Maternal Report of Outcomes of Chiropractic Care for Infants

Published:April 25, 2019DOI:



      The purpose of this study was to investigate the report by mothers of their infants’ condition before and after a trial of care provided by registered chiropractic clinicians in addition to ratings of satisfaction, cost of care, and reports of any adverse events or side effects. A second purpose was to report the demographic profile of infants who presented for care to 16 chiropractic clinics in the United Kingdom.


      This observational study prospectively collected reports by mothers of their infants’ demographic profiles and outcomes across several domains of infant behavior and their own mental state using the United Kingdom Infant Questionnaire. Participating registered chiropractors were recruited through the Royal College of Chiropractors annual meeting in January 2016, and 15 clinics and the Anglo-European College of Chiropractic University College teaching clinic volunteered to participate.


      In all, 2001 mothers completed intake questionnaires and 1092 completed follow-up forms. Statistically significant (P < .05) improvements were reported across all aspects of infant behavior studied, including feeding problems, sleep issues, excessive crying, problems with supine sleep position, infant pain, restricted cervical range of motion, and time performing prone positioning. Maternal ratings of depression, anxiety, and satisfaction with motherhood also demonstrated statistically significant improvement (P < .05). In total, 82% (n = 797) reported definite improvement of their infants on a global impression of change scale. As well, 95% (n = 475) reported feeling that the care was cost-effective, and 90.9% (n = 712) rated their satisfaction 8 or higher on an 11-point scale. Minor self-limiting side effects were reported (5.8%, n = 42/727) but no adverse events.


      In this study, mothers reported that chiropractic care for their infants was effective, safe, and cost-effective. Although the observational design makes it impossible to determine efficacy, the study’s findings indicate that, on average, the changes observed by mothers were positive and may be clinically relevant.

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        • Black N
        Patient reported outcome measures could help transform healthcare.
        BMJ. 2013; 346: f167
        • Boyce MB
        • Browne JP
        • Greenhalgh J
        The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research.
        BMJ Qual Saf. 2014; 23: 508-518
      1. Blas E SivasankaraKurup A Priority public health conditions: from learning to action on social determinants of health. World Health Organization, Geneva, Switzerland2010
        • Valderas JM
        • Kotzeva A
        • Espallargues M
        • et al.
        The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature.
        Qual Life Res. 2008; 17: 179-193
        • Greenhalgh J
        The applications of PROs in clinical practice: what are they, do they work, and why?.
        Qual Life Res. 2009; 18: 115-123
        • Hvitveld H
        • Carli C
        • Nelson EC
        • Mortenson DM
        • Ruppert BA
        • Lindblad S
        Patient reported outcome measures in practice.
        BMJ. 2009; 350: g7818-g7820
        • Black N
        • Burke L
        • Forrest CB
        • et al.
        Patient-reported outcomes: pathways to better health, better services, and better societies.
        Qual Life Res. 2016; 25: 1103-1112
        • Gossec L
        • Dougados M
        • Dixon W
        Patient-reported outcomes as end points in clinical trials in rheumatoid arthritis.
        RMD Open. 2015; 1e000019
        • Newell D
        • Diment E
        • Bolton JE
        An electronic patient-reported outcome measures system in UK chiropractic practices: a feasibility study of routine collection of outcomes and costs.
        J Manipulative Physiol Ther. 2016; 39: 31-41
        • Field JR
        • Newell D
        Clinical outcomes in a large cohort of musculoskeletal patients undergoing chiropractic care in the United Kingdom: a comparison of self- and national health service-referred routes.
        J Manipulative Physiol Ther. 2016; 39: 54-62
        • Alcantara J
        • Lamont AE
        • Ohm J
        • Alcantara J
        Quality of life of children under chiropractic care using PROMIS-25: results from a practice-based research network.
        J Altern Complement Med. 2018; 24: 378-384
        • Clar C
        • Tsertsvadze A
        • Court R
        • Hundt GL
        • Clarke A
        • Sutcliffe P
        Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report.
