New guidelines by Australia’s Chiropractic Board have been criticised by the country’s Health minister, who has demanded an urgent explanation for why practitioners are now being allowed to manipulate babies’ spines, quietly overturning a four-year ban on the practice.
A spokesperson for Health Minister Mark Butler said last week that the decision contradicted the findings of two reviews that concluded there was no evidence supporting the spinal manipulation of children.
The Sydney Morning Herald reports that chiropractors had given themselves approval to resume manipulating the spines of babies after a four-year interim ban enforced by the board and supported by the country’s health ministers.
This decision, quietly revealed in updated guidelines published by the board in November, came despite two reviews – by Victorian healthcare monitor Safer Care Victoria and Cochrane Australia – concluding there was no strong evidence that spinal manipulation helped childhood conditions like colic, back/neck pain, headache, asthma, ear infections or torticollis (twisted neck), despite it commonly being punted to parents as a treatment.
Victorian Health Minister Mary-Anne Thomas said regulation of the board sat with the Australian Health Practitioner Regulation Agency (AHPRA) and that it was to be discussed as a matter of urgency with her state and territory counterparts.
She said that while the review had found little evidence of patient harm occurring in Australia, “spinal manipulation in children is not wholly without risk”.
A growing number of doctors’ groups have criticised the return of spinal manipulation on children.
The Australian Medical Association’s Victorian president Dr Jill Tomlinson described the practice as “manifestly unsafe”. “There is no reason why we should support a practice that carries risk with no clear benefit,” she said.
Tomlinson, who is a hand surgeon, said her members had treated patients who had suffered disc prolapses and strokes after chiropractic work. She said she would raise her concerns about the board’s decision with Safer Care Victoria and the Victorian health minister.
Spinal manipulation involves moving the joints of the spine beyond a child’s normal range of motion using a high-velocity, low-amplitude thrust.
In March 2019, the Chiropractic Board of Australia announced an interim ban on the spinal manipulation of children under two, after public outrage over a video of a Melbourne chiropractor holding a two-week-old baby upside down.
The chiropractor then used a spring-loaded device on the newborn’s spine and tapped him on the head. Then-Victorian health minister Jenny Mikakos described the footage as “deeply disturbing”.
A follow-up review last year by Cochrane Australia, commissioned by AHPRA, reached the same conclusion about the lack of evidence supporting spinal manipulation of children.
However, in November the board released a statement to members saying that a range of care could be provided to children, including manual therapy, soft-tissue therapy and manipulation, if practitioners understood how children’s needs differed from adults and modified their care appropriately.
A spokesman for the Chiropractic Board of Australia said it “will respond to the concerns of the minister once his correspondence is received”.
The board previously said its updated policy would ensure safe and appropriate care, based on the latest evidence and information, by chiropractors who treat children under 12.
University of Sydney health law expert Dr Christopher Rudge said the federal government had powers to potentially change the national law that governed chiropractors to ban the spinal manipulation of children.
But he said this was unlikely, given the low-risk profile of the treatment, and it would be more straightforward for the board to change its policy.
“Practitioners should probably do nothing if they don’t know of a clear benefit,” he said. “Beyond giving false hope to parents or patients themselves, they are taking their money … that’s another risk.”
One senior chiropractor, who spoke anonymously due to fear of industry reprisals, said chiropractors received no hands-on training when it came to treating babies and young children.
While he does not believe spinal manipulation of babies is unsafe, he said chiropractors were not trained to assess babies to determine what treatment was required and whether it was necessary.
“They might have a parent saying the baby has colic but it could be a bowel obstruction,” he said. “Or a headache could be a brain tumour. They lack the training, yet the board says they receive extensive training.”
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Chiropractic neck manipulation and vision loss
The ‘sheen of respectability’ that surrounds chiropractic