Why I don't take my kids to the chiropractor
The Doc Smitty gives 4 reasons on why chiropractors aren't for kids
It’s a question I hear pretty often, “What about using the chiropractor for this?”
Here, I usually pause, take a deep breath and ask a question of my own.
“Do you have concerns with the plan that we have developed so far?”
Sometimes it’s not the case, because a family might simply be seeking a quicker solution or alternative. Of course, I’m happy to have this conversation and, in fact, cherish the fact that a family is willing to ask and talk through their child’s health with me.
But, parents asking about chiropractors are often showing a concern that their child is not improving in the way they had hoped. This could also be true for any other alternative treatment options.
I’m always happy to discuss changing our game plan based on how a child is responding or not.
I desperately want families to feel confident that they are doing the right and best thing for their children.
Sometimes answering a question like “what about using the chiropractor for this,” involves putting myself in their shoes and advising them based on what I would do for my own children.
So the answer to the question, “What about using the chiropractor this this?” is, “I wouldn’t if it were my child.”
I don’t believe chiropractors are trained well enough to be the primary care providers for children.
Those things they do that could be an alternative to traditional treatments are commonly performed for conditions that self-resolve.
The published articles on chiropractic care are not research; they are stories about how an individual child seemed to get better after they completed their chiropractic treatment plan.
1. Chiropractic training in children is very limited.
During their school, chiropractors do a lot of hours of training. A quick survey of a local program shows a total of more than 4,500 hours of lectures and clinic-based work.
How much of that time is dedicated to pediatrics?
60 hours (in a combined pediatrics and obstetrics course).
While there is undoubtedly pediatric information sprinkled throughout the curriculum, that is the only structured time dedicated to learning about children’s health.
As medical students, pediatricians attend various lectures on pediatrics in the first two years, then go on to do a dedicated eight week rotation where they are learning only pediatrics in various contexts (in hospitals, newborn nurseries and clinics). Next, medical students interested in pediatrics do multiple (3-4) month long elective rotations where they can learn more about general pediatrics or pick a specific specialty within pediatrics that interests them.
What about after school?
After chiropractic school, a chiropractor can go on to get special training and be designated a Diplomate in Clinical Chiropractic Pediatrics. This consists of “30 modules (360+ hours) taught over a three-year period. The curriculum is structured and balances academic knowledge with clinical applications. Practical workshops, observation/training at a Children's Center for Special Needs Children, research writing and oral presentation of a professional paper are part of the curriculum and mandatory.“
After medical school, a pediatrician completes a three-year residency program where they participate in the care of children full time. Over those three years, pediatric residents gain experience and are given increasing opportunities to make direct treatment decisions. During this time, they participate in (at least) daily case presentations, lectures and other learning opportunities. Even at a very underestimated six hours of lecture per week, that totals more than 900 hours of lectures training in the three-year period. In addition, the hands-on and in-the-moment teaching working with patients totals about 7,500-9,000 hours (estimating 10 hours days for 5-6 days per week).
The number of opportunities to learn and be prepared to treat children just doesn’t compare.
2. We must weigh risk versus benefit for chiropractic care, just like we would with medicine or any other treatment.
I’ll talk more about the potential benefits of chiropractic care in kids in Reasons No. 3 and No. 4. For now, let’s just talk about the risks.
First off, manipulation of a baby or child’s neck can result in harm. A review of cases published in Pediatrics in January 2007 showed 14 cases of direct harm from spinal manipulation. I do believe that most chiropractors have at least enough common sense to know that they shouldn’t use too much force but the possible risk is there and mistakes do happen in medical practices. Unfortunately, because there is little research in chiropractic pediatrics (see below) it’s hard to estimate baseline level to assess the percentage risk (Based on what I’ve read; presumably, it’s fairly low.)
Another risk is possible harm by missing a diagnosis or having a diagnosis delayed due to failure to seek care. Other cases in the above series described children who had a delayed diagnosis while undergoing a treatment plan. Others had conditions which could have made spinal manipulation more risky, that were missed by the chiropractor.
A third concern I have, has to do more with what other ideas a family might be exposed to while in the chiropractic office. Not all, but many chiropractors have positioned themselves firmly in the: “anti-established medicine camp” in an effort to stake a claim to a subset of patients and families who are looking for that approach to treating their child. Families could be exposed to conversations and ideas which undermine their pediatricians’ advice regarding multiple issues including use of medications and vaccines. While I always welcome healthy discussion about any treatments that I prescribe, it is often difficult because I’m not truly discussing it with the patient in front of me. Instead, I’m actually indirectly discussing the issue with a chiropractor who is not in the room but providing the family advice in other venues.
