Mar 01 2013
Chiropractic and Sudden Infant Death Syndrome
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“Parents are warned that their child may have a life threatening subluxation and immediate correction is necessary to prevent the death of their child. ”
“SIDS is not common. Many pediatricians and family practice doctors will go their entire career without encountering it. ”
Ah, the beauty of it. Take a rare but truly frightening pathology, build a ritual that promises to prevent it, rattle bones and chant incantation, deposit money in bank. Since the event rarely occurs, success is foreordained nearly every time. In the rare event of failure, a crestfallen visage and the simple words, “if you’d only brought her sooner…”
Excuse me while I go retch.
I’ll admit that I was uncharitable, and assumed from the title that you were suggesting a cause and effect. Given the prevalence of “infant adjustments” and the occasional case of an adult patient getting adjusted and then dying later that night as the damage done by neck twisting finally catches up to them, I was thinking you were going to suggest that chiropractors were causing casing of SIDS.
Thank you for the list of tips on how to prevent it. My wife and I are currently working towards a child, and more knowledge makes us less edgy about the risks.
I have to admit I’m a bit confused about the points 2 to 3 on the final list of decreasing SIDS risk, because at the beginning of the post you write that “… there are a number of medical conditions, such as abuse, accidental suffocation, and a variety of underlying disease processes, which can mimic SIDS. As our diagnostic capabilities have improved over the past few decades, a large number of deaths that would have been classified as SIDS are now attributed to one of these other conditions. “.
Aren’t all of those points more likely risk factors for accidental suffocation, which is not SIDS by the given definition?
I’ll just add that I understand there are studies that look into SIDS in bed-sharing vs room-sharing and other scenarios, but do they all rule out accidental suffocation and other causes of death properly?
Oh dear. All four of mine slept on their tummies (talk about FEAR–we were assured that they would choke on vomit if left on their backs, to say nothing of ending up with flattened skulls!), none had pacifiers–ever, they all bed-shared (or slept with us as I refer to it), but they were breastfed, vaccinated, not exposed to smoke, had good prenatal care and were not overheated (something I see a lot of at the mall with babies in a climate-controlled environment with snow suits on!).
I realize that I was apparently just lucky, and I admit that I would likely be compelled to take modern advice (except for the pacifier–I cannot abide them), so I am glad they are grown and that the six g-kids also survived similar babyhoods, although one (and only one) had a pacifier–he’s gay so obviously there’s a correlation!
My sins seem minor, though, in comparison to taking a tiny baby to a chiropractor, which is simply a horrifying thought.
@mika
We don’t know what causes SIDS. Some children have been suffocated when wedged down in the cushions of a couch for instance. This is why a good scene investigation is mandatory. But some cases of SIDS may have been from being suffocated and it was just missed. Some may have been caused when a child with something up against their face was unable to arouse and shift positioning as most infants would. What we know is that there are certain risk factors that are epidemiologically linked to SIDS. I imagine it is difficult to completely rule out some possible causes of these deaths and SIDS, for now, is somewhat of a waste basket.
@Janet
” taking a tiny baby to a chiropractor”
I cringed when I read the words ‘chiropractic pediatrics’ early in Dr. Jones’ post.
My 1st grandchild died of SIDS at a bit over 2 months of age. My daughter, a medical researcher, bed-shared and 8 years on still believes that she ‘killed’ her baby despite the weakness of the link with bed-sharing. SIDS is a wrenching experience that I wouldn’t wish on anyone. The notion of quacks exploiting parental fear and practicing mumbo-jumbo on infants just makes me furious.
Very well written, thoughtful and informative post. Thanks!
@Clay Jones
So just to clarify, is SIDS used for any unexplained infant death, regardless of the actual cause of death? In case the reason remains a mystery after thorough examination and autopsy. So, like you said, some cases of SIDS might be from suffocation that was missed and thus bed-sharing and those other points are listed as risk factors for SIDS.
On a somewhat related note, this was interesting read: http://www.parentingscience.com/bed-sharing.html
I guess there are several factors involved in the risk from bed-sharing.
“Chiropractors don’t see a fraction of the number of pediatric patients that physicians do, so it would be extremely unlikely for them to have a patient die from it either. This can lead to a false impression that an intervention is effective at preventing SIDS.”
