Having mentioned the report on chiropractic for children by SAVER CARE VICTORIA (SCV) several times before, I now better reveal its contents. Here are important excerpts from it, but I encourage everyone to read the full document:
Review of evidence of harm
An extensive search was undertaken to identify evidence of harm sustained by children who had received spinal manipulation. This included a literature review by Cochrane Australia, capture of patient complaints and practitioner notification data from Australian complaints and regulatory agencies, capture of Australian insurance claim data from the primary insurers for registered chiropractors, and stakeholder feedback from both online consultations. This extensive search identified very little evidence of patient harm occurring in Australia. In particular, there were no patient complaints or practitioner notifications that arose from significant harm to a child following spinal manipulation.
Three individual case reports were the only evidence of serious harm identified. Each of these reports related to spinal manipulative techniques performed outside of Australia and not limited to chiropractors. The practices described in these reports are not reflective of Australian chiropractic techniques. This does not mean spinal manipulation in children is not associated with any risk of any adverse effects. An extensive literature review did identify transient or minor adverse events but the prevalence was very low, albeit possibly more common in very young children.
There are two principle reasons why the search did not find strong evidence of harm in Australia. First, it is unlikely that spinal manipulation, as defined within the scope of the review, is a technique that is being routinely applied in Australia to young children or those with an immature spine. Second, skilled chiropractic care requires the practitioner to modify the force applied based on the age and developmental stage of the child. This means that children, particularly very young children, under the care of an Australian chiropractor are not likely to be receiving high impact manipulations.
Nonetheless, it is clear that spinal manipulation in children is not wholly without risk. Any risk associated with care, no matter how uncommon or minor, must be considered in light of any potential or likely benefits. This is particularly important in younger children, especially those under the age of 2 years in whom minor adverse events may be more common.
Review of evidence of effectiveness
SCV commissioned Cochrane Australia to undertake a systematic review of the effectiveness and safety of spinal manipulation of children under 12 years for any condition or symptom, irrespective of the profession providing treatment.
The major finding of this review is that the evidence base for spinal manipulation in children is very poor. In particular, no studies have been performed in Australia.
Specifically, the comprehensive review of the literature failed to identify any strong evidence for the effectiveness of spinal manipulation for a variety of conditions for which children are widely offered chiropractic manipulations. These conditions included colic, enuresis, back/neck pain, headache, asthma, otitis media, cerebral palsy, hyperactivity and torticollis.
There was low certainty (weak) evidence that spinal manipulation may be beneficial for modestly reducing crying time in children with colic, or for reducing the number of wet nights in children with enuresis. For both conditions the evidence was also consistent with either no or worsening effects.
For the other conditions – headache, asthma, otitis media, cerebral palsy, hyperactivity, and torticollis – there was no evidence that spinal manipulation was effective.
Based on this review of effectiveness, spinal manipulation of children cannot be recommended for:
- otitis media
- cerebral palsy
- hyperactivity disorders
The possible, but unlikely, benefits of spinal manipulation in the management of colic or enuresis should be balanced by the possibility, albeit rare, of minor harm.
As pointed out repeatedly, one reason for not finding many reports of adverse effects might be very simple: UNDER-REPORTING! In any case, no good evidence for benefit + a finite risk = a negative risk/benefit balance. And a negative risk/benefit balance, of course, means that we should advise against chiropractic spinal manipulation for children. I am pleased to report that SCV agree; their 1st recommendation is: spinal manipulation … should not be provided to children under 12 years of age.