Chiropractic Care For Infants & Children – What is the Evidence?
CHIROPRACTIC CARE FOR INFANTS & CHILDREN - WHAT IS THE EVIDENCE?
WHO PROVIDES MANUAL THERAPY CARE FOR INFANTS & WHY?
In Australia and overseas, chiropractors, medical practitioners, osteopaths and physical therapists have used manual therapy as part of their care for unsettled, distressed, and excessively crying infants. Musculoskeletal disorders (e.g. neck pain and stiffness), diet, feeding and digestive problems are some issues that may underlie unsettled infant behaviour. Chiropractors most commonly use manual therapy and have conducted much of the research that inform society’s understanding of safety and efficacy of manual therapy in infants. Outcome measures are challenging in infants as they are unable to express pain in the same way adults do, so instead, measures of unsettledness such as crying time, and sleep time have been utilized rather than facial grimace scores (commonly used in Paracetamol trials in infants(1). Evidence in this field remains sparse at this time.
IS MANUAL THERAPY SAFE FOR INFANTS?
In a recent analysis of data from 103 infants exposed to manual therapy, zero serious adverse events and 7 non-serious adverse events were reported(2). Infants not exposed to manual therapy also experienced minor adverse events. The rate of reported non-serious adverse events was 110 per thousand for infants not exposed to manual therapy, and only 7 per 1000 in infants having manual therapy. A recent review of the health literature identified a total of fifteen reported cases of serious adverse events in infants since the 1960’s. Of the 15 cases, 7 were associated with chiropractic care, and in 8 cases, pre-existing pathology was identified (3).
IS MANUAL THERAPY FOR INFANTS EFFECTIVE?
A recent study assessed the effectiveness of manual therapy for healthy but unsettled, distressed and excessively crying infants(2). Infants in the manual therapy’s interventions group had a greater reduction of crying time when compared to control groups (a difference 1.27 hours of less crying per day). The authors considered this to be only a small effect, however its meaningfulness to parents remains unclear.
HOW MUCH FORCE IS USED IN MANUAL THERAPY TECHNIQUES FOR INFANTS & CHILDREN?
Chiropractors have studied the forces associated with manual therapy techniques in infants(4). A recent review found chiropractors treating infants typically modify techniques so that force and speed is suited to the age and development of the child (5). When modified and applied by chiropractors or other manual therapists, spinal manipulation techniques (SMT) such as ‘touch and hold’ and ‘spinal mobilisation’ techniques (i.e. those applied by hand) are reported to fall within recommended force limits for infant and child safety. Typical forces can be compared to the pressure one might apply when testing the ripeness of a tomato.
ARE INFANTS TREATED AT OUR PRACTICE?
Many reading this newsletter will know the answer to this question, having already brought your babies and young children to us for care. We adhere to evidence-based guidelines including adaptation and modification of force and technique. Cameron and Leigh do not use spinal manipulation in their treatment of infants (spinal manipulation is when joints are 'cracked' or moved beyond their 'physiological range of movement'). In over 25 years of private practice Cameron's experience in treating infants is consistent with the current evidence….that is, manual therapy delivered with appropriate force is safe and appropriate for infants with spinal related pain.