Chiropractor Jeremy Boethin’s adjusting table is long enough to comfortably fit a full-grown adult, but on this day his patient took up about a foot of it.
Owen Hentges is 16 weeks old, with tiny tufts of light brown hair and rosy cheeks. Lately, he’s been struggling with infant acid reflux, said his mom, Laura Hentges of Bend.
Boethin, who owns Point Chiropractic on Bend’s west side, laid Owen on his back and cupped his tiny head in his hands, pressing just below both ears with his fingers. The baby wailed.
“His head is just a little uneven on the spine,” Boethin explained. “So I’m just going to put a little finger pressure right here.”
Holding Owen’s head with one hand, Boethin then used the other to study his sacrum (the triangular bone connecting the spine to the pelvis), lifting the baby slightly from the hips and taking note of his pelvic alignment.
“I’ve noticed that lately he’s been really tight through there,” said Owen’s father, Tom Hentges, standing just a few feet away.
“Digestion’s been good, though?” Boethin asked.
“Not today,” Tom said. Then with a chuckle, “We’re hoping this will help.”
Most chiropractors in Central Oregon — more than 20 practices — advertise adjustments for children, including newborns, on their websites. It’s popular among parents like Owen’s, who see it as a more “natural” form of health care, one that allows them to avoid medications.
“I don’t want to put my son on Prilosec,” Laura Hentges said, explaining why she didn’t take Owen to his pediatrician instead. “That seems ridiculous.”
About 3.3 percent of kids ages 4 to 17 saw a chiropractor in 2012, according to the U.S. Centers for Disease Control and Prevention. That doesn’t include infants like Owen.
At the same time, some within the mainstream medical community, including the American Academy of Pediatrics, the leading professional organization for pediatricians, advise against the practice, arguing that while reports of injuries are very rare, there still is not enough research that proves it works. For its part, the American Chiropractic Association, the leading professional organization for chiropractors, said kids do benefit from chiropractic treatment.
In interviews, chiropractors describe being born as a significant source of trauma for a tiny body, which can be squished, turned and pulled during the process.
“If it’s a vaginal birth and they do get stuck in the canal, the doc then is just pretty much taking hold of whatever they can get their hands on: head, shoulder, arm, and they pull the baby out,” said Bend chiropractor Linda Nordhus.
It’s no wonder, they say, that newborns come out with spinal misalignments that interfere with the nerves that control other bodily functions. Ultimately, they claim that interference can cause things like colic — frequent crying episodes and fussiness common in babies — a lack of sleep, ear infections, digestive issues and just about every other ailment there is.
Owen’s acid reflux, Boethin concluded after handing the baby back to his parents, was due to an “underdeveloped digestive process.” He’s still adjusting to being fed through his mouth rather than through an umbilical cord in the womb, he said. It’s also residual misalignment from birth, he said.
“Some of it is when the spine loses its alignment, it irritates the nervous system,” Boethin said.
‘I don’t see a risk’
Jeanne Ohm, a chiropractor and the executive director of the International Chiropractic Pediatric Association, which trains chiropractors to treat children, recommends all babies, even if they don’t have symptoms, be checked by a chiropractor for spinal misalignment, which can lead to more serious issues as the child grows.
She compared it to going to the dentist to check for cavities, which can require root canals if not treated.
“We’re talking about more insidious trauma that doesn’t create a break or an immediate, overt response, but something where there is just a slight misalignment of the spine, putting pressure on that nerve and affecting the body’s ability to function,” Ohm said.
In interviews, most chiropractors said they find misalignments that require adjustment in most babies they see, even if they don’t show symptoms.
Dr. Clay Jones, a pediatric hospitalist at Newton Wellesley Hospital in Newton, Massachusetts, and an outspoken critic of chiropractic adjustments on children, said that kind of message amounts to fear-based marketing designed to scare parents into chiropractors’ offices.
“All kids cry, fuss, spit up occasionally,” he said. “Almost all babies have somewhat of a side preference, where they tend to look more to the right or left because of how they were positioned in the womb. All that is normal baby stuff.”
Chiropractic adjustments performed on babies look and sound much different than those on adults. There is no jerking, twisting or sharp pushing. There also isn’t the cracking and popping sounds common in adult adjustments.
While the motions are similar, chiropractors say the amount of force they use on kids is far less than with adults. Picture pressing on a ripe tomato without poking through the skin, Ohm said.