Mmhmm around this neck of the woods lots of moola is made selling lightning protection to folks. Lightning-strike deaths are not uncommon overall and get plenty of publicity, but still the chances of any one individual being struck are small.
And if a person does get struck he’s unlikely to stomp into your shop to demand his money back.
Commercially it’s a sure-fire winner (pardon the pun).
As I’ve mentioned on several previous occasions, over the years I’ve had correspondence with numerous chiropractors. These experiences have, in general, been exercises in futility because they almost never address the questions I pose. Instead, they accuse me of having a closed mind, of being hateful (one even offered to pray to Jesus for me to help me get rid of my hatred) or, sometimes, it simply degenerates into ad-hominem attacks against Sam Homola or Stephen Barrett – even though their names haven’t come up.
One specific example is related to Clay’s topic in today’s blog. Years ago I was having a frustrating back-and-forth argument with a cretinous semi-literate (a guy whose inability to write a coherent sentence with anything approaching proper grammar and spelling was appalling). He sent me a faded Xerox copy of some purported study that claimed early (i.e. from birth) chiropractic treatment could prevent SIDS.
Many DCs have sent me replies that have affected me in various ways. I’ve been amused, befuddled, bewildered, confused and, from time to time, angry. This response, however, made me absolutely furious! This guy was telling me, in effect, that if a child dies from SIDS that it’s the fault of the parents. Try to imagine parents, already grieving over an unimaginable loss, being told on top of everything else that they are responsible for the tragedy. It boggles the mind to realize that there are so-called healthcare professionals like this guy.
But it’s all just another day in the bizarre world of mondo chiropractico.
Regarding SIDS vs accidental suffocation, the distinction is essentially impossible on autopsy. The findings at the scene and/or an admission of the accident from a parent are essentially the only ways to prove accidental suffocation.
I spent a few months at a medical examiner’s office as a resident, and >95% of the SIDS cases while I was there involved co-sleeping. But when there was no proof of suffocation (and again, there essentially never is on autopsy), the death was almost always signed out as natural rather than accidental. SIDS is very real, but a number of “SIDS” cases are almost certainly suffocations.
I was once told I needed to have my liver adjusted because it would improve my anger issues. It is funny to me how often simply asking questions or for evidence is interpreted as anger. It all boils down to cognitive dissonance theory, right? If I am just an angry jerk, then my criticism can be discounted more easily without actually putting thought into it.
Clay: “I was once told I needed to have my liver adjusted because it would improve my anger issues. It is funny to me how often simply asking questions or for evidence is interpreted as anger. It all boils down to cognitive dissonance theory, right? If I am just an angry jerk, then my criticism can be discounted more easily without actually putting thought into it.”
Then a whole lot of chiropractors need adjustments (liver or otherwise) because many of them have gotten angry at me. VERY many!
Unfortunately, this fraud (because that is what it is) will continue as long as the state legislatures permit it through the chiropractic practice acts. Thank you, Clay, for a fine post exposing this particular instance of chiropractic nonsense, of which there are many.
He had observed that infants undergoing atlanto-occipital chiropractic adjustments developed “vegetative reactions” involving flushing, sweating, hyperextension and even apnea (cessation of breathing).
And this did not induce alarm? How the chiropractic-indoctrinated mind can work!
Since babies’ cervical spines are like jelly, and capable of being tied in knots if they were only long enough, I wonder at the forces needed to induce these reactions — and, of course, the fancy that anything could thereby be induced to assume a healthier anatomical disposition.
FYI:
Clin Infect Dis. 2013 Jan;56(2):171-9. doi: 10.1093/cid/cis870. Epub 2012 Oct 16.
Near-universal prevalence of Pneumocystis and associated increase in mucus in the lungs of infants with sudden unexpected death.
http://www.ncbi.nlm.nih.gov/pubmed/23074306
there are a couple similar references, a curious association
There were 15 kids that died unexpectedly but with a diagnosis and 10 had PJP in the lungs. It seems as if perhaps there might be a high prevalence of PJP in everybodies lungs? I’ll defer to your expertise on that.
“A highly focal Pneumocystis infection associated to increased mucus expression is almost universally present in the lungs of infants dying unexpectedly in the community regardless of autopsy diagnosis.”
It would be interesting to learn the incidence of PJ in lungs of (living) babies in a similar setting.
pmoran
I had a similar reaction to the claim that high-cervical chiro adjustments can cause severe physiological effects.
