The following is a response from Dr. Joel Alcantara, the ICPA Research Director, to remarks from Dr. Howard Chilton in the September 2013 issue of the International Lactation Consultant Association's e-Globe. In the issue, Dr. Chilton, responded to questions about the use of chiropractic care for colicky infants.
We thank the International Lactation Consulting Association (ILCA) for the opportunity to respond to comments made by Howard Chilton, MBBS, MRCP (UK), DCH on the subject of chiropractic care for infants with colic. In this era of evidence-informed medicine, Dr. Chilton is obviously ill-informed on chiropractic for colicky infants and colic medications.
A recent systematic review of the literature on chiropractic and infantile colic by Alcantara and colleagues 1 found 26 published articles in peer-reviewed journals consisting of three clinical trials, two survey studies, six case reports, two case series, and four cohort studies. Overall, the published literature supports chiropractic for colicky infants.
In terms of comparative effectiveness research, it should interest Dr. Chilton that a clinical trial has compared chiropractic versus Dimethicone, a very popular medication prescribed for infants with colic. The study demonstrated that chiropractic care was more effective in relieving infantile colic. 2 This is not surprising to those familiar with the scientific literature on drug prescriptions for colic that finds “little scientific evidence to support the use of Simethicone, Dicyclomine hydrochloride, Cimetropium bromide, lactase, additional fiber or behavioral interventions.” 3
Chiropractic is a vitalistic, holistic and patient-centered approach to patient care. Chiropractic is a caring profession where mutual trust, understanding and acceptance is of paramount importance in our approach with patients, adult or children. As chiropractors, we acknowledge and embrace the non-specific effects of the clinical encounter, what Dr. Chilton refers to as the placebo effect. With all due respect, perhaps Dr. Chilton should not be so arrogant and judgmental and embrace the placebo effect since colic medications such as Dimethicone or Simethicone have been demonstrated to be no better than placebo. 4,5 Even more pressing, safety concerns have been raised with a number of these colic medications. 6,7
A systematic review of the scientific literature on adverse events associated with pediatric spinal manipulation found only 10 documented adverse events attributed to pediatric chiropractic in a span of over 100 years of chiropractic practice. 8 Our own practice-based research network studies point to the safety of pediatric chiropractic with prevalence of adverse events at less than 1% and risk estimates placed at <1000 adverse events per 1 million children followed under chiropractic care for 1 year. 9,10
Dr. Chilton should be more concerned about the practice of “off-label” prescribing for infants and children in his profession. The first study to examine the extent of this practice of prescribing medication for children without the safety, efficacy, and quality assurance that is required of medications was performed in the UK. The study found that 70% of children received either an unlicensed or off-label drug prescription, with approximately one-third of drug prescriptions being unlicensed or off-label. 10,11 Subsequent studies have confirmed the popularity of this practice in pediatric medicine with documented adverse events that is unmatched in frequency and severity by chiropractic or other alternative forms of pediatric care.
The practice paradigm of the 21st century is integrative care that is embraced by lactation professionals, chiropractors, nurses, and other healthcare professionals. It is characterized by mutual respect and shared management that emphasizes wellness and healing of the entire person (bio-psycho-socio-spiritual dimensions), drawing upon the best of both conventional and alternative therapies. 13 Antiquated attitudes expressed by Dr. Chilton have no place in the care of infants and children in the 21st century.
— Joel Alcantara, DC, Research Director of the International Chiropractic Pediatric Association (ICPA)