and neck position 2 (3.7)
 Gastrointestinal complaints 2 (3.7)
 Nonspecific complaints 2 (3.7)
Category 2 (n=307)
 Misshapen head 133 (43.3)
 Feeding difficulties 27 (8.8)
 Colic 26 (8.5)
 Reflux 22 (7.2)
 Abnormal head and neck position 22 (7.2)
 Constipation 19 (6.2)
 Nonspecific complaints 15 (4.9)
 Nonspecific head complaints 13 (4.2)
 Gastrointestinal complaints 8 (2.6)
 Erb's palsy 6 (2.0)
 Respiratory problems 7 (2.3)
 Other musculoskeletal complaints 5 (1.6)
 Other cervical complaints 4 (1.3)
Category 3 (n=34)
 Misshapen head 14 (41.2)
 Ear complaints 10 (29.4)
 Other musculoskeletal complaints 4 (11.8)
 Gastrointestinal complaints 2 (5.9)
 Insomnia 2 (5.9)
 Headache 1 (2.9)
 Colic 1 (2.9)
Category 4 (n=76)
 Lower extremity complaints 18 (23.7)
 Neurological/psychological complaints 14 (18.4)
 Back pain 6 (7.9)
 Respiratory complaints 6 (7.9)
 Cervical complaints 5 (6.6)
 Constipation 5 (6.6)
 Misshapen head 5 (6.6)
 Headache 4 (5.3)
 Ear complaints 3 (3.9)
 Other musculoskeletal complaints 3 (3.9)
 Upper extremity complaints 3 (3.9)
 Nonspecific complaints 2 (2.6)
 Other head complaints 2 (2.6)
Category 5 (n=168)
 Headache 39 (23.2)
 Back pain 28 (16.7)
 Cervical complaints 27 (16.1)
 Lower extremity complaints 16 (9.5)
 Psychological complaints 15 (8.9)
 Nonspecific complaints 11 (6.5)
 Other musculoskeletal complaints 5 (3.0)
 Visual disturbances 5 (3.0)
 Nonspecific head complaints 4 (2.4)
 Upper extremity complaints 4 (2.4)
 Gait abnormality 3 (1.8)
 Speech difficulties 3 (1.8)
 Gastrointestinal complaints 2 (1.2)
 Other gastrointestinal complaints 2 (1.2)
 Constipation 1 (0.6)
 Ear pain 1 (0.6)
 Hip pain 1 (0.6)
 Neurological complaints 1 (0.6)
Category 6 (n=1037)
 Back pain 475 (45.8)
 Headache 155 (14.9)
 Cervical complaints 82 (7.9)
 Lower extremity complaints 70 (6.8)
 Dizziness 51 (4.9)
 Upper extremity complaints 45 (4.3)
 Hip/pelvic pain 44 (4.2)
 Rib complaints 35 (3.4)
 Nonspecific complaints 22 (2.1)
 Neurological complaints 21 (2.0)
 Other head complaints 16 (1.5)
 Other musculoskeletal complaints 13 (1.3)
 Gastrointestinal complaints 4 (0.4)
 Respiratory complaints 3 (0.3)
 Psychological complaints 1 (0.1)
Category 7 (n=582)
 Back pain 278 (47.8)
 Neck pain 65 (11.2)
 Headache 54 (9.3)
 Upper extremity complaints 47 (8.1)
 Lower extremity complaints 40 (6.9)
 Hip/pelvic pain 29 (5.0)
 Rib pain 23 (4.0)
 Neurological complaints 15 (2.6)
 Nonspecific complaints 11 (1.9)
 Nonspecific head complaints 8 (1.4)
 Gastrointestinal complaints 6 (1.0)
 Other musculoskeletal complaints 4 (0.7)
 Respiratory complaints 2 (0.3)

aAge categories: 1, term neonatal (birth-27 days); 2, infancy (28 days-12 months); 3, toddler (13-23 months); 4, early childhood (2-5 years); 5, middle childhood (6-11 years); 6, early adolescence (12-18 years); 7, late adolescence (19-21 years).

×
eAppendix 2.
