In Defense of Pediatric Chiropractic Care

I would like to applaud your publication for printing "Chiropractic Care for Children" by Lee, Li, and Kemp.¹ It is an admirable attempt to educate your readers about chiropractic methods of health care. However, there are several inaccuracies, which should be addressed.

The authors state that, "Conditions treated by DCs [doctors of chiropractic] include otitis media, asthma, allergies, infantile colic, and enuresis." However, treatment of these disorders by chiropractors is beyond the scope of chiropractic practice as defined by the Association of Chiropractic Colleges^{2 - 3} and the International Chiropractors Association.⁴ Perhaps it would be more accurate to state that chiropractors commonly provide care for pediatric patients with vertebral subluxation complexes who concomitantly suffer from otitis media, asthma, allergies, infantile colic, and enuresis.

Additionally, reliance on 1 study of questionable design⁵ to demonstrate chiropractic care as ineffective is misleading. It would seem that the authors have overlooked a body of scientific evidence supporting chiropractic care for the pediatric patient. There have been numerous randomized clinical trials showing the positive effects of chiropractic care.^{6 - 7} Most recently, a study of chiropractic care for children with colic demonstrated a 67% reduction in crying, as opposed to only a 38% reduction in crying for those treated with pharmaceuticals.⁸ The report concluded that, "Spinal manipulation is effective in relieving infantile colic." This adds to a growing body of evidence that supports the positive effects of chiropractic care for children with colic.^{9 - 10}

I must also take exception to the reliance on risk assessment statistics reported for adults^{11 - 12} despite the existence of a report specifically addressing risk assessment for children.¹³ This report more accurately assesses risk for the child at 0.004 per million. Moreover, it should also be noted that the report cited by Shafrir and Kaufman¹⁴ discussed the case of a child with a spinal cord astrocytoma who visited a chiropractor complaining of torticollis. Reports of torticollis associated with astrocytoma tumors are rare^{15 - 16} and Shafrir presents no valid scientific evidence to support the claim of a complication arising as a result of chiropractic care. This report is speculative at best, lacking any sound scientific evidence to support the claim.

To their credit, the authors have expressed the necessity of strengthening collaboration and research between the chiropractic, medical, and public health communities. The International Chiropractic Pediatric Association (ICPA) also supports this type of cooperation among health care providers. While chiropractic care is never to be considered a substitute for prudent, proper medical care, chiropractic remains an extremely safe health care option for children. The ICPA welcomes the opportunity for allopathic health care practitioners to seek professional relationships with responsible chiropractors to evolve the most efficacious care plan for pediatric patients, as this is what remains of utmost importance.