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Recognition of musculoskeletal problems in infants by Norwegian public health nurses: a cross-sectional survey

Gyda Thorsen Nervik, 2015


Background: Recent research shows an increase in paediatric musculoskeletal (pMSK) problems. Public health nurses (PHNs) in Norway meet almost all infants through the public health clinics and there is little information available on their procedures with regards to musculoskeletal problems in infants.


Objectives: The aim of this study was to investigate the procedures of PHNs working in public health clinics in Norway when recognising musculoskeletal problems in infants. PHNs and parents presenting their child to chiropractic clinics in Norway were asked questions about public health nurses’ recognition, recommendations and referrals with regards to pMSK problems.


Design: Cross-sectional study design.


Methods: An online questionnaire was created using the Survey Monkey website and was sent to public health nurses working in public health clinics throughout Norway. A paper-based questionnaire was handed out to parents presenting their infant to four chiropractic clinics in Norway. Data were analysed using Survey Monkey and Microsoft Excel for descriptive statistics.


Subjects: 231 out of 475 responses were received from the public health nurse survey. Of these, 225 worked as public health nurses. 58 parent questionnaires were collected.


Results: The response rate for the public health nurse survey was 48.6%. Most PHNs were between 50-59 years (37.9%) or 40-49 years (36.2%) and the majority of respondents worked in the Eastern part (30.5%) and Northern part (23.3%) of Norway. 93% of PHNs recognised a musculoskeletal problem when the infant prefers to look/sleep to one particular side, and 80.4% recognise breastfeeding difficulties (particularly on one breast) as a MSK problem. The majority of PHNs recommend counter-positioning to parents whose infant has a MSK problem (87.7%); just over half recommend tummy time (58.8%). 42.1% of PHNs replied that they do not know whether there they see an association between assisted births and paediatric MSK problems. 46.7% often refer pMSK cases to specialists, while 48.1% refer depending on the critical nature of the problem. The majority of PHNs refer pMSK cases to physiotherapists (61.9%), 1.9% refer to chiropractors. Most PHNs never (40.4%) or rarely (37.5%) use the KISS/KIDD diagnosis when explaining pMSK problems to parents. Parents participating in the parent survey were mainly from the Western (48.3%) or Eastern (39.7%) parts of Norway. The majority of infants presenting to chiropractic clinics in Norway were in the 0-3 months age group (62.1%). 55.2% of parents reported that their child had a MSK problem and 51.4% answered that the PHN had not recognised this problem in their child. 44.8% of parents had not received any advice for MSK problems from the PHN, however 31% were advised to practice counter-positioning. Half of the parents had sought help for the MSK problem without being referred from the PHN or doctor, and 14.6% had been referred by the PHN. Of these, 41.7% had been referred to a chiropractor.


Conclusion: PHNs in Norway readily recognise MSK problems in infants, give advice about counter-positioning and often refer pMSK cases to physiotherapists. These findings are not completely supported by parents, as the majority reported that they had not been referred to a specialist by the PHN, had not received any advice and the PHN did not recognise the MSK problem in their infant. However, the results were not ideal for comparison due to low response in the parent survey.

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