All Reported Clinical Assessments Treated with Osteopathic Manipulative Medicine in an Outpatient Clinical Setting and Defined by the International Classification of Disease, Tenth Revision by Patient Encounter for Pediatric Patients by Defined Age Categories
Age Categorya No. (%)
Category 1 (n=67)
 Feeding difficulty (R63.3, P92.8, P92.9, F98.29) 26 (38.8)
 Plagiocephaly/cranial molding (Q67.3, M95.2) 13 (19.4)
 Abnormalities of skull and/or face bones (Q75.9) 7 (10.4)
 Cephalhematoma due to birth injury (P12.0) 4 (6.0)
 Torticollis (M43.6) 3 (4.5)
 Caput succedaneum (P12.81) 3 (4.5)
 Gastroesophageal reflux disease (GERD) (K21.9) 2 (3.0)
 Birthmark not otherwise specified (Q82.5) 1 (1.5)
 Constipation (K59.00) 1 (1.5)
 Contracture of left hip (M24.552) 1 (1.5)
 Failure to thrive (R62.51) 1 (1.5)
 Neonatal obstruction of right nasolacrimal duct (H04.531) 1 (1.5)
 Other congenital deformities of chest (Q67.8) 1 (1.5)
 Other injuries to skeleton due to birth trauma (P13.9) 1 (1.5)
 Perinatal jaundice from other excessive hemolysis (P58.8) 1 (1.5)
 Temporomandibular joint (TMJ) disorder (M26.609) 1 (1.5)
Category 2 (n=350)
 Plagiocephaly (Q67.3) 100 (28.6)
 Abnormalities of skull and/or face bones (Q75.9) 47 (13.4)
 Torticollis (M43.6, Q68.0) 42 (12.0)
 Colic/fussy infant (R10.83, R68.12) 34 (9.7)
 Feeding difficulty (P92.9, R63.3) 27 (7.7)
 Constipation (K59.00) 25 (7.1)
 GERD (K21.9) 23 (6.6)
 Injury to brachial plexus due to birth trauma (P14.3) 6 (1.7)
 Otitis media (H65.00, H65.499, H66.90) 5 (1.4)
 Ear pain (H92.09) 4 (1.1)
 Hip pain/dysfunction (M25.552, M25.651, M25.652) 3 (0.9)
 Spasm of muscle (M62.4) 3 (0.9)
 Down's syndrome (Q90.9) 3 (0.9)
 Cough (R05) 3 (0.9)
 Gas pain (R14.1) 3 (0.9)
 Upper respiratory infection (J06.9) 2 (0.6)
 Genu varum of knee (M21.161, M21.162) 2 (0.6)
 Other vomiting of newborn (P92.09) 2 (0.6)
 Congenital facial asymmetry (Q67.0) 2 (0.6)
 Hiccups (R06.6) 2 (0.6)
 Cervical strain (S13.4) 2 (0.6)
 Problems with head (V48.8) 2 (0.6)
 Oral thrush (B37.9) 1 (0.3)
 Nasolacrimal duct obstruction (H04.559) 1 (0.3)
 Dermatitis due to food taken internally (L27.2) 1 (0.3)
 TMJ disorder (M26.6) 1 (0.3)
 Other congenital deformities of chest (Q67.8) 1 (0.3)
 Bowing of leg (Q68.5) 1 (0.3)
 Congenital deformity of ankle (Q74.2) 1 (0.3)
 Strain of fascia at shoulder level of left arm, initial encounter (S46.912A) 1 (0.3)
Category 3 (n=36)
 Plagiocephaly (Q67.3) 14 (38.9)
 Otitis media (H65.91, H66.90, H66.91) 9 (25.0)
 Colic/fussy infant (R10.83, R68.12) 4 (11.1)
 TMJ disorder (M26.60) 2 (5.6)
 Abnormal posture (R29.3) 2 (5.6)
 Insomnia (G47.00) 1 (2.8)
 Otalgia, unspecified ear (H92.09) 1 (2.8)
 Torticollis (M43.6) 1 (2.8)
 Abnormality of gait (R26.9) 1 (2.8)
 Headache (R51) 1 (2.8)
Category 4 (n=81)
 Congenital anomaly of lower extremity (Q74.9, Q66.22, Q66.4) 11 (13.6)
 Lower extremity pain/sprain or strain (M25.579, M79.609, S86.919A) 8 (9.9)
 Abnormal involuntary movements (R25.9) 7 (8.6)
 Plagiocephaly (Q67.3) 6 (7.4)
 Headache (G44.209, R51) 5 (6.2)
 Neck pain/sprain or strain (M54.2, S13.4XXA) 5 (6.2)
 Back pain (M54.9) 5 (6.2)
 Constipation (K59.00) 4 (4.9)
 Attention deficit disorder of childhood with hyperactivity (F90.1) 3 (3.7)
 Dystonia (F24.9) 3 (3.7)
 Other seizures (G40.89) 3 (3.7)
 Otitis media (H65.00, H65.499) 3 (3.7)
 Cough (R05) 3 (3.7)
