Purpose: Complementary and alternative medicine in pediatrics is expanding, with chiropractic now a common choice for families seeking alternative medical care. Many case reports of manipulative therapy in pediatric ailments exist, but none have aimed to address the overlap of chiropractic and conventional medical management specific to orthopaedic pathology. The objective of this case series is to present twenty-three reports of pediatric patients with common orthopaedic ailments who received treatment from both chiropractors and orthopaedic surgeons. In addition, we will review the current data examining the use of manipulative therapy in children from an evidence-based perspective. Methods: This case series was approved by the College of Medicine’s Institutional Review Board. Patients eligible for this review were under nineteen years of age and had a history of chiropractic management for an orthopaedic pathology that warranted consultation. Data collected included chiropractic diagnosis, orthopaedic diagnosis, imaging studies, treatments and complications. Results: Twenty-three patients, average age of twelve years (1-18), were studied. Scoliosis, Legg-Calvé-Perthes disease, developmental dysplasia of the hip (DDH), cerebral palsy, skeletal dysplasia, slipped capital femoral epiphysis, and phalanx fracture were diagnoses included. Eighteen patients were referred from an outside physician and five were referred directly from a chiropractor. Children often had multiple sessions of chiropractic for management of these conditions. Misdiagnosis was recorded in four cases with delay to diagnosis or treatment observed in an additional seven cases. The parents’ perception for chiropractic was positive in every case despite nearly half of the children experiencing diagnostic errors or therapeutic delays. Conclusion: To our knowledge, no evidence exists to support chiropractic treatment for common pediatric disorders such as DDH, scoliosis or Perthes disease. Furthermore, the safety of manipulative therapy in children has not been well studied. Delayed referral, misdiagnosis, adverse events from manipulative therapy, and ineffective treatments were observed in the present study. In some cases, chiropractic functions well as an adjunct to conventional medicine. Unfortunately, the lack of evidence-based recommendations throughout the pediatric chiropractic literature may reduce quality and safety in the delivery of care. More research is indicated in order to validate chiropractic in children.
- Copyright © 2018 by the American Academy of Pediatrics