Interim policy on spinal manipulation for infants and young children

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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