I was alerted to the updated and strengthened guidance to ensure safer practice by chiropractors who treat children under the age of 12 years that has recently been published by the Chiropractic Board of Australia after considering the recommendations made by the Safer Care Victoria independent review. The Board also considered community needs and expectations, and specifically the strong support for consumer choice voiced in the public consultation of the independent review.

The Board examined how common themes in the independent review’s recommendations align with its existing regulatory guidance, and used these insights to inform a risk-based approach to updating its Statement on paediatric care. This includes updated advice reinforcing the need to ensure that parents or guardians fully understand their rights and the evidence before treatment is provided to children. ‘Public safety is our priority, and especially so when we consider the care of children’, Board Chair Dr Wayne Minter said.

According to the statement, the Board expects chiropractors to various things, including the following [the numbers in the following passage were added by me and refer to my brief comments below]:

  • inform the patient and their parent/guardian about the quality of the acceptable evidence and explain the basis for the proposed treatment [1]
  • provide the patient and their parent/guardian with information about the risks and benefits of the proposed treatment and the risks of receiving no treatment [2]
  • appropriately document consent, including considering the need for written consent for high-risk procedures [3]
  • refer patients when they have conditions or symptoms outside a chiropractor’s area of competence, for example ‘red flags’ such as the presence of possible serious pathology that requires urgent medical referral to the care of other registered health practitioners [4]


  1. I know what is meant by the ‘quality of the evidence’ but am not sure what to make of the ‘quality of the acceptable evidence]. Acceptable by whom? In any case, who checks whether this information is being provided?
  2. Imagine the scenatio following this guidance: Chiro informs that there is a serious risk and no proven benefit – which parent would then procede with the treatment? In any case, the informed consent is incomplete because it also requires information as to which conventional treatment is effective for the condition at had [information that chiros are not competent to provide].
  3. Who checks whether this is done properly?
  4. Arguably, all pediatric conditions or symptoms are outside a chiropractor’s area of competence!

In view of these points, I fear that the updated guidance is a transparent attempt of window dressing, yet unfit for purpose. Most certainly, it does not ensure safer practice by chiropractors who treat children under the age of 12 years.

21 Responses to Updated and strengthened guidance “to ensure safer practice by chiropractors who treat children under the age of 12 years”

  • Window dressing indeed!

    Thank you Professor for once again exposing the fallacy of Chiropractic. I have heard the saying, that “they treat from the cradle to the grave.” Or the womb to the tomb.

    • yes, and unfortunately that sometimes speed up the journey to the grave

      • It’s your blog so say what you like, but the fact is that this costly government review discovered no insurance claims or serious injury. Your comments do not support the knowledge base of this growing health discipline and will not stop its development and evolution.

        • “this costly government review discovered no insurance claims or serious injury”
          there is no post-marketing surveillance for chiros
          the review was not aimed at finding adverse effects

          Chiros are a clever breed:
          – they do not monitor adverse effects [which is arguably irresponsible]
          – thus no adverse effects are recorded
          – and then they keep pointing out that there is little evidence for adverse effects

          An effective strategy [albeit deeply dishonest]

  • Best Practices for the Chiropractic Care of Children
    Published Thursday 03 February 2022

    Michael Epstein on Thursday 03 February 2022 at 09:21
    Chiropractors need to have unfettered access to children under 12 years of age so they can examine and diagnose the need for appropriate manipulative and rehabilitative treatment. May I present a recently published and well-designed case report to support my position.
    [case report URL omitted]


    Chiropractic Board of Australia

    Statement on paediatric care
    29 November 2023

    Evidence-based practice fact sheet
    The Board’s Evidence-based practice fact sheet advises that a practitioner’s clinical experience ranks as a very low level of evidence because of the small sample size and the lack of control for factors including placebo effect. As a result, practitioners should recognise that their clinical experience cannot be used to justify treatment when there is good evidence for the efficacy of other treatment modalities that is contradictory.


    Does evidence-based practice mean that I can only use treatments with high level evidence?

    Evidence-based practice means that chiropractors should make decisions about the care of the individual patient by integrating their individual clinical expertise with the best available clinical evidence. Relevant evidence is not always available to help with decision-making about every condition.