 Developmental speech articulation disorder (F80.0) 2 (2.5)
 Pharyngitis, acute (J02.9) 2 (2.5)
 Allergic rhinitis, cause unspecified (J30.9) 2 (2.5)
 Hip pain (M25.559) 2 (2.5)
 Difficulty in walking (R26.2) 2 (2.5)
 Other specific developmental learning difficulties (F81.89) 1 (1.2)
 Enuresis (F98.0) 1 (1.2)
 Acute upper respiratory infection, unspecified (J06.9) 1 (1.2)
 Wrist pain (M25.539) 1 (1.2)
 Low back pain (M54.5) 1 (1.2)
Category 5 (n=192)
 Headache (R51, G43.0, G43.009, G43.909, G44.1, G44.209, G44.219, G44.329, G44.89) 45 (23.4)
 Neck pain/strain/sprain (M54.2, S13.4XXA) 27 (14.1)
 Back pain/dorsalgia/thoracic pain (M54.9, M54.6) 18 (9.4)
 Leg/ankle/foot/limb pain (M25.5, M25.579, M79.606, M79.609, M25.561, M25.569, M25.571) 16 (8.3)
 Low back pain/strain (M54.5, S33.5XXA) 12 (6.3)
 Autism (F84.0) 10 (5.2)
 Chromosomal abnormality (Q99.9) 9 (4.7)
 Tourette syndrome (F95.2) 5 (2.6)
 Torticollis, unspecified (M43.6) 5 (2.6)
 Gait abnormality (R26.9) 5 (2.6)
 Enuresis (F98.0) 3 (1.6)
 Disturbances of vision (H53.16) 3 (1.6)
 Constipation (K59.0, K59.04) 3 (1.6)
 Strabismus (H50.9) 3 (1.6)
 TMJ disorder (M26.6, M26.629) 3 (1.6)
 Speech abnormality (R47.02) 3 (1.6)
 Attention-deficit/hyperactivity disorder (ADHD) of childhood (F90.9) 2 (1.0)
 Inguinal hernia (K40.90) 2 (1.0)
 Spasm of muscle (M62.4) 2 (1.0)
 Allergy to milk products/other foods (Z91.001, Z91.018) 2 (1.0)
 Hip/pelvis pain (M25.559, R10.2) 2 (1.0)
 Arm pain (M25.532, M79.602) 2 (1.0)
 Insomnia, unspecified (G47.00) 1 (0.5)
 Chondritis of external ear, bilateral (H61.033) 1 (0.5)
 Allergic rhinitis (J30.9) 1 (0.5)
 Epidermal cyst (L72.0) 1 (0.5)
 Disorders of sacrum (M53.3) 1 (0.5)
 Generalized abdominal pain (R10.84) 1 (0.5)
 Scoliosis (and kyphoscoliosis), idiopathic (M41.2) 1 (0.5)
 Sacroiliac pain (M53.88) 1 (0.5)
 Occipital neuralgia (M54.81) 1 (0.5)
 Jaw strain (S03.40XA) 1 (0.5)
Category 6 (n=1724)
 Low back pain/lumbar sprain/strain (M54.5, S33.5XXA, S33.5XXD, S33.8XXA, S33.9XXA, S39.012A) 331 (19.2)
 Back pain/dorsalgia/thoracic pain/sprain/strain (M54.6, M54.89, M54.9, S23.3XXA) 274 (15.9)
 Neck pain/strain/sprain (M53.82, M54.2, S13.4XXA, S19.9XXA) 258 (15.0)
 Lower extremity/knee/ankle/foot pain (M25.561, M25.562, M25.569, M25.571, M25.572, M25.579, M72.2, S86.919A) 163 (9.5)
 Cluster/tension/posttraumatic/other headache (G44.021, G44.029, G44.201, G44.209, G44.221, G44.229, G44.311, G44.319, G44.329, R51) 133 (7.7)
 Vertigo (H81.311, H81.319, R42) 86 (5.0)
 Pain/sprain in upper extremity (M25.51, M25.539, M75.50, M75.80, M77.00, M79.603, M79.641, M79.642, M79.644, S43.491S, S63.502A, S63.681S) 72 (4.2)
 Migraine (G43.001, G43.009, G43.10, G43.109, G43.111, G43.909) 55 (3.2)
 Rib/chest wall pain/strain/sprain/costochondritis (M94.0, R07.81, R07.89, R07.9, S23.41XA) 52 (3.0)
 Back muscle spasm (M62.40, M62.459, M62.830, M62.838) 46 (2.7)
 Hip/pelvic pain/sprain (M25.551, M25.552, M25.559, M70.60, R10.2, S73.109A) 40 (2.3)
 Scoliosis (M41.124, M41.30, M41.9) 26 (1.5)
 TMJ disorder/abnormal jaw closure (M26.51, M26.60) 22 (1.3)
 Sacroiliitis/sacroiliac/sacrococcygeal pain (M46.1, M53.3) 15 (0.9)
 Pregnant state, incidental (V22.2, Z33.1) 14 (0.8)
 Torticollis (M43.6) 10 (0.6)
 Unequal leg length (M21.70, Q72.811, Q72.812) 10 (0.6)
 Epilepsy (G40.90) 7 (0.4)
 Nausea and vomiting (R11.2) 7 (0.4)
 ADHD (F90.0, F90.2, F90.9) 6 (0.3)
