ICPA Responds to Article in Chiropractic and Osetopathy Journal

In 2010, the AU journal Chiropractic and Osteopathy published a paper, Chiropractic care for children: too much, too little or not enough? Here is Dr. Alcantara's response:

Chiropractic care for children: too much, too little or not enough? 

I read with great interest the editorial comments made by French and colleagues ¹ on the chiropractic care of children. The question posed by the authors, rhetorical or not, “Should chiropractors be treating children at all?” requires further comment.

We concur with the authors on the principles of evidence-based practice when “strong evidence is not available.” That is, in addition to the published literature, chiropractors should also rely on their clinical expertise and experience and respect the needs and wants of parents for their child’s healthcare. 

On the chiropractic care of children with colic, we disagree with the authors’ perspective. Contrary to the findings of Bronfort and colleagues ², no clinical trial has examined the effectiveness of chiropractic SMT versus sham therapy for infantile colic. The Olafsdottir study ³ compared an unproven chiropractic technique versus no therapy. The Weiberg study ⁴ compared chiropractic SMT versus Dimethicone while the Browning et.al. study ⁵ compared chiropractic SMT versus occipito-sacral decompression. Olafsdottir et.al. ³ found their chiropractic technique ineffective when compared to no therapy while Weiberg et. al. ⁴ found chiropractic SMT superior to Dimethicone and Browning et.al. ⁵ demonstrated that both their techniques are capable of decreasing the hours of crying infants when compared to baseline measures.

Medical treatments have been shown to be no better than placebo or have unacceptable adverse events ⁶. Combined with the safety of pediatric chiropractic SMT ^7-8 in the totality of the evidence, the authors’ suggestion of a trial of “placebo treatment” is unjustified and irresponsible. In keeping with evidence-based practice ⁹ and the principles of biomedical ethics ¹⁰ a trial of “chiropractic care” is warranted at the request and consent of the parent(s) in the care of their children. 

— Joel Alcantara, DC, Research Director of the International Chiropractic Pediatric Association (ICPA)

References

1. French SD, Walker BF, Perle SM. Chiropractic care for children: too much, too little or not enough? Chiropractic & Osteopathy 2010, 18:17
2. Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3
3. Olafsdottir E, Forshei S, Fluge G, Markestad T. Randomised controlled trial of infantile colic treated with chiropractic spinal manipulation. Arch Dis Child 2001;84(2):138-141
4. Wiberg JM, Nordsteen J, Nilsson N. The short term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther 1999;22(8):517-522
5. Browning M, Miller J. Comparison of the short-term effects of chiropractic spinal manipulation and occipito-sacral decompression in the treatment of infant colic: A single-blinded, randomised, comparison trial. Clinical Chiropractic 2008;11:122-129.
6. Garrison MM, Christakis DA. A systematic review of treatments for infant colic. Pediatrics. 2000;106(1 Pt 2):184-190.
7. Vohra S, Johnson BC, Cramer K, Humphreys K. Adverse events associated with pediatric spinal manipulation: a systematic review. Pediatrics 2007;119(1):e275-e283.
8. 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 (NY). 2009;5(5):290-295.
9. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson S. Evidence based medicine: what it is and what it isn't BMJ 1996;312:71-72
10. Cohen MH, Kemper KJ, Stevens L, Hashimoto D, Gilmour J. Pediatric use of complementary therapies: ethical and policy choices. Pediatrics. 2005;116(4):e568-75.