While acknowledging that supporting research remains slim, the Canadian Chiropractic Association is defending the practice of manipulating babies’ spines.
The organization representing the nation’s 9,000 chiropractors says parents can be reassured that its members modify their techniques and the “application of force” when adjusting fragile newborns and infants.
“While the evidence for pediatric conditions is limited, research in this area is ongoing and growing,” the group said in a public statement posted on its website, a rebuttal of a National Post story published earlier in July questioning infant chiropractic care.
Scientific evidence for the effectiveness and efficacy of spinal manipulation in children ‘is not plentiful or definitive’
The Post noted that, while one state government in Australia has ordered an independent expert review of infant spinal manipulation after disturbing YouTube footage emerged of a Melbourne chiropractor treating a two-week-old, Canadian babies are increasingly being adjusted by chiropractors, some of whom are taking weekend training courses run by an organization that has promoted anti-vaccination misinformation.
In its submission to the review panel, the Australian Medical Association called manipulation, mobilization or any applied spinal therapy in babies — or any child under 12, for that matter — “manifestly unsafe and unwarranted” and said the practice should cease immediately.
In Canada, chiropractors are marketing infant adjustments for colic, digestive and sleep problems, plagiocephaly (“flat-head syndrome”) and other problems. Many promote the notion that adjustments are needed to restore balance and function to the nervous system after the “trauma” of birth, a claim pediatricians call an absurd, pseudoscientific fantasy.
One article on a Waterloo, Ont.-area chiropractic website claims misalignments — or subluxations — caused by the trauma of moving through the birth canal puts stress on the developing brain and spinal cord, causing the child “to be stuck in a state of fight/flight,” which, in turn, leads to problems like autism. “A specifically trained pediatric chiropractor is the only provider on the planet trained to find and locate that subluxation and, if found, correct and resolve it,” the article claims.
In fact, there is no recognized pediatric specialization in chiropractic in Canada, the Canadian Chiropractic Association acknowledged in its rebuttal to the Post article. The group also stated that the claim that most newborns need spinal adjustments for birth trauma “is not supported by current scientific evidence.”
“We also acknowledge that a 12-hour continuing education course does not give one sufficient education or training to make a claim of expertise — in the field of paediatric chiropractic or any other field.”
However, the association said pediatric and pre-natal care are integral components of the four-year chiropractic curriculum. Students at Canada’s two chiropractic colleges must complete 50-plus hours of coursework on “paediatric diagnosis and management,” as well as a mandatory one-year internship, during which they care for patients of all ages under the supervision of an experienced chiropractor.
“Chiropractors put patient safety first. This is especially true with paediatric patients,” the CCA said.
So far no one has complained that I hurt their baby, not one!
The CCA also cited a literature review that found published reports of serious adverse events in babies and children receiving chiropractic care are rare.
“I have been adjusting babies and adults for over twenty years. So far no one has complained that I hurt their baby, not one!” one Edmonton chiropractor wrote to the Post. “I wonder how many MD’s (medical doctors) can say that.
“Medical doctors can’t find subluxations because, obviously, they are not trained to find them,” he added.
Curiously, though, the group also cited an article on “best practices for chiropractic care of children” — a consensus document by chiropractors which itself states that the scientific evidence for the effectiveness and efficacy of spinal manipulation in children “is not plentiful or definitive.”
“If the evidence base for treatment of children is lacking, just imagine what infant chiropractic care might draw upon for guidance,” Boston-area paediatrician Dr. Clay Jones wrote in a recent Evidence-Based Medicine blog.
He also states that (despite the CCA statement) chiropractors are increasingly positioning themselves as specialists in pediatrics.
When contacted for this story, the Canadian Chiropractic Association declined an interview. However, in an email, the group reiterated that any claim that most newborns need adjustment to correct nervous system interference caused by birth trauma “is misleading to the public and parents.”
When asked for scientific evidence to support bringing a newborn to a chiropractor for any reason, the group forwarded a link to a study published in BMJ Open, a systematic review of manual therapy for babies suffering from colic. The authors of that review included studies where not just chiropractors, but also osteopaths, physiotherapists and other disciplines administered the adjustments. Some small benefits were found (manipulated babies, for example, cried about an hour less per day). However, “whether these are meaningful to parents remains unclear,” the authors concluded.
In an interview, Jones, who practices at Newton-Wellesley Hospital, said he isn’t personally worried about direct risks, “like, is the chiropractor going to break the baby’s neck? The risk of that is incredibly low.
“Even though there are chiropractors out there that do high velocity, low amplitude adjustments, who make cracks, who make the baby scream, most chiropractors are smart enough to know that that’s going to make parents bristle,” Jones said. “They know they have to promote it as gentle, the ‘same amount of pressure as checking the ripeness of a tomato’ — the shtick that they learn in their marketing classes.”
Jones worries more about the indirect harms of parents being exposed to a subset of chiropractic that is anti-vaccine.
“If you are that deep into the pseudoscience of the chiropractic philosophy where you will treat a newborn infant with claims of improving development, boosting the immune system,” Jones said, “What other propaganda are these parents being exposed to?”