Finally, and most simply, I am constantly concerned about the amount of money and time that parents spend away from work or other activities when their children are sick. I do this by answering questions via online messaging and phone, keeping wait times low and picking low cost treatment options where available. I certainly don’t want families to be charged for care that is not helpful. I believe that most chiropractic care is heavy in promises and costly given the potential benefit (see below).
Thus, while it may seem safe, I do believe that chiropractic care for children does carry some risk. Because of that, it becomes important to analyze what potential benefits might be out there.
3. The explanation of how chiropractic interventions work in kids does not convince me.
It’s sometimes hard to get your head around how chiropractic care might help a child because there are so many different explanations out there.
I found this description in Pathways to Family Wellness (which is a magazine about chiropractic care of families):
Think of your brain as a computer and the nervous system as its hard drive. Your brain coordinates, via your nervous system, every function in your body including breathing, digestion, thought processes, and healing. Nerve messages (in the hard drive) can become impaired or blocked by spinal or vertebral subluxations which occur when there are misalignments of one or more bones of the spine. This results in altered joint motion and nerve irritation, which lessens nerve communication, organ function and general health. The longer the subluxation exists, and the more severe it is, the more profoundly “disorganized” the body becomes.
Symptoms that are listed in the article as possible evidence of a spine problem include: fussiness, uneven head shape or not liking to be laid on their tummy for babies and slow recovery from illness, behavior troubles and difficulty sleeping for older children.
Despite the fact that there is no scientific evidence to support that “spinal or vertebral subluxations” lead to the symptoms described above, it continues to be the main evidence provided for chiropractors about why their care works and, knowing what I know about the human body, I simply cannot follow the logic.
4. Chiropractic research in kids is very weak.
In order to illustrate this issue, we need to compare two entities:
1.The American Academy of Pediatrics (AAP)
2.The International Chiropractic Pediatric Association (ICPA)
Both claim to be the top organization in their field and the primary driver of thought in regards to treating children.
Let’s look at the information that each is putting out there in regards to researching their methods for kids.
Pediatrics (the journal of the AAP), released the 136th volume of its journal in October 2015. It includes about 35 articles, 29 of which are basic research in nature.
Now, let’s look at the research section of the Journal of Pediatric, Maternal and Family Health linked from the ICPA website. So far, in ALL of 2015, there are 13 articles published related to pediatric chiropractic care.
But those overall numbers don’t even begin to tell the whole story.
Included in the research from the ICPA, there is a commentary on how ICPA is developing a research network. There are nine review articles, which just looked at available research on a topic (Hint: There wasn’t much.)
The remaining nine articles are case studies of 1 or 2 patients who improved after chiropractic care. Many of those case studies highlight conditions that would otherwise be expected to improve over time without treatment or with minor intervention/counseling (bedwetting and poor breastfeeding).
Contrast this with only the first study in October Pediatrics which discusses the use of steroid treatment in addition to antibiotics in treating children treating infected joints. This study alone includes 116 patients.
In summary, one study of one treatment of one condition in one issue of Pediatrics has more patients included than all of the available studies for chiropractic care for all possible conditions for all the year 2015.
So, I don’t take my kids to the chiropractor.
I don’t believe chiropractors are trained well enough to be the primary care providers for children.
Those things they do that could be an alternative to traditional treatments are commonly performed for conditions that self-resolve.
The published articles on chiropractic care are not research; they are stories about how an individual child seemed to get better after they completed their chiropractic treatment plan.
Get to know Justin Smith, M.D.
Justin Smith, M.D., is a pediatrician in Trophy Club and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. Dr. Smith is an experienced keynote speaker for a variety of topics including pediatric/parenting topics, healthcare social media and physician leadership. If you are interested in having Dr. Smith present to your conference or meeting, please contact him at thedocsmitty@cookchildrens.org.
After hearing his message for me I decided that my son will never see a chiropractor. I know from my own experience that this is a common attitude. It makes me feel like I'm being conned because no doctor can cure everything without any knowledge of the patient whatsoever. I don't believe in miracles. It may be helpful for some people and some conditions but I simply can't shake the feeling that I'm being taken for a ride. Be honest about your capabilities and the risks and I will consider your position in my healthcare. Don't promise the moon and deliver a wheel of cheese.