 Pain in unspecified joint(s) (M25.50) 6 (0.3)
 Nocturnal enuresis (N39.44) 6 (0.3)
 Obesity (E66.01, E66.9) 5 (0.3)
 Atypical facial pain (G50.1) 5 (0.3)
 Connective tissue disease (M35.9) 5 (0.3)
 Spondylosis/spondylolisthesis (M43.06, M43.16) 5 (0.3)
 Occipital neuralgia (M54.81) 5 (0.3)
 Abnormal posture (R29.3) 4 (0.2)
 Skull fracture (S02.2XXS, S02.91XS) 4 (0.2)
 Dislocated TMJ (S03.0XXA, S03.0XXD) 4 (0.2)
 Autism spectrum disorder (F84.0) 3 (0.2)
 Upper respiratory infection/pneumonia/upper respiratory disease (J06.9, J18.9, J39.9) 3 (0.2)
 Myalgia (M79.1) 3 (0.2)
 Driver injured in collision with other motor vehicles (V43.62XS, V49.49XA, V49.49XD) 3 (0.2)
 Tourette's disorder (F95.2) 2 (0.1)
 Asthma (J45.90, J45.909) 2 (0.1)
 Acne vulgaris (L70.0) 2 (0.1)
 Menstrual cramps (N94.6) 2 (0.1)
 Epigastric pain (R10.13) 2 (0.1)
 Generalized pain (R52) 2 (0.1)
 Postconcussion syndrome (F07.81) 1 (0.1)
 Tobacco abuse (F17.200) 1 (0.1)
 Thoracic outlet syndrome (G54.0) 1 (0.1)
 Other localized visual field defect (H53.452) 1 (0.1)
 Chronic nonsuppurative otitis media (H65.499) 1 (0.1)
 Perforation of tympanic membrane (H72.00) 1 (0.1)
 Acute maxillary sinusitis (J01.00) 1 (0.1)
 Chronic adenotonsillitis (J35.03) 1 (0.1)
 Constipation, unspecified (K59.00) 1 (0.1)
 Rib stiffness (M25.60) 1 (0.1)
 Postural kyphosis, thoracic region (M40.04) 1 (0.1)
 Other spondylosis with myelopathy, lumbar region (M47.16) 1 (0.1)
 Radiculitis, thoracic or lumbar (M54.15) 1 (0.1)
 Other synovitis and tenosynovitis (M65.80) 1 (0.1)
 Pyelonephritis (N12) 1 (0.1)
 Urinary tract infection (N39.0) 1 (0.1)
 Ehlers-Danlos syndrome (Q79.6) 1 (0.1)
 Dysphagia (R13.10) 1 (0.1)
 Rash and other nonspecific skin eruption (R21) 1 (0.1)
 Muscle fasciculation (R25.3) 1 (0.1)
 Fever (R50.9) 1 (0.1)
 Concussion (S06.0) 1 (0.1)
 Other complications due to other internal prosthetic device, implant, and graft (T85.898A) 1 (0.1)
 Unspecified fall, initial encounter (W19.XXXA) 1 (0.1)
a a
 Low back pain/lumbar sprain/strain (M53.87, M54.16, M54.30, M54.5, S33.9XXA) 186 (21.5)
 Neck pain/strain/sprain (M54.12, M54.2, S13.4XXA) 120 (13.9)
 Back pain/dorsalgia/thoracic pain/sprain/strain (M54.6, M54.89, M54.9, S23.3XXA) 113 (13.1)
 Tension/spinal/epidural/other headaches (G44.201, G44.209, G44.221, G44.229, G44.52, O29.4, O89.4, R51) 59 (6.8)
 Pregnancy (O00.0, O00.01, V22.1, V22.2, Z33.1, Z3A.28, Z3A.35) 58 (6.7)
 Chest discomfort/rib pain/costochodritis (M94.0, R07.89, R07.9, S23.41XA) 45 (5.2)
 Lower extremity pain/strain/sprain (M25.561, M25.562, M25.569, M25.579) 42 (4.9)
 Pain/sprain in upper extremity (M25.51, M25.539, M25.549, M75.50, S43.439A, S43.80XA, S46.912A, S63.8X9A, S66.811A) 40 (4.6)
 Hip/pelvis pain (M25.552, M25.559, M70.60, R10.2) 21 (2.4)
 Migraine (G43.009, G43.019, G43.10, G43.109, G43.909) 19 (2.2)
 Scoliosis (M41.115, M41.125, M41.129, M41.20. M41.9) 18 (2.1)
 Muscle spasm (M62.40, M62.838) 16 (1.9)
 Torticollis (M43.6) 14 (1.6)
 Pain/strain or sprain of sacrococcyx (M46.1, M53.3, M53.88, S33.8XXA) 14 (1.6)
 Thoracic outlet syndrome (G54.0) 12 (1.4)
 TMJ disorder (M26.60, M26.602) 9 (1.0)
 Car passenger injured in vehicle collision (V43.62XS) 9 (1.0)
 Spondylolisthesis/intervertebral disk disorder of lumbar region (M43.16, M51.06, M51.1, M51.36, M51.86) 8 (0.9)
 Numbness/paresthesia (R20.2, R20.9) 5 (0.6)
