Chiropractic Care for Children: What Parents Should Know

Which Problems in Children Are Commonly Assessed?

A child's problem often shows up in daily life before it has a name. A parent may notice a child rubbing a stiff neck after long gaming sessions, a teenager whose back aches during football or badminton training, shoulders that look uneven in school photos, or a child who keeps cracking their neck. These descriptions help the chiropractor understand what the child feels day to day.

The problems children are most often seen for at CSC are headaches, often after long periods of looking down at a phone, tablet or book; jaw problems from grinding the teeth; poor posture; upper back pain; lower back pain; pelvic pain; hip pain; knee pain; and foot problems. Each is cared for very gently, with a much gentler version of adult care that keeps the growth plates, the still-growing ends of a child's bones, in mind.

Concerns such as asthma, attention or behavior, colic or ear infections belong with the child's doctor, because care at Chiropractic Specialty Center is for muscle, joint and spine problems. Bedwetting is discussed further down this page, because in CSC's experience it often follows a fall onto the tailbone.

Headaches and Jaw Problems Often Go Together

Headaches are common in children and teenagers. A review of 48 studies found that 62% of 8- to 18-year-olds had primary headaches, the kind not caused by another illness, with tension-type headache in 17% and migraine in 11% [9]. An earlier review of 50 studies found that girls are more likely than boys to have both headache and migraine [10]. The guide to headache and migraine explains how the neck can contribute.

Jaw problems are common too. Studies of 10- to 19-year-olds put jaw joint disorders at between 7.3% and 30.4%, most often muscle pain or a disc that clicks as it slips back into place [11], and parents report night-time teeth grinding in between 3.5% and 40.6% of children, with grinding becoming less common as children grow [12].

The two often go together. In 93 children aged 6 to 14, moderate and severe jaw joint problems were linked with headache, and the more severe the jaw problem, the greater the chance of headache [13]. In 40 teenagers with migraine or tension-type headache, 36 had habits such as clenching, grinding, nail biting or chewing on objects, and the researchers suggest that teenagers with persistent headaches have their jaw checked [14]. That is why the jaw and the upper neck are both looked at when a child has headaches or jaw pain.

Teeth Grinding and Jaw Problems in Children

Teeth grinding is common in children and cannot be stopped, but its effects can be reduced. Stress makes it worse, and exam periods often bring on harder grinding. A child's jaw joint keeps developing as the face grows, so heavy clenching or grinding during these years can wear away and misshape the cartilage of the joint and damage its disc and the ligaments around it. Over time that can lead to long-standing jaw and upper neck problems, with frequent headaches and dizziness of varying degrees.

Braces can also bring on jaw problems when dental visits are long, because the mouth is held open for a long time. During a course of braces, the jaw joint and the muscles around it can be cared for gently alongside the orthodontic treatment.

For a child who clenches or grinds heavily, a custom night guard made by a dentist is especially important. It does not stop the grinding, but it can lessen its impact on the disc and the capsule of the jaw joint, and it may need replacing every six months or sooner when the grinding is heavy. CSC does not make night guards; a dentist makes one to measure. Care for the jaw and the upper neck combines manual physiotherapy methods with gentle, non-force and non-rotatory chiropractic care, by hand or with an instrument rather than with machines such as ultrasound. The guide to a slipped disc in the jaw covers jaw problems in more depth.

Slipped Discs in Teenagers

A slipped disc is much less common in children than in adults, and when it does happen it is usually in a teenager, often after a fall, a sports injury or repeated strain from sport.

A teenager's spine is still growing. The rim of each vertebra where the disc attaches, called the ring apophysis, turns to bone between about 7 and 15 years of age and fuses with the vertebra between about 13 and 19, a little earlier in girls than in boys, and until then it is a weak point between the disc and the bone [6]. That is why a slipped disc in a teenager sometimes takes a small piece of this rim with it. Care for a teenager's back is planned with this growing rim in mind, using gentle, non-rotatory methods, and the guide to herniated disc care explains how disc problems are assessed.

How Does CSC Approach a Child's Neck?

A rapid rotational neck thrust is a quick turn or twist applied to the neck, often near the end of its movement and sometimes with a crack. It is the kind of neck manipulation commonly used for adults. At Chiropractic Specialty Center, young children's necks are cared for with gentle, non-rotatory and non-force methods chosen after assessment, in place of rapid rotational thrusts. Yama Zafer, D.C., who founded the center in 2006, keeps this approach for young children because their necks are still developing and grow stronger with age [1]. Neck injuries in children happen mostly in the upper neck because of the way a child's neck is built [15], and the growth plates of the top neck bone close between about 4 and 8 years of age [5].

Parents can ask for any movement to be described, and shown on a spine model, before their child receives it. The guide to neck manipulation in children sets out the age guidance and the studies in detail.

What Does the Research Say About Chiropractic for Children?

A Danish trial of 199 children aged 7 to 14 with recurrent headaches found fewer days with headache after chiropractic manipulation than after a sham procedure, with no difference in how intense the headaches were, and side effects were minor [3].

On safety, a chiropractic teaching clinic in England reviewed the records of 697 children under 3 who received 5,242 treatments: about 1 child in 100 had a reaction, and there were no serious complications [4]. In a survey of chiropractors and parents in a practice-based research network, chiropractors reported three adverse events across 5,438 office visits by 577 children [16]. The clinical position of Yama Zafer, D.C., is that chiropractic care for children is safe when it is delivered correctly; when problems happen, they come from the practitioner's choices rather than from chiropractic itself, and not all chiropractors are equal. This is why the plan for a child leans toward the gentlest method that suits the problem, with exercise and posture advice doing much of the work.

