This certainly won’t be the first time we point out that journalists don’t always do a great job covering medical topics, and I’m confident that it won’t be the last either. The risk is increased, of course, when they aren’t a dedicated science or medicine reporter, but even that isn’t a fully reliable indicator of a quality piece. In my post today, I’ll discuss a recent article from a “general assignment reporter” working for The Washington Post that takes a look at the world of baby chiropractic and is a bit of a mixed bag.
The article is titled “Is it safe to bring a baby to a chiropractor? Here’s what experts say“. Overall the article isn’t bad. There is some good information for parents, and a few excellent points made by the involved experts, but it provides the false balance that we so often call out here at Science-Based Medicine. I will say, however, that I appreciate the fact that it doesn’t open with the standard emotional story of a baby getting adjusted and a happy parent’s glowing testimonial.
In fact, the opening paragraph actually contains the important nugget of truth that chiropractic treatments being promoted for infants are all unproven. This is followed by the example of a chiropractor (Judd) going viral on TikTok with a video where he uses a vibrating tool to massage a newborn. The video, like many over the past several months, has millions of views:
The baby “got his 1st adjustment and LOVED IT,” reads the caption. The video has been viewed more than 1.2 million times. (Judd later told The Washington Post he used the device, called a vibracussor, to soothe the colicky baby.)
Right off the bat, this demonstrates a fundamental lack of pediatric knowledge. Newborns certainly cry, and are often labelled as fussy at times, but they don’t have colic. Colic is a label that has meaning, even if we don’t know exactly what it is. (Narrator: We pretty much known what it is.) Maybe he is just using it as a general term for crying, but it’s imprecise and an “expert” should be more careful. Regardless, babies often can be consoled by holding and rocking them and there is no evidence that vibration or massage reduces overall crying beyond that through any specific mechanism.
In response to criticism in the comments to his video, the chiropractor responds with a classic bit of fallacious logic:
“It’s very dogmatic,” Judd said. “You get all kinds of hate from one way or another. But, I’m on a mission. I’ve seen what it does.”
Criticism can be hateful at times, but labeling all of it as such is a cheap means of deflection. It reduces arguments to emotional outbursts based on belief, which I find more than a bit ironic considering his use of “mission” and apparent reliance on his own anecdotal experience. Who is actually being dogmatic here? I and many others in the medical community have raised numerous questions regarding pediatric chiropractic over the years, particularly when it involves infants, and at no point have our objections relied on personal beliefs or experiences.
Again, the author of the article makes an important distinction:
More than five-dozen videos of infant and toddler chiropractic care have been posted in the past year by TikTok accounts advertising clinics across the country.
These videos are produced and posted as marketing ploys. They are not educating the public on important medical topics. They are not promoting public health measures. They are advertisements.
Historically, many of these videos were encouraged by practice management services designed to increase profits. There are thousands online that are just pre-packaged templates that are paid for. The rise of social media sites like TikTok has resulted in an explosion of more amateurish videos like the one focused on in the Washington Post piece, but the purpose remains the same.
The evidence that chiropractic care can soothe babies is scant. But clinicians on TikTok claim chiropractic care can offer relief to fussy babies suffering from a variety of ailments, including colic, constipation, reflux, musculoskeletal problems and even, some say, trauma babies experience in childbirth.
Not only scant, but there is also the issue of extremely low plausibility that the unique chiropractic interventions they promote could soothe babies. Fussiness, colic, constipation, and reflux are, in almost all instances when talking about young infants, the name given for a caregiver’s subjective perception of normal infant behaviors rather than discrete medical conditions. If a baby truly is constipated, has a medical condition that is causing pain, or a musculoskeletal problem like congenital muscular torticollis, no evidence supports chiropractic care.
Trauma occurring during childbirth does happen, and as a newborn hospitalist I have seen a number of swollen heads and broken clavicles, but this isn’t what chiropractors mean when they use the term. They are talking about subluxations or functional impairments of the spine that they blame for pain and a wide variety of specific and general health concerns. As you well know, unless very new to SBM, subluxations in the chiropractic rather than orthopedic sense are fictional and there is no real concern from pediatricians that parents need to worry about their baby’s spine after delivery.
The article then describes a few examples of chiropractors treating infants: leg exercises for constipation, cervical spine adjustments for reflux, and full spine adjustment using an ArthroStim device along with that nonsense where they hold babies upside down for improved nervous system function. In that video, the chiropractor demonstrates some classic chirobabble about resetting the nerves and tells dad that babies usually have a blow out poop on the way home and sleep better too, but not always. And, if you can hear over the child’s crying, he establishes justification for multiple future visits to keep the child’s spine healthy.
Up next is the standard defensive posturing used by infant chiropractors:
Chiropractors say treatments for infants and toddlers are safe and gentle — far from the explosive cracks and contortions generally associated with adult chiropractic care.
This is largely true, though there have been many exceptions that I have found online and that have made the news in recent years. They know that not many parents are going to tolerate aggressive adjustments that look, and can be, painful. So chiropractors have adopted the “tomato checker’s defense” strategy.
