Fort Worth, Texas,
17
November
2015

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.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page.He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Comments 1 - 10 (10)
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Edith Suiter
18
November
2015
Someone once told me that if you want to know something about the Jewish religion, would you ask a Baptist? I feel your view is very opinionated. My husband had a active chiropractic practice for over 30 years. In that time, our family physician became more
Michael J. Newman,DDS
18
November
2015
Particularly intense Chiropractic bashing. Who else is there to correct the forceps traumas? Can't wait for your segment on dentistry.
Kacie Jakaiti
18
November
2015
Thank you for this complete and well organized article. I am a physical therapist, and I, too, often get questions about chiropractic care. I appreciate the amount of personal time you have put into bringing your points together for others to read and consider.
Melissa
18
November
2015
What is your opinion on a teenager who has "borderline" scoliosis...he hasn't been officially diagnosed but they are watching it to make sure it doesn't progress...do you think chiropractic care would be beneficial to help promote a healthy spine while still under the care and watchful eye of his pediatrician of course for any changes
Carissa
18
November
2015
Repeated multiple times in your article is this statement: "I don’t believe chiropractors are trained well enough to be the primary care providers for children."In response, I don't believe chiropractors are intending to be the primary care provider for children. Doctors of Chiropractic prefer to work in conjunction alongside other healthcare providers, such as pediatricians like yourself.Perhaps a perspective shift is due on your end.
Justin Smith MD
18
November
2015
Melissa,I have seen nothing that would support the use of a chiropractor for scoliosis. Observation for mild curvature is usually just fine.Michael and Edith,I'm not intending to bash chiropractors but, of course, I have an opinion about the issues I write about. I tried to present logical and researched points that supported my conclusions. If there are any of the points that you disagree with, I would be happy to discuss them.
Brad Steinle
19
November
2015
"Those things they do that could be an alternative to traditional treatments are commonly performed for conditions that self-resolve." From my experience, parents bring their children to chiropractors after a condition that typically self-resolves does not resolve in what would be considered a normal time-frame. Usually, as documented in the case studies that you disregard, there is a direct correlation to the resolution of a persistent condition and the application of gentle, non-manipulative pediatric adjustments. Chiropractic has plenty of research out that is often overlooked. It is reasonable to assume that a profession with half of the number of pediatric doctors in the united states (and not even a quarter of the size of medical doctors) would be half of the research available at a particular time of the year. You fail to mention the journal extending back to 2009, many issues containing more than 25 articles. These articles are focused solely on pediatric and maternal care, not chiropractic in general. Also, chiropractic is not perfectly amenable to all research formats as most are biased towards pharmaceutical testing and the use of placebo. A placebo in chiropractic is typically a "sham adjustment" and its application is not always possible while performing chiropractic research. 14 cases of harm from spinal manipulation does not indicate that the "manipulation" was performed by a chiropractor in every case. Many other professions perform "manipulations." Also, I would be interested to find the number of injuries sustained due to adverse reactions to medication.
Justin Smith, MD
20
November
2015
Brad,I certainly get how structuring studies for chiropractic interventions would be a real challenge but that doesn't mean that it gets a pass on having to prove how it works. Using a singular story (case study) to prove a certain treatment works is dangerous because both clinicians (pediatricians, too) and parents have a huge bias towards wanting to state that the intervention they chose worked.Certainly adverse reactions to medications are a huge problem and one that we are continually trying to address and study. As new information comes out we adjust what choices we make. That is why continued ongoing study, even of "tried and true" interventions is critical to get our patients the best care possible.
Brad Steinle
02
December
2015
I understand and agree with you that more research is needed within the chiropractic profession and there are many people that are attempting to make that push. But as it comes down to it, you justify not taking children to chiropractors by referencing injury due to a lack of research and experience. When you state in your response that adverse drug events (ADEs) are a "huge problem," I believe we can give a clear perspective of the relative danger of "manipulations" (in which you report 14 cases of harm in 2007) to ADEs. The National Center for Health Statistics reports children 0 to 18 years of age seeking medical treatment for an ADE between 1995 and 2005 is 585,922.In fact, the most modest number I have been able to find for ADE was between 2008 and 2012. Reported by ISMP (using FDA figures) was 45,610 adverse drug events reported in children less than 18 years of age. Of these, 64% (29,298) indicated a serious injury.You state that you are constantly researching to improve, but this study clearly explains that ADEs grew substantially over time--from 6,320 in 2008 to 11,401 in 2012. I'm not saying that there is not a place for a pediatrician, in fact, you are part of one of the most important fields in the world. But, maybe there is a place for something different, gentle and relatively safe.
Shelley Walker
03
December
2015
In regards to your statement "Those things they do that could be an alternative to traditional treatments are commonly performed for conditions that self-resolve." - my son spent over FOUR years (ages 5-9) undergoing traditional pediatric medicinal practices for constipation and daytime wetting. We tried diet, medication, physical therapy and he even had electrical probes attached to his bottom at a women's incontinence center in hopes of teaching him to completely void his bladder. Over FOUR years of following our pediatricians recommended treatment only to have our poor little guy having to change clothes at school and generally being completely frustrated. Our neighbors kept recommending chiropractic care but we did not heed their advice due to articles such as yours. We finally gave in one day and after one, yes ONE, lower spine manipulation, he never had daytime wetting again. Ever. That was 8 years ago. We still get vaccines and still go to the pediatrician for annual well-checkups and illness treatment - our chiropractor has not tried to talk us out of traditional medical care. I would love to see medical doctors and chiropractors come together to realize the benefits of both types of treatment and start supporting each other. Would have saved my son from years of embarrassment and frustration.
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