The results, if they were actually valid, from those Koch studies described by Dr Jones should act as a stark warning against letting a chiro anywhere near your baby’s neck not as a justification for having a chiro karate-chop your baby. I think we see evidence of the SCAMsters’ Bass-Ackwards machine operating in full force. “Hey folks, if I poke a kid’s neck I can nearly kill him. Therefore chiropractic subluxations exist. I fix those. You need to let me whack your baby for routine maintenance of his brain.”
We should be grateful that, for all the reasons Dr Jones gave, Koch’s results were probably spurious.
@BSM
The authors actually address that point, claiming that many thousands of chiropractic adjustments of infants have not caused harm and that these transient manifestations are simply markers of what happens when the upper cervical spine is irritated. If done in the chiro office it is fine but if the irritation occurs secondary to a subluxation with the addition of unsafe sleeping position it might lead to SIDS. It is nonsense.
I referred to this case of craniosacral *adjustment* and the death of a young infant, a while back on SBM when craniosacral therapies were being discussed. There was no doubt that the “therapy” and manipulation, caused the 3-month-old infant to go limp, unresponsive and hypoxic immediately after the *treatment*.
http://anaximperator.wordpress.com/2009/05/07/infant-dies-after-craniosacral-therapy/
As follow-up to this sad case, authorities decided not to prosecute the craniosacral therapist because “he promised to not use this therapy again.”…
http://anaximperator.wordpress.com/2010/01/17/infant-dies-after-craniosacral-therapy-therapist-gets-off-scot-free/
I’ve been *known* to put on my hip boot waders to go *slumming* and posting at the Huffington Post. Here I took on a blogger who was extolling the virtues of craniosacral therapy for newborns…
http://www.huffingtonpost.com/juliet-linley/craniosacral-therapy-for-_b_827495.html
The Michael Shea that I referred to on my Ho-Po comment is this guy. This is “Part One” of his craniosacral practice. See the part where he takes a “history of the baby’s birth” and asks permission from his infant patient (informed consent?) to begin *craniosacral treatment*…
http://www.craniosacraltherapy.org/Babies.htm
“The infant needs to be fully informed of the purpose of his or her visit with the therapist. The craniosacral therapist must speak in the first person to the infant. “Do you know what I do?” The therapist explains to the infant what they do and who they are. Infants are quite capable of responding to this information except with certain kinds of shock. They often shake their head knowingly from side to side to indicate “no”. So the therapist carefully observes the infant for their communication style. Infants will use their whole body to speak in response to a question or comment. They will also verbally talk to the therapist. The conversation skills are emotionally based and developed in the body ego i.e. skin, muscles, vocal tones, micro movements, macro movements, etc. It may take a session or two for the therapist to intuit the infants unique style of communication. It is equally important to state questions and comments to the infant simply in a way that only require yes and no answers. The infant just went through a very intense experience and wants to tell the story. Someone needs to listen and the infant needs to know it’s being heard for healing to occur.”
BTW, I too placed my babies (born 1970 and 1976), on their tummies to sleep, in their own bassinet, next to my side of the bed; it prevented aspiration of their spit-up (or so we were told by our pediatricians). Neither baby ever enjoyed a pacifier.
I see Clay Jones isn’t on the list of contributors … someone needs to update this list.
[...] Syndrome is a horrible tragedy that we don’t really understand. Chiropractors, however, think chiropractic can prevent SIDS. A good review of the claims and the [...]
Sorry Sherlock( Lilady)
If you read carefully the baby died of cervical manipulaion not CST.
If someone really thinks that CST could kill a baby, they better not even breath near or on it.
http://anaximperator.wordpress.com/2009/05/07/infant-dies-after-craniosacral-therapy/
BTW, I too placed my babies (born 1970 and 1976), on their tummies to sleep, in their own bassinet, next to my side of the bed; it prevented aspiration of their spit-up (or so we were told by our pediatricians). Neither baby ever enjoyed a pacifier.
I like the language you use also ” tummies” and “Spit-up” . A great ambassador for SBM!
Immunnizations to decrease the risk of SIDS is based on level B evidence (Level B: Recommendations are based on limited or inconsistent scientific evidence.)
@ antiskepticalhealth: Sorry Dick Tracy read my link again.
Does “prone” and “vomit” meet with your approval Dick Tracy?
“A great ambassador for SBM!”
