If you assumed that the best management of a child by chiropractors is not to treat this patient and refer to a proper doctor, think again. This paper was aimed at building upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Its authors composed a best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. They thus syntheized results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process.
The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed the following aspects of the clinical encounter:
- patient communication, including informed consent;
- appropriate clinical history, including health habits;
- appropriate physical examination procedures;
- red flags/contraindications to chiropractic care and/or spinal manipulation;
- aspects of chiropractic management of pediatric patients, including infants;
- modifications of spinal manipulation and other manual procedures for pediatric patients;
- appropriate referral and comanagement;
- appropriate health promotion and disease prevention practices.
The authors concluded that this set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.
Whenever I read the term ‘evidence-informed’ I need to giggle. Why not evidence-based? Evidence-informed might mean that chiros are informed that their treatments are useless or even dangerous for children … but, on reflection and taking their own need for earning a living, they subsequently ignore these facts. And sure enough, the authors of the present paper do mention that a Cochrane review concluded that spinal manipulation is not recommended for children under 12, for a number of conditions, or for general wellness … only to then go on and ignore the very fact.
In doing so, the authors issue a string of self-evident platitudes which occasionally border on the irresponsible. For instance, under the heading of ‘primary prevention’, vaccinations are mentioned as the very last item with the following words:
If parents ask for advice or information about childhood vaccinations, explain that they have the right to make their own health decisions. They should be adequately informed about the benefits and risks to both their child and the broader community associated with these decisions. Consider referral to a health professional whose scope of practice includes vaccinations to address patient questions or concerns.
What that really means in practice, I fear, might be summarized like this: If parents ask for advice or information about childhood vaccinations, explain that they are dangerous, and that even D. D. Palmer recognized as early as 1894 that vaccination is ‘…the monstrous delusion … fastened on us by the medical profession, enforced by the state boards, and supported by the mass of unthinking people …’
Altogether, the ‘Clinical Practice Guideline for Best Practice Management of Pediatric Patients by Chiropractors’ is a thoroughly disreputable document. It was constructed in the way all charlatans tend to construct their consensus documents:
- convene a few people who are all in favour of a certain motion,
- discuss the motion,
- agree with it,
- write up the process
- publish your paper in a third class journal,
- boast that there is a consensus,
- stress that the motion must thereefore be ethical, correct and valuable.
Do chiropractors know that, using this methodology, the ‘flat earth society’ can easily pass a consensus that the earth is indeed flat?
I am sure they do!
“The authors concluded that this set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.”
For some reason the authors failed to include in their ‘recommendations’: “Any chiropractor wishing to treat pediatric patients should first qualify with a MD degree (US).”
(‘Paediatric’ and ‘GMC registerable qualification’ in UK.
Greek for ‘a child’ is paedion. ‘Ped’ is a foot! Sigh.)
Mind you, we have “pedagogy” used in both UK and USA English, contracted (or translated) from paidagōgeō, child leader.
https://www.chiropracticboard.gov.au/News/2023-11-29-chiro-revised-statement-on-paediatric-care.aspx
David: Many thanks for that.
R
To make matters even more confusing, both the Latin ‘pes’ and the Greek ‘πούς’, with their respective roots ped- and podo- are being used for matters relating to the foot. And oh, there is also the rather less commonly known word ‘pedology’, derived from the Greek word πέδον for ‘soil’ …
The Cochrane review that you mention was part of the Safer Care Victoria( SCV) publication on the safety of chiropractic spinal manipulation on children 12 and under. The result of that review concluded that over 99% of parents were satisfied with their child’s chiropractic treatment encounters. I direct interested readers to the commentary published by the chiropractor who was on the SCV advisory board. https://www.cjaonline.com.au/index.php/cja/article/download/312/144/625
SATISFACTION!?
not the same as effectivenes or efficacy; I suppose the satisfaction is mostly with the chiros and their bank managers.
SCV brief was to hear about the safety concerns and not effectiveness of treatment. No insurance claims were noted from their review. Again I advise you and your friends to read the government review and the commentary.file:///C:/Users/USER/Downloads/COMMENTARY+ON+THE+2019+SAFER+CARE+VICTORIA+REVIEW%20(4).pdf
Oh dear, not very bright, see:
Michael Epstein on Friday 11 February 2022 at 09:16
https://www.chiropracticboard.gov.au/News/2023-11-29-chiro-revised-statement-on-paediatric-care.aspx
Of course they were satisfied.
It’s termed (by MDs): “The course of natural history.”
And in paediatric work (however spelt) we all know that treating the parent is as important as treating the child.
Ain’t nature wonderful!