 Obesity (E66.01, E66.9, O99.212) 4 (0.5)
 Light-headedness (R42) 4 (0.5)
 Postconcussion syndrome (F07.81) 3 (0.3)
 Bell's palsy (G51.0) 3 (0.3)
 Carpal tunnel (G56.00, G56.01, G56.02) 3 (0.3)
 Occipital neuralgia (M54.81) 3 (0.3)
 Menstrual problems (N92.1, N94.3, N94.4) 3 (0.3)
 Postpartum blues/depression (O90.6) 3 (0.3)
 Abdominal pain/strain (R10.31, R10.9, S39.011S) 3 (0.3)
 Idiopathic thrombocytopenic purpura (D69.3) 2 (0.2)
 Upper respiratory infection/bronchitis (J06.9, J40) 2 (0.2)
 Pneumonia (J18.9) 2 (0.2)
 Anosmia (R43.0) 2 (0.2)
 Lipoma, unspecified site (D17.9) 1 (0.1)
 Entrapment of lateral cutaneous nerve of thigh (G57.10) 1 (0.1)
 Chronic pain due to trauma (G89.21) 1 (0.1)
 Aural vertigo (H81.319) 1 (0.1)
 Pharyngitis, acute (J02.9) 1 (0.1)
 Constipation (K59.00) 1 (0.1)
 Unequal leg length (M21.70) 1 (0.1)
 Pain in joint involving multiple sites (M25.50) 1 (0.1)
 Neuralgia and neuritis, unspecified (M79.2) 1 (0.1)
 Maternal care for breech presentation (O32.1XX0) 1 (0.1)
 Mild or unspecified preeclampsia (O14.0) 1 (0.1)
 Edema or excessive weight gain in pregnancy (O26.00) 1 (0.1)
 Heartburn (R12) 1 (0.1)
 Abnormal posture (R29.3) 1 (0.1)
 Seizure (R56.9) 1 (0.1)
 Brachial plexus lesions (S14.3XXA) 1 (0.1)
 Muscle strain (T14.90XA) 1 (0.1)
 Other specified complication of medical care, sequela (T88.8XXS) 1 (0.1)
 History of traumatic fracture (V15.51) 1 (0.1)

aAge categories: 1, term neonatal (birth-27 days); 2, infancy (28 days-12 months); 3, toddler (13-23 months); 4, early childhood (2-5 years); 5, middle childhood (6-11 years); 6, early adolescence (12-18 years); 7, late adolescence (19-21 years).

eAppendix 2.
All Reported Clinical Assessments Treated with Osteopathic Manipulative Medicine in an Outpatient Clinical Setting and Defined by the International Classification of Disease, Tenth Revision by Patient Encounter for Pediatric Patients by Defined Age Categories
Age Categorya No. (%)
Category 1 (n=67)
 Feeding difficulty (R63.3, P92.8, P92.9, F98.29) 26 (38.8)
 Plagiocephaly/cranial molding (Q67.3, M95.2) 13 (19.4)
 Abnormalities of skull and/or face bones (Q75.9) 7 (10.4)
 Cephalhematoma due to birth injury (P12.0) 4 (6.0)
 Torticollis (M43.6) 3 (4.5)
 Caput succedaneum (P12.81) 3 (4.5)
 Gastroesophageal reflux disease (GERD) (K21.9) 2 (3.0)
 Birthmark not otherwise specified (Q82.5) 1 (1.5)
 Constipation (K59.00) 1 (1.5)
 Contracture of left hip (M24.552) 1 (1.5)
 Failure to thrive (R62.51) 1 (1.5)
 Neonatal obstruction of right nasolacrimal duct (H04.531) 1 (1.5)
 Other congenital deformities of chest (Q67.8) 1 (1.5)
 Other injuries to skeleton due to birth trauma (P13.9) 1 (1.5)
 Perinatal jaundice from other excessive hemolysis (P58.8) 1 (1.5)
 Temporomandibular joint (TMJ) disorder (M26.609) 1 (1.5)
Category 2 (n=350)
 Plagiocephaly (Q67.3) 100 (28.6)
 Abnormalities of skull and/or face bones (Q75.9) 47 (13.4)
 Torticollis (M43.6, Q68.0) 42 (12.0)
 Colic/fussy infant (R10.83, R68.12) 34 (9.7)
 Feeding difficulty (P92.9, R63.3) 27 (7.7)
 Constipation (K59.00) 25 (7.1)
 GERD (K21.9) 23 (6.6)
 Injury to brachial plexus due to birth trauma (P14.3) 6 (1.7)
 Otitis media (H65.00, H65.499, H66.90) 5 (1.4)
 Ear pain (H92.09) 4 (1.1)
 Hip pain/dysfunction (M25.552, M25.651, M25.652) 3 (0.9)
 Spasm of muscle (M62.4) 3 (0.9)
 Down's syndrome (Q90.9) 3 (0.9)
 Cough (R05) 3 (0.9)
