• Keating G
• Amorin-Woods L

• Chiropractic / adverse effects
• Manipulation, Spinal
• Open Access Document
• Pediatric Chiropractic / Australia

In 2019, Safer Care Victoria (SCV) conducted a government-funded inquiry into the practice of spinal manipulation (SMT) of children under 12 years of age by chiropractors. SCV assembled an advisory panel, commissioned a Cochrane Collaboration Review, and invited submissions from consumers, health practitioners, insurers, education institutions, professional organizations, and interested stakeholders.

The report's principal findings were that while spinal manipulation of children results in very rare instances of harm, since evidence of the effectiveness of SMT is lacking, SMT cannot be recommended for children under 12 for a list of conditions or for general wellness.

Critique and Discussion: Five reviewers evaluated the Cochrane Review that formed a part of the inquiry using the Scottish Intercollegiate Guideline Network (SIGN) instrument. Two reviewers also evaluated the SCV report in its entirety. A strength of the report is the safety review and the information in the detailed responses from consumers. There were 29,599 online submissions received from across Australia, making it the largest survey of this kind. There were no reports of physical, mental, or financial harm to a child derived from this robust process. However, the report and the Cochrane Review contain weaknesses. 1) An internal contradiction erroneously reported a cerebrovascular incident (CVI) rate of 1:20,000 with SMT among children in the main text. 2) There was a departure from the inclusion/exclusion criteria for effectiveness studies. 3) The final recommendations disregard the submissions from consumers, the public, and practitioners.

Conclusion: While it has strengths, the SCV report is also flawed, and its final recommendations should be viewed with caution. The Cochrane Review within the report adds little to the body of knowledge or clinical practice for chiropractors managing children under 12.

Author keywords: Child, Children, Infant, Chiropractic, Government, Manipulation, Safety, Spinal, Risk Assessment, Parents

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