Pediatric chiropractic seems to be garnering considerable attention these days. While it remains fairly controversial - not within the profession, of course, but among the conventional medical establishment and thus (too) much of the public - there are clear signs that chiropractic is and will increasingly be regarded as a valuable health care modality for children. At the same time, however, it remains a near-daily struggle to prove to insurers and others that children deserve chiropractic care as much as adults. Let's take a quick look at recent developments that spotlight pediatric chiropractic, the progress being made in terms of its acceptance, and the challenges that persist to this day.
The USA Today Article
An article in the Jan. 19, 2009 online edition of USA Today titled "Kids Find a New Way to Adjust: Chiropractors" tells the story of Melanie Booth, whose 3-month-old son was referred to a chiropractor by his pediatrician. The infant boy was having difficulty feeding, showing signs of discomfort when lying on his stomach and displaying a tendency to turn his head in one direction only, according to the article. After a single visit to Dr. Elise Hewitt, a chiropractor in Portland, Ore., the boy could move his neck better; eventually, his stomach and feeding problems dissipated as well.
As might be expected, the article proceeds to caution readers that research still needs to be done and raises the question of risk, referencing a 2007 study that documented injuries suffered by children who were treated by DCs. However, it also notes there was no proof spinal manipulation caused the injuries and no way to estimate the frequency of such injuries in the general pediatric population receiving chiropractic care. The article also mentions a professor of pediatrics at Wake Forest University School of Medicine who apparently wouldn't refer a child to a DC for nonmusculoskeletal problems, but then again, "wouldn't ask parents to stop visits if they perceive benefits" and suspects that adverse events in children receiving chiropractic care are extremely rare.
As reported in the Jan. 15 issue of DC, a recent survey on complementary and alternative medicine (CAM) utilization in the U.S. provides the first federal data regarding the percentage of children who visit chiropractors and other CAM providers, and for what conditions they visit them. The survey, conducted by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics, found that in 2007, nearly 12 percent of children (ages 17 and younger) reporting using some type of CAM therapy during the previous 12 months, and 2.8 percent of children (approximately 2 million children) used chiropractic or osteopathic manipulation.
Moreover, "back or neck pain" was the second most common reason for CAM use among children (6.7 percent of children), and children whose parents used chiropractic and other forms of CAM were almost five times as likely (23.9%) to use CAM as children whose parents did not use CAM (5.1%). These survey findings have received considerable media attention and were referenced in both the USA Today article and the ACA news release.
Fighting for Insurance Coverage
UnitedHealthcare and Tufts Healthplan are the most recent examples of third-party payors bent on denying coverage of chiropractic care for children, and both have met a unified chiropractic profession. As of press time, the ACA has just sent a letter to the Massachusetts attorney general, reiterating concerns that "Tufts is reneging on [its] obligations to enrollees as an insurer practicing in your state." Last year, the ACA learned that Massachusetts-based Tufts had a policy that did not allow coverage for pediatric spinal manipulation. The insurer cited an American Academy of Pediatrics resolution as the basis for its policy, an error (the AAP has no such policy) the ACA tried to correct in a letter to Tufts, which then said the policy was based on research and would not be revised.
The ACA then turned to the Council on Chiropractic Guidelines and Practice Parameters (CCGPP), which provided Tufts with extensive information to refute the insurer's claims that chiropractic is unsafe for children. Tufts refused to amend or retract its policy, forcing the ACA to take its case to the state attorney general.
Will Tufts ultimately reverse its stance on pediatric chiropractic? UHC did just that earlier last year. After the national insurer declared chiropractic manipulative treatments for pediatric and headache patients to be unproven and therefore not a covered service in late 2007, the ACA, ICA, CCGPP and other major chiropractic organizations sent a joint letter to UHC, along with a detailed analysis by the CCGPP supporting the use of chiropractic for treating headaches and its safety for use in pediatric patients. The ACA Council on Chiropractic Pediatrics sent a separate analysis to UHC.
One month later, UHC issued a stay on its policy decision while it reviewed research provided by the ACN Group Chiropractic Professional Advisory Committee (ACN-CPAC) and other chiropractic groups, and in February 2008, announced that it would "not proceed with the chiropractic services policy change."
Ongoing Research
In July 2008, the Foundation for Chiropractic Education and Research announced it was launching a new grant project designed to assess "the status of research and expert consensus in chiropractic care for the pediatric patient." According to the foundation, the project, led by Cheryl Hawk, DC, PhD, will give practitioners insight into evidential and practice experiences relative to chiropractic care of children. "The Status of Chiropractic Pediatric Care: An Investigation of Research and Expert Opinion" will be co-authored by Michael Schneider, DC, PhD (cand.), Randy Ferrance, DC, MD, and Ronald Rupert, DC, MS.
The International Chiropractic Pediatric Association (ICPA) is also involved in ongoing research on chiropractic care for children. The ICPA has developed a Practice-Based Research Network designed to gather data on pediatric chiropractic and determine parameters of care, with an overall goal of defining evidence-based standards for family chiropractic. Ongoing projects are focused on pregnancy safety and effectiveness and midwifery and chiropractic; scheduled/upcoming projects will focus on children's safety and effectiveness. For more information, visit www.icpa4kids.com.
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