MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

I would warn every parent who thinks that taking their child to a chiropractor is a good idea. For this, I have three main reasons:

  1. Chiropractic has not been shown to be effective for any paediatric condition.
  2. Chiropractors often advise parents against vaccinating their children.
  3. Chiropractic spinal manipulations can cause harm to kids.

The latter point seems to be confirmed by a recent PhD thesis of which so far only one short report is available. Here are the relevant bits of information from it:

Katie Pohlman has successfully defended her PhD thesis, which focused on the assessment of safety in pediatric manual therapy. As a clinical research scientist at Parker University, Dallas, Texas, she identified a lack of prospective patient safety research within the chiropractic population in general and investigated this deficit in the paediatric population in particular.

Pohlman used a cross-sectional survey to assess the barriers and facilitators for participation in a patient safety reporting system. At the same time, she also conducted a randomized controlled trial comparing the quantity and quality of adverse event reports in children under 14 years receiving chiropractic care.

The RCT recruited 69 chiropractors and found adverse events reported in 8.8% and 0.1% of active and passive surveillance groups respectively. Of the adverse events reported, 56% were considered mild, 26% were moderate and 18% were severe. The frequency of adverse events was more common than previously thought.

This last sentence from the report is somewhat puzzling. Our systematic review of the risks of spinal manipulation showed that data from prospective studies suggest that minor, transient adverse events occur in approximately half of all patients receiving spinal manipulation. The most common serious adverse events are vertebrobasilar accidents, disk herniation, and cauda equina syndrome. Estimates of the incidence of serious complications range from 1 per 2 million manipulations to 1 per 400,000. Given the popularity of spinal manipulation, its safety requires rigorous investigation.

The 8.8% reported by Pohlman are therefore not even one fifth of the average incidence figure reported previously in all age groups.

What could be the explanation for this discrepancy?

There are, of course, several possibilities, including the fact that infants cannot tell the clinician when their pain has increased. However, the most likely one, in my view, lies in the fact that RCTs are wholly inadequate for investigating risks because they typically include far too few patients to generate reliable incidence figures about adverse events. More importantly, clinicians included in such studies are self-selected (and thus particularly responsible/cautious) and are bound to behave most carefully while being part of a clinical trial. Therefore it seems possible – I would speculate even likely – that the 8.8% reported by Pohlman is unrealistically low.

Having said that, I do feel that the research by Kathie Pohlman is a step in the right direction and I do applaud her initiative.

21 Responses to Severe adverse effects of chiropractic in children

  • You continue to put the finest of points on this. It certainly seems reasonable to suggest only thieves, reprobates or morons can continue to refer to themselves as chiropractors.
    “Pretending to get sick people well since 1895”…Indeed, people sick of carrying around excess money.

    • @Michael Kenny
      Your many previous posts would indicate that you are a Physiotherapist.
      How would you describe one health profession saying this “only thieves, reprobates or morons can continue to refer to themselves as chiropractors” of another health profession?
      Unprofessional is the politest term I can use to describe your comments.

      • @ CC: Oh sorry I forgot the word fraud.

        • As a Physiotherapist @Michael Kenny you are subject to a professional code of conduct.
          Being anonymous on this blog does not change that in any way or absolve you of your professional responsibility.
          And now you double down with “fraud”?
          Unimpressed.
          I have a great deal of respect for many physio’s who I work with, associate with, share research with and refer. Pity they are being dragged down by your unprofessional comments.
          The physio’s in Australia are leading the physio world in research which is great to see especially as we are such a small country. They are shaking up the status quo within your profession and as an Australian I’ am proud of their achievements. When I discuss research with them they are professional and courteous. You could learn from them.

  • Yes, the self selection could affect the result. Also the chiropractors may be unaware of adverse effects or may be reluctant to report them.

  • As a Parker University graduate (Class of 2015) I can say I’ve never heard of Dr. Pholman until today when a patient brought up this article, And being that I’m a D.C. who trained/interned with ICPA (International Chiropractic Pediatric Association) certified doctors, and continues to assess and treat the pediatric population at my own practice, I’ve decided to do a little digging.

    Dr. Katie Pholman has not yet published ANY evidence showing that chiropractic is dangerous or ineffective in pediatric population.

    Fact: 1)There are no conclusive studies published with JAMA, NCBI, or the NIH showing any evidence mild or otherwise that Chiropractic Manipulative Therapy (CMT) AKA Adjustments causes any irreparable damage(VAD, VBAI, etc) in pediatric or adult populations. 2) There are multiple studies which you can find on the ICPA website , and elsewhere, showing clinical studies on chiropractic and children with Otitis media, colic, and other conditions that do show strong scientific evidence of the effectiveness of chiropractic care.3) While some chiropractors, including myself don’t agree with the current vaccine schedule… Due to lack of unbiased, 3rd party research not paid for by vaccine manufacturers or laboratories affiliated with those companies… I tell parents who ask about vaccination to do research and point them to GOOD research.

    As a so called clinician you should be ashamed of your cherry picked data from multiple unrelated resources and the misinformation you so irresponsibly spread.

  • EE: “The 8.8% reported by Pohlman are therefore not even one fifth of the average incidence figure reported previously in all age groups.

