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.

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Interim policy: spinal manipulation for infants and young children

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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.

Developing the final policy

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The Board and the Australian Health Practitioner Regulation Agency (AHPRA) look forward to the outcomes of the independent review. The Board recognises that the practice of spinal manipulation is not limited to the chiropractic profession, and the primary consideration for the evidence review is public safety. Therefore, we welcome Safer Care Victoria bringing its consumer and patient safety expertise to lead the review with input from relevant practitioner experts.

The Board will communicate with all registered chiropractors at the completion of the review to advise of the outcome and clarify any change in policy on spinal manipulation of infants and young children. In developing a final policy on this matter, the Board will consider all available evidence, its obligations to protect the public under the National Law and any further decisions by Health Ministers.

For more information

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Page reviewed 1/09/2022

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