A 2025 narrative review provided general information about use of chiropractic with children. It emphasized the limited data on specific conditions and safety, although the authors did describe the modifications DCs make in manual therapy for children. The authors concluded that pediatric health care providers should discuss the use of all complementary therapies with patients, so guidance can be optimal with a focus on promoting health and safety. FREE FULL TEXT

A 2025 systematic review and meta-analysis evaluated whether sedentary behavior is a risk or prognostic factor for spinal pain in children and adolescents. 129 articles were included; 14 were longitudinal (n = 8,433) and 115 were cross-sectional (n > 697,590). 86 studies were included in the meta-analyses. Results indicated that, based on cross-sectional data, there is low certainty evidence of a small positive association between sedentary behavior and spinal pain (adjusted odds ratio 1. Longitudinal data did not find an increased risk for the onset of spinal pain due to sedentary behavior (adjusted risk ratio 1.07). The authors concluded that there are minimally higher odds of spinal pain related to sedentary behavior in children and adolescents. FREE FULL TEXT

A 2025 systematic review and meta-synthesis synthesized qualitative research on musculoskeletal pain consequences in adolescents. 12 studies were included (n=213). Children (age range 8-22 years) reported functional impediments that impacted daily living, mobility, school, socializing, and sleep. Distress and concern regarding movement, health, isolation, autonomy, support, healthcare experiences, and their future were also reported. Adolescents report complex and burdensome consequences of musculoskeletal pain. The functional impediments and the psychosocial impacts lead adolescents to feel distressed, isolated, and unsupported. This knowledge can be used to develop meaningful communication in clinical encounters with adolescents. ABSTRACT

A 2025 systematic review and network meta-analysis compared the effectiveness of different PT treatments for nonspecific LBP (NSLBP) in children and adolescents. 11 RCTs with 827 participants were included in the meta-analysis. Results indicated that PT treatments effectively reduced NSLBP intensity post-treatment and at 6-month follow-up. Network meta-analysis showed both therapeutic exercise and a combination of therapeutic exercise and manual therapy were effective compared to no treatment. There were no significant differences between therapeutic exercise and the combination of therapeutic exercise and manual therapy. The authors concluded that, although physical activity is the most effective treatment for NSLBP in children and adolescents, manual therapy may yield even better results. However, physical exercise should serve as the cornerstone in the physiotherapeutic approach to managing NSLBP intensity in this age group. ABSTRACT

A 2025 RCT of 103 infants investigated the effect of osteopathic treatment on the perceived psychological stress of caregivers compared to usual care. Infants aged 1 week to 3 months with IC were included. Infants in the intervention group received 3osteopathic treatments at intervals of one week. The treatments were custom-tailored and based on osteopathic principles. Controls received their osteopathic treatment after a 3-week untreated period. The primary outcome was the assessment of parental psychological stress (3 questions), measured using a numeric rating scale (NRS; 0-10). Average daily crying time (measured using the Likert scale), crying intensity (measured using the NRS) and the parents’ self-confidence (measured using the Karitane Parenting Confidence Scale) were assessed. Results indicated clinically relevant improvements in favor of the intervention group for the main outcome—caregiver stress. Crying intensity and crying time/day showed improvement of similar magnitude. The authors concluded that osteopathic treatments given over a period of 2 weeks led to statistically significant and clinically relevant positive changes of parental psychological stress as well as improvement in infants’ symptoms of colic. FREE FULL TEXT

A 2025 single-blind RCT evaluated the effect of added probiotic supplementation in the diet of 36 mothers with infants with infantile colic, measuring infants’ crying frequency and maternal attachment and quality of life. One group of mothers received a probiotic drink containing Bifidus ActiRegularis (5×108) strain once a day for 15 consecutive days. The control group received nonpharmaceutical standard care treatment. Data were collected for 15 days from the mothers using a baby diary, Mother Attachment Scale and Postpartum Quality of Life Scale. Results indicated that the probiotic group had significantly reduced crying intensity and statistically significant improvement in quality of life and maternal attachment scores. However, these results must be interpreted with caution because the control group was not given a drink, but only standard care, so a placebo effect cannot be discounted. ABSTRACT

