Chiropractors give themselves green light to crack babies’ backs after four-year ban

Chiropractors have given themselves the green light to resume manipulating the spines of babies following a four-year interim ban supported by the country’s health ministers.

In a move that has been slammed by doctors as irresponsible, the Chiropractic Board of Australia has quietly released new guidelines permitting the controversial treatment for children under two.

New guidelines allow chiropractors to recommence spinal manipulations on babies and young children. Credit: Getty Images

The Royal Australian College of General Practitioners (RACGP) hit out at the decision, saying there was no evidence supporting the spinal manipulation of babies and children and that the practice should be outlawed.

“There is no way in the world I would let anyone manipulate a child’s spine,” said Dr James Best, the College’s Specific Interests Child and Young Person’s Health chair.

“The fact that it hasn’t been ruled out by this organisation is very disappointing and concerning. It’s irresponsible.”

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, following public outcry 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 Safer Care Victoria report at the time, which involved a systematic review by Cochrane Australia, found no strong evidence that spinal manipulation helped childhood conditions such as colic, back/neck pain, headache, asthma, ear infections or torticollis (twisted neck), despite it commonly being spruiked as a solution to these issues.

“The major finding of this review is that the evidence base for spinal manipulation in children is very poor,” it said.

A follow-up review last year by Cochrane Australia, commissioned by the national healthcare watchdog AHPRA (the Australian Health Practitioner Regulation Agency), reached the same conclusion.

The initial review, provided to all Australian health ministers, recommended that spinal manipulation should not be done on children under 12. It also recommended urgent research to develop an evidence base for spinal manipulation on children and advanced training for those providing paediatric care.

However, in November the Chiropractic Board of Australia put out a statement to “clarify” to members its expectations regarding paediatric care. It said a range of care could be provided to children, including manual therapy, soft tissue therapy and manipulation, if practitioners understand how children’s needs differ from adults and modify their care appropriately.

Neurosurgical Society of Australasia Board executive Dr Patrick Lo, who is also the Victorian chair of the Royal Australian College of Surgeons, said children were particularly vulnerable to injuries from spinal manipulation.

“Adults have a balanced neck, head and shoulders – everything is supported – whereas kids have a very big head-to-neck ratio,” the neurosurgeon said.

“If you flick it around, the lollipop ball will fall off. That’s our major concern. Those areas are so critical to the function and development of the child and we are putting those at risk.”

Lo said he had treated young adults who had suffered disc prolapses following spinal manipulations performed by chiropractors. He said some of his colleagues had treated patients who had experienced strokes following spinal manipulation.

Lo will raise his concerns about the new guidelines for chiropractors at an upcoming meeting with Safer Care Victoria.

Doctors have been at war with chiropractors over the treatment of babies and children for more than a decade.

In 2013, The Age reported on the disputed case of a Melbourne paediatrician who claims he treated a four-month-old baby after one of her vertebrae was fractured during a chiropractic treatment for torticollis, which causes the neck to twist to one side.

And in 2016, the RACGP urged its members to never refer patients to chiropractors after a YouTube video emerged showing a Melbourne chiropractor flexing a newborn baby’s back before pressing firmly on her spine to produce a cracking sound. The movement, which was meant to treat colic and reflux, caused the baby to cry.

A spokesman for the Chiropractic Board of Australia said its updated policy would ensure safe and appropriate care by chiropractors who treat children under 12. He said this guidance was based on current evidence and information.

When asked why Safer Care Victoria’s key recommendation – that spinal manipulation not be performed on children under 12 – had not been incorporated into the new policy, he said the board had considered the review’s common themes. He said these included “best practice and evidence-based care, proper informed consent, practice within the chiropractor’s skill”.

AHPRA has received 335 notifications about chiropractors since 2021, with five of these relating to child patients. A total of 96 notifications resulted in regulatory action, such as cautioning a practitioner, imposing conditions on their registration or accepting an undertaking from a practitioner.

A Safer Care Victoria review identified very little evidence of patient harm occurring in Australia, but noted “it was clear that spinal manipulation in children is not wholly without risk”.

“We respect every parent’s right to choose appropriate healthcare options for their child – when weighing up treatment options, you need to consider any risk associated with that care against any potential benefits,” a Safer Care Victoria spokeswoman said.

The Australian Chiropractors Association said the review found that chiropractic care for children was extremely safe. It said that in more than 29,000 online submissions, there were no reports of harm to a child receiving chiropractic care.

“Chiropractors are registered professionals, completing a rigorous five-year university degree-level course, equipping them with the expertise to appropriately tailor their care to children of all ages,” a spokesman said.

The association welcomed the board’s updated statement on paediatric care.

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