Chiropractic Board of Australia - Statement on paediatric care
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Statement on paediatric care

Download a PDF copy of the Position statement on paediatric care (84.9 KB,PDF).

22 June 2017

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

The Chiropractic Board of Australia

In regulating the profession, the Board is responsible for registering practitioners, setting the professional standards and investigating concerns about chiropractors1. The Board aims to make sure the public has access to safe and competent services from members of the profession. It does this through its work in the National Registration and Accreditation Scheme (the National Scheme) in partnership with the Australian Health Practitioner Regulation Agency (AHPRA).

The National Scheme has patient safety at its heart, and all health practitioners have a duty to make safe and effective patient care their primary concern.

1Except in New South Wales, which has a co-regulatory model.

The Board’s Code of conduct for chiropractors (2022) (the Code) and Guidelines for advertising a regulated health service are published on its website. These documents, and the Board’s other codes and guidelines, outline the Board’s guiding principles and expectations of practitioners to deliver effective healthcare in an ethical framework.

The Code helps guide practitioners’ professional judgement, and assists the Board in setting and maintaining expectations of good practice.

The introduction to the Code states: ‘‘If professional conduct varies significantly from this code, practitioners should be prepared to explain and justify their decisions and actions. Serious or repeated failure to meet this code may lead to patient harm and have consequences for registration.’

Section 4.3 of the Code outlines the Board’s expectations on caring for children and young people, including that good chiropractic practice involves placing the interests and wellbeing of the child or young person first.

The Code requires practitioners to practice in an evidence-based and patient-centred manner so that they provide the best healthcare for their patients. Evidence-based practice involves a practitioner considering available evidence, including research and other sources of information, in addition to their clinical experience and the patient’s values during their clinical decision-making process.

Healthcare decisions made in the context of evidence-based practice must be adequately underpinned by proper informed consent. As set out in section 4.2 of the Code, the informed consent process includes providing information on material risks and expected outcomes.

Whilst lower forms of evidence may be adequate to support a well-constructed and controlled trial of clinical care for some conditions, clinical experience alone is rarely adequate to support clinical decision-making that is contrary to current evidence and/or best-practice approaches. Patient consent does not end a practitioner’s responsibilities to provide ethical and professional care consistent with the standards and expectations of the Board.

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 Concerns about practitioners 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