A 2025 systematic review evaluated the efficacy and safety of cranial orthotic therapy (helmet therapy) in children under 12 months with moderate to severe positional plagiocephaly and brachycephaly. 19 studies were included. Repositioning therapy demonstrated effectiveness in reducing cranial asymmetry for mild to moderate cases, but several studies (class I and II evidence) indicated that it was less effective than both physical therapy and helmet use. Physical therapy, particularly manual therapy combined with caregiver counseling, showed superior outcomes for non-synostotic cranial asymmetry. Helmet therapy was consistently recommended for infants with moderate to severe deformities, with better outcomes when initiated during early infancy. The authors concluded that helmet therapy is safe and effective for specific cases, especially moderate to severe PP or brachycephaly, with improved results when started early. However, the decision to use helmet therapy should be individualized, considering the severity of deformity, patient age, and response to other treatments. ABSTRACT

A 2025 systematic review and meta-synthesis synthesized qualitative research on musculoskeletal pain consequences in adolescents. 12 studies were included (n=213). Children (age range 8-22 years) reported functional impediments that impacted daily living, mobility, school, socializing, and sleep. Distress and concern regarding movement, health, isolation, autonomy, support, healthcare experiences, and their future were also reported. Adolescents report complex and burdensome consequences of musculoskeletal pain. The functional impediments and the psychosocial impacts lead adolescents to feel distressed, isolated, and unsupported. This knowledge can be used to develop meaningful communication in clinical encounters with adolescents. ABSTRACT

A 2025 systematic review and network meta-analysis compared the effectiveness of different PT treatments for nonspecific LBP (NSLBP) in children and adolescents. 11 RCTs with 827 participants were included in the meta-analysis. Results indicated that PT treatments effectively reduced NSLBP intensity post-treatment and at 6-month follow-up. Network meta-analysis showed both therapeutic exercise and a combination of therapeutic exercise and manual therapy were effective compared to no treatment. There were no significant differences between therapeutic exercise and the combination of therapeutic exercise and manual therapy. The authors concluded that, although physical activity is the most effective treatment for NSLBP in children and adolescents, manual therapy may yield even better results. However, physical exercise should serve as the cornerstone in the physiotherapeutic approach to managing NSLBP intensity in this age group. ABSTRACT

A 2024 task force of clinician-scientists developed evidence-based practice position statements for physical therapists for the safe and effective use of spinal manipulation and mobilization for children (<18 years) with varied musculoskeletal (MSK) or non-MSK conditions. The major recommendations were: 1) It is not recommended to perform spinal manipulation and mobilization on infants, cervical and lumbar spine manipulation on children, or spinal manipulation and mobilization on children for non-musculoskeletal pediatric conditions. 2) It may be appropriate to treat musculoskeletal conditions using spinal mobilization and manipulation on adolescents, spinal mobilization on children, or thoracic manipulation on children for neck-back pain only. 3. No high-certainty evidence to recommend these interventions was available. Reports of mild to severe harm exist; however, risk rates could not be determined. FREE FULL TEXT

• A 2024 RCT investigated the effect of scoliosis-specific physical therapy exercises and manual therapy on 31 participants with AIS. The parameters measured were trunk deformity, spinal function, mobility, and mental health. Patients in the intervention group received 50 min of exercises combined with 10 min of MT, while the control group performed 50 min of the same exercises at home. Both groups received treatment 3 x wk/4 weeks and were assessed at baseline and post-intervention.
• Results indicated that the Cobb angle was significantly reduced in the intervention group and increased in the control group. The intervention group also showed significant improvements in spinal mobility, movement capability, quality of life, and trunk morphology indices. The authors concluded that combining the exercise protocol with MT shows potential benefits. FREE FULL TEXT

A 2024 RCT evaluated the effect of spinal mobilization on curvature magnitude, angle of trunk rotation (ATR), and pulmonary function in 40 adolescents with idiopathic scoliosis (AIS). The experimental group received spinal mobilization for 30 min per session followed by 60 min core stabilization exercises (CSE), 2 a week for 10 weeks. The control group received CSE only at the same frequency and duration. Evaluation of Cobb angle, ATR, and pulmonary function tests (PEF: Peak Expiratory Flow, FEV1: Forced Expiratory Volume in 1 s, FVC: Forced Vital Capacity, and FEV1/FVC: Tiffeneau index) were performed at baseline and post-intervention. Results indicated that both groups showed significant improvements in Cobb angle, ATR, PEF, and FVC, with the experimental group showing significantly greater improvements in Cobb angle and ATR (-2.5 ± 1.43) compared to the control group. The control group showed no change in FEV1, but the experimental group showed improvement. There was no change in FEV1/FVC ratio in either group. The authors concluded that adding spinal mobilization to treatment sessions can effectively reduce curvature and improve scoliosis-related problems in the short term. FREE FULL TEXT

