Last week, Sharon Kirkey, a Canadian journalist writing for the National Post, penned an article that called chiropractic care of the newborn and young child into question. It’s not a deep dive into the issue, but she covers the most important concern well, namely that there is a lack of evidence of benefit and very real risk of both direct and indirect harm. She includes a few helpful comments from a pediatric allergy specialist, a biomedical engineer who investigates chiropractic claims, the American Academy of Pediatrics and the Canadian counterpart, our own Samuel Homola, and me.
Chiropractic propaganda abounds
In the article, Kirkey points out examples of propaganda cleverly designed to convince parents of the safety and benefit of chiropractic care for very young children. One such example that I discussed with Kirkey is the nearly ubiquitous description of pediatric spinal adjustments as involving the amount of force used to check the ripeness of a tomato. There are hundreds, if not thousands, of chiropractic videos and websites online that use this little factoid to reassure parents that there won’t be any scary, forceful adjustments. There are also, and you may want to sit down before clicking on them, many examples of more vigorous adjustments (2:30 mark), even more vigorous adjustments (also at 2:30 mark), and adjustments that cause the young patients to cry out in pain (0:45 mark).
Though these more forceful examples do exist, most chiropractors are smart enough to not scare away their customers. The more gentle techniques are by far the most common approach to adjusting young kids, often appearing comically imperceptible. Use of a spring-loaded thumping device is also common. I’ve played with these and they provide little more than a very light impulse that barely indents the skin. I’ve yet to find a reasonable explanation for how if such light pressure can correct a subluxation, why children aren’t constantly riddled with them at all times. Of course, that’s actually a fear sometimes promoted in chiropractic marketing so that parents return time and time again:
Children are constantly learning new things and frequently are in situations to subluxate their spines and nerve systems. Kids are also growing so quickly, so any barrier to a child growing and learning has a bigger impact on their future life and health.
Kirkey mentions an absurd and equally ubiquitous bit of propaganda employed by chiropractors who are looking for young patients to pad their patient panels. It can often be found on websites in the form of scary memes showing pictures of babies being pulled from their mother’s birth canal or abdomen accompanied by the claim that 80% (sometimes 90%) of newborns have subluxations or nerve dysfunction requiring chiropractic adjustment. These trauma-induced subluxations can, they claim, result in a variety of health problems ranging from fussiness and poor feeding to SIDS.
A 1966 paper by grossly negligent osteopath and craniosacral therapist Viola Frymann is most commonly cited to support this claim. Needless to say, it’s nonsense and doesn’t even involve subluxations. Rather it is about minor cranial abnormalities only able to be appreciated by someone trained in cranial therapy. In other words, they don’t exist. But it’s close enough for the newborn chiropractic crowd, who likely never actually looked at the paper.
Also mentioned in the article is the fact that many chiropractors will claim to be able to treat a wide variety of non-musculoskeletal complaints in young children. This includes colic, bedwetting, hyperactivity, and constipation to name a few. Kirkey points out that some even claim to treat learning disabilities and dyslexia. Equally absurd are the common claims that children undergoing chiropractic care are healthier on average than those who aren’t. Here is the study commonly cited. It’s terrible.
Kirkey doesn’t accuse all chiropractors of such chicanery. She is clear to point out that only some of them make claims regarding the care of babies and young children. Just how many isn’t clear, however. One of the quoted experts, biomedical engineer and consumer health advocate Ryan Armstrong, points out that there are evidence-based chiropractors out there and laments that regulatory bodies aren’t doing anything about all the nonsense.
A response from the Canadian Chiropractic Association
Not long after Kirkey’s article was published, a response appeared. It didn’t come from just any disgruntled chiropractor, however, but David Peeace, the president of the Canadian Chiropractic Association. The CCA claims that roughly 90% of the more than eight thousand Canadian chiropractors are members. The organization appears to focus only on musculoskeletal concerns, at least officially, but does refer to chiropractors as “primary healthcare providers.”
They also promote the existence of the chiropractic subluxation but boldly, at least in their official policy statement on the subject, admit that discussions regarding immunizations aren’t in their scope of practice. It could be worse. Of course there is no shortage of Canadian chiropractors advising against routine vaccination.
The response from Peeace is worse. It’s not long, but it’s packed with bad arguments and fails to refute the concerns raised in the original article. He begins by missing the point of a study referenced by Kirkey:
We were extremely disappointed in Sharon Kirkey’s depiction of our profession, including the misrepresentation of an outdated 2007 study. Neither causation nor incidence rates can be inferred from the study. While your writer implies a focus on chiropractic treatments in infants or young children, the study included non-chiropractic treatments in patients up to 18 years of age, with only one patient in the study under the age of five.
Here is the study in question, which Peeace was clearly unable to read and understand. I won’t call him a liar when being ignorant will suffice in this case.
Overall, the number of reported adverse events found in the authors’ literature review were very small compared to the large number of children undergoing spinal adjustments, but they are almost certainly underreported. What they did find were 14 cases of direct harm, most of which involved an injury that occurred immediately after the manipulation. Ten involved a chiropractor and two were not specified.
There were 20 cases of delayed medical care, all of which involved a chiropractor. Conditions that went untreated for a time, some of which resulting in death, included various cancers, meningitis, diabetes, and a musculoskeletal condition for which urgent surgery is the only appropriate treatment. Of the adverse events reported, several were in young children and the most serious tended to be in infants. Again, this study doesn’t prove that chiropractic results in large numbers of bad outcomes in children, but it certainly supports the concerns of pediatricians and family practitioners, particularly when taking into account the absence of any proven benefit in young children.
Chiropractic treatment is appropriate and clinically indicated within the context of primary pediatric care in numerous musculoskeletal (MSK) conditions, including torticollis (tight, stiff neck muscles), muscular and biomechanical imbalances, and developmental physical delays involving MSK deficits.
Chiropractors refer to physicians or the emergency room based on their diagnosis, just as physicians refer directly to chiropractic or physical therapy services. If an infant is treated by a chiropractor, the treatment is gentle, diagnostically guided and developmentally and age-appropriate.
There is no “context of primary pediatric care” in which any infant or young child should undergo chiropractic management. They are simply not trained in caring for this patient population and are unable to reliably recognize the many possible conditions requiring urgent medical evaluation, some of which can present with subtle findings and parental complaints. I have no confidence in their ability to make a diagnosis in these kids.
Importantly, infants receiving diagnosis and treatment within the chiropractic scope of practice enjoy successful outcomes with conservative and comfortable care. This is supported by newer research demonstrating serious adverse events in infants and children receiving chiropractic therapy are rare.
They enjoy successful outcomes because the reasons that they are being brought to chiropractors are typically benign and self-limited in nature, such as colic. There is no legitimate chiropractic literature in pediatric care from which to base claims of treatment outcomes. There are mostly case reports and small unblinded case series. Many parents who are unhappy with their child’s care may simply not go back and it is unlikely that many chiropractors are keeping a strict record of all pediatric outcomes in their clinic for analysis.
Conclusion: Pediatricians are right to be alarmed by pediatric chiropractic
The National Post article has it right. Chiropractic care of babies and young children is not appropriate for any condition for a variety of reasons. First and foremost, there is no benefit and there is a real, although small, chance of serious direct adverse outcomes. There is a more concerning risk of delayed medical care of a serious condition. The rebuttal from the president of the Canadian Chiropractic Association doesn’t change this.