 Gas pain (R14.1) 3 (0.9)
 Upper respiratory infection (J06.9) 2 (0.6)
 Genu varum of knee (M21.161, M21.162) 2 (0.6)
 Other vomiting of newborn (P92.09) 2 (0.6)
 Congenital facial asymmetry (Q67.0) 2 (0.6)
 Hiccups (R06.6) 2 (0.6)
 Cervical strain (S13.4) 2 (0.6)
 Problems with head (V48.8) 2 (0.6)
 Oral thrush (B37.9) 1 (0.3)
 Nasolacrimal duct obstruction (H04.559) 1 (0.3)
 Dermatitis due to food taken internally (L27.2) 1 (0.3)
 TMJ disorder (M26.6) 1 (0.3)
 Other congenital deformities of chest (Q67.8) 1 (0.3)
 Bowing of leg (Q68.5) 1 (0.3)
 Congenital deformity of ankle (Q74.2) 1 (0.3)
 Strain of fascia at shoulder level of left arm, initial encounter (S46.912A) 1 (0.3)
Category 3 (n=36)
 Plagiocephaly (Q67.3) 14 (38.9)
 Otitis media (H65.91, H66.90, H66.91) 9 (25.0)
 Colic/fussy infant (R10.83, R68.12) 4 (11.1)
 TMJ disorder (M26.60) 2 (5.6)
 Abnormal posture (R29.3) 2 (5.6)
 Insomnia (G47.00) 1 (2.8)
 Otalgia, unspecified ear (H92.09) 1 (2.8)
 Torticollis (M43.6) 1 (2.8)
 Abnormality of gait (R26.9) 1 (2.8)
 Headache (R51) 1 (2.8)
Category 4 (n=81)
 Congenital anomaly of lower extremity (Q74.9, Q66.22, Q66.4) 11 (13.6)
 Lower extremity pain/sprain or strain (M25.579, M79.609, S86.919A) 8 (9.9)
 Abnormal involuntary movements (R25.9) 7 (8.6)
 Plagiocephaly (Q67.3) 6 (7.4)
 Headache (G44.209, R51) 5 (6.2)
 Neck pain/sprain or strain (M54.2, S13.4XXA) 5 (6.2)
 Back pain (M54.9) 5 (6.2)
 Constipation (K59.00) 4 (4.9)
 Attention deficit disorder of childhood with hyperactivity (F90.1) 3 (3.7)
 Dystonia (F24.9) 3 (3.7)
 Other seizures (G40.89) 3 (3.7)
 Otitis media (H65.00, H65.499) 3 (3.7)
 Cough (R05) 3 (3.7)
 Developmental speech articulation disorder (F80.0) 2 (2.5)
 Pharyngitis, acute (J02.9) 2 (2.5)
 Allergic rhinitis, cause unspecified (J30.9) 2 (2.5)
 Hip pain (M25.559) 2 (2.5)
 Difficulty in walking (R26.2) 2 (2.5)
 Other specific developmental learning difficulties (F81.89) 1 (1.2)
 Enuresis (F98.0) 1 (1.2)
 Acute upper respiratory infection, unspecified (J06.9) 1 (1.2)
 Wrist pain (M25.539) 1 (1.2)
 Low back pain (M54.5) 1 (1.2)
Category 5 (n=192)
 Headache (R51, G43.0, G43.009, G43.909, G44.1, G44.209, G44.219, G44.329, G44.89) 45 (23.4)
 Neck pain/strain/sprain (M54.2, S13.4XXA) 27 (14.1)
 Back pain/dorsalgia/thoracic pain (M54.9, M54.6) 18 (9.4)
 Leg/ankle/foot/limb pain (M25.5, M25.579, M79.606, M79.609, M25.561, M25.569, M25.571) 16 (8.3)
 Low back pain/strain (M54.5, S33.5XXA) 12 (6.3)
 Autism (F84.0) 10 (5.2)
 Chromosomal abnormality (Q99.9) 9 (4.7)
 Tourette syndrome (F95.2) 5 (2.6)
 Torticollis, unspecified (M43.6) 5 (2.6)
 Gait abnormality (R26.9) 5 (2.6)
 Enuresis (F98.0) 3 (1.6)
 Disturbances of vision (H53.16) 3 (1.6)
 Constipation (K59.0, K59.04) 3 (1.6)
 Strabismus (H50.9) 3 (1.6)
 TMJ disorder (M26.6, M26.629) 3 (1.6)
 Speech abnormality (R47.02) 3 (1.6)
 Attention-deficit/hyperactivity disorder (ADHD) of childhood (F90.9) 2 (1.0)
 Inguinal hernia (K40.90) 2 (1.0)
 Spasm of muscle (M62.4) 2 (1.0)
 Allergy to milk products/other foods (Z91.001, Z91.018) 2 (1.0)
 Hip/pelvis pain (M25.559, R10.2) 2 (1.0)
 Arm pain (M25.532, M79.602) 2 (1.0)
 Insomnia, unspecified (G47.00) 1 (0.5)
 Chondritis of external ear, bilateral (H61.033) 1 (0.5)
 Allergic rhinitis (J30.9) 1 (0.5)
 Epidermal cyst (L72.0) 1 (0.5)
 Disorders of sacrum (M53.3) 1 (0.5)
 Generalized abdominal pain (R10.84) 1 (0.5)