There is nothing unscientific about using plain language, when it suffices.
.
@ Davdoodles: Heh, heh…I *deliberately* used “spit-up” terminology…because there is a difference between “spit-up” and vomit.
http://www.aboutkidshealth.ca/En/ResourceCentres/PregnancyBabies/NewbornBabies/HealthIssuesinYourNewbornBaby/Pages/Spitting-up-and-Vomiting.aspx
It also *helps* to know some basic anatomy. I do know that “sacral” refers to the sacrum and when you open the link I provided, you will see how the infant’s cranium and sacrum were manipulated by the *craniosacral therapist*.
lilady,
I think you just burned that poster to AntiSkepticalHealth.
I always appreciate plain language like “on their tummies” or “on their backs”. Not being a medical person, I haven’t had the terminology drummed into me. I never remember which is prone or supine…I also never remember starboard or port. Oh well.
Thanks for your support. Unfortunately, I believe ASH is a sock puppet of Thingy who was posting her bile at me yesterday on another science blog. The moderator there removed all her postings.
lilady – checked out that HuffPo article. It’s nice to see the many good skeptical questions in the comments.
No, ASH appears to be a sockpuppet for rwk, if you remember that particular chiropractor who infested the comments a while back. Based on the no sockpuppets rule, he/she/it is now in the “automatic moderation” list until he/she/it learns to behave.
@ Dr. Gorski: I was 50% correct…I nailed ASH as a sock puppet.
First of all, this person called himself a craniosacral therapist, but the holding technique (i.e. folding babies until they became quiet – possibly because of lack of oxygen…) was more or less an invention of himself, and not the official repertoire of CST. Of course with these amateur healers the customers never can tell which is the official therapy, and which the interpretation of invention of the individual therapist. Supposedly CST only involves light touch to address subtleties that only the CST can observe such as motions of 0.001 millimeter (that’s just a little more than the wavelenth of red light and roughly the diameter of a bacterium) of the cranial bones. No kidding.
Second, the Dutch Health Inspectorate is not “the authorities”. They consider themselves as appointed to monitor officially registered health care workers: MDs, pharmacists, dentists, health care psychologists, nurses and of course hospitals and similar institutions. People who visit quacks suchs as homeopaths, chiropractors, acupuncturists, ayurveda healers and so on, do this at their own risk. Only when amateur healers inflict bodily harm AND there is a possibility of harm to others, the Health Inspectorate takes action. That’s regrettable, but entirely within the law on the Professions in Health Care passed by the Dutch Parliament!
But the guy was charged by the public prosecutor. It took rather long because very many experst had to be heard and the Public Prosecutor isn’t very experienced in medical affairs. The court case was in the end of 2011. The prosecutor asked for half a year imprisonment suspended PLUS 240 hours community service (e.g. sweeping streets, maintaining parks or assisting in hospitals or old people’s homes for example washing dishes).
He was sentenced on December 23, 2011. The judges upheld the suspended sentence, but not the community service.
The therapist has appealed the sentence, claiming that his treatment couldn’t have been the cause of death.
MTR, a way to remember what orientation is supine is that when one is supine, soup can be held in one’s navel (if one is an “innie”).
An interesting development in Australia regarding pediatric chiropractic
(see http://www.standard.net.au/story/1349915/chiropractic-funding-called-into-question/?cs=27 ):
“‘I absolutely believe it’s child abuse,’ said Professor MacLennan, who is also the vice-president of Friends of Science in Medicine.”
-r.c.
This is a bit late but worth sharing I think. There used to be a chiropractic organization called “Stop SIDS” which promoted the nonsense that babies are born with “vertebral subluxations.” These could cause SIDS and other health problems so it was wise to get the baby “adjusted” as soon as possible after birth. Thanks to the Way Back Machine, I found a link to the website:
http://web.archive.org/web/20030201150602/http://www.stopsids.org/faq.html
Note the use of x-rays (of a baby!!!!!) to “diagnose” the subluxation and the machine to adjust the subluxation.
It would be interesting to do a study of long-time chiropractic patients to see if they have a greater incidence of cancer.
This new article on pediatric chiropractic just published by Medill Reports:
http://news.medill.northwestern.edu/chicago/news.aspx?id=217529
I believe there are safe ways to bed-share with infants, is this not true?
If so, Simplexion, please share. I used a bassinet placed nearby.