Kevin Phillips, a chiropractor at Heartstone Family Chiropractic in Bend, recalls a doctor’s shock when he moved to adjust his daughter’s spine moments after she was born.
“When I put my hands on her, he stiffened … he got very nervous,” Phillips said. “My feeling about that was, ‘Wow, you don’t know anything about this. You think I’m going to address this tiny body the same as I would a 200-pound adult, and that’s just ridiculous.’”
Phillips uses no more force than the amount you could use to press on your eyeball without feeling uncomfortable, he said. In fact, the last baby he adjusted slept through the whole thing.
“I don’t see a risk,” Phillips said.
A 2010 study in the journal Chiropractic & Osteopathy summarized the existing research on injuries related to manual therapy on children, including chiropractic adjustments, and found that minor or moderate adverse events are common, but serious ones are rare. Spinal manipulation appears to have significantly fewer side effects than medication, but just as many as exercise, the study found.
That study was designed to update a 2007 research review on the same subject in the journal Pediatrics, which found that although serious adverse events like permanent disability or death, could be associated with spinal manipulation, causation or frequency couldn’t be established.
‘A big deal to miss it’
Some chiropractors balk when asked what conditions they treat. Phillips said that’s not the way chiropractors view their practice.
“To me, we’re so focused on conditions that we lose the whole point of what health really is, in my opinion,” he said. “Conditions are a sign that the body is having a hard time functioning. But if you take the symptoms away, that doesn’t mean the body is functioning better.”
Parents bring their children to chiropractors to fix all kinds of ailments, including colic, ear infections, asthma, allergies, digestion problems, trouble sleeping and sprains. But many chiropractors are careful to point out that they’re not medical doctors and they don’t directly treat those issues. They fix misalignments in the spine that could cause interference in the nerves that lead to those areas.
Ohm said she tells parents right away she doesn’t treat issues like ear infections, she adjusts the spine, and often those issues clear up as a result.
“Because there is not literature to substantiate that, no, we don’t treat those conditions,” she said, “but we see tremendous changes in the body’s ability to function.”
Jones, the pediatric hospitalist, said he’s not so concerned about injuries resulting from adjustments; he agrees they’re rare. His bigger concern is that chiropractors don’t have the expertise necessary to identify the signs of a medical condition that requires urgent intervention. For example, the first sign of meningitis, a deadly brain and spinal cord membrane infection, is something as simple as fussiness, he said.
“It’s easy to diagnose meningitis in a 10 year old; it’s not easy in a 10 day old,” Jones said, “and so we have protocols in place when babies come in acting certain ways. We, somewhat in a knee-jerk fashion, look for these bad things because it’s such a big deal to miss it.”
The small amount of research on the subject makes it impossible to determine whether chiropractic adjustments can help with colic in babies, according to the Cochrane Collaborative, a nonprofit organization that gathers and summarizes evidence on health care topics. Although most of the studies Cochrane reviewed reported fewer hours of crying among those who received adjustments, the difference was not statistically significant when studies with a high risk of bias were removed.
Boethin said he has good relationships with his patients’ pediatricians, and his chiropractic training prepared him to recognize when the child has an illness that’s beyond his scope of practice.
He said he has referred patients to medical doctors for things like ruptured ear drums, prolonged fevers, raspy-sounding lungs (a sign of pneumonia) and torn ligaments. And when he and his wife found a tick on his daughter’s head, they called their pediatrician right away.
“I think you need a health care team, regardless of whether it’s a kid or an adult,” he said. “You need lots of people on your side for the variety of things that might happen regarding your health.”
Similarly, Dr. Cora Breuner, a pediatrics professor at the University of Washington and attending physician at Seattle Children’s Hospital, encourages both patients and providers to discuss all providers involved in the patients’ care.
She said she has good relationships with the chiropractors her patients also see, and often calls them to discuss care.
“It’s extremely important that if you’re going to a chiropractor, you need to make sure your practitioners are communicating with each other,” Breuner said.
After Owen’s appointment, Laura Hentges said the results she and her husband saw after seeing Boethin encouraged them to take their son. Hentges said she stopped having severe headaches almost a decade ago after Boethin performed adjustments on her spine. Now, she said Owen is seeing results, too: He’s sleeping better.
Hentges said she was a little nervous at first, but her fears dissolved when she first watched Boethin adjust her son.
“I feel like for him, it’s more kind of like a massage,” she said.
— Reporter: 541-383-0304,