I hope I have quickly gotten the attention of many readers with this title. I want to gently, carefully, address a challenge that plagues the chiropractic world (for big and little people alike): the perceived safety of the chiropractic adjustment. Because I am primarily a pediatric-focused practitioner and this is a column on pediatrics, let’s focus on that population.
A Recent Case Report
I am a proud member of the International Chiropractic Pediatric Association. It was on the ICPA’s social media site that I recently became aware of a recent paper, published on March 31, 2026, in the journal Child’s Nervous System and found on PubMed: “Pediatric Vertebral Artery Dissection and Ischemic Stroke Following Chiropractic Nanipulation.”1
Per this case report: “A 20-month-old male with history of poor weight gain and asthma attacks presented to the emergency room with acute onset of lethargy, vomiting, cyanosis, and respiratory distress ... Cerebrovascular imaging revealed a luminal irregularity in the V4 segment of the right vertebral artery, consistent with dissection.”
The study also stated that “on the day of presentation, the parents took the patient to visit a gastroenterologist and a chiropractor to address his poor weight gain. The chiropractor allegedly performed CCM (Chiropractic Cervical Manipulation), which the patient initially tolerated well.”
The authors go on to list two other cases, citing a 6-year-old and a 2-month-old patient, both showing signs of supposed vertebral artery injury following a chiropractic adjustment.
By bringing this paper to your attention, I am not making a statement regarding the validity of such claims. The purpose of drudging up such a negative paper is not to cause (further) dissention between the allopathic and the holistic worlds; nor is it to chastise or instruct our chiropractic audience on their treatments or chosen technique.
I bring this to your attention because a) many of our medical colleagues and patients will be aware of this study and likely not read past the alarming title; and b) this is a sobering reminder that we must be aware of how our care is still perceived.
How We Are Still Perceived
The misconception that every chiropractic cervical adjustment results in injury or stroke is not new information. Isolated incidents of VBI after cervical adjustment have been loudly reported likely since the beginning of our profession. Despite the high alarm, repeated studies have successfully shown that there is an extremely small risk and that pre-existing vertebral artery insufficiency is almost always the underlying factor. The obvious next sentence is for the DC to screen effectively for such a risk before delivering the adjustment.
The study by Arnold, et al.,1 acknowledges that “there is an increasing utilization of chiropractors among the pediatric population.” YEAH! Those of us who love caring for babies and children are exciting to agree with that statement. The problem is that, without further knowledge, the assumption exists (both in and out of the chiropractic world) that a spine is a spine is a spine.
The spine of an infant or young child is not just a small adult spine,and as such, requires a very different consideration and approach.
As a pronounced pediatric specialist, I am very aware of how my work is perceived, both by the parents of my young patients and by all of the other professionals with whom I communicate / collaborate. As an ICPA instructor,, I am diligent in teaching my students to be aware of such an “appearance of evil.”
The reason this admonition is even more critical in current times is the existence of social media. One only has to only look briefly to find numerous posts, both by accusing opposition and by the defensive chiropractor, about how something that was said or done in the office was perceived as harmful to a child.
The facts don’t have to be checked, a double-blind study doesn’t have to be performed, and expert witnesses are not consulted. The biased opinion is blasted far and wide across the internet, causing wide misinformation – and potentially stopping life-changing care from ever taking place.
How to Change the Narrative
Here are a few simple ways to not only avoid such misconceptions, but also build up the credibility and public embracing of the amazing benefits of skilled chiropractic care for children:
Get Trained: Because parents are seeking chiropractic care for their children in much greater numbers than in the past, there is also a lot more quality training available specifically focused on the pediatric population. As I said earlier, the pediatric spine is not just a small adult spine. The matrix and juxtaposition are very different. For example, do you know:
- The newborn atlas is in three pieces, connected by cartilage. Similarly, the occipital base to which the atlas connects is also in three pieces. The atlanto-occipital joint doesn’t ossify until age 9-15. This allows this joint to move in surprising ways and also makes it delicate to extensive forces. Of course, the brainstem is housed in this region, as well as critical cranial nerves like the vagus (CNX), hypoglossal (CNXII) and glossopharyngeal (CNIX). Bilaterally, the jugular veins travel through this narrow pathway and provide drainage for 95% of the blood from the head.
- The forces of birth can be incredibly strong, having been measured to be between 30 and 70 lbs. of pressure depending on the level of difficulty and measure taken during the birth process.2 To put this in perspective, the forces measured “to create a sheering force in the cervical spine” in an adult after a MVA whiplash-type injury range from 32-56 lbs. of pressure.3 The birth process is not to be overlooked as a likely cause of significant cervical strain and injury in the newborn patient.
I am choosing my words carefully here: If you wish to care for the pediatric population in your office, please invest the time and money to gain the needed skills. In the same way that a podiatrist would not manage your high blood pressure and a dentist would not perform your colonoscopy (hopefully), the chiropractic profession, like any other, must be trained appropriately and well in these specialized populations.
This is the only way to not only heal our patients, but also to gain the credibility necessary to attract the patients in the first place.
Educate Your Patients and the Community: As I stated before, it’s not my right or intention to dictate your technique or approach. However, be aware of how your approach is perceived. From your adjusting technique to your exam procedures, to even how your office/media content is designed, in all things communicate your dedication to knowledge, mastery, and safety.
Take the time to demonstrate to that worried parent how gentle your contact with their newborn feels. Take the time to provide educational materials which validate the efficacy of your care. Create an environment in your office that is welcoming and shows your dedication.
If you need educational resources, here’s a good article I often share that also shows actual measured pressure used by common pediatric therapies such as craniosacral therapy, physical therapy, massage, and chiropractic. The authors show that chiropractic and CST are, by far, the most gentle and effective treatments. (Todd, AJ, Carroll, MT, Mitchell, EK. Forces of commonly used chiropractic techniques for children: a review of the literature. J Manipulative Physiol Ther, 2016;39:401-410)4
I also suggest you read Pathways to Family Wellness magazine, produced by the ICPA and available both in magazine form (great to have in your reception rooms) and online.
Practical Takeaway
It is an unfortunate fact that there is a level of misconception about the safety of chiropractic in the medical world at large. Due to the increasing numbers of pediatric patients, this is a real challenge as we care for our young patients.
The absolutely best way forward is to address this misconception in a positive light – with education, increasing skill, and awareness of how our care is perceived. I for one, see lives changing in a miraculous way each and every day in my practice. I’m confident that chiropractic care, including the critical care of children, will continue to flourish. Just like a spectacular garden, it just needs the right attention and love to do so.
References
- Arnold JC, Brumett AM, Ortiz Rodriguez KJ, et al. Pediatric vertebral artery dissection and ischemic stroke following chiropractic manipulation, Childs Nerv Syst, 2026 Mar 31;42(1):141.
- Dorough A, Vallone S. Differentiating the impact of biomechanical forces of labor and delivery vs. the effect of a posterior tongue tie on neonatal and infant feeding dysfunction: a clinical evaluation. J Clin Chiropr Pediatrics, November 2023.
- Cormier J, Fwin nL, Reinbart L, et al. Comprehensive review of low-speed rear impact volunteer studies and a comparison to real-world outcomes. Spine, 2018 Sep 15; 43(18): 1250-1258.
- Todd, AJ, Carroll, MT, Mitchell, EK. Forces of commonly used chiropractic techniques for children: a review of the literature. J Manip Physiol Ther, 2016;39:401-410.