    However, clinical experience on its own is rarely sufficient to justify a clinical decision. A chiropractor is entitled to use their clinical experience to help in their decisions regarding patient care. In cases where there is only low-level evidence to support a particular treatment choice, they should inform the patient of this fact and that it is their clinical experience that the treatment may be effective for the presenting condition. Without this information and understanding of the benefits and risks involved, the patient is unable to make an adequately informed decision about their health care.

    More importantly where there is evidence that a form of care is inappropriate or unsafe, a practitioners’ clinical experience or patient’s preference should not be used to override the evidence.

    As Edzard said “In view of these points, I fear that the updated guidance is a transparent attempt of window dressing, yet unfit for purpose. Most certainly, it does not ensure safer practice by chiropractors who treat children under the age of 12 years.” [my bolding]

  • Having read most of your “alternative medicine” reviews, I admit I share some, but not all of your views. However, I believe we agree on some essential elements; All health care practice should be scientifically plausible and be and be independently accountable. That said, I have concerns your reviews sometimes lack balance. I wonder if personal agenda over rules objectivity. I ponder the thought; Would you provide the same rigorous and robust critical reviews if medical specialists prescribed alternative therapies, with no published clinical evidence supporting their intervention and only objective scientific evidence of the true untreated illness? Then, What if that medical intervention had published evidence of serious life threatening side effects (a 30% death rate). I wonder if you would review such a case with all medical evidence provided? Would your own bias allow you even examine this data?

    Just so happens I have all the data on such a case; based on our families experience. Happy to pass on all the evidence and published reviews for you to review. I am happy to be held accountable by your evidence based review if you can prove to me my interpretations are wrong. But I suspect your agenda does not include exposing medical specialists providing dangerous alternative therapies. If any medical specialists would like to take this challenge, i am happy to provide confidential information regarding this case.

    My intention has always to support good medical care. I am not anti traditional medicine; my academic and clinical history confirms this. I am pro science; well I was until what happened.

    Await your reply

    • “Would you provide the same rigorous and robust critical reviews if medical specialists prescribed alternative therapies, with no published clinical evidence supporting their intervention and only objective scientific evidence of the true untreated illness?”
      Yes as long as it is within my area of expertise!
      But I am puzzled: you call my work biased and rigorous at the same time.

    • “All health care practice should be scientifically plausible”


      It should be evidence based. That is to say probability based; not plausibility based.

      Establishing that the benefits of a treatment outweigh its risks is far more important than establishing its scientific plausibility.

      Answering the question “Does it work? If so, how well does it work?” is far more important than answering the question “How might it work, if indeed it is (eventually) found to work in practice?”

      A scientifically plausible treatment that has a small effect size and a high/unknown risk is, perhaps, best avoided: caveat emptor and caveat lector.

  • I apologise for the inference. I find the language too forceful for good reason. We want change to improve the outcome for individuals seeking answers. The incisive but overly forceful language can alienate those you wish to influence. It’s not your followers, on the whole that need to adapt but the others. whilst it pleases your tribe, it may also further push some into less enlightened places. It’s not the people who applaud your reviews that you need to influence. And believe me when I say I dont ever desire conflict and that’s not my intention. I have but one focus.

    Thank you for responding. How do I pass to you my data.

  • Michael Epstein wrote: “this costly government review discovered no insurance claims or serious injury”

    What a fortunate outcome for chiropractors, but let’s not forget this:

    Call for age limit after chiropractor breaks baby’s neck
    A baby’s neck has been broken by a chiropractor in an incident doctors say shows the profession should stop treating children. The injury was reported to the Chiropractic Board of Australia, which closed the case without reporting it to the public and allowed the chiropractor to keep practising as long as they undertook education with an ”expert in the field of paediatric chiropractic”. (The Sun-Herald has also seen evidence that chiropractors have been entering Sydney hospitals, including neo-natal intensive care wards and surgical wards, to treat patients without the required permission. NSW Health has warned that any chiropractor working in a hospital without permission could put patients at risk, while the Australian Medical Association NSW says the behaviour is “outrageous”.) Melbourne paediatrician Chris Pappas cared for a four-month-old baby last year after one of her vertebrae was fractured during a chiropractic treatment for torticollis – an abnormal neck position that is usually harmless. He said the infant was lucky to make a full recovery. ”Another few millimetres and there would have been a devastating spinal cord injury and the baby would have either died or had severe neurological impairment with quadriplegia,” he said. Dr Pappas complained to the Australian Health Practitioner Regulation Agency, which referred the case to the Chiropractic Board. Three weeks ago, he received a letter from AHPRA saying the case had been closed after the chiropractor committed to completing further education. Dr Pappas said he was concerned the decision was an endorsement of chiropractic treatment for infants when there was no scientific evidence to support it. ”I think they have put the chiropractor’s interests before the interests of the public,” Dr Pappas said. ”[Treating infants] is inappropriate and it carries a very small but real risk of causing damage, and in some cases, devastating damage.”
    Ref. Julia Medew, Amy Corderoy, Sydney Morning Herald (29th September 2013)

