We identified 1275 citations. Of these, 57 discrete documents met the eligibility criteria for the study (see Table ) determined by three reviewers who then determined by consensus, each citation's appropriate level on the strength of evidence scale. The bibliography is available to readers on request.
The new evidence from the relevant time period (January 2004 to June 2007) was 1 systematic review, 1 RCT, 2 observational studies, 36 descriptive case studies and 17 conference abstracts.
When this additional evidence is combined with the previous systematic review undertaken up to 2003, there are now in total, 2 systematic reviews, 10 RCT's, 3 observational studies, 177 descriptive studies, and 31 conference abstracts defining this body of knowledge (see Table ).
One systematic review on infantile colic was completed by CCOHTA in December 2003 [2
]. Four reports met the review's inclusion criteria. These reports described four randomized controlled trials (two published in peer-reviewed journals, one conference abstract and one unpublished manuscript) with spinal manipulation in all trials performed by chiropractors. Quality scores were measured by the Jadad scale. The systematic review concluded that (1) there is no convincing evidence that spinal manipulation alone can affect the duration of infantile colic symptoms, (2) the effect of spinal manipulation on sleep time, parental anxiety, quality of life and the number of infants meeting diagnostic criteria for colic could not be determined using available evidence, and (3) the potential harm from the spinal manipulation of infants with colic could not be determined using evidence available from controlled trials.
Systematic review 2007 update
One systematic review on the effects of manual therapy of kinetic imbalance due to suboccipital strain syndrome (KISS) in infants with positional preference, plagiocephaly and colic was reported in 2005 [3
]. The systematic review concluded there is no scientific evidence that spinal manipulation is useful in infants with signs and symptoms of the proposed KISS syndrome.
Randomized controlled trials
The 9 RCT's involved a total of 590 children [4
]. Two trials on asthma involved 80 and 36 children respectively. All spinal manipulation was performed by chiropractors. The first trial concluded that in children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit. The second trial concluded that after 3 months of combining chiropractic spinal manipulation with optimal medical management for pediatric asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower.
Two trials on enuresis involved 171 and 46 children respectively. All spinal manipulation was performed by chiropractors. The first trial concluded the study results do not support the claim that chiropractic care in enuretic children is an effective therapy for this condition. The second trial concluded that the study results strongly suggest the effectiveness of chiropractic treatment for primary nocturnal enuresis.
Two trials on infantile colic involved 50 and 86 children respectively. All spinal manipulation was performed by a chiropractor. In the first trial the study concluded that spinal manipulation is effective in relieving infantile colic. In the second trial the study concluded that chiropractic manipulation is no more effective than placebo in the treatment of infantile colic.
One trial on chronic otitis media was a feasibility study involving 22 children with spinal manipulation performed by a chiropractor and concluded that recruitment for a randomized controlled trial is feasible and could be enhanced by medical collaboration.
One trial on jet lag involved 15 children with spinal manipulation performed by a chiropractor and concluded that chiropractic care did not reduce the effects of jet lag.
One trial on radial head subluxation involved 84 children. Manipulation of the radial head was performed by a physician. The study concluded that in the reduction of radial head subluxations, the hyperpronation technique required fewer attempts at reduction compared with supination, was successful more often than supination, and was often successful when supination failed.
Randomized controlled trials 2007 update
One RCT on adolescent idiopathic scoliosis reported in 2006 was a pilot study involving 6 children with manipulation performed by chiropractors [13
]. The investigators concluded that this pilot study showed the viability for a larger randomized trial.
There was one observational study involving 24 children with manipulation performed by chiropractors [14
]. It concluded that chiropractic treatment was effective for the wide range of symptoms associated with "learning and behavioural impairments resulting from brain damage and/or neurological dysfunction accompanied by impairing emotional overlay".
Observational studies 2007 update
Two observational studies involved 49 children and all manipulation was performed by chiropractors [15
]. One study reported in 2006, involved 14 children with autism, and compared upper cervical (Atlas Orthogonal technique) provided to 7 children with full spine manipulation provided to 7 children. The study concluded that the clinical improvement of autistic children under full spine chiropractic care was enhanced four fold when the technique of adjustment was shifted to upper cervical AO technique.
One study in 2004 examined 25 infants demonstrating difficulties with breastfeeding and compared 10 infants without complaint. The study concluded that soft tissue work, cranial therapy, and spinal adjustments may have a direct result in improving the infant's ability to suckle efficiently.
The 141 descriptive studies involved a total of 2245 children. The literature retrieved reveals a host of conditions reported by a number of practitioners, primarily chiropractors, who claim to successfully treat a variety of pediatric health conditions with manipulation. The conditions include, but are not limited to the following: scoliosis, congenital torticollis, juvenile arthritis, strabismus, foot inversion, neurologic performance (learning, behaviour, attention), enuresis, Erb's palsy, infantile colic, asthma, esophoria, fever, shoulder impingement, encopresis, neurogenic bladder, bronchitis, atelectasis, birth trauma, back pain, neck pain, headache, otitis media, seizure, tetraparesis, Bell's palsy, constipation, disk herniation, lumbar fracture, hemiparesis, Osgood Schlatter, radial head subluxation, and developmental delay.
Descriptive studies 2007 update
The 36 descriptive studies, mainly single case reports, involved a total of 138 children and reported a wide range of health conditions treated by chiropractors. The conditions include GERD, constipation, palsy, developmental delay, torticollis, elbow pain, autism, enuresis, sleep dysfunction, ADHD, wry neck, heel pain, uveitis, scoliosis, irritable baby syndrome, gastroenteritis, seizures, colic, migraine, motion sickness, otitis media and dyslexia.
Abstracts at conference proceedings
There were 14 conference proceeding abstracts involving a total of 173 children.
Five RCT's involved asthma, autism, infantile colic (2), and otitis media with chiropractors performing all spinal manipulation. The trial on asthma was a feasibility study with 6 children. The trial on autism involved 14 children and concluded that the clinical improvement of autistic children under full spine chiropractic adjustment can be enhanced four fold and may reach to complete cure if the technique of adjustment is shifted to upper cervical. The first trial on infantile colic involved 30 children and concluded that chiropractic spinal manipulation is more effective than placebo in the treatment of the symptomatology of infantile colic. The second trial on infantile colic involved 45 children and concluded that chiropractic spinal manipulation is effective and safe in the treatment of infantile colic. The trial on chronic otitis media involved 30 children and concluded that there is a significant decrease in the number of days it takes to resolve a chronic otitis media using chiropractic care compared to one treated with antimicrobial therapy.
The nine descriptive studies involved 48 children with chiropractors performing manipulation for the following conditions: autism, headache, acute otitis media, seizure, difficult breast feeding, and torticollis.
Abstracts at conference proceedings 2007 update
There were 17 conference proceeding abstracts involving a total of 72 children.
One observational study involving 15 children (8 in treatment group, 7 in control group) reported on the effects of joint manipulation on the performance of young swimmers.
The 16 descriptive studies involved 57 children with chiropractors performing manipulation for the following health conditions: conversion disorder, torticollis, enuresis, headache, GERD, seizure, scoliosis, ADHD, palsy and developmental delay.