A chiropractor treating a new born baby

As the Government of Victoria, Australia, winds up its review of chiropractic spinal manipulation of children under 12, the Journal of Contemporary Chiropractic (based in the United States) has published a narrative review of the European Medical Literature on an issue often debated within pediatrics. It is the issue of spinal manipulation and infantile colic. The review provides a thorough look at the documented, peer-reviewed and indexed evidence surrounding the condition and the effectiveness of chiropractic care in its management. 

This is perhaps a complicated undertaking, given the unclear etiology behind what is termed “infantile colic.” Even now in 2019, there is no single cause illuminated by research and hence it is still largely defined as prolonged, intense or unexplained crying[1]. When it comes to causes, we often see a list of possible contributions. They include [1]: an undeveloped digestive system, bacterial imbalance in the gut, food allergies or intolerances, overfeeding, underfeeding, gas, migraine, familial stress or anxiety. 

In the recent review, the authors (Rome et al) flagged three potential subgroups of colic, including 1) infant colic, 2) irritable infant syndrome of musculoskeletal origin and 3) inefficient feeding crying infants with sleep disorder. They also cited Miller and Phillips (who suggested those subgroups) suggestion that, “particular regimens may be more effective for a certain subgroup [2].”

Rome et al’s work points out some interesting contradictions pertaining to chiropractic care and colic. One such statement lies right at the beginning of their comprehensive discourse on the matter: 

The systematic review of Carnes et al[3] “found moderate favourable evidence for reduction in crying time in infants receiving manual therapy.” That finding provides an understanding for the Clinical Practice Guidelines for Unsettled and Crying Babies from the Royal Children’s Hospital in Melbourne [4] in lieu of any guideline from the multi-discipline Victorian Paediatric Clinical Network (VPCN), [5] which is responsible to the Minister for Health: “medication is rarely indicated” and “formula changes are usually not helpful.” It then states without evidence that “Spinal manipulation is no more effective than a placebo.” The Mayo clinic website [6] lists parents reporting that chiropractic manipulation has been noted as “soothing crying babies,” one of the symptoms of colic.” 

They go on to discuss exactly where and what type of evidence for chiropractic care for colic exists. While the etiological mystery of colic remains unsolved, and both chiropractic and medical science must advance to get a comprehensive answer on the issue, one thing is for sure: the evidence is there. You’ll have to read the full paper for details of said evidence, but the authors did remark that “We see the problem addressed by this paper as being an ignorance of the peer-reviewed, published and indexed evidence for manipulation of infants presenting with colic in the medical literature, specifically from Europe [2].” 

Interestingly, this review alone covered 45 such papers, which is a substantial number indeed. It did not cover another 60 available on ICL (acronym unknown). This alone confounds the oft-repeated notion that there is no evidence for chiropractic care and colic. 

Another finding from the narrative report is this [2]:

A Swiss study noted that infants younger than 6-months were the third most common paediatric patients attending 144 chiropractic clinics in that country. A 2014 UK survey by Navrud et al found that of infants attending chiropractors, the presenting complaint was colic in 41% of cases. We note the overall satisfaction was a rating of 75.1%.

This was echoed in findings that, in Norway and Denmark, colic was the most common reason for infants presenting at chiropractic clinics. 

It would seem that the underlying message in the paper is that:

  • Australian medical opposition to chiropractic, infant manipulation, and the subluxation are in distinct contradiction to that of European counterparts.
  • European medical manipulation of infants with colic is standard medical procedure in Europe.
  • European medical specialists manipulate the upper cervical spine in infants.
  • European medical specialists recognise “KISS” or locked vertebrae (which is basically German for something like “subluxation).
  • Skilled manipulation of infants is very safe, and;
  • Chiropractic is equally as effective as medicines without any side-effects [when it comes to colic].              

Rome et algo on to discuss particular areas for concern when it comes to colic, with the paper covering upper cervical involvement, birth trauma, gastric problems, somato-autonomic phenomena and neurophysiology specifically, as well as a broad discussion of chiropractic’s excellent safety record when it comes to children.  

While the discussion on each piece of evidence and each specific area is detailed, it is perhaps the conclusion that may ring truest for many of those in the profession:“On balance we can state with confidence that the published, indexed evidence places conventional chiropractic management of infantile colic as safe and effective in the manner clearly documented as clinical methods in the European Medical literature.” 

This is music to our ears (unlike, perhaps, the prolonged, intense, unexplained crying of colicky babies). 

An investigation into chiropractic spinal manipulation on children is still underway in Victoria. A survey regarding this topic can be found at  https://engage.vic.gov.au/chiropractic-spinal-care-children-reviewand will remain open until 21 June 2019. It only takes a few minutes and is just one of the ways you can make your voice heard on this important issue. 

REFERENCES: 

  1. Staff writer, (2019), “Colic,” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/colic/symptoms-causes/syc-20371074
  2. Rome, P, Waterhouse J, Maginness G and Ebrall P (2019), “Medical Management of Infantile Colic and Other Conditions with Spinal Manipulation: A Narrative Review of the European Medical Literature,” Journal Contemporary Chiropractic, https://journal.parker.edu/index.php/jcc/article/view/63
  3. Carnes D, Plunkett A, Ellwood J, Miles C. Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta analyses. BMJ Open 2018;8:e019040 DOI:10.1136/ bmjopen-2017-019040 (cited in 2)
  4. Unsettled and crying babies (Colic). The Royal Children‘s Hospital. Sept 2012 https://www.rch.org.au/ clinicalguide/guideline_index/Crying_Baby_Infant_ Distress/ (cited in 2)
  5. Guidelines. Victorian Paediatric Clinical Network https://www2.health.vic.gov.au/hospitals-and-health- services/quality-safety-service/clinical-networks/ clinical-network-paediatric (cited in 2)
  6. Colic Symptoms and causes. Mayo Clinic. https://www. mayoclinic.org/diseases-conditions/colic/symptoms- causes/syc-20371074 2018 (cited in 2)
  7. *Image: Adobe Stock image

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