Please don’t try chiropractic first, or at all, for any pediatric condition
As discussed numerous times on the pages of Science-Based Medicine, children are increasingly a target of chiropractors, with some even pushing for recognition as primary care practitioners. Despite a thoroughly inadequate training, and a lack of experience with ill pediatric patients, they believe that they have what it takes to recognize and manage common pediatric conditions or refer to an actual pediatric medical professional when they deem it appropriate. While a significant percentage of pediatric illness is self-limited, and thus might appear to respond to chiropractic manipulation, I have seen many deteriorate quickly and with little warning. The idea of an ill child suffering at the hands of a charlatan is terrifying.
Many chiropractors are of course more than happy to see pediatric patients without acting as their PCP. They love to claim that children are at risk of developing misalignment of the bones of the skull and spine, chiropractic subluxations, and numerous other conditions unique to alternative medical reality, particularly during the first few years of life. They tell caregivers that these insults can be subtle, or even silent for years, and that regular maintenance care is required to prevent severe problems, even going so far as to blame SIDS and “shaken baby syndrome” on these fictional entities.
Many chiropractors are also quick to claim that they can prevent or cure some of the most common conditions seen by pediatricians and family healthcare providers, such as viral infections of the upper respiratory tract, asthma, bedwetting, and ear infections to name just a few. By simply improving the function of the nervous system, chiropractors believe that they can “boost” the immune system’s ability to fight infections, improve control over bladder function, and even reduce airway inflammation and bronchoconstriction. If you think that sounds like nonsense, you’re right!
Tree of Life – the first-known sketch by Charles Darwin of an evolutionary tree describing the relationships among groups of organisms (Cambridge University Library).
The Merriam-Webster Dictionary defines science as:
Knowledge about or study of the natural world based on facts learned through experiments and observation.
Knowledge as distinguished from ignorance or misunderstanding.
While this should distinguish science from pseudoscience, those who practice the latter often lay claim to the same definition. But one of the major differences between science and pseudoscience is that science advances through constant rejection and revision of prior models and hypotheses as new evidence is produced; it evolves. This is the antithesis of pseudoscience. At the heart of pseudoscience-based medicine (PBM) is dogma and belief. It clings to its preconceptions and never changes in order to improve. It thrives on the intransigence of its belief system, and rejects threats to its dogma. Despite the constant claims by peddlers of pseudoscience that SBM practitioners are closed-minded, we know that, in fact, PBM is the ultimate in closed-minded belief. Of course, those of us who claim to practice SBM aren’t always quick to adopt new evidence. We sometimes continue practices that may once have been the standard of care but are no longer supported by the best available evidence, or perhaps may even be contradicted by the latest evidence. Often this is a byproduct of habituated practice and a failure to keep current with the literature. While this is certainly a failure of modern medicine, it is not an inevitable outcome. It is not emblematic of the practice of medicine, as it is with PBM. When medicine is science-based, it strives for continual improvement based on modifications around emerging evidence. (more…)
Ear infections used to be a devastating problem. In 1932, acute otitis media (AOM) and its suppurative complications accounted for 27% of all pediatric admissions to Bellevue Hospital. Since the introduction of antibiotics, it has become a much less serious problem. For decades it was taken for granted that all children with AOM should be given antibiotics, not only to treat the disease itself but to prevent complications like mastoiditis and meningitis.
In the 1980s, that consensus began to change. We realized that as many as 80% of uncomplicated ear infections resolve without treatment in 3 days. Many infections are caused by viruses that don’t respond to antibiotics. Overuse of antibiotics leads to the emergence of resistant strains of bacteria. Antibiotics cause side effects. A new strategy of watchful waiting was developed.