A Response from the International Chiropractic Pediatric Association

Lactation Matters received the following response from Dr. Joel Alcantara, the Research Director of the International Chiropractic Pediatric Association in response to remarks from Dr. Howard Chilton in the September issue of ILCA’s e-Globe. In the issue, Dr. Chilton, one of the plenary speakers at this year’s ILCA Conference in Melbourne, Australia, responded to questions about the use of chiropractic care for colicky infants. He said,

“I find too often when I am asked to manage the colicky and unsettled baby that they have already been seen by a chiropractor and have had some form of cranial or spinal treatment. This type of management is unproven, has no basis in science and is potentially dangerous, both of itself and from the delay in the application of sound medical and nursing procedures for this complaint. The movement of chiropractors into the management of paediatric, and especially neonatal conditions, is very
troubling.

The parents of young children are highly vulnerable when their children are perceived to be unwell and, combined with their reasonable wish to avoid medications, are easily mislead by the anecdotal claims of such pseudoscience. As I heard someone remark recently: “the collective noun for ‘anecdote’ is not ‘evidence’.” I wish I’d thought of it!

However when one is marketing what is in effect the placebo effect one is certainly motivated to be sympathetic and kind and to give extra attention and time to the concerns of the parent. It is this benefit that derives from the chiropractor in this field, and perhaps it is in this area that conventional medicine can improve.”

Lactation Matters always welcomes discourse such as this as we seek to develop evidence based practice and we thank the International Chiropractic Pediatric Association for reaching out to us to publish their comments.

By Joel Alcantara, Research Director of the International Chiropractic Pediatric Association

We thank the ILCA for the opportunity to respond to comments made by Howard Chilton, MBBS, MRCP(UK), DCH on the subject of chiropractic care for infants with colic. In this era of evidence-informed medicine, Dr Chilton is obviously ill informed on chiropractic for colicky infants and colic medications. A recent systematic review of the literature on chiropractic and infantile colic by Alcantara and colleagues¹ found 26 published articles in peer-reviewed journals consisting of three clinical trials, two survey studies, six case reports, two case series, and four cohort studies. Overall, the published literature supports chiropractic for colicky infants. In terms of comparative effectiveness research, it should interest Dr Chilton that a clinical trial has compared chiropractic versus Dimethicone, a very popular medication prescribed for infants with colic. The study demonstrated that chiropractic care was more effective in relieving infantile colic.² This is not surprising to those familiar with the scientific literature on drug prescriptions for colic that finds “little scientific evidence to support the use of Simethicone, Dicyclomine hydrochloride, Cimetropium bromide, lactase, additional fiber or behavioral interventions.”³

Chiropractic is a vitalistic, holistic and patient-centered approach to patient care. Chiropractic is a caring profession where mutual trust, understanding and acceptance is of paramount importance in our approach with patients, adult or children. As chiropractors, we acknowledge and embrace the non-specific effects of the clinical encounter – what Dr Chilton refers to as the placebo effect. With all due respect, perhaps Dr Chilton should not be so arrogant and judgmental and embrace the placebo effect since colic medications such as dimethicone or semithicone have been demonstrated to be no better than placebo.^4,5  Even more pressing, safety concerns have been raised with a number of these colic medications.^6,7

A systematic review of the scientific literature on adverse events associated with pediatric spinal manipulation found only 10 documented adverse events attributed to pediatric chiropractic in a span of over 100 years of chiropractic practice.⁸ Our own practice-based research network studies point to the safety of pediatric chiropractic with prevalence of adverse events at less than 1% and risk estimates placed at <1000 adverse events per 1 million children followed under chiropractic care for 1 year.^9,10 Dr Chilton should be more concerned about the practice of “off-label” prescribing for infants and children in his profession. The first study to examine the extent of this practice of prescribing medication for children without the safety, efficacy, and quality assurance that is required of medications was performed in the UK. The study found that 70% of children received either an unlicensed or off-label drug prescription, with approximately one-third of drug prescriptions being unlicensed or off-label.^10,11 Subsequent studies have confirmed the popularity of this practice in pediatric medicine with documented adverse events that is unmatched in frequency and severity by chiropractic or other alternative forms of pediatric care.