        Chiropr Man Ther. 2014; 22: 12
        • Hestbaek L
        • Jørgensen A
        • Hartvigsen J
        A description of children and adolescents in Danish chiropractic practice: results from a nationwide survey.
        J Manipulative Physiol Ther. 2009; 32: 607-615
        • Miller J
        Demographic survey of pediatric patients presenting to a chiropractic teaching clinic.
        Chiropr Osteopat. 2010; 18: 33
        • Allen-Unhammer A
        • Willson FJH
        • Hestbaek L
        Children and adolescents presenting to chiropractors in Norway: National Health Insurance data and a detailed survey.
        Chiropr Man Therap. 2016; 24: 29-38
        • Ernst E
        Chiropractic spinal manipulation for infant colic: a systematic review of randomised clinical trials.
        Int J Clin Pract. 2009; 63: 1351-1353
        • Gotlib A
        • Rupert R
        Chiropractic manipulation in pediatric health conditions – an updated systematic review.
        Chiropr Osteopat. 2008; 16: 11
        • Bronfort G
        • Haas M
        • Evans R
        • Leininger B
        • Triano J
        Effectiveness of manual therapies: the UK evidence report.
        Chiropr Osteopat. 2010; 18: 3
        • Dobson D
        • Lucassen PLBJ
        • Miller J
        • Vlieger AM
        • Prescott P
        • Lewith G
        Manipulative therapies for infantile colic.
        Cochrane Database Syst Rev. 2012; 12CD004796
        • Miller AS
        • Huizinga B
        PinksterM, Telford ACJ, ten Heggeler JM, Miller JE. Development and testing of a multidimensional parent reported outcome measure for common presenting complaints of infancy: the UK infant questionnaire.
        J Clin Chiropr Pediatr. 2016; 15: 1292-1300
        • Barr RG
        • Kramer MS
        • Boisjoly C
        • McVey-White L
        • Pless IB
        Parental diary of infant cry and fuss behaviour.
        Arch Dis Child. 1988; 63: 380-387
        • St. James-Roberts I
        • Hurry J
        • Bowyer J
        Objective confirmation of crying durations in infants referred for excessive crying.
        Arch Dis Child. 1993; 68: 82-84
        • von Kries R
        • Kalies H
        • Papousek M
        Excessive crying beyond 3 months may herald other features of multiple regulatory problems.
        Arch Pediatr Adolesc Med. 2006; 160: 508-511
        • Guyer J
        • Millward LJ
        • Berger I
        Mothers’ breastfeeding experiences and implications for professionals.
        Br J Midwifery. 2012; 20: 724-733
        • Oldbury S
        • Adams K
        The impact of infant crying on the parent-infant relationship.
        Community Pract. 2015; 88: 29-34
        • Zeifman DM
        • St. James-Roberts I
        Parenting the crying infant.
        Curr Opin Psychol. 2017; 15: 149-154
        • Johnson K
        Reduced tummy time can slow motor development.
        Med Post. 2003; 39: 51
        • Schertz M
        • Zuk L
        • Zin S
        • Nadam L
        • Schwartz D
        • Bienkowski RS
        Motor and cognitive development at one-year follow-up in infants with torticollis.
        Early Hum Dev. 2008; 84: 9-14
        • Smarius LJ
        • Strieder TG
        • Loomans EM
        • et al.
        Excessive infant crying doubles the risk of mood and behavioral problems at age 5: evidence for mediation by maternal characteristics.
        Eur Child Adolesc Psychiatry. 2017; 26: 293-302
        • Lam P
        • Hiscock H
        • Wake M
        Outcomes of infant sleep problems: a longitudinal study of sleep, behavior and maternal well-being.
        Pediatrics. 2003; 111: e203-e207
        • Chaudron LH
        • Szilagyi PG
        • Campbell AT
        • Mounts KO
        • McInerny TK
        Legal and ethical considerations: risks and benefits of postpartum depression screening at well-child visits.