Bedwetting and the Tailbone

Bedwetting is common in children. In the experience of Yama Zafer, D.C., it often follows a sudden fall in which the child lands on the tailbone, and over the years he has cared for many of these children with gentle techniques for the sacrum, the bone at the base of the spine through which the nerves that help control the bladder pass. His view is that a hard landing there can unsettle the balance of the nerve signals to the bladder.

Research on this is limited but points the same way. In one published case, an 8-year-old boy's bedwetting stopped after chiropractic treatment of his lower back and returned several times, each time after a minor injury to his lower back, settling again with further treatment [17]. An imaging study found that children who wet the bed were far more likely than other children to have arches of the sacrum that had not fully joined, which suggests that the way the sacrum develops may play a part [7].

In a controlled trial of 46 children, those who received chiropractic adjustments for ten weeks went from 9.1 to 7.6 wet nights per two weeks, and a quarter of them at least halved their wet nights, while the children given a sham treatment did not change, although the difference between the two groups fell just short of statistical significance [18]. A Cochrane review counted that trial as weak evidence in favor of chiropractic, weak because it was a single small trial [19]. In the records of 33 children and teenagers treated with a chiropractic method, 22 stopped wetting the bed within a year [20], and in a report of three children aged 10 to 15 treated with a gentle hands-on method, the bedwetting stopped within a day and had not returned 10 to 24 months later [21].

None of these studies tested the gentle sacral techniques used at CSC, and most had no comparison group, so they point in a direction rather than settle the question. Constipation often goes with bedwetting, and the child's doctor is involved to check for it and for other causes, such as a urinary infection.

When Should a Child See a Medical Doctor First?

Some symptoms in a child call for medical assessment before any chiropractic visit:

• Back or neck pain with fever, or pain that wakes the child at night.
• Pain after a fall, a collision or a sports injury, especially with swelling or a reluctance to move.
• Unexplained weight loss or tiredness alongside back or neck pain.
• A baby with feeding difficulty, an unusual head position or a concern about development.

If a child with back or leg pain, including a child receiving chiropractic care, develops new or worsening numbness around the genitals, between the genitals and anus, or around the anus, the child needs urgent medical attention: a thorough assessment by a competent clinician the same day. The same applies to new difficulty passing urine, even if the child still has bladder and bowel control, and to any loss of that control. Several causes are possible. Some may call for an invasive procedure, but an assessment helps establish what is happening and what care is appropriate; surgery is not automatically required.

Sudden weakness, trouble speaking or walking, vision changes or a sudden severe headache need urgent medical care.

Short of these signs, most children's aches can be assessed calmly. Some children need no treatment at all: reassurance, a change of activity or a few exercises at home may be all that is needed.

How Do Consent and a Child's Comfort Work?

A parent or guardian gives consent after the findings, the proposed care, its risks and the alternatives have been explained. The child is told what will happen in words they understand, and the family agrees a simple signal for pause or stop. If a child is frightened, resists or reports pain, the practitioner pauses. Care is not meant to hurt at all. The center's motto is "No pain, more gain": a child does not have to hurt more to get better. Parents can decline any procedure, ask for another option or a second opinion, and stop at any point, and a sound plan is explained on its merits rather than through warnings about declining.

What Should Parents Check Before Choosing a Chiropractor for a Child?

In Malaysia, chiropractic is a recognized practice area under the Traditional and Complementary Medicine Act 2016 (Act 775), so chiropractors register with the Traditional and Complementary Medicine Council and hold a practicing certificate, and a parent can ask to see both. Physiotherapists are registered as allied health professionals. The checklist of questions to ask before chiropractic care for a child covers registration, experience with children, the exact neck procedure, the evidence, consent and progress reviews, in an order that suits the consultation.

Costs are explained before any care begins, and the current chiropractic prices and physiotherapy prices are published on our website.

Keeping a Child Safe During Any Hands-On Treatment

Whatever a method is called, anyone who works on a child's spine or joints should be able to say which body they are registered with, and should take a history and examine the child before doing anything. A parent can decline any treatment that has not been explained first, and at Chiropractic Specialty Center a parent or guardian can stay with the child throughout every visit.

Forceful pulling, jerking or twisting of a child's neck or back has no place in a child's care, because the growth plates and ligaments described above are still forming; the guide to Ring Dinger, towel jerks and the Y-strap explains why pulling the neck is a concern. A loud crack, often filmed for social media, is the sound of a gas cavity forming in the joint fluid [22]. It does not show that a bone has been put back in place, and the guide to neck cracking in children explains the sound in more detail.

Touching, pulling or squeezing a child's genitals is unethical and unproven, and it is never treatment. No condition in a child calls for a chiropractor, a physiotherapist, a massage or bone-setting practitioner, or a traditional therapist to handle a child's genitals, whatever the method is called. If this happens, stop the session, make a police report with PDRM, and call Talian Kasih on 15999, or 999 if a child is in immediate danger. Under Malaysian law, including the Child Act 2001 and the Sexual Offences Against Children Act 2017, it can amount to sexual abuse of a child, which is punishable by imprisonment.

Concerns about a practitioner's registration can be reported to the Ministry of Health through its public complaints system (SISPAA).