A 2024 Cochrane review evaluated the effectiveness of therapeutic exercise (TE), including generic therapeutic exercises (GTE) and physiotherapeutic scoliosis-specific exercises (PSSE) in treating AIS, compared to no treatment, other non-surgical treatments, or between treatments. 13 RCTs (583 participants) were included in the analysis. Comparing TE versus no treatment, evidence is very uncertain whether TE reduces the Cobb angle. Low-certainty evidence indicates PSSE makes little or no difference in the angle of trunk rotation (ATR), may reduce waist asymmetry slightly, but may not affect the participant’s perception of cosmetic issues or self-image, although it may improve QoL slightly. Only Cobb angle results were clinically meaningful. Low-certainty evidence indicates PSSE plus bracing may reduce Cobb angle more than bracing alone. Low-certainty evidence indicates GTE plus other non-surgical interventions may reduce Cobb angle more than non-surgical interventions alone. It is uncertain whether PSSE plus other non-surgical interventions reduces Cobb angle and ATR. PSSE plus bracing versus bracing alone may make little to no difference in subjective measurement of cosmetic issues, self-image score, and QoL. None of these results were clinically meaningful. The authors concluded that evidence on the efficacy of TE is currently sparse due to heterogeneity, small sample size, and multiple comparisons. FREE FULL TEXT

A 2024 systematic review and meta-analysis evaluated the effects of spinal manipulation and/or exercise interventions for non-specific low back pain (LBP) or thoracic spine pain in adolescents. 8 RCTs, 2 non-randomized trials, and 1 qualitative study were included in the analysis. Very low to moderate certainty evidence indicated that in adolescents with LBP, spinal manipulation (1-2 sessions/wk over 12 wks) plus exercise may be associated with clinically important pain reduction versus exercise alone. Group-based exercise over 8 weeks may reduce pain intensity. The qualitative study found the information provided via education/advice and compliance with treatment were related to effective treatment. The authors concluded that spinal manipulation and group-based exercise may reduce LBP intensity in adolescents. Education should be included in care programs. FREE FULL TEXT

A 2024 systematic review and meta-analysis evaluated the effects of spinal manipulation and/or exercise interventions for non-specific low back pain (LBP) or thoracic spine pain in the pediatric population. 10 quantitative studies (8 RCTs and two non-randomized clinical trials) and one qualitative study were included in the analysis. With very low to moderate certainty evidence, in adolescents with LBP, spinal manipulation (1-2 sessions/week over 12 weeks, 1 RCT) plus exercise may be associated with a greater likelihood of experiencing clinically important pain reduction versus exercise alone. Group-based exercise over eight weeks (2 RCTs and one non-randomized trial) may reduce pain intensity. The qualitative study found the information provided via education/advice and compliance with treatment were related to effective treatment. No economic studies or studies examining thoracic spine pain were identified. The authors concluded that spinal manipulation and group-based exercise may be beneficial in reducing LBP intensity in adolescents. Education should be provided as part of a care program. The overall evidence is sparse. FREE FULL TEXT

A 2024 Cochrane review evaluated the effectiveness of therapeutic exercise (TE), including generic therapeutic exercises (GTE) and physiotherapeutic scoliosis-specific exercises (PSSE) in treating AIS, compared to no treatment, other non-surgical treatments, or between treatments. 13 RCTs (583 participants) were included in the analysis. When comparing TE versus no treatment, the evidence is very uncertain as to whether TE reduces the Cobb angle. Low-certainty evidence indicates PSSE makes little or no difference in the angle of trunk rotation (ATR), may reduce waist asymmetry slightly, but may not affect the participant’s perception of cosmetic issues or self-image, although it may improve QoL slightly. Only Cobb angle results were clinically meaningful. Low-certainty evidence indicates PSSE plus bracing may reduce Cobb angle more than bracing alone. Low-certainty evidence indicates GTE plus other non-surgical interventions may reduce Cobb angle more than non-surgical interventions alone. It is uncertain whether PSSE plus other non-surgical interventions reduces Cobb angle and ATR. PSSE plus bracing versus bracing alone may make little to no difference in subjective measurement of cosmetic issues, self-image score, and QoL. None of these results were clinically meaningful. The authors concluded that evidence on the efficacy of TE is currently sparse due to heterogeneity, small sample size, and multiple comparisons. FREE FULL TEXT

