Pediatrics

There is currently insufficient research evidence related to adverse events and manual therapy. However, clinical studies and systematic reviews from adult patients undergoing manual therapy, particularly spinal manipulation report that mild to moderate adverse events are common and self limiting. However serious adverse events are rare and much less than for medication commonly prescribed for these problems. More high quality research specifically addressing the effectiveness and safety of pediatric manual therapy is needed

ESSENTIAL LITERATURE

CLINICAL EFFECTIVENESS OF MANUAL THERAPY FOR MANAGEMENT OF MUSCULOSKELETAL CONDITIONS
 Christine Clar et. al. 2014 
Conclusion:
The evidence suggests there are similar improvements in the manipulation and/or mobilisation intervention groups compared to active treatment, however, some trials also found no improvement in comparison to a control group.

THE USE OF SPINAL MANIPULATIVE THERAPY FOR PEDIATRIC HEALTH CONDITIONS: A SYSTEMATIC REVIEW OF THE LITERATURE
Gleberzon et. al. 2012 
Conclusion:
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. Many studies reviewed suffered from several methodological limitations. Further research is clearly required in this area of chiropractic health care, especially with respect to the clinical effectiveness of SMT on pediatric back pain.

CHIROPRACTIC OR OSTEOPATHIC MANIPULATION FOR CHILDREN IN THE UNITED STATES: AN ANALYSIS OF DATA FROM THE 2007 NATIONAL HEALTH INTERVIEW SURVEY
Ndetan et. al. 2012 
Conclusion:
Chiropractic/Osteopathic manipulation is primarily used for back and neck pain, which is increasing in prevalence in children. Teens are more likely to use it than are younger children.

 
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THE EVIDENCE BASE FOR CHIROPRACTIC TREATMENT OF MUSCULOSKELETAL CONDITIONS IN CHILDREN AND ADOLESCENTS: THE EMPEROR’S NEW SUIT?
Hestbaek et. al. 2010 
Conclusion:
That which appeared at first to be a large body of literature in relation to chiropractic treatment of children turned out to be a case of the emperor’s new suit. Of the almost 500 identified titles, there were several hundred case studies, reviews, letters etc., but only four clinical studies related to the effect of manual therapy on musculoskeletal problems in children, one of which was a pilot study and two lacked a control group. It is long overdue that we, as caretakers of musculoskeletal health, face reality. However, we as a profession must not “bear it up to the end”. Therefore, we must stop making reviews and recommendations based upon hot air and instead start creating a proper robe for the emperor. He needs it.

POSSIBLE ADVERSE EVENTS IN CHILDREN TREATED BY MANUAL THERAPY: A REVIEW
B Kim Humphreys 2010 
Conclusion:
There is currently insufficient research evidence related to adverse events and manual therapy. However, clinical studies and systematic reviews from adult patients undergoing manual therapy, particularly spinal manipulation report that mild to moderate adverse events are common and self limiting. However serious adverse events are rare and much less than for medication commonly prescribed for these problems. More high quality research specifically addressing adverse events and pediatric manual therapy is needed.

BEST PRACTICES RECOMMENDATIONS FOR CHIROPRACTIC CARE FOR INFANTS, CHILDREN, AND ADOLESCENTS
Hawk et. al. 2009 
Conclusion:
This consensus document describes the procedures and other features of chiropractic care which, based on the expert panel’s clinical experience and the available evidence, represent the most beneficial approach to chiropractic care for infants, children, and adolescents. This document provides a general framework for what constitutes an evidence-based and reasonable approach to the chiropractic management of infants, children, and adolescents. It should not be seen as a final product, but rather as a work-in-progress that will require refinement as new evidence emerges in the future.

THE SAFETY AND EFFECTIVENESS OF PEDIATRIC CHIROPRACTIC: A SURVEY OF CHIROPRACTORS AND PARENTS IN A PRACTICE-BASED RESEARCH NETWORK
Alcantara et. al. 2009
Conclusion:
The indicated primary reason for chiropractic care of children was “wellness care.” With respect to condition-based presentations, musculoskeletal conditions were the most common, in addition to nonmusculoskeletal conditions of childhood. The most common techniques used were diversified technique, Gonstead technique, Thompson technique, and activator methods. Treatment-associated complications were not indicated by the chiropractic and parent responders. Chiropractor responders indicated three adverse events per 5,438 office visits from the treatment of 577 children. The parent responders indicated two adverse events from 1,735 office visits involving the care of 239 children. Both sets of responders indicated a high rate of improvement with respect to the children‘s presenting complaints, in addition to salutary effects unrelated to the children‘s initial clinical presentations.

ADVERSE EVENTS ASSOCIATED WITH PEDIATRIC SPINAL MANIPULATION: A SYSTEMATIC REVIEW
Vohra et. al. 2007 
Conclusion:
Serious adverse events may be associated with pediatric spinal manipulation; neither causation nor incidence rates can be inferred from observational data. Conduct of a prospective population-based active surveillance study is required to properly assess the possibility of rare, yet serious, adverse events as a result of spinal manipulation on pediatric patients.