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

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:

  • headache
  • asthma
  • otitis media
  • cerebral palsy
  • hyperactivity disorders
  • torticollis.

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.

7 Responses to Chiropractic spinal manipulation of children: an independent review

  • “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.”

    Could this be because these get better with development? Nah. Better to attribute it to something that has no plausible mechanism that would account for these results.

  • What is going on here?

    Given that the evidence of benefit from spinal manipulation (let alone the implausibility that there would or could be any benefit), is so weak – virtually zero, why would any conscientious chiropractor want to manipulate a child’s neck?

    Come to that, why would any parent take a child to a practitioner who would want to do that?
    Whence commeth their belief?

    • It may be that there are very few, according to the report, that are actually doing spinal manipulation…

      “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.”

      “This means that children, particularly very young children, under the care of an Australian chiropractor are not likely to be receiving high impact manipulations.”

      Why would those few do it? My thought is that it is “philosophy-based”.

  • Just a few comments on Facebook in regards to a show on TV from Australia.

    My comment to Sunday TVNZ – Your segment attempting to show Chiropractic for children as a dangerous and unsafe practice was appalling. I expect that level
    of “journalism” in Australia – but not here. I guess in only showing one side, you failed to investigate the most recent “Safer Care Victoria” review.
    Let me enlighten you….
    “Appalling”, “deeply disturbing”, “young children and infants are being exposed to potential harm” from “risky practices”. This is how the Victorian Health Minister described the Chiropractic care of children back in February.
    In May, the Victorian Minister announced a government review of Chiropractic care for children under 12 years old by saying, “Now is the time for parents who have experienced the dangerous practice of child spinal manipulation to have a say and share their story”.
    And so they did.
    21,874 people wrote submissions to the government, in the biggest public response of its kind in the history of Victoria.
    Submissions were also received from the Australian Medical Association, the Royal Australian College of GPs and other professional bodies who have historically opposed the Chiropractic profession.
    There was NOT ONE example of a serious adverse event involving the Chiropractic care of a child in Australia in any of those tens of thousands of submissions.
    More than that, Chiropractic professional indemnity insurance records were searched and not a single case of injury involving a child was found. NOT ONE!
    An amazing 98% of submissions said that Chiropractic care had been HELPFUL in their child’s health care.
    It turns out that the Health Minister was way off the mark.
    98% reported positive outcomes !!!!!!!!
    Where was this in your segment?
    I will also attach footage of Mr Cunningham explaining that he has not witnessed anything dangerous or unsafe, and that Simon (Floreani) is obviously a very kind and caring practitioner.
    https://youtu.be/5c12nse47WM
    Hide or report this
    Surgeon admits he’s seen “nothing dangerous” with Paediatric Chiropractic
    YOUTUBE.COM
    Surgeon admits he’s seen “nothing dangerous” with Paediatric Chiropractic

  • The Safer Care Victoria report was balanced which was a surprise.
    It discusses all the manual therapy professions just not chiropractic.
    Not one chiropractic university academic was included yet Friends of Science of Medicine got one of their allies onboard.
    The medical reviewers did a thorough impartial job.
    The Victorian health minister put out several negative press reports prior to the review and was primed to present it to the other state health ministers at the recent annual COAG meeting but she failed to table it as she got no support from the other health ministers.
    Bet she was pee’d off big time.

  • It is of course very important to recognise that in many jurisdictions fully qualified and experienced physiotherapists (as opposed to alternative healthcare givers) who have a specialism of assistance with cerebral palsy or those with spastic issues in terms of limb control or range of movement restriction are engaged primarily in establishing base lines to assess progress or regress of the condition. These professionals would be the first to say that there is no or very little progress to be had via simple manipulation or exercise as the control issues are neuro-physiological not skeletal. If there are skeletal malformations they are congenital and are not ones that can or should be tackled by any degree of force or so called manipulation. That is not to say that there is no benefit in “exercises” for general well being but that a complete program devised by a true qualified physio and perhaps as part of a MDT is the only path toward alleviation of these conditions. There is a sinister arm to some alternative healthcare providers who would seek to manipulate the desire in the parents to see improvement in chronic pediatric conditions perhaps more than any other. We must make these people aware that they will be held accountable.

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