A 2024 systematic review assessed the effect of nonsurgical alternative therapies, including chiropractic care, myofunctional therapy, and osteopathy, on infant ankyloglossia-related breastfeeding challenges. 4 studies were included in the review (2 cross-sectional, 1 case report, and 1 case series). Results indicated that frenotomy in combination with alternative therapy yielded favorable outcomes for maternal pain, infant weight gain, feeding duration, and maintenance of latch. All studies lacked control or comparator groups, preventing definitive conclusions about the role of alternative therapies in ankyloglossia in infants. ABSTRACT

A 2024 systematic review assessed the effectiveness of conservative treatments for calcaneal apophysitis (Sever’s disease), the most common cause of heel pain in children. Eight randomized controlled studies were included in the analysis. Treatment included insoles, therapeutic exercise, Kinesio taping, and foot orthoses. Overall, results indicated that conservative treatments were effective in alleviating pain and improving function in calcaneal apophysitis (Sever’s Disease). FREE FULL TEXT

A 2024 systematic review and meta-analysis evaluated the exercise components of ankle injury prevention programs for high school athletes. 10 studies were included in the analysis. Results showed a statistically significant reduction of ankle injuries in prevention programs vs control groups. The authors emphasized the importance of coach and player education to optimize the frequency and duration of the programs (> 30 minutes/Wk for 6 Wks) to reduce the incidence of ankle injury. FREE FULL TEXT

A 2024 systematic review assessed the effect of Kinesiotape (KT) for improving upper extremity (UE) function in children and adolescents with cerebral palsy (CP). 5 randomized controlled trials were included in the analysis. Improvement in upper extremity function with significant improvement in range of motion was demonstrated in 3 studies. Fine motor skills were improved in 2 studies, and 1 study showed improved grip strength, gross motor function, and spasticity. The study concluded that KT showed improvement in UE function. FREE FULL TEXT

A 2023 clinical practice guideline built upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Recommendations addressed these aspects of the clinical encounter: patient communication, including informed consent; appropriate clinical history, including health habits; appropriate physical examination procedures; red flags/contraindications to chiropractic care and/or spinal manipulation; aspects of chiropractic management of pediatric patients, including infants; modifications of spinal manipulation and other manual procedures for pediatric patients; appropriate referral and comanagement; and appropriate health promotion and disease prevention practices. This set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors. FREE FULL TEXT

A 2023 systematic review and meta-analysis assessed the effect of manual therapy in alleviating infant crying, a common symptom of nocturnal crying (NC) and infantile colic (IC). 27 studies (13 NC and 14 IC) were included. Meta-analysis showed favorable effects of tuina therapy on the total effective rate (TER) of NC, chiropractic therapy on the crying time change of IC, and massage on the total crying time of IC. While tuina, chiropractic, and massage show results in alleviating symptoms, the overall evidence remains limited due to the low quality and heterogeneity of the included studies. FREE FULL TEXT

• A 2023 systematic review and meta-analysis assessed the outcomes of nonpharmacological intervention in infants with infantile colic. The analysis included 3 studies involving a total of 386 infantile colic infants treated with chiropractic, craniosacral therapy, or acupuncture. Results indicated that crying time and intensity were reduced, and sleep duration increased. The authors concluded that the risk of bias was low in the studies. FREE FULL TEXT 

• A 2023 systematic review and meta-analysis evaluated the effectiveness of osteopathic or chiropractic manipulation in reducing crying time and increasing sleeping time in infants with infantile colic. The analysis included 5 RCTs with a total of 433 infants. Manual therapies did not significantly decrease crying time or increase sleeping time, compared with no intervention. The quality of the evidence was rated as very low for both outcome measures. FREE FULL TEXT 

• A 2023 letter to the editor critiqued the above systematic review on manipulation for infantile colic. The authors stated that the meta-analysis suggested a positive and clinically meaningful effect for the most relevant outcome—crying time—and indicated no issues with adverse effects. They suggest that a more appropriate conclusion would be to support a weak recommendation in favor of manipulation to reduce crying time rather than to state it has no effect. FREE FULL TEXT

