Chiropractic Board reinstates interim policy

17 Jun 2024

The Chiropractic Board of Australia has reinstated an interim policy on the spinal manipulation of children under two years of age, pending further consultation with Australia’s health ministers.

This follows a request from the Health Ministers Meeting on 14 June.

Board Chair Dr Wayne Minter AM said the Board expects chiropractors to comply with the interim policy, which advises chiropractors to not use spinal manipulation to treat children under two years of age, until further consultation with Health Ministers can allow for developing a final position.

‘While there has been no evidence of serious harm to infants from chiropractic care in Australia, the Board’s role is first and foremost to protect the public.

‘We look forward to working with Ministers to develop an evidence-based final policy on paediatric care that balances the paramount need to protect patients, with the right for parents and other patients to have a say in the care they choose,’ Dr Minter said. 

The Board first released an interim policy on the spinal manipulation of children under 12 years of age in 2019 while evidence about its safety and effectiveness could be gathered. After commissioning Cochrane Australia to provide an updated systematic review of the effectiveness and safety of spinal manipulation in children under 12, the Board published updated guidelines in-line with its findings in November 2023, allowing chiropractors to treat children according to current evidence and/or best-practice approaches.

However, following a request by Australian Health Ministers, the Board has reinstated the policy to allow time for further consultation with Health Ministers. 

‘The Board is committed to ensuring the public has access to, and receives, safe, ethical and competent care from registered chiropractors,’ Dr Minter said. 

‘We welcome any engagement with ministers that can further strengthen responsible practice.’ 

The Board expects chiropractors to comply with the interim policy, in addition to following the guidance provided in the Statement on paediatric care (2023) and the shared Code of conduct  (2022).    

The Board expects chiropractors to: 

• understand that children have significant anatomical, physiological, developmental and psychological differences and needs from adults and that their healthcare management requires specific skills and expertise 
• modify all care and treatment (including technique and force) to suit the age, presentation and development of the patient
• discuss their proposed management plan with the patient and their parent/guardian 
• inform the patient and their parent/guardian about the quality of the acceptable evidence and explain the basis for the proposed treatment
• provide the patient and their parent/guardian with information about the risks and benefits of the proposed treatment and the risks of receiving no treatment
• appropriately document consent, including considering the need for written consent for high-risk procedures 
• refer patients when they have conditions or symptoms outside a chiropractor’s area of competence, for example ‘red flags’ such as the presence of possible serious pathology that requires urgent medical referral to the care of other registered health practitioners, and
• communicate effectively with other health practitioners involved with the care of the patient, such as the patient’s general practitioner or paediatrician.

When chiropractors do not have the clinical skills and knowledge to appropriately assess and/or manage a paediatric patient, the Board expects them to refer the patient to another healthcare practitioner who has the appropriate skills, or to co-manage the patient with them. In all cases, the patients’ best interests must be the priority. 

This interim policy will be in place pending further consultation with Health Ministers. The Board will consider its obligations under the National Law and any further decisions by Health Ministers in developing a final position.