    Followed by this:

    Doctor stands by claim on baby injury despite chiropractic body’s denial
    The peak body representing chiropractors says a Melbourne doctor’s claim that an infant’s neck was broken during a chiropractic treatment last year is wrong. However, the paediatrician involved, Dr Chris Pappas, has stood by his diagnosis of the baby’s injury and said a thorough investigation excluded any other possible causes…national president of the Chiropractors’ Association of Australia Dr Laurie Tassell said an expert report on the case commissioned by the Australian Health Practitioner Regulation Agency (AHPRA) and cited in ‘The Australian’ showed the baby’s neck had not been broken. In a written statement, Dr Tassell said the baby had a condition known as congenital spondylolysis, a malformation of the spine that ”can be confused with a ‘hangman’s fracture’.” Dr Tassell declined to be interviewed or to comment on whether he had a copy of the report, but said the chiropractor who treated the infant had not applied sufficient force to cause a fracture.”
    Ref. Julia Medew, The Age (17th October 2013)

    And this:

    No doubt baby’s neck was fractured doctors say
    The furore surrounding a chiropractor accused of fracturing a baby’s neck gathered momentum today with claims the investigation was flawed…Spinal surgeon Mr John Cunningham said he and his colleagues had no doubt the child suffered a fracture…”I strongly suspect that the injury was through the congenital defect, the weak point, which would have contained cartilaginous tissue. This would not be visible on the initial CT as cartilage is simply not seen. A second CT, performed some weeks later [see paragraph 34 of the report here ], clearly indicates new bone formation and healing of a concurrent fracture.” Mr Cunningham said the CAA [Chiropractors’ Association of Australia] must have appreciated the significance of the second CT scan. “What I find disingenuous is the manner in which they only released to the press the first CT report,” he added.
    (No link available but the above article appeared in the Medical Observer on 18th October 2013.)

    For those interested, the case is discussed here:

  • It’s not an insult. Its the foundation of humanity. Humans are tribal and it’s an evolved trait to enhance survivability. But humans have adapted a complex tribal schema due to our extended pre-adolescence providing the time for social cultural and genetic interaction to formulate inherent bias further strengthening tribal connections. The role of visuospatial cognition is a key factor in this process when scent dependent navigation became unreliable in the habitually upright arboreal early hominid human ancestor. I was going to discuss bias arising from expectation as a cornerstone of human tribal behavior but enough is enough. My doctorate examined unique elements of human upright with cognition from an evolutionary and developmental perspective. I have no energy to upset anyone anymore, so it’s unintentional. My experience induced PTSD explains my desire to avoid conflict.

    • who said it was an insult?

    • You refer to “tribal”
      You refer to “followers”
      You refer to “bias”
      You refer to “agenda”
      This is the deliberately inflammatory language of the conspiracy theory loon.
      And you then have the cheek to claim you want to avoid conflict and upsetting people, and to gaslight us into believing it was just the innocent use of a word with scientific meaning.

      • Well said!

      • zebra and Pete Attkins. There is nothing inflammatory in describing the evidence based characteristics of all humans, based on evolution. We are all tribal, on the internet we all have followers, usually sharing similar beliefs and bias. A significant issue in scientific research to date is inherent bias in research. Its a fact its not psuedoscience. Many people are influenced by their inherent agenda influencing them to accept only the narrative that supports their bias. I don’t understand where you get conspiracy look from. For a large part of my life I conducted research based on evidence form peer reviewed publications on movement and cognition. I was then asked to design a component of a large longitudinal study into child development. From there I was provided with a prestigious NHMRC scholarship to complete my PhD in this subject. I completed my Phd based on published peer reviewed articles. I was contacted by arguably the leading neurodevelopmental psychologist to complete post graduate work with her in her lab in Canada but declined, after what happened to us. An anonymous email is [email protected] if you, or anyone else for that matter, wish to read a summary of our care to then better understand our experience then i warmly invite you to email me and I will pass on the information. If you are still in doubt then I can send you the clinical files. We still carry some concerns, so i ask you that all information stays confidential. I do give a brief overview of my past clinical and academic background to reject your conspiracy theory loon. This statement does not hold fact. Facts and evidence is what we desire to discuss. Zebra, all these thing you mention are all human traits and these are facts. I have not accused anyone of anything except for being human and holding suspicion is the foundation of scientific process. For example, in the past it was observed smoking may cause illness. This specific suspicion was confirmed through scientific research confirming it to be true. A suspicion is the foundation of scientific exploration. Evidence is required to explore the null hypothesis. All I am asking is to examine the evidence, then provide me with a plausible scientific explanation. This is my only focus…evidence!

