In October 2013, a sensational headline surfaced from the Australian press: “Chiropractor Breaks Baby’s Neck!” It turns out, a pediatric chiropractor fractured a child’s vertebrae while trying to treat torticollis. About a year before that, a baby with torticollis actually came to me after receiving brief treatment from a chiropractor. The chiropractor had recommended physical therapy treatment to the family after a few chiropractic adjustments, because she realized it was outside her scope of practice. I was surprised a parent sought the help of a chiropractor to begin with. I was thankful that the chiropractic referred out when she did. When I followed up with her to see what adjustments she performed on the child, she declined to comment. At the time, I did not think chiropractic care was evidence-based to support treating children. A year later, after much inquiry into the world of chiropractic care, I still do not recommend spinal manipulations for children.
Ask any physical therapist what the diagnostic and treatment process entails for the children they see, and you will soon learn that physical therapists are considered musculoskeletal experts. We are movement specialists. If a child comes to see us for recovery after injury, a congenital condition, or any array of health problems that limit their mobility, our focus will primary be on helping them regain their function. Much like chiropractors, we focus on alignment and imbalance. But that’s where our similarities end. Unlike chiropractors, physical therapists focus on the muscles, the movements across joint structures, the movements of the body as a whole, and the neuromuscular connection. In the case of babies and toddlers, we analyze their premature or developmentally lagging movement patterns and help them reach their milestones. How do we do that? By teaching them the best way to move given their condition, using exercises to allow for strength and fluidity behinds their movements, to encourage proper alignment and growth in the years ahead. If we have to put our hands on their growing joints and muscles, it is to facilitate, to cue, to help position them by gentle stretching and gentle stimulation of their young musculoskeletal and neurological system.
In recent years, a new crop of chiropractors are on the rise. Pediatric chiropractors. Ask any chiropractor what chiropractic care means for children, and you will hear terms like “subluxation,” “spinal adjustment,” and “joint manipulation.” Instead of teaching patients and families the physiology behind their symptoms and limitations. Chiropractors allow patients to be passive receivers of care. Adults with back pain often seek chiropractic treatments for a “quick fix.” A few readjustment and a few “maintenance” episodes later, symptoms are supposedly diminished. If you ever watch a chiropractor in practice, treatment is full of quick high-velocity thrusts to the spine. Pediatric chiropractors believe that this type of manipulation is necessary to help alleviate a slew of childhood health complaints linked to cranial-sacral misalignment, including but not limited to: ear infections, colic, sleep issues, allergic reactions, chronic infections, and even serious conditions such as cerebral palsy. The truth is, there has been no evidence to support the benefits of chiropractic manipulations beyond treatment for acute, uncomplicated, low back strain in adults. In fact, there have been numerous studies linked to manipulation-related injuries in children. Complications can be as serious and fatal as brain hemorrhages or paraplegia. Because chiropractic readjustment often mask pain and symptoms, harm can also be created by delayed diagnosis of serious conditions such as cancer or meningitis.
The battle between physical therapists and chiropractors is a well-established one. However, much of the evidence against chiropractic treatment of children comes from not just physical therapists, but orthopedists, pediatricians, radiologists, and even chiropractors themselves. The spine of a small child or newborn baby should never be manipulated using chiropractic techniques. Chiropractic manipulations are considered invasive and hardly justified by science or literature. The idea that chiropractic treatments can correct spinal trauma attained at birth or during regular play activities is based on the “subluxation” theory. Which is just that, a theory. In the case of torticollis, more than 97% of the cases can be treated by conservative, non-invasive means involving exercises and stretching. In the case of ear infections, colic, and other bothersome childhood ailments, many of them are self-limiting conditions. Evidence shows that chiropractic corrections in these cases are due to nothing more than a placebo effect.
So the next time a chiropractor advises you to attend “routine alignment checks” for you or your child, just say, “no thanks.” Chiropractor education is limited to 1 year or so beyond college. To become a “pediatric chiropractor,” practitioners are not even required to have hands-on pediatric clinical experience. Compare that to a doctor of physical therapy degree, which requires 3 years of clinical and institutional training after college. It is a no-brainer whose expertise to seek in times of pain or injury. Pediatric physical therapists also have residencies, fellowships, and a national exam to participate in to become a certified specialist. There is a reason physical therapists make up a huge portion of medical professionals in any healthcare setting, and chiropractors can only be found in private clinics that are rarely covered by insurance. If childhood asthma, ear infections, cerebral palsy, torticollis, and developmental delay could be treated by a simple readjustment of the spine, chiropractors would be the first people pediatricians refer to, and they are not.
Do you have experience with chiropractors that you would like to share? Please leave a comment.
Novella, S. Chiropractor Breaks Baby’s Neck- A Risk vs. Benefit Analysis. Science-Based Medicine. Available online athttp://www.sciencebasedmedicine.org/chiropractor-breaks-babys-neck-a-risk-vs-benefit-analysis/ (Accessed June 23, 2014)
Ohm, J. Why Should Children Have Chiropractic Care? Pathways to Family Wellness. Issue 5. Available online athttp://www.icpa4kids.org/ (Accessed June 23, 2014)
Homola, S. Should Chiropractors Treat Children? Skeptical Inquirer. Volume 34.5, September/October 2010. Available online at http://www.csicop.org/si/show/should_chiropractors_treat_children/ (Accessed June 23, 2014)
Homola, S. Pediatric Chiropractic Care: Scientifically Indefensible? Science-Based Medicine. Available online athttp://www.sciencebasedmedicine.org/pediatric-chiropractic-care-scientifically-indefensible/ (Accessed June 24, 2014)