Gonstead Chiropractors in Berwick, Cowes, Belgrave

Well done on considering Chiropractic Care for your child. There may be benefits for your child to receive Chiropractic care, and these discussed these with your Chiropractor.

Naturally, you may have questions about the safety of Chiropractic care for your child. The information following reflects current safety data in reference to Paediatric Chiropractic and manual therapy for children. It is clear that the current data indicates a very low rate of adverse events in Chiropractic Care for Children.

Understanding types of adverse events:

Safety information is based on different categories of events, such as

Mild – self limited, not requiring additional medical care
Moderate – transient disability requiring medical care but no hospitalization
Severe – permanent disability requiring hospitalization or death
Adverse events caused by delayed diagnosis or misdiagnosis. [2, 3]

We will provide you with all the current evidence, so that you are fully informed.

Mild- Moderate Adverse Events:

These types of events are more commonly reported [5]. They include symptoms such as crying, soreness, transient headache, fainting (one case), restlessness or sleep disturbance. Mild adverse events are time limited (usually resolving within 24 hours), thus requiring no additional care.

Recent studies have indicated very low rates of these types of events, ranging between 0.51 and 9.0% [21][22] [23]. Whilst these studies indicate a very low rate of mild adverse events, care must be taken to avoid extrapolating rates of adverse events to the whole population, and further well designed studies are required to determine exact rates.

Serious Adverse Events (SAE):

There have been a total of 14 instances of serious adverse events involving the application of some form of manual therapy on children younger 18 years [5]. Some of these involved Chiropractors, and some involved practitioners of other types (e.g. Medical, Physiotherapists, Osteopaths, or Unknown).

No serious adverse event by a Chiropractor has been reported in the literature since 1992 [7]. In studies from 2004 onwards all Adverse Events (AE) were minor (Humphreys 2010) [8].

In many cases where serious events have occurred, there has been the application of inappropriate techniques [9]12]13][14][15], or the presence of underlying pathology [5]. For example, at least 3 had underlying pathologies or conditions that are contraindications to manual care, such as spinal cord astrocytoma [9], osteogenesis imperfecta [10], congenital occipitalization [11].

Modern Chiropractors are trained to perform a thorough history and examination in order to identify contraindications to care. Chiropractors are also trained to use those techniques that best suit the age and condition of the patient. Practitioners will modify their treatment style whenever it is used on a child and a variety of techniques can be considered for neonates or infants that are very gentle often with any pressure used to be equivalent to that used to test the ripeness of a tomato. Techniques that involves rotation and high force are contraindicated

There have been no cases of deaths associated with child or infant chiropractic care [5].

Some interesting information:

• Adverse Events rates for Pediatric manual care are less than for adults [8].
• Serious adverse events are rare and much less than for medication commonly prescribed for these problems [8].

In conclusion

• Adverse events can occur after manual therapies, but the reported incidence is rare.
• One child per 100 to 200 attending may have a mild adverse event, with irritability or soreness lasting less than 24 h, resolving without the need for additional care beyond initial chiropractic recommendations [7].
• Your Chiropractor is trained to follow processes to identify underlying pathologies, including performing a thorough history and examination. The technique’s used by your Chiropractor is modified for your child.

If you have further questions about the safety of Chiropractic Care for your child, please ask your Chiropractor for more information.

References:

1. Di Fabio RP. Efficacy of Manual Therapy. Phys Ther 1992;72:853-864.
2. Marchand AM. A Literature Review of Paediatric Spinal Manipulation and Chiropractic Manipulative Therapy: Evaluation of Consistent Use of Safety Terminology. J Manipulative Physiol Ther 2012;(xx:1-7).
3. Vohra S, Johnston BC, Cramer K, Humphreys K. Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review. Pediatrics 2007;119(1):275-283.
4. Carnes D, Mars T, Mullinger B, Froud R, Underwood M. Adverse events and manual therapy: a systematic review. Man Ther 2010;15:355-63.
5. Todd AJ, Carroll MT, Robinson A, Mitchell EKL. Adverse Events Due to Chiropractic And Other Manual Therapies For Infants And Childre: A Review Of The Literature. J Manipulative Physiol Ther 2014;(xx:1-14).
6. Held JP. Dangers of cervical manipulation in neurology [in French]. Ann Med Phys (Lille) 1966:251-259.
7. Doyle MF. Is chiropractic paediatric care safe? A best evidence topic. Clinical Chiropractic 2011;14:97-105.
8. Humphreys BK. Possible adverse events in children treated by manual therapy: a review. Chiropractic & Osteopathy 2010;18 (12):1-7.
9. Shafrir Y, Kaufman BA. Quadriplegia after chiropractic manipulation in an infant with congenital torticollis caused by a spinal cord astrocytoma. J Pediatr 1992;120:266-268.
10. Ziv I, Rang M, Hoffman HJ. Paraplegia in osteogenesis imperfecta. J Bone Joint Surg Br 1983;65:184-185.
11. L’Ecuyer JL. Congenital occipitalization of the atlas with chiropractic manipulations: a case report. Nebr State Med J 1959;44:546-549.
12. Jacobi G, Riepert T, Kieslich M, Bohl J. Fatal outcome during physiotherapy (vojta’s method) in a 3-month old infant. Case report and comments on manual therapy in children. Klin Padiatr 2001;(213):76-85.
13. Holla M, Ijland MM, van der Vliet AM, Edwards M, Verlaat CW. Death of an infant following “craniosacral” manipulation of the neck and spine. Ned Tijdschr Geneeskd 2009;(153):828-31.
14. Zimmerman AW, Kumar AJ, Gadoth N, Hodges FJ. Traumatic vertebrobasilar occlusive disease in childhood. Neurology 1978;28:185-188.
15. Struewer J, Frangen TM, Ziring E, Hinterseher U, Kiriazidis I. Massive hematothorax after thoracic spinal manipulation for acute thoracolumbar pain. Orthop Rev (Pavia) 2013;(5):120-2.
16. Rageot E. Complications and accidents in vertebral manipulation [in French]. . Cah Coll Med Hop Paris 1968;9:1149-1154.
17. Simonian PT, Staheli LT. Periarticular fractures after manipulation for knee contractures in children. J Pediatr Orthop Rev (Pavia) 1995;(15):288-91.
18. Klougart N, Leboeuf-Yde C, Rasmussen LR. Safety in chiropractic practice. Part II: treatment to the upper neck and the rate of cerebrovascular incidents. J Manipulative Physiol Ther 1996;(19):563-9.
19. Wilson P, Greiner M, Duma E. Posterior rib fractures in a young infant who received chiropractic care. Pediatrics 2012;130:1359-62.
20. Leboeuf C, Broen P, Herman A. Chiropractic care of children with nocturnal enuresis: a prospective outcome study. J Manipulative Physiol Ther 1991;14:110-115.
21. Hayes NM, Bezilla TA. Incidence of iatrogenesis associated with osteopathic manipulative treatment of pediatric patients. J Am Osteopath Asso 2006;106:605-608.
22. Miller JE, Benfield K. Adverse effects of spinal manipulative therapy in children younger than 3 years: A retrospective study in a chiropractic teaching clinic. J Manipulative Physiol Ther 2008; 31:419-423.
23. Alcantara J, Ohm J, Kunz D. The safety and effectiveness of pediatric chiropractic: A survey of chiropractors and parents in a practice-based research network. Explore 2009;5:290-295.