A reply to the recent article in the Archives of Pediatric &
Adolescent Medicine from the Research Director of the
International Chiropractic Pediatric Association (ICPA)

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:


Alain Joffe, MD
Archives of Pediatrics & Adolescent Medicine
The Johns Hopkins University School of Medicine
550 N Broadway Ste 728
Baltimore, MD 21205-2021

Dear Alain Joffe, MD,

I would like to applaud your publication for printing "Chiropractic Care for Children" by Lee ACC, Li DH and Kemp KJ. [1] It is an admirable attempt to educate your readers about chiropractic methods of health care. However, there are several inaccuracies, which should be addressed.

The authors state "Conditions treated by D.C.'s include otitis media, asthma, allergies, infantile colic, and enuresis. " However, treatment of these disorders by chiropractors is beyond the scope of chiropractic practice as defined by the Association of Chiropractic Colleges (ACC) [2] [3] and the I.C.A. [4] Perhaps it would be more accurate to state that chiropractors commonly provide care for pediatric patients with vertebral subluxation complexes that concomitantly suffer from otitis media, asthma, allergies, infantile colic, and enuresis.

Additionally, reliance on one study of questionable design [5 ] as demonstrating chiropractic care as ineffective is misleading. It would seem that the authors have overlooked a body of scientific evidence supporting chiropractic care for the pediatric patient. There have been numerous randomized clinical trials showing the positive effects of chiropractic care. [6 ] [7] [8] Most recently a study of chiropractic care for children that suffer colic demonstrated a 67% reduction in crying opposed to only a 38% reduction in crying for those treated with pharmaceuticals. [9] The report concluded, "Spinal manipulation is effective in relieving infantile colic." This adds to a growing body of evidence that supports the positive effects of chiropractic care for children with colic. [10] [11]

I must also take exception to the reliance on risk assessment statistics reported for adults, [12] [13] despite the existence of a report specifically addressing risk assessment for children. [14] This report more accurately assesses risk for the child at 0.004 per million. Moreover, it should also be noted that the report cited by Shafrir and Kaufman [15] discussed the case of a child with a spinal cord astrocytoma who presented to a chiropractor complaining of torticollis. Reports of torticollis associated with astrocytoma tumors are rare [16] [17] and Shafrir presents no valid scientific evidence to support the claim of a complication arising as a result of chiropractic care. This report is speculative at best, lacking any sound scientific evidence to support the claim.

To their credit, the authors have expressed the necessity of strengthening collaboration and research between the chiropractic, medical, and public health communities. The International Chiropractic Pediatric Association (I.C.P.A.) also supports this type of cooperation among health care providers. While chiropractic care is never to be considered a substitute for prudent, proper medical care, chiropractic remains an extremely safe health care option for children. The I.C.P.A. welcomes the opportunity for allopathic health care practitioners to seek professional relationships with responsible chiropractors to evolve the most efficacious care plan for pediatric patients, as this is what remains of utmost importance

Respectfully yours,
Richard A Pistolese
Research Director
I.C.P.A., Inc.
  1. Lee ACC, Li DH, Kemper KJ.
    Chiropractic Care for Children
    Arch Pediatr Adolesc Med 2000; 154 (4) April: 401407

  2. The Association of Chiropractic Colleges
    Issues in Chiropractic, Position Paper #1. July 1996
    The Chiropractic Paradigm
    July 1996

  3. The Association of Chiropractic Colleges
    Issues in Chiropractic, Position Paper #2
    ACC Chiropractic Scope and Practice
    July 1996

  4. ICA policy statements
    International Chiropractors Association Web site (2000)

  5. Balon J, Aker P, Crowther E, et al.
    A Comparison of Active and Simulated Chiropractic Manipulation
    as Adjunctive Treatment for Childhood Asthma

    N Engl J Med. 1998; 339:1013-1020
    You may want to review the responses to this article from the
    Chiropractic Research and Academic Community

  6. Nielsen NH, Bronfort G, Bendix T, Madsen F, Weeke B.
    Chronic Asthma and Chiropractic Spinal Manipulation:
    A Randomized Clinical Trial

    Clin Exp Allergy 1995; 25 (1): 80-88

  7. Yates RG; Lamping DL; Abram NL; Wright C;
    Effects of Chiropractic Treatment on Blood Pressure and Anxiety:
    A Randomized, Controlled Trial

    J Manipulative Physiol Ther 1988; 11(6): 484

  8. Nielsen NH, Bronfort G, Bendix T, Madsen F, Weeke B.
    Chronic Asthma and Chiropractic Spinal Manipulation:
    A Randomized Clinical Trial

    Clin Exp Allergy 1995; 25 (1): 80-88

  9. Wiberg JM, Nordsteen J, Nilsson N.
    The Short-term Effect of Spinal Manipulation in the Treatment of Infantile Colic:
    A Randomized Controlled Clinical Trial with a Blinded Observer

    J Manipulative Physiol Ther 1999; 22(8): 517-22

  10. Klougart N, Nilsson N, Jacobsen J.
    Infantile Colic Treated by Chiropractors: A Prospective Study of 316 Cases
    J Manipulative Physiol Ther 1989 (Aug); 12 (4): 281288

  11. Nilsson N;
    Infant colic and chiropractic
    Eur J Chiropr 1985; 33(4): 264-265

  12. Kaptchuk TJ, Eisenberg DM.
    Chiropractic: Origins, Controversies, and Contributions
    Arch Intern Med 1998; 158: 2215-2224

  13. Assendelft W, Bouter L, Knipschild P.
    Complications of Spinal Manipulation:
    A Comprehensive Review of the Literature

    J Fam Pract 1996; 42: 475-480

  14. Pistolese RA.
    Risk Assessment of Neurological and/or Vertebrobasilar Complications
    in the Pediatric Chiropractic Patient

    J Vertebral Sublux Res 1998; 2(2): 73-8

  15. Shafrir Y, Kaufman BA.
    Quadriplegia After Chiropractic Manipulation in an Infant with
    Congenital Torticollis Caused by a Spinal Cord Astrocytoma

    J Pediatr 1992; 120 (2 Pt 1): 266-9

  16. Kiwak KJ, Deray MJ, Shields WD.
    Torticollis in Three Children with Syringomyelia and Spinal Cord Tumor
    Neurology 1983;33(7):946-8 1983

  17. Bussieres A, Cassidy JD, Dzus A.
    Spinal Cord Astrocytoma Presenting as Torticollis and Scoliosis
    J Manipulative Physiol Ther 1994; 17(2):113-8


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