    What could be the explanation for this discrepancy?”

    Perhaps because the approach is modified?

    https://www.researchgate.net/publication/304397086_Forces_of_Commonly_Used_Chiropractic_Techniques_for_Children_A_Review_of_the_Literature

  • WHAT?!
    So basically this article was written as a biased piece against chiropractic care.
    Talk to a Maximized Living chiropractic doctor. They did what western medicine couldn’t. The. End.

  • I love to see research on chiropractic, one way or the other, just because so little of it exists. However, is it really worth talking about a thesis? Let’s stick to the published literature?

    • there are 7650 Medline-listed papers on the subject of chiropractic;
      and yes, it is worth discussing a PhD thesis; most likely, it is better than the average piece of chiro-research.

  • As a graduate of Parker College of Chiropractic myself (2008) and a third generation chiropractor in my family, I nor my father or grandfather have ever had any kind of adverse effects adjusting children of all ages including newborns. So there’s about 80 something years of clinical research right there. We’ve had good results for things like bedwetting, allergies, ear infections, eczema you name it as well as the typical musculoskeletal issues that children have. This article is the biggest load of garbage and clearly just a hit piece on chiropractors. I’ve never heard of the author and don’t understand the ire towards an entire profession that they clearly know nothing about. But, let’s look to the other side of the coin here. I have Lyme disease. I went to medical doctors for help with it because I was told you HAVE to go the medical route for this disease. Every doctor I went to injured me severely with medication errors galore. I was really amazed at the lack of knowledge about the disease and the nonchalantness of the doctors/nurses that gave the medications incorrectly that left me disabled! I’m also a nurse and, if I ever gave a medication wrong and injured a patient, I would have quit the profession! It took a chiropractor using a protocol that I now use myself called the Lebowitz protocol to get me well after a year and a half of just being made worse and worse by medical doctors. I went from being bed bound to back to work in two months. I’m still in a wheelchair most of the time thanks to the damage done to me by medication and medical doctors well, a nurse practitioner actually put me in the chair. I’ve been in it for another year and a half and still trying to find a miracle to fix my legs. I’m sure it won’t be an MD that finds the key. All they seem to do is cause more damage. SO, you want to complain about a profession you know nothing about… Well, I don’t know one single chiropractor that has ever put anyone in a wheelchair so put that in your pipe and smoke it doc. I honestly feel like all the hate towards us is because MDs know that if people knew the truth about chiropractic that they would eventually be phased out. I must say I was appalled at my experience as a patient. MDs don’t listen, many would tell me I didn’t even have Lyme when I had extensive testing done that proved I did. They seemed pretty clueless about my condition. Especially the n.p. who made me bed bound twice with inappropriate drugs. I had to be my own doctor, nurse, scheduler, secretary, etc. I kept wondering when do I get to be the patient? I never really did. And became so scared of them, I now will NEVER go back I don’t care if my leg falls off, I’ll go to a chiropractor.

    • your ‘results’ could be due to placebo, regression towards the mean, natural history of the condition, etc.
      the lack of adverse effects is not credible; even placebo has more that zero.
      the ‘hit piece’ comes from a chiro-newsletter.
      I am glad your your Lyme disease got better; regression towards the mean, natural history of the condition? anecdotes are not evidence.

    • Christian Blanchard wrote: “As a graduate of Parker College of Chiropractic myself (2008) and a third generation chiropractor in my family, I nor my father or grandfather have ever had any kind of adverse effects adjusting children of all ages including newborns.”

      @ Christian Blanchard

      How do you know that? What about customers who never returned?

      Christian Blanchard wrote: “I don’t know one single chiropractor that has ever put anyone in a wheelchair”

      Do you mean that you personally don’t know of any who have? I ask because this is someone who was put in a wheelchair by a chiropractor and wrote a book about it using a headstick:
      https://www.amazon.com/Locked-But-Not-Out-Courage/dp/1427647488

      Background here: https://tinyurl.com/yd66rk7z

    • “.. .if people knew the truth about chiropractic that they would eventually be phased out.”

      I agree. It seems logical that if people knew, chiros would be phased out.

      Three generations of anecdotes are still just anecdotes, Christian.

      Sorry about your lyme disease but again, doctors missing the diagnosis is still just anecdotal. And from a suspicious source—you—as well.

      As for Lebowitz, I just looked through his website and some of his writing. My eyes started burning. I think it’s a voo doo hex emanating from the screen that affects people who, unlike him, believe in science.

  • There are videos of research done to prove or disprove that chiropractic adjustment could cause the “pinched nerve” that was so popular in the past. They applied different kinds of force to cadaver spines much more than an adjustment. They could not move a segment enough to entrap a nerve. They went even further. The spines broke without herniating a disc. So you are claiming cauda equina and herniated discs? Where’s YOU’RE proof. There’s none in this article. The author just states it without any evidence. And the CVA thing has been disproven years ago. The number was less than .10% and they included people that had the incident up to three days after an adjustment. More people have strokes going to the bathroom. So, that one is definitely out. Your credibility is paper thin here. So, you were saying?

  • “The author just states it without any evidence.”

    Yes, you did.

    A more important question, Christian. Do I now have to worry about having a stroke when I go to the bathroom? Evidence, dammit, evidence!

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