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July 30, 2013 — Recently, an Australian TV program called Catalyst aired a feature on chiropractic focusing primarily on chiropractors caring for children. The International Chiropractors Association’s (ICA) Council on Chiropractic Pediatrics expressed concern with the numerous inaccuracies and misrepresentations included in the show about chiropractic and chiropractic pediatric care. The statements made by the “experts” for this program were personal opinions and not based on fact.
According to Lora Tanis, DC, chair of ICA’s Council on Chiropractic Pediatrics, chiropractors have been caring for children for more than 100 years. “It is not a new trend,” she said. “It may seem that way because more parents are bringing their children for chiropractic care as they want care that is natural and also effective. This does not mean that we don’t appropriately refer patients when it is outside our scope of practice. We do. Today,” Tanis added, “many chiropractors in the U.S. not only co-manage patients with a medical physician but parents often go to both a DC and a MD. That is the trend. In UK for example, patients who are seen at the Anglo European College of Chiropractic (AECC) Teaching Clinic are primarily referred by MD’s. That is what we should be encouraging: health professionals working together to provide what works best for the patient, not try to discredit one another because of personal biases.”
The ICA Council on Chiropractic Pediatrics understands the value and need for advanced education in any “specialty,” and to that end, it developed a three-year postgraduate program in pediatrics offered through chiropractic accredited institutions. The University of Bournemouth in UK also conducts a Master’s of Science in Advanced Professional Practice (Pediatrics). To suggest that these programs are teaching “rubbish” or “unscientific” material is an insult to the profession, to the institutions and to the instructors who include chiropractors and non-chiropractors with advanced degrees.
The council also understands the value of research and shares much of the same frustrations as the medical community in its endeavor to conduct upper level research in pediatrics. With lack of funding and ethical concerns raised about research criteria as it pertains to the pediatric patient, the progress in designing randomized controlled trials and collecting data for this population lags behind the adult population. There is however, a growing body of case reports, reviews, and surveys to support the field clinician and offer hypothesis for future design studies.
The ICA Pediatrics Council, however, emphasizes that the safety record for chiropractic with regard to adults and children is one of the highest among health care providers. The article cited on the television program from the journal, Pediatrics, “Adverse Events Associated with Pediatric Spinal Manipulation: A Systematic Review”, authored by Sunita Vohra, MD, FRCPC, MSc, et. al. failed to acknowledge that only 14 literature citations of adverse events were found over a period of 38 years (1966-2004) after a comprehensive search of 8 major electronic databases (Medline, AMED, MANTIS, etc.).¹ Nine were serious events with only 5 pertaining to chiropractic care. They also did not mention that a medical doctor and physiotherapist were also listed.
In contrast, Miller and Benfield published a study in the Journal of Manipulative and Physiologic Therapeutics (JMPT) in 2008 entitled, “Adverse effects of spinal manipulation therapy in children younger than 3 years: a retrospective study in a chiropractic teaching clinic.” Miller and Benfield examined 781 pediatric patients under three years of age (73.5 percent of whom were under 13 weeks) who received a total of 5,242 chiropractic treatments at a chiropractic teaching clinic in England between 2002 and 2004.² There were no serious adverse effects (reaction lasting >24 hours or needing hospital care) over the three-year study period. There were seven reported minor adverse effects, such as transient crying or interrupted sleep.
In the June 2012 issue of JMPT, Marchand published another study entitled “Chiropractic Care of Children from Birth to Adolescence and Classification of Reported Conditions: An Internet Cross-Sectional Survey of 956 European Chiropractors”.³ This study showed that pediatric patients represented 8.1% of European chiropractic practices; patients were seen mainly for skeletal and neurologic conditions, and few NSEs were reported after chiropractic care.
Evidence-based practice is based on three factors: best available research, clinician’s judgment and patient’s preference. The producers of the Catalyst program disregarded the evidence from the chiropractor and the patient. By doing that they did a disservice to the Australian public. Their public deserve their opinions to be heard and respected and expect the media to be objective and unbiased, especially when it involves something as important as health care for their children.
The ICA Council on Chiropractic Pediatrics will continue to pursue avenues of support for the premise of chiropractic care for the pediatric patient through advanced education and the publication of case reports, surveys, reviews, and controlled trials as and when they can be ethically and appropriately designed and funded.
Source: ICA Council on Chiropractic Pediatrics, icapediatrics.com
References
1Vohra S, Johnson BC, et al. Adverse Events Associated with Pediatric Spinal Manipulative Therapy: A Systemic Review. Pediatrics 2007; 119(1).
2Miller JE, Benfield K. Adverse Effects of Spinal Manipulative Therapy in Children Younger than 3 Years: A Retrospective Study in a Children’s Teaching Clinic. JMPT 2008; 31(6):419-423.
3Marchand A. Chiropractic Care of Children from Birth to Adolescence and Classification of Reported Conditions: An Internet Cross-Sectional Survey of 956 European Chiropractors. JMPT 2012; 35 (5):372-380.
