World Chiropractic Alliance

Responding to
Eight Chiropractic Issues

 
 

Issue 8: Chiropractic for children

The issue of chiropractic for children has been hotly debated, with many chiropractors and their patients promoting the use of subluxation-correction as a way to ensure that all children have the greatest chance for healthy, happy lives. On the other end of the spectrum are those who state that children under a certain age should never be given chiropractic care or, at best, for an extremely limited number of "treatments."

As one "expert" stated, "Manual care of infants should generally only involve a course of care involving one or at most a few treatments and treatment in excess of this may well be detrimental." This expert cited, as his evidence, a book by Dr. Claudia Anrig, past president of the International Chiropractic Pediatric Association, noted lecturer in the area of pediatric chiropractic and editor of the textbook, "Pediatric Chiropractic."

Yet Dr. Anrig, when told of this case, was emphatic in her disputation of the "expert's" interpretation of her work.

"Regarding the care of an infant who has torticollis and plagiocephaly which was trauma introduced. There is "no formula" of care for the presence of subluxation and their manifesting disorders. Each patient and their outcome are different. There are many factors that contribute to outcome -- severity of trauma, chronicity, parent involvement, and environmental factors (home life) to state a few.

The statements made by the opposing side would not reflect my opinion or other leaders in the profession regarding the care of children. I would never suggest that a 'few adjustments' could resolve a trauma case, and to suggest that over a few adjustments could be 'detrimental' concerns me about the experts clinical background.

The opposing side may have picked through the textbook to find what he wanted to find. For example he probably went to Dr. Peter Fysch's chapter 14, page 619- 620. On page 620 it is stated under the heading of Acquired Torticollis, "A positive response is usually seen after the first adjustment unless a great deal of chronicity is present". What would be missing is the line before, "Older children with acquired torticollis……" Dr. Fysch's statement was in regards to an older child not an infant/trauma case.

Other places in the book which the opposing expert might have attempted to distort would have been from Dr. Carol Phillips chapter. She presented case studies regarding the care of infants with torticollis and their outcome after receiving chiropractic adjustments and craniosacral therapy.

Page 438-439 this case was an infant torticollis with irritability; Page 444-448 this was congenital torticollis case; Each of these cases did not reflect the presentation of plagiocephaly." 1

In her textbook, Pediatric Chiropractic,2 Dr. Anrig writes:

The frequency of care should be individually assessed. The vertebral subluxation complex in its earliest stages may not manifest as a clinically symptomatic disorder. Objective findings, not necessarily a symptomatic picture alone, should be the criteria for its identification. The rendering of spinal adjustments in the young may be one of the most effective forms of contributing to the prevention of spinal dysfunction and other health disorders.

Dr. Anrig goes on further to explain the phases of care in her text:

"It is during this time that the doctor can inform the parents of the three general phases of chiropractic care. Relief care which is the rendering of care until relief or stabilization of the condition is achieved. This varies from several weeks to several months. Visits are usually more frequent in the beginning and decrease as objective findings diminish. Reconstruction/rehabilitative care is the delivery of care to alter more permanently the biomechanical structure of the spine. Frequency of visits varies depending on many factors; objective findings for biomechanical changes, age, lifestyle habits.

The third phase has been called by the following names: prevention or wellness. This program is the rendering of spinal adjustments when subluxations are present to allow the developing spine and its influence on the nervous system to have optimum function during the course of the child's developmental process. This program is similar to the preventive approach of dentistry. The evaluation of the spine will be generally more frequent than in dentistry due to the ongoing stresses and vulnerability of the spine. The frequency rate will be greater if the child is going through a stage of increasing repetitive falls or stresses to the spine. The purpose is to evaluate the spine and to adjust if objective findings are present. It is negligent for the chiropractors to space out the visits when objective findings and lifestyle warrant more frequent evaluation."

Dr. Anrig goes on to recommend a frequency of chiropractic evaluations ranging from immediately after birth and then every 2-4 weeks in the non-traumatized infant. Dr. Anrig's recommendations in a non-trauma case coupled with Dr. Souza's recommendation that treatment in a more difficult case such as congenital torticollis may take up to one year3 clearly demonstrate that chiropractic is reasonable for children and that it is impossible to impose "cutter cutter" standards as to the number of visits needed to achieve maximum benefit.

Additionally, there are numerous position and policy statements by the World Chiropractic Alliance and the International Chiropractors Association which support the use of chiropractic for children, without the arbitrary limitations that some critics would like to see imposed. 4-5

References:

  1. Personal Communication via e-mail.
  2. Anrig C, Plaugher G. Pediatric Chiropractic. Williams and Wilkins. 1998.
  3. Souza T. Differential Diagnosis and Management for the Chiropractor. Jones and Bartlett. 2005. 
  4. Position Statements of the World Chiropractic Alliance: http://www.worldchiropracticalliance.org/positions/positionpapers.htm Chiropractic Diagnosis and Referral
    Caring for Asymptomatic Pateints; Vertebral Subluxation as the Sole Rationale for Care; The CCP Guidelines; The Mercy Guidelines; Chiropractic For Children; Policy on PrePay
  5. Policy Statements of the International Chiropractor's Association:
    Diagnostic Responsibility of the Chiropractor; Vertebral Subluxation as an acceptable Primary Diagnosis; Thermography