Earlier this year, Melbourne chiropractor Andrew Arnold made headlines when a (now deleted) video of him performing spinal manipulation on a two-week-old baby was shared to his clinic’s Facebook page.
Arnold’s actions were condemned by health minister Jenny Mikakos, who called the video “extremely disturbing.” Shortly thereafter, the Chiropractic Board of Australia barred Arnold from treating children under 12 years of age while they investigate him.
All of the clinic’s social media accounts have since been deleted, and Harry Nespolon, the president of the Royal Australian College of General Practitioners, has called for a nationwide ban on chiropractic treatments on babies.
In a letter to the review panel, the Australian Medical Association said there is no “credible scientific evidence that manipulation, mobilization or any applied spinal therapy in children under 12 years of age is warranted or safe.”
On the heels of the ongoing debate in Australia, chiropractors in Canada appear to be taking a different approach.
Beyond that, several Canadian chiropractors offer treatments for infants. Some, such as Vancouver’s Jassal Chiropractic, say that spinal misalignments may occur “through the processes of labour, birth or delivery intervention,” and a chiropractor can help. Others, like Toronto clinic West End Mamas, claim treatments can help with “digestive issues and colic” in infants.
Several medical doctors have expressed concern over this growing trend. When asked about chiropractic treatments for babies, consumer health advocate Ryan Armstrong told the National Post that “babies do not need to be adjusted and they should not have their spines manipulated.”
In response, the Canadian Chiropractic Association (CCA) released a statement on July 5 defending the use of chiropractic techniques on young children. In it, the association reaffirmed that chiropractors put patient safety first and that safety is of the utmost importance when the patient is a child.
(The CCA is a national, voluntary association representing “Canada’s licensed Doctors of Chiropractic.”)
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“When treating infants and children, chiropractors follow best practices. This includes modifying techniques and the application of force to support the needs and comfort of the child,” read the statement.
“The evidence for pediatric conditions is limited” but research is ongoing, said the CCA.
“Like other health-care professions, the processes and challenges of translating an ever-increasing evidence base into practice is a health-care wide issue not a chiropractic-specific one, but one that the chiropractic profession and educators take seriously.”
In the statement, the association also cited a study which found that “published cases of series adverse events in infants and children receiving chiropractic, osteopathic, physiotherapy or manual medical therapy are rare.”
We need more research
Dr. John LeBlanc is skeptical about both the CCA’s statement and chiropractic treatments for babies more generally. He’s a pediatrician and epidemiologist at the IWK Health Centre in Halifax.
“The thing that bothered me about the CCA statement was there was a ‘limited but growing’ body of evidence,” LeBlanc told Global News. “One can’t really make such a broad statement.”
He believes it was irresponsible for the CCA to promote pediatric chiropractic treatments while also admitting that more research is needed. “Chiropractors need to define their scope of practice and scientifically prove what works in specific conditions before they advocate something as acceptable care,” he said.
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While chiropractic manipulations may not cause any physical harm to babies, performing them before more research is done “gives a false sense of security where none exists,” said LeBlanc.
Even some chiropractors admit that there are some things for which chiropractic has been shown not to work, and LeBlanc says this should give parents pause.
A recent study found that the efficacy of chiropractic care to treat non-musculoskeletal disorders (such as colic in infants) “has yet to be definitely proven or disproven, with the burden of proof still resting upon the chiropractic profession.”
Another study determined that, since five to 10 per cent of all chiropractic patients are children and teens, the chiropractic community has a “responsibility” to undergo further research on the subject.
LeBlanc believes it is difficult for the general public to parse through the medical data, which is why medical associations exist — to bridge the gap.
“I think the responsibility of the CCA is to try and clarify that… to really say where things work and where they don’t,” he said.
Given the current research, LeBlanc can’t see any situation in which chiropractic services for babies would be necessary.
“It’s difficult to understand what value bring to the care of children that isn’t already offered by family doctors and nurse practitioners,” LeBlanc said. “At this point, they cannot argue that spinal manipulation is an essential or even important aspect of care.”
Can babies experience birth-related physical trauma?
A claim often made by chiropractors is that birth can cause physical trauma to a baby, whether delivered naturally or by c-section surgery.
LeBlanc said there is “not a shred of evidence” to support birth causes spinal subluxation that may require manual spinal manipulation after birth.
“There are some who are saying ‘yes, this is so-called evidence-based’ or ‘evidence-informed,'” he said. “I’m glad the CCA acknowledged that.”
In the statement, the CCA admits that the claim about birth trauma “isn’t supported by current scientific evidence.”
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However, LeBlanc is still worried because — despite the CCA stance — many chiropractors continue to share the falsehood as though it’s a fact.
“The message that sends is that, somehow, evolution or mother nature or God (depending on how one views how human beings came to be) somehow screwed up over the last hundred thousand years in terms of birth,” he said.
“It sends a message that we’re born unhealthy.”
Parents need a ‘trusted source of information’
LeBlanc worries that some chiropractors might prey on the fear and anxiety of a new parent in order to make money.
“Some of the chiropractic treatments are relatively short — they may just be a few sessions — but others can just go on and on… and that’s very costly,” he said. “People have to think about a trusted source of information.”
Unfortunately, it can be difficult for members of the general public to determine which sources can be trusted. “It’s also an issue of turf… doctors don’t like chiropractors and vice versa,” LeBlanc said. “If you go to a medical professional, they’re just going to pooh-pooh it.”
The solution, said LeBlanc, is to read as much as you can.
“Read widely, both on the medical side and the chiropractic side,” he said. “Ask yourself: Does the person who’s putting this information out have a vested interest?”
In LeBlanc’s view, chiropractors do have a stake in promoting treatment for children because it will produce more revenue. “It’s the same as if you go to a car dealership or any other place that’s offering a service, you simply have to take it with a grain of salt what they are saying.”
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Unfortunately, seeking out “objective sources” takes time — something which most new parents don’t have. “That’s where people have to rely on chiropractic associations like ,” LeBlanc said.
When asked about its stance on pediatric chiropractic treatments, the CCA reiterated its commitment to “advocate for the profession in a manner that supports quality care and upholds public trust.”
“To be clear, pediatric patients with mild to moderate musculoskeletal dysfunction are often referred for conservative management including a public health nurse, physiotherapist, occupational therapist, and chiropractor,” read the statement provided to Global News. “As allied health professionals, chiropractors work collaboratively with a range of health-care providers to co-manage and provide advice and referrals in the best interests of the patient.”
The association says that there are no age-related chiropractic specializations in Canada.
“Chiropractic treatments can effectively relieve pain, restore function and mobility and improve health outcomes — and Canadians of all ages rely on chiropractic to manage a range of age-specific musculoskeletal conditions,” the statement said.
“The study of pediatrics is an integral component of the four-year/five-year chiropractic curriculum in Canada. Graduating students must complete a series of clinical competency examinations, which include pediatrics, before obtaining their license to practice. Doctors of chiropractic (DCs) are trained, licensed and regulated to assess, diagnose and treat Canadians of all ages.”
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