“In 2000, a survey found that there were about 30 million pediatric visits to chiropractors; by 2009, that figure had more than doubled, to 68 million.”
In 2000, a survey found that there were about 30 million pediatric visits to chiropractors; by 2009, that figure had more than doubled, to 68 million.2 The National Board of Chiropractic Examiners’ most recent practice analysis, issued in 2010, found that about 17 percent of chiropractic patients were under age 18 — approximately 7.7 percent aged five years or younger and some 9.4 percent between ages six and 17.
Chronic Ear Infections
For slightly older children, one of the most common reasons to visit the chiropractor is a chronic ear infection. A 2011 review of the literature by Pohlman and Holton-Brown, published in the Journal of Chiropractic Medicine, paints a conflicting picture of the evidence for its effectiveness (although the safety findings are strong).8 “From the 49 studies (17 surveys/editorials/commentaries, 15 case reports, 5 case series, 8 reviews and 4 clinical trials) found in this report, there was limited quality evidence for the use of SMT for children with otitis media,” the authors wrote. “There is currently no evidence to support or refute using SMT for OM and no evidence to suggest that SMT produces serious adverse effects for children with OM.”
How might chiropractic care improve chronic ear infections? Dr. Brocker explains the process this way, “Fluid is getting trapped in the middle ear cavity, creating a breeding ground for bacteria and viruses. Medically, you’d use an antibiotic to kill the bacteria, but that doesn’t do anything about the fluid buildup. We’re asking, why is the fluid trapped? If the muscles surrounding the Eustachian tubes are spasming, that can close down the tube’s opening and not allow the fluid to drain. Our goal is to stop those muscles from spasming.”
Quality of Life
Some claims have been made about chiropractic’s potential to have an effect on larger childhood developmental disorders and syndromes like cerebral palsy, ADHD, autism, post-stroke, Down syndrome and so on. Dr. Brocker says that no one could ever legitimately claim to “cure” a child with such conditions. “But chiropractic may make some changes that allow them to lead a more comfortable life,” she says. “You can improve their quality of life by keeping their system moving and allowing their nervous system to work the best it can, so their body can reach its fullest potential.”
“I’m not sure if there’s any evidence that shows some of these things, but I’ve had parents come back to me after I’ve adjusted their child and found some places that are restricted, and say that their behavior seems more calm and they’re more relaxed in their own body,” says Dr. Watters.
Pediatric Chiropractic Specialty
There are few chiropractic practices that specialize solely in children, as those of Dr. Hewitt, Dr. Brocker and Dr. Watters. “There are only about 225 DICCPs around the world, and about 175 or so spread across the 50 states in this country,” Dr. Hewitt says. “But there is more and more interest now at the student level in pediatric chiropractic practice.”
Because of the growing focus on chiropractic integration and collaboration with the medical mainstream, students are coming into the profession interested in specialization — and pediatrics is a specialty that particularly attracts the interest of young chiropractors. “There’s much more awareness among students, as well as the profession and the general public, that chiropractic can help children than there was in past years,” Dr. Hewitt says. “Every time I speak in public, my breakout sessions are always crowded because people want to learn more about pediatrics. I think in the next 20 years we will see a lot more chiropractors in this specialty.”
Launching a pediatric chiropractic practice today should be relatively easy, Dr. Hewitt believes. She hasn’t advertised in 15 years and gets patients only via referral, yet she has a two-month waiting list for new patients.
“There’s a huge need. Medical care is great for saving our lives but doesn’t do a lot for everyday quality-of-life issues that plague us. There’s a lot more anxiety and stress in kids’ lives today. As a chiropractor, the adjustments we do are great, powerful and can be life-changing,” she says. “But there are other aspects to a conservative first approach to health care that are particularly important for kids: focusing on adequate nutrition, sleep and physical activity. Parents are looking for answers besides putting their kids on more drugs. This is a great gift that we have to offer our children.”
A 2012 systematic reviewed stated, “studies that monitored both subjective and objective outcome measures of relevance to both patients and parents tended to report the most favorable response to SMT, especially among children with asthma.”1
- Evidence is insufficient to support chiropractic care for ADHD in children.2,3
- Autism spectrum disorders.