A 2023 systematic review assessed non-pharmacological approaches to neonatal pain during diagnostic and treatment procedures (such as metabolic screening, vaccinations/venipuncture). Unpleasant neonatal experiences are proven to be associated with negative long-term consequences. 19 studies were included in the analysis (a total of 1930 newborns). Neonatal pain, was assessed by different neonatal pain evaluation scales. Non-pharmacological interventions including glucose solutions, non-nutritive sucking, breastfeeding, olfactive stimulus, auditory stimulus and sensory stimulus (skin-to-skin care, kangaroo/maternal holding, heat, therapeutic massage, swaddling/facilitated tucking and acupressure) showed decreased behavioral and physiologic pain responses. The authors concluded that non-pharmacological approaches are safe, effective and can be easily applied in daily practice. There is a need for continued research on non-pharmacological interventions for neonatal pain to help healthcare providers build a tailored pain treatment plan for neonates submitted to procedural pain. FREE FULL TEXT

A 2023 systematic review assessed conservative treatments for positional plagiocephaly in infants. 9 articles were included in the analysis. Results indicated that manual therapy is considered the first line of intervention in plagiocephaly with non-synostotic asymmetries. In cases of moderate or severe plagiocephaly, helmet therapy can be an effective second-line intervention. This condition is best prevented through counseling parents or caregivers, and early treatment is essential for optimal therapeutic outcomes. FREE FULL TEXT

A 2023 systematic review and meta-analysis assessed the evidence of the efficacy of manual therapy (MT) on adolescent idiopathic scoliosis (AIS). Four RCTs of MT were included in the analysis. The authors concluded that there is insufficient data to determine the effectiveness of spinal manipulation limited by the very low quality of included studies. High-quality studies with appropriate design and follow-up periods are warranted to determine if MT may be beneficial as an adjunct therapy for AIS. Currently, there is no evidence to support spinal manipulation. FREE FULL TEXT

A 2023 systematic review assessed non-pharmacological approaches to neonatal pain during diagnostic and treatment procedures (such as metabolic screening, vaccinations/venipuncture). Unpleasant neonatal experiences are proven to be associated with negative long-term consequences. 19 studies were included in the analysis, representing a total of 1930 newborns. Main outcome, neonatal pain, was assessed by different neonatal pain evaluation scales. Non-pharmacological interventions, including sucrose/glucose solutions, non-nutritive sucking, breastfeeding, olfactive stimulus, auditory stimulus and sensory stimulus (skin-to-skin care, kangaroo/maternal holding, heat, therapeutic massage, swaddling/facilitated tucking and acupressure) showed decreased behavioral and physiologic pain responses. The authors concluded that non-pharmacological approaches are safe, effective and can be easily applied in daily practice. There is a need for continued research on non-pharmacological interventions for neonatal pain to help healthcare providers build a tailored pain treatment plan for neonates submitted to procedural pain. FREE FULL TEXT

A 2022 systematic scoping review identified and mapped the available evidence regarding the effectiveness and harms of spinal manipulation and mobilization used by a variety of health professions for children with a broad range of conditions. 87 articles were included. The descriptive synthesis revealed no evidence to explicitly support the effectiveness of spinal manipulation or mobilization for any condition. Mild transient adverse reactions were commonly described in RCTs and occasional moderate-to-severe adverse events in systematic reviews. There was strong to very strong evidence for “no significant effect” of spinal manipulation for managing asthma (pulmonary function), headache, and nocturnal enuresis, and inconclusive or insufficient evidence for all other conditions. There is insufficient evidence to draw conclusions regarding spinal mobilization to treat children with any condition. FREE FULL TEXT

A 2022 systematic review and meta-analysis updated evidence of preventive physical therapy interventions to improve back care in children and adolescents. 20 studies were included in the analysis. The most common physiotherapy interventions were exercise, postural hygiene, and physical activity. The authors concluded that evidence supports physical therapy for back care and prevention of non-specific low back pain in children and adolescents. The evidence ranged from very low to moderate quality and gave the most support to interventions involving physical exercise, postural hygiene, and physical activity. FREE FULL TEXT

A 2022 cohort study investigated spinal pain frequency in 1556 children ages 6-17 years. 63% reported at least one occurrence of spinal pain. Half had no pain; 28% were categorized as having “rare” pain. The most common diagnosis was non-specific (e.g., “back pain”). Tissue-specific diagnoses (e.g., muscle strain) were less common, and pathologies (e.g., fracture) were rare. The authors concluded that pain is common in children ages 6-17. These findings accord with recommendations from adult back pain guidelines that most children with spinal pain can be reassured that they do not have a serious disease and encouraged to stay active. ABSTRACT

