Best Practices Recommendations for Chiropractic Care for Infants, Children, and Adolescents: Results of a Consensus Process

Received 30 April 2009; received in revised form 10 July 2009

Abstract

Objective

There has been much discussion about the role of chiropractic care in the evaluation, management, and treatment of pediatric patients. To date, no specific guidelines have been adopted that address this issue from an evidence based perspective. Previous systematic reviews of the chiropractic literature concluded that there is not yet a substantial body of high quality evidence from which to develop standard clinical guidelines. The purpose of this project was to develop recommendations on “best practices” related primarily to the evaluation and spinal manipulation aspects of pediatric chiropractic care; nonmanipulative therapies were not addressed in detail.

Methods

Based on both clinical experience and the results of an extensive literature search, a set of seed documents was compiled to inform development of the seed statements. These were circulated electronically to the Delphi panel until consensus was reached, which was considered to be present when there was agreement by at least 80% of the panelists.

Results

A multidisciplinary panel of 37 was made up primarily of doctors of chiropractic with a mean of 18 years in practice, many with post-graduate training in pediatrics. The panel represented 5 countries and 17 states; there were members of the American Chiropractic Association, the International Chiropractors Association, and the International Chiropractic Pediatric Association. The panel reached a minimum of 80% consensus on the 51 seed statements after 4 rounds.

Conclusions

A broad-based panel of experienced chiropractors was able to reach a high level (80%) of consensus regarding specific aspects of the chiropractic approach to clinical evaluation, management, and manual treatment for pediatric patients, based on both scientific evidence and clinical experience.

Key Indexing Terms: Chiropractic, Pediatrics, Manipulation, Spinal, Child, Infant, Adolescent

a Vice President of Research and Scholarship, Cleveland Chiropractic College, Kansas City, Missouri and Los Angeles, Calif

b Visiting Assistant Professor, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Penn

c Hospitalist, Internal Medicine/Pediatrics, Medical Director, Hospital-Based Quality, Riverside Tappahannock Hospital, Tappahannock, Virg

d President, Council on Chiropractic Pediatrics, American Chiropractic Association

e Board of Directors, Integrative Pediatrics Council

f Private Practice, Portland Chiropractic Group, Portland, Ore

g Adjunct Assistant Professor, New York Chiropractic College, Seneca Falls, NY

h Private Practice, Ithaca, NY

i Chair, Council on Chiropractic Pediatrics, International Chiropractors Association

j Private Practice, Tanis Chiropractic, Hewitt, NJ

Submit requests for reprints to: Cheryl Hawk, DC, PhD, Vice President of Research and Scholarship, Cleveland Chiropractic College, 10850 Lowell Avenue, Overland Park, KS 66210

PII: S0161-4754(09)00204-8

doi:10.1016/j.jmpt.2009.08.018

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