Hold on to your butts.

– Ray Arnold, Chief-Engineer at Jurassic Park

As regular readers will know, I have written extensively on the absurdities of pediatric chiropractic. In particular, I have focused on newborn and infant chiropractic. One aspect of this practice that is almost a defining feature, despite a few infuriating examples to the contrary, such as the “crack heard round the world” I discussed back in 2016, is that chiropractic management of infants tends to be almost comically gentle. As I frequently say, parents might be fooled by medical misinformation but they will usually bristle at interventions that clearly hurt their babies.

Though all but a few seconds of my recent interview by Inside Edition ended up on the cutting room floor, I even reassured the producers that I have never been particularly worried about direct injury to babies from chiropractors, though I did say it was possible. I’ve always been much more concerned about potential indirect harm, such as might occur from delaying appropriate care or from anti-vaccine propaganda. I was wrong to downplay the risk of direct injury.

While still a rare event, after reading a recent case report published by the American Academy of Pediatrics in the September 2021 issue of Pediatrics in Review, the official AAP source for continuing education, I will handle the discussion of risk a bit differently.

“Abnormal Behavior in a 2-Month-Old Boy”

In the report, pediatricians and a radiologist at University of Nebraska’s Children’s Hospital and Medical Center describe the case of a previously healthy 2-month-old who was brought to the emergency department after four days of increased fussiness when awake, less time where he was awake and interactive, and episodes of unusual movements of his arms and legs. The only finding on history was mild torticollis, a common and generally benign problem with turning the head easily from side to side. Torticollis almost always resolves with simple physical therapy that can be performed by caregivers at home. Unfortunately, the family had been bringing him to a chiropractor for treatment that involved neck adjustments.

When examined by the pediatric medical professionals in the emergency department, he was witnessed having a tonic-clonic seizure with stiffening and then rhythmic jerking of his arms and legs and fixed eye deviation to the right. This seizures lasted about 90 seconds before self-resolving. The team appropriately ordered a number of labs, obtained IV access, and initiated treatment for a presumed life-threatening bacterial infection while carefully considering other possible causes of infant seizures, such as abusive head trauma, electrolyte abnormalities, and stroke.

Imaging of the child’s brain was swiftly obtained, which revealed large areas of infarction involving the posterior parietal, posterior temporal, and occipital lobes of both cerebral hemispheres that consistent with ischemic stroke. Something had happened which appeared to have compromised bilateral posterior cerebral arterial blood flow to those regions of the brain. As seen on this child’s CT scan, without enough oxygen to meet metabolic demand the involved brain tissue quickly begins to die.

The finding of infarct was also seen on a follow-up MRI of the brain. A CT angiogram of the neck was obtained, which involves the injection of a special dye that allows mapping of the blood vessels, which demonstrated absent flow in the left vertebral artery. Finally an MRA (MRI + angiogram) confirmed poor blood flow through the posterior cerebral arteries on both sides of the brain. A diagnosis of vertebral artery dissection was confirmed.

The child was started on anti-seizure medication and aspirin, and he was eventually discharged home with close neurology follow-up. At 6 months of age, he continued to have an abnormal EEG but no further clinical seizure activity was reported. At 9 months of age, he was found to have some difficulty with eye tracking but had an otherwise normal exam with no developmental concerns. But because of the widespread nature of his brain injury, it is highly likely that developmental difficulties will become apparent as he ages and more is expected from him. Only time will tell what his ultimate outcome will be.

Conclusion: Risk from infant chiropractic always outweighs potential benefit

Vertebral artery dissection, where the inner lining of a vital blood vessel is torn and then predisposed to the development of a blood clot that obstructs flow to the brain, is rare in any population. It is extremely rare in infants and it does not just happen in this population without some kind of trauma or underlying disorder. The child in this case report was severely injured by an unproven and implausible chiropractic intervention for a condition that has a proven safe and effective medical treatment. Add this report to the large and growing pile of evidence supporting calls to remove the right of chiropractors to treat young children.

Author

  • Clay Jones, M.D. is a pediatrician and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @SBMPediatrics and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey. The comments expressed by Dr. Jones are his own and do not represent the views or opinions of Newton-Wellesley Hospital or its administration.

Posted by Clay Jones

Clay Jones, M.D. is a pediatrician and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @SBMPediatrics and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey. The comments expressed by Dr. Jones are his own and do not represent the views or opinions of Newton-Wellesley Hospital or its administration.