        Pediatrics. 2007; 119: 123-128
        • Carnes D
        • Plunkett A
        • Ellwood J
        • et al.
        Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses.
        BMJ Open. 2018; 8e019040
        • O’Brien M
        • Buikstra E
        • Hegney D
        The influence of psychological factors on breastfeeding duration.
        J Adv Nurs. 2008; 63: 397-408
        • Dennis C
        • McQueen K
        The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review.
        Pediatrics. 2009; 123: e736-e751
        • Radesky JS
        • Zuckerman B
        • Silverstein M
        • et al.
        Inconsolable infant crying and maternal postpartum depressive symptoms.
        Pediatrics. 2013; 131: e1857-e1864
        • Wake M
        • Morton-Allen E
        • Poulakis Z
        • Hiscock H
        • Gallagher S
        • Oberklaid F
        Prevalence, stability and outcomes of cry-fuss and sleep problems in the first 2 years of life: prospective community-based study.
        Pediatrics. 2006; 117: 836-884
        • Lee AM
        • Lam SK
        • Sze Mun Lau SM
        • Chong CS
        • Chui HW
        • Fong DY
        Prevalence, course and risk factors for antenatal anxiety and depression.
        Obstet Gynecol. 2007; 110: 1102-1112
        • Kurth E
        • Kennedy HP
        • Spichiger E
        • Hösli I
        • Stutz EZ
        Crying babies, tired mothers: what do we know? A systematic review.
        Midwifery. 2011; 27: 187-194
        • Stewart D
        • Vigod S
        Postpartum depression.
        N Engl J Med. 2016; 375: 2177-2187
        • Gaynes BN
        • Gavin N
        • Meltzer-Brody S
        • et al.
        Perinatal depression: prevalence, screening accuracy and screening outcomes.
        Evid Rep Technology Assess (Summ). 2005; : 1-8
        • Marillier KE
        • Lima AM
        • Donovan LY
        • Taylor C
        • Miller J
        Mama, please stop crying: lowered postnatal depression scores in mothers after a course of chiropractic care for their infants.
        J Clin Chiropr Pediatr. 2014; 14: 1179-1182
        • Schmid PN
        • Hetlevik MA
        • Miller J
        Infant presentations and outcomes at a chiropractic clinic in the UK: parent report of treatment outcomes using the United Kingdom Infant Questionnaire (UKIQ).
        J Clin Chiropr Pediatr. 2016; 15: 1237-1242
        • Miller A
        • Telford A
        • Huizing B
        • Pinkster M
        • ten Heggler J
        • Miller J
        What breastfeeding mothers want: specific contextualized help.
        Clin Lactation. 2015; 6: 117-121
        • Hurst H
        • Bolton J
        Assessing the clinical significance of change scores recorded on subjective outcome measures.
        J Manipulative Physiol Ther. 2004; 27: 26-35
        • Bolton J
        Sensitivity and specificity of outcomes measures in patients with neck pain: detecting clinically significant improvement.
        Spine. 2004; 29: 2410-2417
        • Miller J
        • Newell D
        • Bolton J
        Efficacy of chiropractic manual therapy in infant colic: a pragmatic single-blind, randomised controlled trial.
        J Manipulative Physiol Ther. 2012; 35: 600-607
        • Miller JE
        • Miller L
        • Sulesund AK
        • Yevtushenko A
        Contribution of chiropractic therapy to resolving suboptimal breastfeeding: a case series of 114 infants.
        J Manipulative Physiol Ther. 2009; 32: 670-674
        • 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: 517-522
        • Klougart N
        • Nilsson N
        • Jacobsen J
        Infantile colic treated by chiropractors: a prospective study of 316 cases.
        J Manipulative Physiol Ther. 1989; 12: 281-288
        • Jaskulski JM
        • Miller JE
        Infant demographic profile and parent report of treatment outcomes at a chiropractic clinic in the UK: an observational study.
