From: The safety of spinal manipulative therapy in children under 10 years: a rapid review
Author(s), Year | Subjects & Setting; n | Intervention(s) | Method of Measurement of AE | Follow-up | Key Findingsa |
---|---|---|---|---|---|
Hubbard, 2010 [62] | 7-year-old; female; migraine HA, mid-back and abdominal pain for previous 2 mos, episodic vomiting for intermittently for 9 mos | 8-week course of low velocity, low-amplitude adjustments, following upper cervical pediatric protocol; 7 tx to C1 over 13 visits. | Cannot say | During course of tx | No report of adverse symptoms occurred after the intervention |
Muir, 2012 [63] | 5-year-old; male; ADHD (no medication): acting out, inability to follow instructions, poor home and school performance | 11 tx over summer, 2-3x/week in November (re-evaluation at 4 wks, 2x/month between December–May); SMT, soft tissue therapy, and myofascial release therapy | Cannot say | 1 year | No AE were reported |
Bourque, 2018 [53] | 5-month-old; male; fussing, irritability, crying, grunting, rigidity, abnormal position of left arm, 2 wks of constipation, breastfeeding difficulties on right side, apparent discomfort lying on stomach; fracture of left clavicle during birth | 1x/week for 2 wks, 2 tx over 2 mos; sacro-occipital technic for occipital restriction, Thoracic spine (T2 and T5) was treated with the “touch and hold” technique by holding a specific, light pressure on the fixated vertebrae. | Cannot say | Patient A: 5 weeks Patient B: 4 weeks | No AE related with the intervention |
Berube, 2004 [57] | 6-day-old; female; symptoms of digestive disorder that began at 4-days-old, difficulty with eructation, taking several minutes to elicit, trouble eliminating stool accompanied by crying; immediate crying when lying supine | SMT performed with diversified technique modified for gestational age and size using low force; 1x/week, 4 weeks, re-evaluation with tx after 4 weeks | Cannot say | Cannot say | No AE due to chiropractic manipulation was reported by the parent |
Dorough, 2018 [58] | 2.5-year-old; male; speech delay, difficulty lying prone, unable to lift head up well, crying when pushing up from ground | Cervical spine modified Gonstead Technique and instrument-assisted Sigma-Instrument; 7 visits 1x/wk., 8 weeks | Cannot say | Over the course of treatment | No adverse reactions to tx were reported to occur with the intervention |
Martin-Marcotte, 2018 [59] | 21-month-old; female; episodes of constipation for the past 15 mos | Modified Diversified Technique for the child’s age and development; 2x/week, 4 weeks, re-evaluation after 10 visits, 1x/month subsequently | Cannot say | Over the course of treatment | No adverse reaction to adjustment reported |
McCormick, 2018 [60] | 15-month-old; male; motor developmental delay, not able to crawl, pull up to stand, stand alone or walk | Full spine SMT with Diversified Technique (Activator instrument-assisted); 1x/week for 4 weeks, 1x/every other week for 12 weeks | Cannot say | During the course of care | No adverse reactions were identified or reported to occur with the intervention |
Lacroix, 2016 [64] | 4-month-old; female; recurrent regurgitation after feeding, averse to being carried, difficult eructation, interrupted sleep, choking and rumination, wheezing during sleep, fussiness, distended stomach, excessive intestinal gas | 17 chiropractic adjustments over 20 weeks; craniosacral technique and Diversified adjusting technique (high velocity low amplitude) | Cannot say | During the course of care | No AE were reported to occur with the intervention |
Makela, 2018 [65] | 3-year-old; female; autism spectrum disorder, no verbal or non-verbal communication, off balance when walking, toe-walking 50% of the time | SMT provided on 11 visits over 6 weeks; spring-loaded instrument assisted technique; after re-evaluation, 2x/week with re-evaluation every month (Dec – Mar) | Cannot say | During the course of care | No adverse reactions to treatment were reported |
Dobson, 1996 [46] | 5-year-old; male; asthmatic; seeks care to promote “normal” & vitality posture; ROM limited in extension; muscle tension cervical spine; neutral lateral radiograph revealed an os odontoideum | 3x/week for 4 weeks, 4x/week for 2 weeks, 1x/week for 3 years; toggle-recoil (short lever high velocity, very low amplitude) adjustment when indicated | Cannot say | Cannot say | No negative effects were experienced with the intervention |
