Chiropractors successfully treat a wide variety of paediatric health conditions. The evidence for this care rests primarily with clinical experience, descriptive case studies and very few observational and experimental studies. A good recent review done by two chiropractors examines this very elegantly. The review was done on the biomedical literature from January 2004 to June 2007 and it was designed to get a feel for the extent of new evidence about chiropractic manipulation for a wide range of paediatric health problems over that period. The review updated a similar, previous review published in 2005.

Tellingly, this systematic review concluded that:

1. There is no convincing evidence that spinal manipulation alone can affect the duration of infantile colic symptoms; (look a colon, you don’t see many of those about there days!)

2. The effect of spinal manipulation on sleep time, parental anxiety, quality of life and the number of infants meeting diagnostic criteria for colic could not be determined using available evidence;

3. The potential harm from the spinal manipulation of infants with colic could not be determined using evidence available from controlled trials.

There were also two trials carried out on enuresis one involving 171 children and the other 46 children. The first trial concluded the study results do not support the claim that chiropractic care in enuretic children is effective. However, the second trial concluded that the study results strongly suggest the effectiveness of chiropractic treatment for primary nocturnal enuresis!

There is a fair amount of evidence but it is clinically based and consists of 177 descriptive studies which are mainly single case reports and, so, interesting but not significant.

So we have some negative and a few positive results depending which way you are looking at the whole thing and what are we to make of it all?

The key thing is this: there is just not enough science out there to make a real judgement for and against and, as the chiropractic profession will freely and regularly admit, far more work is needed. Disappointingly the study added that there has been no “substantive shift in this body of knowledge during the past 3 1/2 years”. However it is worth bearing in mind that this is far from core business for the profession and far, far, more research is being carried on other subjects such as low-back pain in adults over the same period.

But if you are a practitioner who has numerous successful outcomes on single case basis you may arrive at some ‘premature’ conclusions and with some justification. However, generalizing such premature conclusions to larger patient populations is a position not well grounded in science and should be avoided if possible.

The health interests of paediatric patients would be advanced if more rigorous scientific inquiry was undertaken to examine the value of manipulative therapy in the treatment of paediatric conditions.
Let’s get it done.

Chiropractic manipulation in pediatric health conditions – an updated systematic review

Allan Gotlib and Ron Rupert
Canadian Chiropractic Association, CMCC Homewood Professor,
30 St. Patrick St. Suite 600, Toronto, Ontario, M5T 3A3, Canada
Parker College of Chiropractic, 2500 Walnut Hill Lane, Dallas, Texas 75229, USA