 Scoliosis (and kyphoscoliosis), idiopathic (M41.2) 1 (0.5)
 Sacroiliac pain (M53.88) 1 (0.5)
 Occipital neuralgia (M54.81) 1 (0.5)
 Jaw strain (S03.40XA) 1 (0.5)
Category 6 (n=1724)
 Low back pain/lumbar sprain/strain (M54.5, S33.5XXA, S33.5XXD, S33.8XXA, S33.9XXA, S39.012A) 331 (19.2)
 Back pain/dorsalgia/thoracic pain/sprain/strain (M54.6, M54.89, M54.9, S23.3XXA) 274 (15.9)
 Neck pain/strain/sprain (M53.82, M54.2, S13.4XXA, S19.9XXA) 258 (15.0)
 Lower extremity/knee/ankle/foot pain (M25.561, M25.562, M25.569, M25.571, M25.572, M25.579, M72.2, S86.919A) 163 (9.5)
 Cluster/tension/posttraumatic/other headache (G44.021, G44.029, G44.201, G44.209, G44.221, G44.229, G44.311, G44.319, G44.329, R51) 133 (7.7)
 Vertigo (H81.311, H81.319, R42) 86 (5.0)
 Pain/sprain in upper extremity (M25.51, M25.539, M75.50, M75.80, M77.00, M79.603, M79.641, M79.642, M79.644, S43.491S, S63.502A, S63.681S) 72 (4.2)
 Migraine (G43.001, G43.009, G43.10, G43.109, G43.111, G43.909) 55 (3.2)
 Rib/chest wall pain/strain/sprain/costochondritis (M94.0, R07.81, R07.89, R07.9, S23.41XA) 52 (3.0)
 Back muscle spasm (M62.40, M62.459, M62.830, M62.838) 46 (2.7)
 Hip/pelvic pain/sprain (M25.551, M25.552, M25.559, M70.60, R10.2, S73.109A) 40 (2.3)
 Scoliosis (M41.124, M41.30, M41.9) 26 (1.5)
 TMJ disorder/abnormal jaw closure (M26.51, M26.60) 22 (1.3)
 Sacroiliitis/sacroiliac/sacrococcygeal pain (M46.1, M53.3) 15 (0.9)
 Pregnant state, incidental (V22.2, Z33.1) 14 (0.8)
 Torticollis (M43.6) 10 (0.6)
 Unequal leg length (M21.70, Q72.811, Q72.812) 10 (0.6)
 Epilepsy (G40.90) 7 (0.4)
 Nausea and vomiting (R11.2) 7 (0.4)
 ADHD (F90.0, F90.2, F90.9) 6 (0.3)
 Pain in unspecified joint(s) (M25.50) 6 (0.3)
 Nocturnal enuresis (N39.44) 6 (0.3)
 Obesity (E66.01, E66.9) 5 (0.3)
 Atypical facial pain (G50.1) 5 (0.3)
 Connective tissue disease (M35.9) 5 (0.3)
 Spondylosis/spondylolisthesis (M43.06, M43.16) 5 (0.3)
 Occipital neuralgia (M54.81) 5 (0.3)
 Abnormal posture (R29.3) 4 (0.2)
 Skull fracture (S02.2XXS, S02.91XS) 4 (0.2)
 Dislocated TMJ (S03.0XXA, S03.0XXD) 4 (0.2)
 Autism spectrum disorder (F84.0) 3 (0.2)
 Upper respiratory infection/pneumonia/upper respiratory disease (J06.9, J18.9, J39.9) 3 (0.2)
 Myalgia (M79.1) 3 (0.2)
 Driver injured in collision with other motor vehicles (V43.62XS, V49.49XA, V49.49XD) 3 (0.2)
 Tourette's disorder (F95.2) 2 (0.1)
 Asthma (J45.90, J45.909) 2 (0.1)
 Acne vulgaris (L70.0) 2 (0.1)
 Menstrual cramps (N94.6) 2 (0.1)
 Epigastric pain (R10.13) 2 (0.1)
 Generalized pain (R52) 2 (0.1)
 Postconcussion syndrome (F07.81) 1 (0.1)
 Tobacco abuse (F17.200) 1 (0.1)
 Thoracic outlet syndrome (G54.0) 1 (0.1)
 Other localized visual field defect (H53.452) 1 (0.1)
 Chronic nonsuppurative otitis media (H65.499) 1 (0.1)
 Perforation of tympanic membrane (H72.00) 1 (0.1)
 Acute maxillary sinusitis (J01.00) 1 (0.1)
 Chronic adenotonsillitis (J35.03) 1 (0.1)
 Constipation, unspecified (K59.00) 1 (0.1)
 Rib stiffness (M25.60) 1 (0.1)
 Postural kyphosis, thoracic region (M40.04) 1 (0.1)
 Other spondylosis with myelopathy, lumbar region (M47.16) 1 (0.1)
 Radiculitis, thoracic or lumbar (M54.15) 1 (0.1)
 Other synovitis and tenosynovitis (M65.80) 1 (0.1)
 Pyelonephritis (N12) 1 (0.1)
 Urinary tract infection (N39.0) 1 (0.1)
 Ehlers-Danlos syndrome (Q79.6) 1 (0.1)
 Dysphagia (R13.10) 1 (0.1)
