The following is the summary of “Spinal manipulation and mobilization in the treatment of infants, children, and adolescents: a systematic scoping review” published in the December 2022 issue of Pediatrics by Milne, et al.

The goals of this review are to locate and map the literature on the benefits and risks of spinal manipulation and mobilization for pediatric patients; locate and synthesize the policies, legislation, position statements, and practice recommendations that inform their clinical usage. A systematic scoping review was conducted using 4 electronic databases (PubMed, Embase, CINHAL, and Cochrane) and grey literature from inception to February 4, 2021. Those that took part were newborns, kids, and teens (from 0-18 years old) who suffered from any kind of childhood ailment or condition—mobilization and manipulation of the spinal column. The effects of common pediatric ailments were investigated. Using the Joanna Briggs Institute Checklist for Systematic Reviews and Research Synthesis, the Joanna Briggs Institute Critical Appraisal Checklist for Text and Opinion Papers, the Mixed Methods Appraisal Tool, and the International Centre for Allied Health Evidence Guideline Quality Checklist, 2 reviewers (A.P., L.L.) independently screened and selected studies, extracted key findings, and assessed the methodological quality of included papers.

Using levels of evidence framework, a descriptive synthesis of the findings was conducted using levels of evidence framework. In total, 87 pieces were included. Articles have varying levels of quality in terms of their methodology. Clinically, chiropractors, physical therapists, occupational therapists, and other medical professionals are using spinal manipulation and mobilization to treat children and adolescents who suffer from a wide range of conditions, including but not limited to: adolescent idiopathic scoliosis (AIS), asthma, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), back pain, neck pain, breastfeeding problems, cerebral palsy (CP), dysfunctional voiding, excessive crying, headaches No evidence was found in the descriptive synthesis to expressly support the usefulness of spinal manipulation or mobilization for any ailment in pediatric populations. The majority of Randomised controlled trials (RCTs) described mild, temporary symptoms, although systematic reviews of RCTs and other lower-quality studies occasionally revealed moderate to severe side effects.

For the management of asthma (pulmonary function), headache, and nocturnal enuresis, there was strong to very strong evidence of ‘no substantial effect,’ but for all other disorders investigated, there was inconclusive or insufficient evidence. Spinal mobilization has not been adequately studied to draw any firm conclusions about its efficacy in treating any condition affecting children.  Although there are promising outcomes from a small number of high-quality studies, our descriptive synthesis of the available evidence does not lend credence to the use of spinal manipulation or mobilization in juvenile populations for any ailment. More adverse incidents need to be reported so that researchers may assess actual dangers. There is a need for randomized controlled trials of spinal manipulation and mobilization in children.