Background and Significance: A study by Lee and colleagues extrapolated that some 30 million visits were made by pediatric patients to chiropractors in 1997 at a cost of $1 billion with $510 million being paid out-of-pocket by parents. A 2005 study by the National Board of Chiropractic Examiners revealed that the percentage of chiropractic patients under 17 years of age has increased 8.5% since 1991 from 9.7% to 18.2%. The chiropractic care of children is therefore a substantial aspect of chiropractic and the care of children in general. Safety and effectiveness are issues germane to all healthcare providers. To contribute to evidence-based practice, this study was undertaken to determine the incidence and types of iatrogenesis as well as the effectiveness associated with the chiropractic care of children.
Materials and Methods: This study was approved by the Institutional Review Board of Life University, Atlanta, GA, USA. Doctors of Chiropractic participating in a practice-based research network provided the data. These include geographical information, the reasons or the types of patient complaints addressed, and treatment-associated aggravations, complications or improvements. All data were entered into a Word Document (Microsoft Word, Microsoft Corp) and exported to a spreadsheet (Excel, Microsoft Corp) and analyzed using descriptive statistics.
Results: The data reported herein was derived from 53 chiropractors contributing 1161 pediatric cases. All patients received chiropractic adjustments at each visit which totaled 10249 office visits. The average patient age was 6.46 years. There were 555 females and 605 males. The average number of office visits completed was 8.83.
The 3 primary complaints (in decreasing frequency) were: ENT/Respiratory Disorders (N=64), Gastrointestinal Problems (N=42) and Musculoskeletal Problems (N=39). Secondary complaints (in decreasing frequency) were: Neuromuscular Dysfunction/ Headaches (N=21), ENT/Respiratory Disorders (N=20), and Immune Dysfunction (N=18).
With respect to treatment-associated outcomes; 776 reported experiencing an overall improvement in their presenting symptoms with 17 reported treatment-associated aggravations from 16 patients. There were no treatment-associated complications. The treatment-associated aggravations were muscle soreness or stiffness (N=11), mother reporting the patient as “fussy” post-adjustment (N=2) while one patient had reported worsening in colic symptoms the night after the adjustment. Other patients reported fever (N=2) or spitting up (N=1).
Interestingly, 36 DCs reported patient improvements which were unrelated to the presenting complaint. These were improvements in patient mood (N=37), sleep (N=30), immune function (N=19), and range of motion (N=15).
Discussion: To date, this is the first study of its kind in documenting treatment-associated aggravations, complications and improvements in the chiropractic care of children. Of 1161 clinical cases presenting the gamut of both non-musculoskeletal and musculoskeletal complaints, less than one percent reported minor adverse events spanning 10, 249 office visits. Sixty-six percent reported improvements in their presenting complaints while another 8% reported improvements unrelated to their presenting complaints.
Conclusion: This study provides practice-based evidence on the safety and effectiveness of pediatric chiropractic. Longitudinal studies incorporating risk analysis are needed to fully address these issues. We advocate for more research in this field.
Joel Alcantara, DC 1 and Jeanne Ohm, DC 2
- Research Director, International Chiropractic Pediatric Association, Media, PA and Private Practice of Chiropractic, San Jose, CA
- Private Practice of Chiropractic, Media, PA and Executive Director, International Chiropractic Pediatric Association, Media, PA
Presented at ECU Annual Convention, Brussels, May 2008.