Pediatric Complementary and Alternative Medicine

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Manipulation and Body Therapies  

Examples of manipulation and body-based therapies include chiropractic and osteopathic manipulation, massage therapy, reflexology, and rolfing.  These therapies focus primarily on the manipulation and movement of the structures and systems of the body, including the bones, joints, soft tissues, circulatory and lymph systems.  Although these practices differ in the way they are performed, they all are based on the principle that the human body is self-regulating and has the ability to heal itself, and that the parts of the human body are interdependent.  Practitioners in all these areas tend to tailor their treatments to specific patient needs. ¹

Chiropractic manipulation

Chiropractic care is based on the theory that all diseases and immune system problems can be traced to subluxations or misaligned vertebrae in the spinal column.  If left untreated, subluxations can lead to narrowing and pressure on the nerves leaving the spinal column, producing disease in the tissue and innervated organs. ² Adjustment and realignment of these misalignments is the main therapeutic intervention used by chiropractors.   

Examples of Use

Although most adults consult chiropractors for musculoskeletal disorders, children frequently see chiropractors for respiratory problems, ear, nose, and throat problems, and general preventive care.  Pediatric diseases commonly treated by chiropractors include otitis media, asthma, allergies, colic, and enuresis.  Randomized controlled clinical trials supporting the use of chiropractic care for these pediatric conditions are rare. ³

Risks

The safety of chiropractic care for children is a concern of many allopathic health care providers.  Fortunately, serious neurologic or vertebral traumas following chiropractic care are believed to be rare although the true incidence remains unknown.⁴  It is believed that the most serious complications are related to cervical manipulation ³ but better reporting and more pediatric population-based studies are needed. ⁴

Of additional concern is that many pediatric health care providers worry that those patients who initially seek chiropractic care may delay or prevent more appropriate medical diagnoses and treatment.  According to the International Chiropractic Pediatric Association, ⁵ chiropractic therapy is not a treatment for disease. Its purpose is to reduce nerve system stress, a serious and often painless condition most children (and adults) have in their bodies. Nerve system stress interferes with the proper functioning of the nervous system, can weaken internal organs and organ systems, lower resistance, reduce healing potential and set the stage for sickness and disorders of all kinds.  However, when a small sample of 11 pediatric trained chiropractors in the Boston area were presented with a hypothetical case of a two-week old infant with a fever, 38% percent of the responders stated they would see the child immediately themselves rather than refer the child to a physician or emergency facility. ⁴ This is of particular concern because the International Chiropractic Association policy recommends and advises that consultations with other health care providers be done for all difficult or protracted cases. ⁶

Chiropractics and Childhood Immunizations

Another concern expressed by allopathic providers is the failure of some chiropractors to promote childhood immunization.  The American Chiropractic Association (ACA) policy states that “the use of vaccines is not without risk, the American Chiropractic Association supports each individual's right to freedom of choice in his/her own health care based on an informed awareness of the benefits and possible adverse effects of vaccination. The ACA is supportive of a conscience clause or waiver in compulsory vaccination laws thereby maintaining an individual's right to freedom of choice in health care matters and providing an alternative elective course of action regarding vaccination”. ⁷ Although the number of chiropractors against vaccines remains unknown, it is believed that they are in the minority and do not represent the views of many practicing chiropractors. ⁸

For more information:

The International Chiropractic Pediatric Association - an organization dedicated to training, education and research in chiropractic pediatrics.

www.icpa4kids.com/ (website accessed 5/6/08)

http://www.chiropractic.org/guidelines/ChapterFour.pdf  This chapter contains the protocols and guidelines for pediatric chiropractic care written by the International Pediatric Chiropractic Association in June 2000. (website accessed 5/6/08)  

Osteopathic Manipulation

An osteopathic physician will often use a treatment method called manipulation which is a gentle, precise amount of force to promote healthy movement of tissue, eliminate abnormal movements, and release compressed bones and joints.⁹ Osteopaths differ from chiropractors in their view of the musculoskeletal system. The focus of osteopathic medicine has been the need to optimize blood circulation to maintain or restore health. The chiropractic approach is focused more on the nervous system and adjustments of the spinal vertebrae to improve nerve transmission.

