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Table 4 Evidence Table: Case Series

From: The safety of spinal manipulative therapy in children under 10 years: a rapid review

Author(s), YearSubjects & Setting; nIntervention(s)Method of Measurement of AEFollow-upKey Findingsa
Iyer, 2017 [34]Patient A: 7-month-old; male; difficulty with constipation since birth;
Patient B: 7-month-old; male; constipation since birth;
n = 2
Gentle acupressure stimulation on feet, scar tissue mobilization, gentle manipulation was applied to the cervical and lumbar segments and SI joints, with the line of drive being posterior to anterior and lateral to medial (magnitude of thrust and force adapted to patient age and neuromusculoskeletal maturity); patient A also had DNS rehabilitation
Patient A: 2x/week, 5 wks
Patient B: 2x/week, 4 wks
Cannot sayDuring course of txNo adverse reactions were reported to occur with the intervention
Young, 2017 [56]Patient A: 26-month-old; female; crying on waking complaining of neck pain; no known previous accidents or injuries during play, played in bouncy house, no complaints of pain the day of; pain increased on 4th day with reduced range of motion and torticollis;
Patient B: 33-month-old; male; playing in bouncy house, no complaint of pain or injury, awoke next morning with right-sided neck pain, 1 day later could not turn head to the right;
n = 2
Activator 4 applied at its lowest force setting, ischemic compression to trigger points to patient tolerance, home since and range of motion exercises
Patient A: 1 tx
Patient B: 4 tx over 2 weeks, with 3 tx including SMT
Cannot sayPatient A: 1 week and 3 years later
Patient B: throughout care and 3 years later
No reported adverse consequences to occur with the intervention
Zhang, 2004 [35]Children with acute otitis media < 2 mos, < 10 years old, no medical tx; n = 20Low force (2–32 oz), Toftness chiropractic adjustment by a metered hand-held pressure applicator at the cervical, thoracic, lumbar and sacral contact site; number of adjustments range from 3 to 6Cannot sayDuring the study periodNo side effects or deterioration of clinical presentations were found to occur with the intervention
Paravicini, 2018 [66]Male infants; 4.5–15 mos old; diagnosed with arthrogenic newborn torticollis, radiographs demonstrated rotational malposition and translation of atlas on axis in all cases; unresponsive to previous conservative tx methods; n = 6Mobilization under anesthesia by doctor of chiropractic and assistant; atlas in full flexion; in cases of subluxated C1–2 articulation, a little traction was added; assistant chiropractor stabilized shoulders of sedated patient; line of drive along almost horizontal joint place with minimal force and no impulseCannot sayDuring the interventionNo AE occurred with the intervention
Alcantara, 2008 [47]Patient A: 21-month-old; male; complaint of constipation since birth;
Patient B: 7-month-old; female; complaint of constipation since 2 mos;
Patient C: 21-month-old; female; encopresis and severe constipation since 10 months old;
n = 3
Patient A: Decreased HVLA type thrusts; Activator technique, 3x/week for 3 weeks, 2x/week for 3 weeks, 1x/week (2 mos of care); dietary changes
Patient B: 2x/week for 3 weeks; Activator
Patient C: frequency not reported (2 mos of care); HVLA type thrust
Cannot sayPatient B: 1-yr FU, normal bowel movements
Patient C: 3-yr FU normal bowel movements
Parents did not report any adverse reactions to occur with the intervention
Alcantara, 2010 [49]Patient A: 7-year-old; male; ADHD; Adderall, Zoloft taken during chiropractic care; Patient
B: 8-year-old; male; no medications;
n = 2
Patient A: 20 visits over 32 weeks; proEFA supplement
Patient B: 49 visits over 24 weeks
HVLA type thrusts: diversified and Gonstead techniques
Cannot sayDuring the course of careNo AE documented/reported by patients or parents to occur with the intervention
Miller, 2008 [50]Retrospective review of pediatric cases (patients = 781, total visits = 1310); < 3 years old; Chiropractic college teaching clinic; n = 781 (dismissed no treatment =82); 697 treated & reported outcomes; total visits = 5242Patients receiving a type of chiropractic manipulation provided by interns (n = 697)
Full spine pediatric SMT; n = 531
Occipital-sacral decompression; n = 50
Cervical spine pediatric SMT; n = 47
Thoracic spine pediatric SMT; n = 11
Lumbar spine pediatric SMT; n = 2
Pelvic pediatric SMT; n = 17
Other: n = 33
Negative side effects were detected by interpreting parental comments in the FU to the previous tx or same day as tx (n = 697). Defined as any adverse reaction reported by the parent. When an adverse reaction was reported by the parents, a description was detailed.
Mild: transient and lasting < 24 h
Moderate: requiring medical (general practitioner) tx
Severe: requiring hospital tx
During the course of careMale; 8 weeks old; post first cervical spine SMT tx for infant colic; parents called to report infant was not feeding well and was mildly distressed; following day parents report infant was fine and parents resumed care at the clinic
Female; 8 weeks old; post 4th tx of cervical and thoracic SMT for infant colic; mother called to report infant had been crying since the tx; mother later reported the infant slept better than usual and resumed care at the clinic
Female; 6 weeks old; few hours post first cervical spine SMT tx, parents reported a “head tilt”; infant was examined and presented with full range of motion and no antalgic posture; care continued
Female; 7 weeks old; post first cervical spine SMT for infant colic; mother reported infant cried a lot, slept for 2 h, then awoke and continued to cry; continued for 3 more visits and self-discharged; at FU phone call mother reported infant was “doing fine” and did not require more care
Male; 5 weeks old; FU with the parents; reported they would not attend the 7th visit because after the 6th visit of SMT for infant colic, the baby was restless and crying for almost 8 h; they did not continue with tx
Male; 17 weeks old; reported birth trauma; on 25th visit immediately post pelvic SMT, infant began to crying, mother felt this was a cry of pain; a corrective ilium adjustment was performed by tutor and the baby stopped crying; mother called later that day to report child was fine; mother continued to bring her child for monitoring and care for next several months
Female; 12 weeks old; on 11th visit, cervical spine SMT done for kinematic imbalance due to suboccipital strain, infant cried during tx and continued to cry after returning home; FU next day by phone, mother reported the infant was better but wished to stop tx
  1. AE Adverse events, D/t Due to, FU Follow-up, HA Headache, HVLA high velocity low amplitude, SMT spinal manipulative therapy, Months mos, RR relative risk, Tx Treatment, W/o Without, W/ With, Wks Weeks
  2. aResults reported in this column cannot be used to infer about the risk of adverse events or the effectiveness of SMT