Introduction: A Safer Care Victoria (SCV) review of chiropractic manipulation of children under 12 appears to have been misinterpreted and misquoted in the media and elsewhere. (1) The Review’s recommendation did not ban spinal manipulation, it did however, advise all four professions who provide the manual therapy that they should not provide spinal manipulation of the cervical spine for children under 12 years of age for a certain range of conditions as it claimed there was a lack of evidence of safety or efficacy. (Recommendations 2, 5, 6, SCV p 6, 7) There was no recommendation for a ban on Chiropractic spinal manipulation, due to the lack of evidence of harm.
Although not specified in 2020 or 2023, in June 2024, the Chiropractic Board of Australia (CBA) ‘reinstated’ its ‘2020 interim policy’ regarding paediatric patients of 2-years of age. (2 - 5) This followed a request of health ministers (COAG) due to ‘community concerns’ attributed to a misinterpretation of Chiropractic manipulative techniques. It is not known how the two years of age limit was derived in June 2024, as no evidence was cited. Board chairman Dr Wayne Minter stated ‘Following a request from health ministers in June, the Board has reinstated the interim policy on the spinal manipulation of children under two years of age, pending further consultation with ministers.’ (4)
The authors could not locate where the 'aged 2 years' limit-advice, nor any evidence that may have been published earlier in any CBA statement.
Claims in the SCV Review that there was little evidence to support the involvement of Chiropractors in the limited range of non-musculoskeletal conditions that were studied. (SCV p24) We produce examples of evidence which tend to contradict such claims of limited evidence.
Objective: It would seem that the SCV recommendation has been misinterpreted by health authorities and reflected incorrectly by the media, that a ban on manipulating the spine of under 12-year-old children was recommended and implemented.
The recommendation stated ‘Spinal manipulation, as defined in Section 123 of National Law, should not be provided to children under 12 years of age’. (SCV p 2) This statement did not advocate a ban as it recommended only that treatment should not be provided ‘for the management of the following conditions’ (p 6), as it claimed there was ‘weak’ evidence to substantiate it.
It was not stated that spinal manipulation should not be administered due to harm.
Method: A critical analysis of the SCV Review was conducted. A search of The Index to Chiropractic Literature was undertaken with key words placed in the All Fields search box. A PubMed search was also undertaken with emphasis on the European medical literature and on the limited number of Chiropractic journals listed on the PubMed portal
Review: The SCV Review states: ‘Spinal manipulation, as defined in section 123 of National Law, should not be provided to children under 12 years of age, by any practitioner, for general wellness or for the management of the following conditions: developmental and behavioural disorders, hyperactivity disorders, autism spectrum disorders, asthma, infantile colic, bedwetting, ear infections, digestive problems, headache, cerebral palsy and torticollis’. (p 6) We challenge the narrow term of reference of this study by Cochrane Australia as it denied many studies and clinical reports which would have been applicable under different terms. And we note that other manipulative techniques are available that fall outside Section 123.
Summary: The misinterpretation of the findings of the SCV Review that manipulation of children was banned led to misconceptions being dispersed though the media and community. The recommendation was addressed to all manipulative professions, and was applicable to the treatment of certain conditions.
There was no evidence of prior serious adverse events in Australia to justify the falsely claimed ban on spinal manipulation of children under 12 years of age.
In additional research, the SCV Review claimed there was insufficient evidence for spinal manipulation to address certain disorders. It omitted to state that it may be appropriate for spinal manipulation to address and manage certain symptoms associated with these conditions, patient preference and patient demand, as well as the many clinical studies that were supportive of this model of care.
Conclusion: Given the volume of other forms of evidence that are available for specified conditions, more appropriate research reporting should be implemented on such matters.
Such a discrepancy raises the question as to the particular selection of evidence cited in the SCV Review.
Claims that there was a ban placed on cervical spinal manipulation of children due to harm are grossly inaccurate. Claims that such a ban applied to the whole spine of children under 12 are also inaccurate. It is maintained here that the term ‘should not’ is not a ban.
Large sections of the media have been irresponsible and misleading in the inaccurate reporting of this matter. In doing so, a false image is generated which in turn, plays into the hands of the uninformed and monopolistic critics.
Claims of a lack of evidence supporting aspects of the Chiropractic model are challenged depending where and in what sources one conducts research.
There is a noted absence of evidence of serious harm through spinal manipulation by Chiropractors, on children in Australia. As such, the Safer Care Victoria Review is dismissed as a misleading anomaly.
The motive of the Review would seem to have been compromised by the apparent inconsistencies, contradictions, and ambiguities as well as what would appear to be an absence of neutrality of input.
Author keywords: Chiropractic; Safer Care Victoria; paediatrics; Chiropractic Board of Australia.
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