Clinical Practice Guideline for Best Practice Management of Pediatric Patients by Chiropractors: Results of a Delphi Consensus Process

Abstract

Objective: To build upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Design: Best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. Methods: Synthesis of results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process. Results: The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed these aspects of the clinical encounter: patient communication, including informed consent; appropriate clinical history, including health habits; appropriate physical examination procedures; red flags/contraindications to chiropractic care and/or spinal manipulation; aspects of chiropractic management of pediatric patients, including infants; modifications of spinal manipulation and other manual procedures for pediatric patients; appropriate referral and comanagement; and appropriate health promotion and disease prevention practices. Conclusion: This set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.

Perceived factors and barriers affecting physiotherapists’ decision to use spinal manipulation and mobilisation among infants, children, and adolescents: an international survey

“…However, lack of communication and guardian consent were reported as dominant barriers affecting the use of spinal manipulation in infants and children. Such findings are similar to those reported in the chiropractic literature where issues related to patient communication and consent require adaptation and special skills from the clinicians before treatment is undertaken [ 8 , 9 ].…”

The effects of chiropractic adjustment on inattention, hyperactivity, and impulsivity in children with attention deficit hyperactivity disorder: a pilot RCT

“…The present pilot study was not adequately powered to test hypotheses regarding the clinical benefit of chiropractic for ADHD; rather, it aimed to assess the feasibility of the experimental design. While our findings do not definitively rule out the potential benefit of chiropractic adjustment in certain patients with ADHD, particularly those with conditions known to respond positively to this treatment, such as spinal pain, chiropractic clinicians may consider co-managing patients with ADHD as part of a multidisciplinary team, on a case-by-case basis, depending on the clinical context and adherence to best practice guidelines ( Keating et al, 2023 ).…”

Spinal manipulation and mobilisation in paediatrics – an international evidence-based position statement for physiotherapists

“…We agree that manipulation for non-musculoskeletal conditions such as asthma, otitis media, cerebral palsy, attention deficit hyperactivity disorder, and musculoskeletal conditions such as torticollis, scoliosis, and plagiocephaly should not be recommended. We, however, disagree with a recent chiropractic guideline statement update that posits that ‘the absence of research evidence does not equate to evidence of absence and subsequent denial of care’ [ 62 ]. Our evidence-based position statements direct physiotherapists toward safer practice.…”