See http://www.acatoday.org/pdf/NH_Osteopath.pdf (accessed 5/8/08) ¹⁰ for more information on the differences between chiropractors and osteopaths.

Examples of Use

Osteopathic manipulation has been used in pediatrics for asthma, recurrent otitis media, and as therapy for children with cerebral palsy.  Studies supporting results have been limited.  For example, a 2005 Cochrane Review of 68 studies of asthmatic children and adults found that there was insufficient evidence to support the use of manual therapies for patients with asthma.  ¹¹

In a study of 69 children with cerebral palsy, parents of 21 of the 23 children receiving osteopathic manipulation reported improvement in walking, standing, and running as compared to 2 of 21 parents in the children in the control group who received no therapy.  Note: the remaining 19 of the 69 children received acupuncture. ¹²

In a small study of 57 children ages 6 months to 6 years with recurrent acute otitis media, results suggested that osteopathic manipulation may prevent or decrease surgical intervention or antibiotic overuse.  The authors of the study suggested that a larger study is needed to show if results can be replicated. ¹³   

Massage Therapy

Pediatric massage therapy is defined as the manual manipulation of soft tissue in children and teens.  The goal of massage therapy is to promote health and well-being.  Massage therapy can be applied using varying degrees of pressure, pacing (based on increasing or decreasing movements by the therapist), and to different parts of the body. ¹⁴

There are a number of different types of massage therapy.  These include Swedish, deep tissue, sports, chair, Oriental, and reflexology.  Methods differ based on the movements of the therapist and the location of the treatment on the patient’s body.   

1.                  Swedish: performed on a table or chair with oil. The therapist’s stroking, kneading and rolling of the muscles are felt to help improve circulation, facilitate oxygen consumption, and remove waste products. 

2.                  Deep tissue: used for muscle damage after an injury, such as whiplash or back strain.

3.                  Sports: to help prevent athletic injury, keep the body flexible, and heal the body should injury occur.

4.                   Chair: massage of the upper body, while fully clothed and seated in a special portable chair.

5.                   Oriental massage: typically involves acupressure and shiatsu, a Japanese method similar to acupuncture that uses finger pressure instead of needles.  The goal is to release discomfort and rebalance energy. ¹⁵

6.                  Reflexology is typically done on the hands and feet.  Reflexology is based on the belief that certain pressure sensors in the hands and feet are part of the body’s reflexive “fight or flight” response and these areas are linked to other specific areas and organs in the body. Practitioners believe that by applying pressure to these specific sensors they can tap into the reflex network and can subsequently promote health in the corresponding areas of the body. ¹⁶

Examples of Use

There are a number of studies that  promote the benefits of massage in children. Unfortunately, many of these studies had weaknesses that need to be addressed in future studies; they had low statistical power, they failed to report basic descriptive statistics, their descriptions of results didn’t logically follow study designs, and they lacked replication. ¹⁴  

A 2006 review looked at 24 randomized control trials of massage therapy in children between 2 to 19 years of age.  This review showed that massage therapy had the strongest benefit in lessening children’s anxiety.  Although it also appears that massage therapy helps to lessen arthritic pain and improve muscle tone, these results were based on single studies and they need to be replicated in future studies.  Research also did not support claims that massage therapy improves children’s immune system function, reduces spasticity, or ameliorates hostility.  The review concluded that more studies need to be done looking at the use of massage in children before claims came be made about benefits. ¹⁷

An observational study of 50 children between the ages of 3 to 14 years used six 30 minute reflexology sessions on the feet during the treatment of their chronic constipation and encopresis.  The results showed that the children’s soiling episodes and frequency of bowel movements increased significantly (p=<0.5).  The authors of this study suggest further research is needed to see if the results are long-term and replicable. ¹⁸

http://www6.miami.edu/touch  This is the website of the Touch Research Institute.  This institute has researched the effects of massage therapy at all stages of life.  This website does contain pediatric specific information (website accessed 5/6/08).

