Interim policy on spinal manipulation for infants and young children

Download a PDF copy of the Position statement on the Interim policy on spinal manipulation for infants and young children (46.2 KB,PDF).

14 March 2019

Overview

Health Ministers have announced an independent expert review by Safer Care Victoria on spinal manipulation for infants and young children.

The Chiropractic Board of Australia (the Board) has set an Interim Policy – Spinal manipulation for infants and young children 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.

Background

The role of the Board is to protect the public as mandated by the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law).

The Board regulates the chiropractic profession by setting registration standards, codes, guidelines and policies and ensuring that only health practitioners who are suitably trained and qualified to practice in a safe, competent and ethical manner are registered.
 
Chiropractic paediatric care
In June 2017, the Board published a position statement on chiropractic paediatric care. In this statement, the Board stipulated an expectation that chiropractors ensure their clinical practice is consistent with current evidence and/or best-practice approaches. However, the Board acknowledges there is no current clinical guideline, or peer-reviewed publication to guide chiropractors with respect to the care of infants and young children, and the use of spinal manipulation in particular.

The Board is committed to ensuring the public has access to, and receives, safe, ethical and competent care from registered chiropractors. For this reason, a review of the current best evidence for the efficacy of spinal manipulation to treat childhood illnesses or health concerns in infants and young children, with a concurrent analysis of adverse events or harms reported as arising from spinal manipulation within this population, is a high priority. The independent expert review to be led by Safer Care Victoria will be used to inform future policy on the regulation of spinal manipulation for infants and young children for public protection.

Chiropractors receive extensive university education and training, including about caring for children. Parents typically seek chiropractic services for their children for musculoskeletal disorders. In caring for children chiropractors may provide a range of treatment modalities including manipulation, dietary and ergonomic advice, exercise, counseling and other manual therapies such as massage.

Best-practice approaches to providing chiropractic care to children are published in peer reviewed literature. This evidence should be used to guide clinical practice and ensure chiropractors provide safe care. Current research indicates that the incidence of serious adverse events, either directly from manual therapy or indirectly by delayed or mis-diagnosis, is rare but does occur. The Board considers that more research is required to better understand this.

The Board expects practitioners to make sure their clinical practice is consistent with current evidence and/or best-practice approaches. Practitioners should critically evaluate their strengths and weaknesses and use continuing professional development (CPD) and other educational tools to ensure their knowledge and skills are appropriate for their work.

The Board expects practitioners to:

  • discuss their proposed management plan with the patient’s parent and/or guardian
  • 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 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’2 and contraindications to care
  • modify all care and treatment (including technique and force) to suit the age, presentation and development of the patient
  • 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’, and
  • communicate effectively with other health practitioners involved with the care of the patient such as the patient’s general practitioner or paediatrician.

When practitioners 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.

This should happen immediately when there are serious conditions that require urgent referral present, such as ‘red flags’. In all cases, the patients’ best interests must be the priority.


2 The presence of possible serious pathology that requires urgent medical referral.

As the national regulation and registration body governing the chiropractic profession, the Board would be very concerned about any practitioner who is not practising chiropractic safely and within the limits of their competency, training and expertise. Complaints or concerns about registered chiropractors can be brought to the attention of the Board through AHPRA. Anyone seeking details about the management of complaints or concerns (referred to under the National Law as ‘notifications’) or if anyone wants to raise a concern or make a complaint about the, advertising, health, conduct or performance of a chiropractor they can do so by going to the AHPRA website, see the Complaints or concerns section.

All complaints or concerns received will be assessed by the Board and be dealt with according to the disciplinary processes and provisions defined in the National Law.

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Page reviewed 16/07/2019