        J Clin Chiropr Pediatr. 2018; 17: 1398-1404
        • Reijneveld SA
        • Brugman E
        • Hirasing RA
        Excessive infant crying: the impact of varying definitions.
        Pediatrics. 2001; 108: 893-897
        • Wurmser H
        • Laubereau B
        • Hermann M
        • Papousek M
        • von-Kries R
        Excessive infant crying: often not confined to the first 3 months of age.
        Early Hum Dev. 2001; 64: 1-6
        • Marchand A
        A proposed model with possible implications for safety and technique adaptations for chiropractic spinal manipulative therapy for infants and children.
        J Manipulative Physiol Ther. 2015; 38: 713-726
        • Honda N
        • Ohgi S
        • Wada N
        • Loo KK
        • Hagashimoto Y
        • Fukuda K
        Effect of therapeutic touch on brain activation of preterm infants in response to sensory punctate stimulus: near-infrared spectroscopy-based study.
        ADC Fetal Neonatal Edition. 2013; 98: F244-F249
        • Navrud IM
        • Bjornli ME
        • Feier CH
        • Haugse T
        • Miller J
        A survey of parent satisfaction with chiropractic care of the pediatric patient.
        J Clin Chiropr Pediatr. 2014; 14: 1167-1171
        • Smith MJ
        • Choma TJ
        Patient satisfaction in musculoskeletal medicine.
        Curr Rev Musculoskelet Med. 2017; 10: 207-211
        • Marzorati C
        • Pravettoni G
        Value as the key concept in the health care system.
        J Multidiscip Healthc. 2017; 10: 101-106
        • Zuzak TJ
        • Boňková J
        • Careddu D
        • et al.
        Use of complementary and alternative medicine by children in Europe: published data and expert perspectives.
        Complement Ther Med. 2013; : S34-S47
        • Black LI
        • Clarke TC
        • Barnes PM
        • Stussman B
        • Nahin RL
        Use of complementary health approaches among children aged 4-17 years in the United States: National Health Interview Survey 2007-2012.
        National Health Stat Report. 2015; 78: 1-19
        • Hemmi MH
        • Wolke D
        • Schneider S
        Associations between problems with crying, sleeping and/or feeding in infancy and long-term behavioural outcomes in childhood: a meta-analysis.
        Arch Dis Child. 2011; 96: 622-629
        • Katkade VB
        • Sanders KN
        • Zou KH
        Real world data: an opportunity to supplement existing evidence for the use of long-established medicines in health care decision making.
        J Multidiscip Healthc. 2018; 11: 295-304
        • ABPI
        The vision for real world data – harnessing the opportunities in the UK.
        (Available at:)
        • Malhotra K
        • Buraimoh O
        • Thornton J
        • Cullen N
        • Singh D
        • Goldberg AJ
        Electronic capture of patient-reported and clinician-reported outcome measures in an elective orthopaedic setting: a retrospective cohort analysis.
        BMJ Open. 2016; 6e011975
        • Hurwitz EL
        • Coulter ID
        • Adams AH
        • Genovese BJ
        • Shekelle PG
        Use of chiropractic services from 1985 through 1991 in the United States and Canada.
        Am J Public Health. 1998; 88: 771-776
        • Amorin-Woods LG
        • Parkin-Smith GF
        • Nedkoff L
        • Fisher C
        Outcomes of a pilot study in chiropractic practices in Western Australia.
        Chiropr Man Ther. 2016; 24: 34
        • Lishchyna N
        • Mior S
        Demographics and clinical characteristics of new patients presenting to a community teaching clinic.
        J Chiropr Educ. 2012; 26: 161-168
        • Hanson HA
        • Miller JE
        An electronic parent reported infant outcome measure in chiropractic clinics: a feasibility study.
        J Clin Chiropr Pediatr. 2018; 17: 1413-1417