Medical Malpractice

The March 9, 2010 issue of the Journal of Pediatric, Maternal & Family Health highlights a review of the cases referenced by a recent report claiming chiropractic care is dangerous for children.

The report claiming chiropractic care is dangerous for children was published in the January 2007 issue of the medical journal Pediatrics. The author in that report referenced studies in the published research literature spanning a time period from 1900 to 2004.

The authors were able to find 10 cases of direct adverse events associated with chiropractic care of children. Based on these 10 cases over a 104-year period, they came to the conclusion that serious adverse events may be associated with pediatric chiropractic care. Conversely, they reported that they found 32 articles that did not identify any adverse events associated with chiropractic care of children.

The current study takes a look at the "serious" adverse events and examines other information that was not taken into account.

Three of the cases were identified as producing minor adverse events such as muscle soreness. Muscle soreness is pretty much a self-limiting situation.

One case involved a loss of consciousness after the first two adjustments known as "syncope." While dramatic, this is a common occurrence that is the result of a "vaso-vagal response" and is considered a minor event.

A 10 year-old child who experienced "irritability" after the adjustment was classified as experiencing an adverse event. The basis the authors used to determine that irritability in 10 year-olds is an adverse event was not fully explained.

Moderate adverse events were defined as being those that involved "transient disability involving seeking medical care but not hospitialization." One child experienced headaches and a stiff neck that gradually resolved over a two-week period with continued chiropractic care. Another experienced similar problems in the low back that also was resolved in a couple of weeks of continued chiropractic care. It is unclear why the authors incorrectly applied their own definitions and considered these events were moderate when no medical attention was sought or needed.

In the serious category, all of the cases involved children who had pre-existing conditions before presenting for chiropractic care that were blamed on the adjustments received. They included: episodes of head and neck trauma, including landing on the head and neck during gymnastics practice producing neurological trauma; osteogenesis imperfecta (brittle bone disease) and numerous associated previous bone fractures that resulted in neurological damage. In one case, they blamed chiropractic care equally with a spinal cord tumor for a 4 year-old boy. The child's post surgical paraplegia was partially blamed on the chiropractic care even though the surgeons found no normal mid-back spinal cord left after the tumor material was removed.

Commentary: Two points, if we may. Over a 104-year period, 10 cases of chiropractic care of children were found that incorrectly implicated chiropractic care in negative outcomes. In each case, the researchers either incorrectly classified them according to their own criteria or outright ignored pre-existing traumatic and neurological considerations. To claim this as evidence that chiropractic care is dangerous for children is disingenuous at best and malicious at worst.

In 2000, the Archives of Pediatric and Adolescent Medicine reported that there are more than 30 million visits made by children to chiropractors every year. Yet, the average chiropractor pays in the range of $1000 to $2000 per year for malpractice coverage while the average pediatrician pays $100,000 to $200,000 for the same level of coverage, often from the same insurance companies. While concern for safety should never be minimized, it should, nonetheless, be put into perspective relative to the true dangers that are out there.