RE: Review of chiropractic spinal care for children under 12 years
The Australian Medical Association (AMA Victoria) appreciates the opportunity to respond to the Safer Care Victoria (SCV) consultation on chiropractic manipulation of children under 12 years.
The AMA is pleased that SCV has decided to review this practice which is manifestly unsafe and unwarranted.
Chiropractic spinal manipulation on children has received recent media attention and prompted community concerns about its safety, appropriateness and the professional duties of those undertaking it. Most notably, in February this year medical experts and the Victorian Government condemned the controversial practice of infant spine manipulation after footage emerged of a Melbourne chiropractor treating a two-week old baby on the chiropractor’s own site.
Treatment of infants and very young children
We are aware that chiropractors are treating children for problems such as “infantile colic” by manipulative therapies. There is no credible evidence for this, it is a dangerous practice in itself and it potentially impedes the proper assessment and management of an infant. Additionally, it preys on often tired parents by the promise of a frequently false unequivocal diagnosis and false “quick fix”. This is plainly unconscionable and dangerous behaviour.
In preparing our response, we engaged with doctors across many specialities who have offered valuable insights into the matters being considered as part of this review. It is our very firm view that the risk of undertaking spinal manipulation on small infants is of no benefit and is potentially extremely dangerous. Newborn babies are extremely fragile and AMA Victoria warns that damage done to a baby or infant may not be immediately obvious to parents, and may not manifest until many years later. This is supported by a study conducted by the American Academy of Pediatrics [1] which found serious adverse events may be associated with paediatric spinal manipulation.1
Another critical issue is that it is very unlikely that parents are providing informed consent to such procedures. For parents to provide informed consent, they would need to be fully advised of the risks including, for example:
• the diagnosis of “infant colic” is a catch all for a range of symptoms with different aetiologies;
• the potential drastic short and long term consequences of spinal manipulation on their baby;
• there are no scientific safety and efficacy studies undertaken; and
• there is no credible scientific evidence for manipulation.
Chiropractors should also be directing parents to general practitioners for the proper holistic assessment and care of the child and family.
Additionally, infants and very young children cannot provide assent for a procedure for which there is no evidence they require and which may leave them with long term consequences. Consideration of whether such potentially dangerous therapies, which are not underpinned by a strong evidence-base, should be supported by private health insurance rebates is also warranted.
Treatment of children under 12 years of age
Although there is limited evidence that some musculoskeletal treatments are effective in adults, there is no credible scientific evidence that manipulation, mobilisation or any applied spinal therapy in children under 12 years of age is warranted or safe.
AMA Victoria does not support clinical interventions unless there is scientific evidence that such treatments are useful in treating the illness. AMA Victoria also supports patients being fully informed on the illness and the risks and benefits to any treatment. When the risks are to be borne by a non-assenting child, the requirement of evidence and consent is especially important.
AMA Victoria strongly advocates that chiropractic (and other health professionals) spinal care for children under 12 years of age is dangerous, unwarranted and must cease immediately.
If you would like to discuss any aspect of our response, please contact Ms Nada Martinovic, Senior Policy Advisor on (03) 9280 8773 or [email protected].
Yours sincerely
Associate Professor Julian Rait OAM AMA VICTORIA PRESIDENT
1 Sunita, V., et al., Adverse Events Associated with Pediatric Spinal Manipulation: A Systemic Review, Pediatrics, 2007: 119; 275-283.
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I am truly delighted that the AMA Victoria agrees with many points I have tried to make previously (see for instance here, here and here). The statement is unsurpassed in its directness and strength. My congratulations to Prof Raith – very well done!
Let’s hope that professional bodies of other regions and counties will swiftly follow suit with equal clarity.
5 Responses to Chiropractic spinal care for children is dangerous, unwarranted and must cease immediately
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Now this is a bold statement:
“AMA Victoria does not support clinical interventions unless there is scientific evidence that such treatments are useful in treating the illness.”
I have a feeling that DC is making a disingenuous statement about orthodox medicine But I have to agree to an extent that when medical bodies try to criticise alternative medicine on the basis it isn’t evidence-based they are leaving themselves open to criticism when questions are raised about the evidence base for some orthodox practices, especially historically.
Criticisms of alternative medicine, such as in this report, shouldn’t simply stop at ‘evidence’ but should always consider the a priori plausibility of any treatment as well. It’s one thing to find that a previously accepted medical intervention has been found to be ineffective following further investigation, it is quite another to find that a nonsensical, scientifically implausible, even impossible practice such as chiropractic is being used in any circumstance, particularly in vulnerable groups such as children and animals.
Niall
With regard to a priori plausibility and “nonsensical, scientifically implausible, even impossible practice such as chiropractic”, the UK chiropractor regulator, the General Chiropractic Council (which doesn’t cover scope of practice) has guidance for chiropractors that states “The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model” https://www.gcc-uk.org/assets/publications/subluxationstatement2017.pdf
It seems to allow chiropractors in the UK to have free rein.
Oh, I just think they will look back on their letter and think…we should have worded, or at least been more clear, on some aspects.
What was surprising is that no chiropractic university academics were appointed to the Safe Care Victoria review.
The resulting review by medical experts was detailed and balanced. Which was surprising and it discussed all the manual therapies not just chiropractic.
Subsequently, the Victorian health minister did not gain support from the other state health ministers at their annual COAG meeting.
That must sting after all her previous public statements prior to the review.