- Limited literature regarding chiropractic care and autism.4 Preliminary studies suggest some benefit from chiropractic care.4
- “Given the ineffectiveness of pharmaceutical agents, a trial of chiropractic care for sufferers of autism is prudent and warranted.”4 (Information obtained from abstract.)
- A 2010 systematic review states that SMT is not effective for asthma, compared to sham manipulation.5 However, a 2007 review indicates that the entire clinical encounter of chiropractic care, including SMT, is beneficial to patients with asthma.6
- Another 2010 systematic review states that “chiropractic care showed improvements in subjective measures and, to a lesser degree objective measures, none of which were statistically significant...some asthmatic patients may benefit from this treatment approach; however, at this time, the evidence suggests chiropractic care should be used as an adjunct, not a replacement, to traditional medical therapy.”7
- “Chiropractic care is a viable alternative to the care of infantile colic and congruent with evidence-based practice, particularly when one considers that medical care options are no better than placebo or have associated adverse events.”9
- Cochrane database systematic review and a 2010 review found that evidence was insufficient to make conclusions about the effectiveness of SMT.3,10
- Evidence is insufficient for SMT.3
- Evidence is insufficient for manual therapy for spinal disorders in the pediatric population specifically. There was one RCT for TMJ disorders.11
- Evidence is insufficient to support or refute SMT for OM3,12 but there is no evidence of serious adverse events from SMT for children with OM.12
- Study looked at osteopathic manipulation, massage and chiropractic and found that the literature is insufficient.13
1. Gleberzon BJ, Arts J, Mei A, McManus EL. The use of spinal manipulative therapy for pediatric health conditions: a systematic review of the literature. J Can Chiropr Assoc. Jun 2012;56(2):128-141.
2. Karpouzis F, Bonello R, Pollard H. Chiropractic care for paediatric and adolescent Attention-Deficit/ Hyperactivity Disorder: A systematic review. Chiropr Osteopat. 2010;18:13.
3. Ferrance RJ, Miller J. Chiropractic diagnosis and management of non-musculoskeletal conditions in children and adolescents. Chiropr Osteopat. 2010;18:14.
4. Alcantara J, Alcantara JD, Alcantara J. A systematic review of the literature on the chiropractic care of patients with autism spectrum disorder. Explore (NY). Nov 2011;7(6):384-390.
5. Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3.
6. Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW. Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research. J Altern Complement Med. Jun 2007;13(5):491-512.
7. Kaminskyj A, Frazier M, Johnstone K, Gleberzon BJ. Chiropractic care for patients with asthma: A systematic review of the literature. J Can Chiropr Assoc. Mar 2010;54(1):24-32.
8. Hawk C, Schneider M, Ferrance RJ, Hewitt E, Van Loon M, Tanis L. Best practices recommendations for chiropractic care for infants, children, and adolescents: results of a consensus process. J Manipulative Physiol Ther. Oct 2009;32(8):639-647.
9. Alcantara J, Alcantara JD, Alcantara J. The chiropractic care of infants with colic: a systematic review of the literature. Explore (NY). May-Jun 2011;7(3):168-174.
10. Dobson D, Lucassen PL, Miller JJ, Vlieger AM, Prescott P, Lewith G. Manipulative therapies for infantile colic. Cochrane Database Syst Rev. 2012;12:CD004796.
11. Hestbaek L, Stochkendahl MJ. The evidence base for chiropractic treatment of musculoskeletal conditions in children and adolescents: The emperor’s new suit? Chiropr Osteopat. 2010;18:15.
12. Pohlman KA, Holton-Brown MS. Otitis media and spinal manipulative therapy: a literature review. J Chiropr Med. Sep 2012;11(3):160-169.
13. Pepino VC, Ribeiro JD, Ribeiro MA, de Noronha M, Mezzacappa MA, Schivinski CI. Manual therapy for childhood respiratory disease: a systematic review. J Manipulative Physiol Ther. Jan 2013;36(1):57-65.