The tomato checker’s defense involves pointing out, and I have seen this in hundreds of their marketing videos, that chiropractic adjustments on infants only use the amount of pressure you might use to check for the ripeness of a tomato. Rarely, oddly enough, they will instead claim that they only use an amount of pressure that wouldn’t cause pain when pushing on your eyeball. This is actually used later in the piece by a quoted baby chiropractor. It is comical to imagine how pressure that would barely indent the skin is somehow moving spinal bones around in the human body, but this is also the profession that in some cases believes that it can move the spinal bones of elephants by hand.*
Now come the safety concerns from real experts:
“Ultimately, there is no way you’re going to get an improvement in a newborn from a manipulation,” Tabaie said. “The only thing that you might possibly cause is harm.”
Tabaie is a pediatric orthopedic surgeon and, like many others, he worries that an infant’s bones and joints are less developed and prone to overstretching and injury. Here is where I diverge a bit from Tabaie and the other quoted experts. Though I agree that there is no potential for specific benefit from spinal manipulation, and I fully acknowledge that harm is possible, has happened, and the risk to benefit ratio is decidedly unfavorable here, I don’t think that a heavy-handed focus on the risk of direct harm is the right approach.
Actual injury caused by a chiropractor treating an infant is exceedingly rare. Chiropractors can, and often do, attempt to make opponents out to be alarmist as they demonstrate how gentle their adjustments are. Parents can see that what is being done to their child is not any more harsh than burping a baby or giving a tummy massage in most cases, and they may be more likely to ignore other warnings.
We should be focusing instead on the indirect harm that comes from the potential for delays in appropriate care when a potentially ill or injured infant is brought to a practitioner that lacks adequate pediatric training and expertise, and on the anti-vaccine and general anti-medicine beliefs that are so common in infant chiropractic circles. When we talk about the potential for direct harm, we should be clear that we are talking specifically about high velocity adjustments and stretching beyond the normal range of motion. We should provide education, and attempt to guide parents away from choosing chiropractic care for their infant, but empower those who do to ask up front that these aggressive techniques not be used on their child.
The author gives one reason why some parents seek out chiropractic care for their babies:
Parents say part of the reason they are attracted to chiropractic care is that practitioners promise relief for problems traditional medicine often cannot solve, particularly colic, one of the most distressing and little understood conditions that affect newborns.
There is some truth to this statement. Chiropractors who treat infants do often validate parental concerns or even fears while offering a solution. The mystery, and inability of us conventional doctors to solve it, is frequently emphasized during evaluations. But rather than having problems that can’t be fixed, most infants in these situations have self-limited and non-specific issues that go away with time. So there can unfortunately be a false perception of benefit and the development of an entrenched narrative that parents then share with others.
The author is very misinformed when it comes to colic, however. While caring for a baby that either cries a lot, simply because they sit on the wrong end of a spectrum of normal development, or is merely perceived as crying a lot because of caregiver stress, anxiety, depression, sleep deprivation, or sensitivity, it can certainly be distressing. It can even play a role in neglect and physical abuse of infants. But colic is well understood by pediatricians, as demonstrated later in the article by a primary care pediatrician in Colorado:
“Colic is a developmental phase in a normal kid,” Milobsky said. “But it’s been sold as something that can be treated or solved, as opposed to being understood that this is just a developmental period that has a wide spectrum of presentations.”
The key to managing colic is ruling out an injury or medical condition requiring treatment, such as a milk protein allergy, followed by education on soothing techniques and an assessment for any red flags signalling severe caregiver stress or mental health concerns. Focusing on ways to reduce sensitivity to crying, or on how to safely get some space from a baby that is hard to console, can literally be lifesaving. Though there is no plausible reason to connect spine problems and colic, there have been a number of studies assessing chiropractic as a treatment that are of varying degrees of design quality, and overall are not convincing.
There are some solid examples of motivated reasoning from baby chiropractic proponents in this article. The lead author of a randomized and controlled colic study that failed to show benefit and who is a professor at the University of South Denmark still recommends chiropractic:
“You owe it to the baby to try,” she said.
The director of pediatric integrative medicine at the Andrew Weil Center for Integrative Medicine chalks up the lack of supporting evidence to how difficult it is to measure relief from discomfort in babies when studying manual therapies, but points out that ultimately it’s our fault:
“Conventional medicine has to evolve to understand what chiropractic is all about,” Weydert said.
The chiropractor that posted the viral video discussed in the opening to the article points out that insurance doesn’t cover his services so parents pay out of pocket, demonstrating some classic fallacious reasoning along the way:
If his treatments weren’t working, he said, people wouldn’t spend the money.
Finally, the president of the American Chiropractic Association’s Council on Pediatric Chiropractic claims that infant chiropractic is safe and effective, though she admits that more research is needed to prove that it works. This truly is a science and reason free zone we have entered into:
“We can’t really say for sure what’s happening,” she said. “It’s sort of like a black box. But, what we do know is that, clinically, what we’re doing is effective because we see a change in the symptoms of the child.”
Unfortunately the article, which overall was better than most I’ve read from the mainstream press on alternative medicine, ends with a believer in abject nonsense, who can present no legitimate evidence to support their belief in such a thoroughly implausible notion as baby chiropractic, getting the last word. She knows it works, therefore they can keep doing it until, one day, the evidence proves it. I mean, it has only been 127 years since a superstitious magnet healing middle-school drop out who believed in ghosts, but not vaccines, and wanted to start a new religion based on the ideas he stole from the founder of osteopathy, just made it all up one day. Maybe 2023 will be their year!
*For a more satirical take on exotic large animal chiropractic, please check out this article from my buddy Zoo Knudsen.