Chiropractors have again been banned from manipulating babies’ spines. Here’s what the evidence actually says

Chiropractors in Australia will no longer be able to perform spinal manipulation on children under the age of two, following health concerns from doctors and politicians.

But what is the treatment of the spine at the center of the controversy? Does it work? Is there evidence of damage?

We are a team of researchers who specialize in evidence-based musculoskeletal health. I (Matt) am a registered chiropractor, Joshua is a registered physiotherapist and Giovanni trained as a physiotherapist.

Here’s what the evidence says.

Remind me, how did this all come about?

A Melbourne-based chiropractor posted a video on social media in 2018 using a spring-loaded device (known as an Activator) to manipulate the spine of a two-week-old baby hanging upside down by his ankles.

The video sparked widespread concern among the public, medical associations and politicians. This prompted a ban on the procedure in young children. The Victorian Health Minister commissioned Safer Care Victoria to conduct an independent review of spinal manipulation techniques in children.

Recently, the Chiropractic Board of Australia reinstated the authorization of chiropractors to perform spinal manipulations on infants under two years of age. But this week, it backtracked, following heavy criticism from medical associations and politicians.

What is spinal manipulation?

Spinal manipulation is a treatment used by chiropractors and other health professionals such as doctors, osteopaths and physiotherapists.

It is an umbrella term that includes the well-known “back-slapping” techniques.

It also includes gentler forms of treatment, such as massage or joint mobilization. These involve applying pressure to the joint without generating a “cracking” sound.

Does spinal manipulation work in babies?

Several international guidelines for health care professionals recommend spinal manipulation to treat adults with conditions such as back pain and headache as there is an abundance of evidence on the subject. For example, spinal manipulation for back pain is supported by data from nearly 10,000 adults.

For children, it’s a different story. Safer Care Victoria’s 2019 review of spinal manipulation found very few studies testing whether this treatment was safe and effective in children.

The studies were generally small and of poor quality. Some of those small, poor-quality studies suggest that spinal manipulation offers little benefit for back pain, abdominal pain, and possibly bedwetting—some common reasons for parents to take their child to a chiropractor. But overall, the review found that the overall body of evidence was very weak.

However, for most of the other conditions in children that chiropractors treat—such as headaches, asthma, otitis media (a type of ear infection), cerebral palsy, hyperactivity, and torticollis (“twisted neck”)—there does not appear to be any benefit. .

The number of studies investigating the effectiveness of spinal manipulation in infants under two was even smaller.

There was one high-quality study and two small, poor-quality studies. These did not show a clear benefit of spinal manipulation in colic, otitis media with effusion (known as glue ear) or tortuous neck in infants.

Is spinal manipulation safe in infants?

In terms of safety, most of the studies in the review found that serious complications were extremely rare. The review noted an infant or child dying (a report from Germany in 2001 following spinal manipulation by a physiotherapist). The most frequent complications were mild in nature such as increased crying and fussiness.

However, because the studies were so small, they cannot reliably tell us anything about the safety of spinal manipulation. Studies that are designed to properly investigate whether a treatment is safe usually involve thousands of patients. And these studies have not been done yet.

Why do people see chiropractors?

Safer Care Victoria also surveyed more than 20,000 people living in Australia who had taken their children under 12 to a chiropractor in the past ten years.

Nearly three-quarters said it was for the treatment of a child aged two or younger.

Almost all of the people surveyed reported a positive experience when they took their child to a chiropractor and reported that their child’s condition improved with chiropractic care. Only a small number of people (0.3%) reported a negative experience and this was mainly related to the cost of treatment, lack of improvement in their child’s condition, excessive use of X-rays and perceived pressure to avoid medication.

Many of the respondents had also consulted their GP or maternity/child health nurse.

Now what about spinal manipulation in children?

At the request of state and federal ministers, the Chiropractic Board of Australia confirmed that spinal manipulation on babies under two will continue to be banned until it further discusses the matter with health ministers.

Many chiropractors believe this is unfair, especially given the strong consumer support for chiropractic care described in the Safer Care Victoria report and the rarity of serious harm reported to children.

Others believe that in the absence of evidence of benefit and uncertainty about whether spinal manipulation is safe in children and infants, the precautionary principle should apply and children and infants should not receive spinal manipulation.

Ultimately, high-quality research is urgently needed to better understand whether spinal manipulation is beneficial for the range of conditions for which chiropractors provide care and whether the benefit outweighs the extremely small chance of a serious complication.

This will help parents make an informed choice about their child’s health care.