title: Adverse Events Due to Chiropractic and Other Manual Therapies for Infants and Children: A Review of the Literature.
abstract: OBJECTIVE
  The purpose of this study was to review the literature for cases of adverse events in infants and children treated by chiropractors or other manual therapists, identifying treatment type and if a preexisting pathology was present.
  
  
  METHODS
  English language, peer-reviewed journals and non-peer-reviewed case reports discussing adverse events (ranging from minor to serious) were systematically searched from inception of the relevant searchable bibliographic databases through March 2014. Articles not referring to infants or children were excluded.
  
  
  RESULTS
  Thirty-one articles met the selection criteria. A total of 12 articles reporting 15 serious adverse events were found. Three deaths occurred under the care of various providers (1 physical therapist, 1 unknown practitioner, and 1 craniosacral therapist) and 12 serious injuries were reported (7 chiropractors/doctors of chiropractic, 1 medical practitioner, 1 osteopath, 2 physical therapists, and 1 unknown practitioner). High-velocity, extension, and rotational spinal manipulation was reported in most cases, with 1 case involving forcibly applied craniosacral dural tension and another involving use of an adjusting instrument. Underlying preexisting pathology was identified in a majority of the cases.
  
  
  CONCLUSIONS
  Published cases of serious adverse events in infants and children receiving chiropractic, osteopathic, physiotherapy, or manual medical therapy are rare. The 3 deaths that have been reported were associated with various manual therapists; however, no deaths associated with chiropractic care were found in the literature to date. Because underlying preexisting pathology was associated in a majority of reported cases, performing a thorough history and examination to exclude anatomical or neurologic anomalies before applying any manual therapy may further reduce adverse events across all manual therapy professions.
authors.affiliation: Chiropractor, Private Practice; PhD Student, Department of Rural and Indigenous Health, Faculty of Medicine, Nursing and Health Sciences, School Of Rural Health, Moe, Victoria, Australia. Electronic address: angela@toddchiro.com.au.
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Todd
authors.affiliation: Senior Research Fellow, School of Rural Health-Churchill, Monash University, Churchill, Australia.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Carroll
authors.affiliation: Lecturer, Department of Rural and Indigenous Health, School of Rural Health, Monash University, Moe, Australia.
authors.forename: Anske
authors.initials: A
authors.lastname: Robinson
authors.affiliation: Lecturer, Department of Rural and Indigenous Health, School of Rural Health, Monash University, Moe, Australia; Lecturer, School of Rural Health-East Gippsland, Monash University, Bairnsdale, Australia.
authors.forename: Eleanor K L
authors.initials: EKL
authors.lastname: Mitchell
mesh_terms: D002648:Child; D006801:Humans; D007223:Infant; D026882:Manipulation, Chiropractic / Q000009:adverse effects*; D026201:Musculoskeletal Manipulations / Q000009:adverse effects
keywords: Adverse Effects; Children; Chiropractic; Infant; Manual Therapy; Patient Harm; Pediatrics; Safety