  • I have no doctorate, no scientific degree, no formal education, nor printed any scientific studies. BUT I have stayed at a Holiday Inn once.

    And I simply have a wife , who at the young age of 40 experienced a devastating, life changing brain stem stroke IMMEDIATELY following a chiropractic rapid upper neck manipulation. Sandy survived, but her broken body and challenges she now faces daily I wish on no one.

    Needless and risky senseless neck twisting should be sent packing into the dustheap of cheap tricks that it is.

    I still cannot comprehend why the Government has not stepped in and put an end to this barbaric nonsense.

  • Dr Wayne PhD wrote: “There is nothing inflammatory in describing the evidence based characteristics of all humans, based on evolution. We are all tribal…”

    @ Dr Wayne

    But isn’t context is important? What about other characteristics of all humans, e.g. acting the daft laddie (not free from pretension or calculation) and possessing the ability to deliver a timely double entendre?

    Dr Wayne PhD wrote: “A significant issue in scientific research to date is inherent bias in research…Facts and evidence is what we desire to discuss.”

    True, but chiropractic has a particular problem with bias – i.e. evidence-based chiropractic is an oxymoron which leaves chiropractor-conducted research relying heavily on the ‘Chiropractic Method of Investigation’:

    1. Start with a Conclusion

    2. Propose Theory. Only theories that support the conclusion should be considered. Little or no attempt should be made to test or disprove the proposed theory.

    3. Collect Supporting Evidence. One single example of supporting evidence is sufficient, even if there are thousands of examples of evidence that do not support or contradict the theory. Only “supporting” evidence is considered.

    4. Reject Modify or Retain Evidence. If the evidence is undeniably proved to be faulty, then reject it and find some evidence that does support the Theory. The Theory is not normally rejected at this point because only one example of supporting evidence is required to justify the theory. Contradictory evidence is ignored.

    If forced to abandon a theory then claim that you didn’t believe it all along and that false Chiropractors proposed it.
    Propose another Theory that supports your conclusion. Go to step 2.

    Golden Rule: Conclusion is always the same regardless of evidence or the theory.

    Corollary: For Straight Chiropractors. No evidence at all is required to support a conclusion.

    The Scientific Method is designed to discover the truth and eliminate falsehoods, lies, ignorance and misunderstanding. The Chiropractic Method is self-delusional. It can never uncover a falsehood or prove a truth. It only reinforces existing perceptions of the truth. The Chiropractic Method is simply blind faith and has no bearing on truth whatsoever.

    In essence: The Scientific Method: base your conclusions on observations/evidence; The Chiropractic Method: base your observations/evidence on your conclusions.

    Lifted from here:

    • My original post observes this forum discusses the lack of evidence based care in alternative therapies and the occassional evidence of injury from non-evidence based care. I asked a question – if medical specialists provided alternative non-evidence based care, would your group provide the same robust scrutiny based on the evidence provided.

      Now I have someone claiming I am a conspiracy nut. Nothing is further from the truth. I have my language and literary skill (which is poor) criticised and hidden meanings attributed.

      All I have asked is; can you provide the same impartial scrutiny of the 7 months of hospitalisation our daughter and family endured. Evidence was ignored and alternative diagnosis and treatment was provided until she suffered intestinal failure.

      I feel unsure if anyone with expertise will contact me to recieve the data and make comment an assessment. I know there are eminent medical specialists out there who could do. But it’s likely they know I offer them a poisoned challis. The evidence is compelling.

      That’s all.

      Think I will sign off. Don’t think I am welcome.

  • This is now being reported by the Sydney Morning Herald:

    Chiropractors give themselves green light to crack babies’ backs after four-year ban

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