A 2022 cross-sectional web-based survey of 245 Quebec DCs (response rate: 21%) found that about half defined themselves as general musculoskeletal (MSK) healthcare practitioners. Respondents strongly affirmed confidence in diagnosing MSK disorders in all age groups as well as non-MSK disorders among young teens. They reported moderate agreement with similar statements concerning the diagnosis of non-MSK disorders in newborns, preschoolers, and children. Respondents rarely referred pediatric patients to a medical practitioner. When presented with potential pediatric red flags, the respondents commonly indicated that they would refer the patient to a physician in an emergency or for co-management. FREE FULL TEXT

A 2022 systematic review and meta-analysis investigated the effect of neuromuscular electrical stimulation on mobility in children with spastic cerebral palsy. 14 randomized controlled trials (2 crossover studies and 12 parallel studies including 421 patients) were included in the meta-analysis. Compared with the control group (conventional physical therapy), the treatment group exhibited greater improvement in walking speed and the standing, walking, running, and jumping dimensions of the Gross Motor Function Measure. ABSTRACT

A 2022 systematic review assessed the effectiveness of OMT for all pediatric complaints. 47 RCTs examining 37 pediatric conditions were reviewed. Twenty-three studies reported significant favorable outcomes for OMT relative to the control intervention, and 14 additional studies reported non-significant outcomes, which suggested potential favorable effects of OMT. Overall, there was moderate evidence for the effectiveness of OMT for 13 of the 43 comparisons, particularly for the length of hospital stay for preterm infants, but no high-quality evidence for any condition. The authors concluded that few pediatric conditions had been investigated in more than one study, which resulted in no high-quality evidence for any condition. ABSTRACT

A 2022 randomized controlled trial with 96 infants compared the efficacy of osteopathic manipulative therapy (OMT) to light touch therapy (LTT) in reducing cranial asymmetries in infants with nonsynostotic plagiocephaly (NSP). The outcome was a reduction of the oblique diameter difference index (ODDI) score <104%, assessed at the end of the intervention (at 3 months) and at 1 year of age. Results showed a significant reduction of the ODDI score <104% in the OMT group, compared with the LTT. The authors concluded that in infants with NSP, a course of 6 OMT sessions significantly reduced cranial asymmetries at both the 3-month and 1-year follow-up assessments, compared with LTT. ABSTRACT

A 2022 cross-sectional study conducted at a tertiary care pediatric hospital assessed a convenience sample of 101 participants aged 6-18 years. The main observations consisted of symptom provocation, the performance of Vestibular Ocular Reflex (VOR), Head Thrust Test (HTT), computerized dynamic visual acuity test, and cervical impairment as measured by a cervical flexion-rotation test, range of motion, and self-reported neck pain. There was a fair agreement between VOR and HTT. Patients with dizziness and headaches showed these measures were greater in the patients with cervical dysfunction findings. The findings suggest that such measures of symptom provocation may be influenced by coexisting cervical impairment. FREE FULL TEXT

A 2022 randomized controlled trial evaluated craniosacral therapy (CST) for 58 infants < 90 days of age with infantile colic compared with a no-treatment control group. The treatment period was 24 days; crying hours were the primary outcome. Secondary outcomes were hours of sleep and symptom severity, measured by an Infantile Colic Severity Questionnaire (ICSQ). Infants in the CST group received 1-3 treatments one week apart. Results indicated that the CST group’s outcomes were significantly superior to those of the control group. FREE FULL TEXT

A 2022 systematic review and meta-analysis assessed the nonpharmacological treatment of childhood functional constipation. 52 RCTs (4668 children, aged 2 weeks and 18 years) were included in the analysis. Interventions included gut microbiome-directed interventions, other dietary interventions, oral supplements, pelvic floor-directed interventions, electrical stimulation, dry cupping, and massage therapy. Meta-analyses for treatment success and/or defecation frequency, including 20 RCTs, showed abdominal electrical stimulation (n = 3), Cassia Fistula emulsion (n = 2), and a cow’s milk exclusion diet (n = 2 in a subpopulation with constipation as a possible manifestation of cow’s milk allergy) may be effective. Evidence from RCTs not included in the meta-analyses indicated that some prebiotic and fiber mixtures, Chinese herbal medicine (Xiao’er Biantong granules), and abdominal massage are promising therapies. In contrast, studies showed no benefit for the use of probiotics, synbiotics, an increase in water intake, dry cupping, or additional biofeedback or behavioral therapy. We found no RCTs on physical movement or acupuncture. FREE FULL TEXT

