Australia has a chiropractor problem no different than here in the United States. All manner of chiropractic nonsense, including claims of treating infants and toddlers with a range of conditions both real and imagined, has been a reality in the land down under for over a century. There is, however, one very important regulatory difference between our two countries.
Back in 2016, I wrote about Australian chiropractor Ian Rossborough, who at the time was facing harsh criticism after posting a marketing video featuring his aggressive and clearly painful adjustment of a very young infant. He ended up with a temporary suspension of his ability to treat pediatric patients, but that ended sometime in 2018. In 2019, however, a second controversy arose after a different chiropractor promoted his practice using a video demonstrating a pile of pseudoscientific garbage while treating another baby that ticked off the healthcare regulators.
Because of Andrew Arnold’s video, or more accurately because of the public outrage and calls for action by actual medical professionals, the Chiropractic Board of Australia (CBA) issued an interim policy that prohibited spinal manipulation of children under two years of age pending expert review. Again, because I want to be very clear, the CBA fully supported infant chiropractic care, even when it included craniosacral therapy for colic or the use of an “activator” to treat torticollis, they just caved in to pressure from national health authorities. That 2019 policy was updated in November of last year, once more giving chiropractors clearance for treating kids under 2 years, in response to two systematic reviews performed by Cochrane Australia in 2019 and 2022 that they claimed demonstrated the safety and effectiveness of spinal manipulation in this younger age group.
Not so fast.
You will likely not be shocked to learn that the 2019 review by Cochrane Australia, and the 2022 update that did not differ in any substantial way, do not justify claims of safety or effectiveness in the treatment of young children. At best, they cannot be used to show that there are large numbers of children who have been directly harmed by chiropractic adjustments, although this ignores the possibility of indirect harms from delayed care or antimedicine/antivaccine misinformation, for example. In the report, the authors discuss reasons why strong evidence of harm may not have been discovered:
There are two principle reasons why the search did not find strong evidence of harm in Australia. First, it is unlikely that spinal manipulation, as defined with the scope of the review, is a technique that is being routinely applied in Australia to young children or those with an immature spine. Second, skilled chiropractic care requires the practitioner to modify the force applied based on the age and developmental stage of the child. This means that children, particularly very young children, under the care of an Australian chiropractor are not likely to be receiving high impact manipulations.
Nonetheless, it is clear that spinal manipulation in children is not wholly without risk. Any risk associated with care, no matter how uncommon or minor, must be considered in light of any potential or likely benefits. This is particularly important in younger children, especially those under the age of 2 years in whom minor adverse events may be more common.
https://www.safercare.vic.gov.au/sites/default/files/2019-10/20191024-Final%20Chiropractic%20Spinal%20Manipulation.pdf
The two sentences I emphasized are important. I often point out that risk of direct harm, though possible and it has certainly occurred, is very low, though this has nothing to do with how skilled the chiropractor is in their craft. It has everything to do with marketing. Parents are not very likely to appreciate their baby being forcefully adjusted and crying out in pain, which is why the vast majority chiropractors who treat infants use silly devices like the activator and often go to great lengths to explain how their adjustments are equivalent to checking a tomato for ripeness. I discuss this in detail in a previous post.
In regards to the second emphasized sentence, the reviews found no good evidence to support claims of any benefit:
Specifically, the comprehensive review of the literature failed to identify any strong evidence for the effectiveness of spinal manipulation for a variety of conditions for which children are widely offered chiropractic manipulations. These conditions included colic, enuresis, back/neck pain, headache, asthma, otitis media, cerebral palsy, hyperactivity and torticollis.
There was low certainty (weak) evidence that spinal manipulation may be beneficial for modestly reducing crying time in children with colic, or for reducing the number of wet nights in children with enuresis. For both conditions the evidence was also consistent with either no or worsening effects.
For other conditions – headache, asthma, otitis media, cerebral palsy, hyperactivity, and torticollis – there was no evidence that spinal manipulation was effective.
Based on this review of effectiveness, spinal manipulation of children cannot be recommended for:
- headache
- asthma
- otitis media
- cerebral palsy
- hyperactivity disorders
- torticollis
The possible, but unlikely, benefits of spinal manipulation in the management of colic or enuresis should be balanced by the possibility, albeit rare, of minor harm.
https://www.safercare.vic.gov.au/sites/default/files/2019-10/20191024-Final%20Chiropractic%20Spinal%20Manipulation.pdf
It was more than a bit of a stretch to hold up these findings as impetus to return to manipulating infants and toddlers. Apparently the real Australian heath authorities, such as Australian Health Minister Mark Butler, thought so as well. He has also pointed out that the decision was contradicted by the systematic reviews.
In addition to Butler, Victorian Health Minister Mary-Anne Thomas and Australian Medical Association’ Victorian president Dr. Jill Tomlinson have spoken out. And the return to manipulating children under age two was called both “reckless” and “deeply disturbing” by the Chair of child and young person health at the Royal Australian College of General Practitioners. In light of the renewed criticism, the CBA has issued a policy update that reinstated the ban until further consultation with the Health Ministers.
I’m obviously hoping that this will become a permanent ban, and there is chatter regarding this as a potential outcome. I can’t imagine something like that ever happening in the United States, however. We continue to provide no real protection for children when it comes to abject quackery and I just don’t see that changing.
Here is a response to the reinstated ban from some “conservative, traditional” chiropractors that I just don’t have the strength to get into right now. You’ll never guess what they think about the pandemic. Enjoy!