Massage Therapy for Hospitalized or Hospice Settings

It is important to note that massage therapy for children in the hospital or hospice setting can have unique demands.  Integrative touch and compassionate touch are gentler types of massage therapy that may be more appropriate for these patients. ¹⁴

For More Information:

http://www.integrativetouch.org/  This is the website for integrative touch for kids.  Integrative Touch is non-profit organization whose purpose is to enhance well being, minimize suffering and facilitate healing for children with chronic, acute and life limiting illnesses. (Website accessed 5/6/08)

http://www.compassionate-touch.org/home.html  This website describes compassionate touch for later stages of life.  This includes children with chronic or life-threatening diseases.  The site was developed by three massage therapists who practice compassionate touch. (Website accessed 5/6/08)  

Rolfing

Rolfing is a form of bodywork named after its founder, Dr. Ida Rolf.  Rolfing is based on the idea that fascia or the fibrous layers covering the muscles stiffens, shortens, and loses its elasticity after prolonged poor posture and mental and emotional stress. ¹⁹  

Examples of Use

Rolf therapists use their elbows, fingers, and knuckles to stretch and open fascia to correct habitual patterns of misalignment in the head, shoulders, abdomen, pelvis, and legs. This is believed to help open up breathing, improve digestion, balance the nervous system, and improve physical and emotional health. ²⁰

Studies about the benefits of Rolfing in children have not been done. An extensive Medline search netted no results.  However, the Rolf.org website reports that Rolfing can create a palpable change in the child’s connective tissue matrix, provide loving supportive touch, and can have “a profound effect on the developing child’s awareness and comfort in his or her rapidly changing body and mind”. ²¹      

References

1. http://nccam.nih.gov/health/backgrounds/manipulative.htm, accessed 4/23/08.
2. Breuner, C. (2002).  Complementary medicine in pediatrics:  A review of acupuncture, homeopathy, massage, and chiropractic therapies.  Current Problems in Pediatric and Adolescent Health Care, 32, 353-384.
3. Lee, A., Li, D., & Kemper, K. (2000).  Chiropractic care for children.  Archives of Pediatric and Adolescent Medicine, 154, 401-407.
4. Vohra, S., Johnston, B., Cramer, K., & Humphreys, K. (2007).  Adverse events associated with pediatric spinal manipulation:  A systematic review.  Pediatrics, 119(1), e275-e283.
5. http://www.icpa4kids.org/research/chiropractic.htm, accessed 4/23/08
6. http://www.chiropractic.org/guidelines/ChapterFour.pdf, p. 4, accessed 4/23/08.
7. http://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=117, accessed, 5/6/08.
8. Campbell, J., Busse, J., & Injeyan, S. (2000).  Chiropractors and vaccination:  A historical perspective. Pediatrics, 105(4), e43-e51.
9. http://www.osteohome.com, accessed 4/24/08.
10. http://www.acatoday.org/pdf/NH_Osteopath.pdf, accessed 5/8/08.
11. Hondras, M., Linde, K., & Jones, A. (2005).  Manual therapy for asthma.  Cochrane Database of Systematic Review, issue 2, article number CD001002.
12. Duncan, B., Barton, L., Edmonds, D., & Blashill, B. (2004).  Parental perceptions of the therapeutic effect from osteopathic manipulation or acupuncture in children with spastic cerebral palsy.  Clinical Pediatrics, 43, 349-353.
13. Mills, M., Henley, C., Barnes, L., Carreiro, J., & Degenhardt, B. (2003).  The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media.  Archives of Pediatric and Adolescent Medicine, 157, 861-866.
14. Beider, S., Mahrer, N., & Gold, J. (2007).  Pediatric massage therapy:  An overview for clinicians.  Pediatric Clinics of North America, 54, 1025-1041.
15. http://holisticonline.com/massage/mas_types.htm, accessed 5/6/08.

16. http://www.reflexology-research.com/whatis.htm, accessed 5/6/08.

17. Beider, S. & Moyer, C. (2007).  Randomized controlled trials of pediatric massage:  A review.  eCAM, 4(1), 23-34.

18. Bishop, E., McKinnon, E., Weir, E., & Brown, D. (2003).  Reflexology in the management of encopresis and chronic constipation.  Paediatric Nursing, 15(3), 20-21.

19. http://www.rolf.org/about/index.htm, accessed 4/24/08.

20. http://altmedicine.about.com/od/therapiesfromrtoz/a/Rolfing.htm, accessed 4/24/08.

21. http://www.rolf.org/about/app_child.htm, accessed 4/24/08.