Wilson, 2012 [48] | 21-day-old; female; reported to pediatrician w/ concern of abnormality/ crepitus on back; presented to chiropractor due to fussiness and colic at 16-days-old | Day 23, follow-up investigation by child abuse center with the chiropractor confirmed the parents report. Parents described chiropractor initially held patient upside down by hips, with hands around hips and lower ribs. Applied pressure along spine with fingertips. Used a “spring-activated device” on back (in same location of fracture), while patient lay prone on the mother’s chest. | Chest radiograph and investigation by child abuse center to confirm reports | At 35 days of life, evidence of rib fracture healing with no new fractures | Acute fractures of 7th and 8th posterior ribs |
Shafrir, 1992 [51] | 4-month-old; male; head tilt noted in first week of life attributed to neck trauma during delivery, noted discomfort when placed on abdomen, could not raise head from prone; told would resolve but no improvement in head tilt after 4 months | First tx: Neck manipulation including flexion, extension and axial loading and unloading Second tx: parents returned after first response to manipulation, were reassured and infant was provided another neck manipulation | 3 h post second tx, admitted to hospital; routine chest radiograph showed enlargement of the spinal canal from C3-T8. MRI of the head and spine showed a mass within the spinal cord, extending into the medulla superiorly and occupying the entire canal from mid-cervical to the lower thoracic region. During surgery, thrombosed veins were noted on the dorsum of the enlarged spinal cord, when spinal cord was incised at C6 level, creamy white, viscoelastic tumour tissue exuded spontaneously. No normal cord tissue was identifiable at this level. Cervical and lower thoracic portions of the tumour were easily removed from normal-appearing spinal cord tissue. Pathologic examination revealed mostly necrotic tissue, with the lack of inflammatory infiltrates (suggesting acute necrosis, rather than due to a high-grade malignancy), with several areas of low-grade astrocytoma. | Immediately after tx | After first tx: difficult to arouse him from a nap, he was described as limp, pale and moaning After second tx: immediately post-manipulation was alert, later began to moan and grunt continuously, fed poorly, fever developed. Three hours after second neck manipulation, he was admitted to the hospital, where he was described as listless and fussy, w/ a weak cry. Early next morning, he had a brief, generalized seizure, followed by “gasping” respirations and cyanosis, requiring tracheal intubation, followed by another 3 h seizure. Infant was admitted to the intensive care unit while comatose and rarely responsive to painful stimuli. Later, infant opened eyes and had conjugate movements. Infant had flaccid paralysis of both legs and right arm, with some active motion and withdrawal of the left arm. Post-operatively, infant regained motor and sensory function to the T4 level. 18 months later, he had full use of the upper extremities, sensory function at approximately T9 level and some spontaneous but non-functional motion of the right leg. Diagnosis: congenital spinal cord astrocytoma |
Humphris, 2014 [52] | 6-month-old; female; left head rotation and ipsilateral flattening of her posterolateral cranium, frequent regurgitation of breast milk immediately after feeding with inability to feed from the right breast, unsettled sleep patterns | 3 visits over 4 months; Diversified technique with a light, modified, HVLA impulse; no other interventions provided | Cannot say | Cannot say | No AE were reported or observed to occur with the intervention |
Fairest, 2013 [54] | 6-week-old; female; left-sided cranial flattening and favored left head rotation, occasional regurgitation of an entire breastfeed immediately after feeding, groaning when placed prone in an inclined position, unsettled sleep patterns; advised by GP & midwife to seek chiropractic care | 1x/week, 10 weeks; 7 visits included Diversified technique (modified HVLA thrust) to cervical (7 visits) and sacrum (1 visit) and Activator to thoracic (2 visits), 3 visits of no SMT | Cannot say | Cannot say | No AE were observed, nor reported to occur with the intervention |
Gordon, 2011 [55] | 2-week-old; male; facial and upper limb postural asymmetry following a forceps-assisted vaginal birth after Caesarean, droopy lip on the right, right arm assumed waiter’s tip posture at rest | Chiropractic craniosacral techniques: low-force static hold adjustments to cervical and sacral segments; soft tissue therapy to cervical muscles; 2x/week for 2 weeks, then 1x/every other week for 12 weeks | Cannot say | Cannot say | No adverse effects of management were reported |