 Rash and other nonspecific skin eruption (R21) 1 (0.1)
 Muscle fasciculation (R25.3) 1 (0.1)
 Fever (R50.9) 1 (0.1)
 Concussion (S06.0) 1 (0.1)
 Other complications due to other internal prosthetic device, implant, and graft (T85.898A) 1 (0.1)
 Unspecified fall, initial encounter (W19.XXXA) 1 (0.1)
a a
 Low back pain/lumbar sprain/strain (M53.87, M54.16, M54.30, M54.5, S33.9XXA) 186 (21.5)
 Neck pain/strain/sprain (M54.12, M54.2, S13.4XXA) 120 (13.9)
 Back pain/dorsalgia/thoracic pain/sprain/strain (M54.6, M54.89, M54.9, S23.3XXA) 113 (13.1)
 Tension/spinal/epidural/other headaches (G44.201, G44.209, G44.221, G44.229, G44.52, O29.4, O89.4, R51) 59 (6.8)
 Pregnancy (O00.0, O00.01, V22.1, V22.2, Z33.1, Z3A.28, Z3A.35) 58 (6.7)
 Chest discomfort/rib pain/costochodritis (M94.0, R07.89, R07.9, S23.41XA) 45 (5.2)
 Lower extremity pain/strain/sprain (M25.561, M25.562, M25.569, M25.579) 42 (4.9)
 Pain/sprain in upper extremity (M25.51, M25.539, M25.549, M75.50, S43.439A, S43.80XA, S46.912A, S63.8X9A, S66.811A) 40 (4.6)
 Hip/pelvis pain (M25.552, M25.559, M70.60, R10.2) 21 (2.4)
 Migraine (G43.009, G43.019, G43.10, G43.109, G43.909) 19 (2.2)
 Scoliosis (M41.115, M41.125, M41.129, M41.20. M41.9) 18 (2.1)
 Muscle spasm (M62.40, M62.838) 16 (1.9)
 Torticollis (M43.6) 14 (1.6)
 Pain/strain or sprain of sacrococcyx (M46.1, M53.3, M53.88, S33.8XXA) 14 (1.6)
 Thoracic outlet syndrome (G54.0) 12 (1.4)
 TMJ disorder (M26.60, M26.602) 9 (1.0)
 Car passenger injured in vehicle collision (V43.62XS) 9 (1.0)
 Spondylolisthesis/intervertebral disk disorder of lumbar region (M43.16, M51.06, M51.1, M51.36, M51.86) 8 (0.9)
 Numbness/paresthesia (R20.2, R20.9) 5 (0.6)
 Obesity (E66.01, E66.9, O99.212) 4 (0.5)
 Light-headedness (R42) 4 (0.5)
 Postconcussion syndrome (F07.81) 3 (0.3)
 Bell's palsy (G51.0) 3 (0.3)
 Carpal tunnel (G56.00, G56.01, G56.02) 3 (0.3)
 Occipital neuralgia (M54.81) 3 (0.3)
 Menstrual problems (N92.1, N94.3, N94.4) 3 (0.3)
 Postpartum blues/depression (O90.6) 3 (0.3)
 Abdominal pain/strain (R10.31, R10.9, S39.011S) 3 (0.3)
 Idiopathic thrombocytopenic purpura (D69.3) 2 (0.2)
 Upper respiratory infection/bronchitis (J06.9, J40) 2 (0.2)
 Pneumonia (J18.9) 2 (0.2)
 Anosmia (R43.0) 2 (0.2)
 Lipoma, unspecified site (D17.9) 1 (0.1)
 Entrapment of lateral cutaneous nerve of thigh (G57.10) 1 (0.1)
 Chronic pain due to trauma (G89.21) 1 (0.1)
 Aural vertigo (H81.319) 1 (0.1)
 Pharyngitis, acute (J02.9) 1 (0.1)
 Constipation (K59.00) 1 (0.1)
 Unequal leg length (M21.70) 1 (0.1)
 Pain in joint involving multiple sites (M25.50) 1 (0.1)
 Neuralgia and neuritis, unspecified (M79.2) 1 (0.1)
 Maternal care for breech presentation (O32.1XX0) 1 (0.1)
 Mild or unspecified preeclampsia (O14.0) 1 (0.1)
 Edema or excessive weight gain in pregnancy (O26.00) 1 (0.1)
 Heartburn (R12) 1 (0.1)
 Abnormal posture (R29.3) 1 (0.1)
 Seizure (R56.9) 1 (0.1)
 Brachial plexus lesions (S14.3XXA) 1 (0.1)
 Muscle strain (T14.90XA) 1 (0.1)
 Other specified complication of medical care, sequela (T88.8XXS) 1 (0.1)
 History of traumatic fracture (V15.51) 1 (0.1)

aAge categories: 1, term neonatal (birth-27 days); 2, infancy (28 days-12 months); 3, toddler (13-23 months); 4, early childhood (2-5 years); 5, middle childhood (6-11 years); 6, early adolescence (12-18 years); 7, late adolescence (19-21 years).

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