A 2022 systematic review and meta-analysis commissioned by WHO synthesized evidence on the effects of unhealthy food and beverage consumption in children on overweight and obesity. 60 studies were included in the analysis. Results indicated that consumption of sugar-sweetened beverages (SSB) and unhealthy foods in childhood might increase body mass index (BMI) or odds of overweight/obesity. Artificially sweetened beverages and 100% fruit juice consumption may make little/no difference to BMI, % body fat, or overweight/obesity outcomes. A positive association between SSB intake and % body fat was found, but no association with change in BMI. FREE FULL TEXT

A 2022 scoping review summarized the available scientific literature on the relationship between nutrition and autism spectrum disorder (ASD) symptoms in childhood. 5 meta-analyses, 29 systematic reviews, and 27 original studies were retrieved that focused on therapeutic diets, specific food products, fatty acids and micronutrients, and ASD symptoms during childhood. The results of the available studies were sparse and inconclusive, and hence, no firm conclusions could be drawn. There is currently insufficient evidence for a relationship between nutrition and ASD symptoms in childhood, making it impossible to provide practical nutrition guidelines; more methodological sound research is needed. FREE FULL TEXT

A 2021 double-blind randomized controlled trial to evaluate the effect of osteopathic manipulation on suboptimal infant breastfeeding at one month. The intervention consisted of two sessions of early OMT, while in the control group, the manipulations were performed on a doll behind a screen. The primary outcome was the exclusive breastfeeding rate at 1 month, which was assessed in an intention-to-treat analysis. The parents, research assistants and pediatricians were masked to group assignment. In the intervention group, 31 of 59 (53%) of infants were still exclusively breastfed at 1 month vs 39 of 59 (66%) in the control group. After adjusting for breastfeeding behavior, cesarean section, use of supplements, and breast shields, the adjusted OR was 0.44 (95% CI 0.17 to 1.11; p=0.08). No adverse effects were reported in either group. The authors concluded that OMT did not improve exclusive breastfeeding at 1 month. ABSTRACT

A 2021 randomized clinical trial in Denmark compared SMT to sham in the treatment of headaches for children aged 7-14 years. After a 4-month follow-up, statistically, significant differences were found in a reduction of the number of days with a headache and the global perceived effect in the intervention group. No statistically significant difference was found between the groups in headache intensity during episodes or in the consumption of medication, with both outcomes showing very minor improvements overall. FREE FULL TEXT

A 2021 systematic review evaluated the efficacy and safety of complementary and alternative therapies used to treat infantile colic A total of 13 interventions were found from Sweden, Norway, Russia, Italy, Turkey, Iran, and Finland; the U.S. and U.K. were not included. Acupuncture, various aromatherapy oils (topical or inhalation), and massage therapy were all found to be effective at reducing symptoms, with no adverse effects noted. No studies of spinal manipulation were included (due to the limited regions from which studies were selected). ABSTRACT

A 2021 systematic review evaluated the effectiveness of physical therapy interventions in the management of non-synostotic positional head deformities in infants. Interventions included education to parents about positioning, manual therapy, and motor stimulation. The authors concluded that physical therapy interventions may be useful for infants with non-synostotic head deformities at improving cranial asymmetries and motor development. However, the validity of such a conclusion is limited as most trials included had a high risk of bias. ABSTRACT

A 2021 randomized controlled trial evaluated the effect of osteopathic manipulation of the T9–T10 vertebrae on the evolution of tonsillitis. The patients, evaluator, and data analyst were all blinded to treatment group assignment. Patients in the control group (CG; n=40) underwent a “sham” manipulation. High-velocity, low-amplitude manipulation was applied to the T9–T10 vertebrae for patients in the osteopathic manipulative group (OMG; n=80). The number of days needed to resolve the tonsillitis was significantly lower (p = 0.025) in the OMG (2.03 ± 0.95 days) than in the CG (2.39 ± 0.82 days). In the OMG, 60.8% had no recurrences of tonsillitis, compared to 22.5% of the CG, in the following year. No patients reported adverse effects. FREE FULL TEXT

A 2019 case report demonstrated the conservative management of rectus abdominis muscle tear in a 14 year old female. The patient received spinal manipulation and truncal stabilization and returned to play 5 weeks after injury without pain or discomfort.²