The practice paradigm of the 21^st century is integrative care that is embraced by lactation professionals, chiropractors, nurses, and other healthcare professionals. It is characterized by mutual respect and shared managementthat emphasizes wellness and healing of the entire person (bio-psycho-socio-spiritual dimensions), drawing upon the best of both conventional and alternative therapies.¹³ Antiquated attitudes expressed by Dr Chilton have no place in the care of infants and children in the 21^st century.

References

1. Alcantara J, Alcantara JD, Alcantara J. The chiropractic care of infants with colic: a systematic review of the literature. Explore (NY). 2011;7(3):168-74.
2. 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(8):517-22.
3. Hall B, Chesters J, Robinson A. Infantile colic: a systematic review of medical and conventional therapies. J Paediatr Child Health 2012 Feb;48(2):128-37
4. Metcalf TJ, Irons TG, Sher LD, Young PC. Simethicone in the treatment of infant colic: a randomized, placebo-controlled, multicenter trial. Pediatrics 1994; 94(1): 29-34
5. Danielson B, Hwang CP. Treatment of infantile colic with surface active substance (simethicone). Acta Paediatr Scan 1985;74(3):446-50.
6. Crotteau CA, Wright ST, Eglash A. Clinical inquiries. What is the best treatment for infants with colic? J Fam Pract 2006;55(7):634-6.
7. Lucassen PL, Assendelft WJ, Gubbels JW, van Eijk JT, van Geldrop WJ, Neven AK. Effectiveness of treatments for infantile colic: systematic review. BMJ 1998;316(7144):1563-9.
8. Vohra S, Johnston BC, Cramer K, Humphreys K. Adverse events associated with pediatric spinal manipulation: a systematic review. Pediatrics. 2007;119(1):e275-83
9. Alcantara J, Ohm J, Kunz D. The safety and effectiveness of pediatric chiropractic: a survey of chiropractors and parents in a practice-based research network. Explore (NY). 2009;5(5):290-5.
10. Alcantara J, Ohm J, Kunz D. A practice-based prospective study on the incidence and prevalence of adverse events associated with pediatric chiropractic spinal manipulative therapy. J Ped Matern & Fam Health – Chiropr [Submitted for Publication]
11. Choonara I, Sharon C. Unlicensed and off-label drug use in children. Implications for safety. Drug Safety 2002; 25 (1):1-5
12. Turner S, Gill  A, Nunn T,et al. Use of ‘off-label’ and unlicensed drugs in paediatric intensive care unit. Lancet 1996;347:549-50
13. Bell IR, Caspi O, Schwartz GE, et al. Integrative medicine and systemic outcomes research: issues in the emergence of a new model for primary health care. Arch Intern Med 2002;162: 133-40.

Dr. Joel Alcantara, I.C.P.A. Research Director, spearheads the profession’s largest and most successful Practiced Based Research Network (PBRN) and continuously oversees numerous projects relevant to evidenced based family chiropractic care. He is instrumental in involving members of the International Chiropractic Pediatric Association in publishing the research so necessary in the profession. His commitment to publishing is establishing recognition and validity to the necessity, safety and effectiveness of chiropractic care for pregnant women and children.

Dr. Alcantara was born in the Philippines and grew up in Calgary, Alberta. Prior to attending Chiropractic College, he was trained in Chemistry-Biochemistry and Cellular, Molecular and Microbial Biology at the University of Calgary. Upon graduating from Palmer College of Chiropractic West in 1995, he was given a full-time faculty appointment at his alma mater in the Research Department. In the two years prior to his position with the I.C.P.A. , he held the rank of Assistant Professor at Life Chiropractic College West. During his tenure at both chiropractic colleges, he has taught an array of subjects from Chiropractic Pediatrics, Physical Diagnosis, Research Methods, Public Health and various chiropractic clinical courses. He has published widely in scientific journals and in the popular chiropractic media and has co-authored several chapters in various chiropractic textbooks. Dr. Alcantara is completing his Master of Public Health degree at San Jose State University with a specialty in Community Health Education.