Interim policy on spinal manipulation for infants and young children

The Interim Policy – Spinal manipulation for infants and young children is an interim policy to protect the public until the outcomes of the expert review are known, and a final policy is developed on the issue. The Board advises chiropractors to not use spinal manipulation to treat children under two years of age, pending the recommendations arising from the independent expert review.

For the purpose of this interim policy, ‘spinal manipulation’ means moving the joints of the spine beyond the child’s usual physiological range of motion using a high velocity, low amplitude thrust.

The Board expects chiropractors to comply with the interim policy, in addition to following the guidance provided in the Statement on paediatric care (2017) and the Code of conduct for chiropractors (2022).

The Board expects chiropractors to:

• discuss their proposed management plan with the patient’s parent and/or guardian
• where the patient is under the age of two, advise the parent and/or guardian that spinal manipulation is not an available treatment option
• inform the parent and/or guardian about the quality of the acceptable evidence, and explain the basis, for the proposed treatment
• provide patients (or parent and/or guardian) with information about the risks and benefits of the proposed treatment, the risks and benefits of alternative treatments and the risks of receiving no treatment
• understand that children have significant anatomical, physiological, developmental and psychological differences and needs from adults and that their healthcare management requires specific skills and expertise; including informed consent, examination, diagnosis, referral of ‘red flags’ and contraindications to care
• modify all care and treatment (including technique and force) to suit the age, presentation and development of the patient
• communicate effectively with other health practitioners involved with the care of the patient, such as the patient’s general practitioner or paediatrician, and
• promptly refer patients to the care of other registered health practitioners when they have conditions or symptoms outside a chiropractor’s scope of practice, for example ‘red flags’.

When chiropractors do not have the clinical skills and knowledge to appropriately assess and/or manage a paediatric patient, the Board expects them to refer the patient to another healthcare practitioner who has the appropriate skills, or to co-manage the patient with them. In all cases, the patients’ best interests must be the priority.

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