A 2019 double-blind randomized controlled trial evaluated efficacy of customized orthotics for patients (n=72) with Morton’s neuroma. The customized insoles were shaped for the patient’s foot with ethyl vinyl acetate metatarsal and arch supports. The control group received a flat insole. Results indicated that the customized orthotics relieved walking pain and improved patient-reported measures of function.³

• A 2020 study evaluated the correlation between spinal coronal balance and static baropodometry in children with AIS. It found that coronal balance is correlated with plantar pressure distribution with a positive correlation with the larger surface of the forefoot than rear foot and a heavier load ratio on the forefoot than the rearfoot.⁴
• A 2019 systematic review and meta-analysis investigated calcium-phosphorus balance in patients with AIS. Although there were no statistically significant differences in phosphorus and parathyroid hormone levels, they concluded that Vitamin D deficiency may be involved in the pathogenesis of AIS by influencing the calcium-phosphorus metabolism of bone. The authors suggest screening vitamin D levels in AIS patients.⁵

1. Corso M, Cancelliere C, Silvano M, Taylor-Vaisey A, Cote P. The safety of spinal manipulative therapy in children under 10 years: a rapid review. Chiro Man Ther. 2020;28(12). https://chiromt.biomedcentral.com/articles/10.1186/s12998-020-0299-y
2. Ruff AN, Cornelson SM, Panter AS, Kettner NW. Rectus abdominis muscle tear diagnosed with sonography and its conservative management. J Ultrasound. 2019. https://www.ncbi.nlm.nih.gov/pubmed/31721108
3. de Oliveira HAV, Natour J, Vassalli M, Rosenfeld A, Jennings F, Jones A. Effectiveness of customized insoles in patients with Morton’s neuroma: a randomized, controlled, double-blind clinical trial. Clin Rehabil. 2019;33(12):1898-1907. https://www.ncbi.nlm.nih.gov/pubmed/31505943
4. Ma Q, Lin H, Wang L, Zhao L, Chen M, Wang S, Rao Z, Luo Y. Correlation between spinal coronal balance and static baropodometry in children with adolescent idiopathic scoliosis. Gait Posture. 2020;75:93-97. FREE FULL TEXT https://www.sciencedirect.com/science/article/pii/S0966636219300219?via%3Dihub
5. Zhu Q, Chen J, Chen C, Wang H, Yan S. Association between calcium-phosphorus balance and adolescent idiopathic scoliosis: a meta-analysis. Acata Orthop Traumatol Turc. 2019;53(6):468-473. FREE FULL TEXT https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938986/

• A 2019 systematic review for the effectiveness and harms of specific SMT techniques for pediatric patients reviewed 26 included studies and concluded that gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents.⁷
• A 2019 systematic review of manual therapy for pediatric patients reviewed 24 studies and found moderate positive evidence for low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for scoliosis (osteopathic manipulative therapy) and torticollis (manual therapy). All other condition’s overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported.⁸
• A 2018 systematic review to assess the effect of manual therapy interventions for healthy but unsettled, distressed and excessively crying infants reviewed 19 studies found moderate strength evidence for the effectiveness of manual therapy on: reduction in crying time. The risk of adverse events was low.⁹

A 2017 retrospective chart review of 201 patients treated in a hospital-based sports medicine clinic compared patients receiving manual therapy and physical therapy to those receiving only physical therapy. It concluded that addition of manual therapy appears safe, but did not improve pain efficiency or patient adherence.¹⁰

A 2019 review found that the available evidence is considered uncertain regarding the effectiveness of manipulation techniques for infant torticollis.¹¹

1. Burger M, Coetzee W, du Plessis LZ, et al. The effectiveness of Schroth exercises in adolescents with idiopathic scoliosis: A systematic review and meta-analysis. S Afr J Physiother. 2019;75(1):904. FREE FULL TEXT
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A 2021 randomized clinical trial in Denmark compared SMT to sham in the treatment of headaches for children aged 7-14 years. After a 4-month follow-up, statistically significant differences were found in a reduction of the number of days with a headache and the global perceived effect in the intervention group. No statistically significant difference was found between the groups in headache intensity during episodes or in the consumption of medication, with both outcomes showing very minor improvements overall. FREE FULL TEXT

A 2021 systematic review evaluated the efficacy and safety of complementary and alternative therapies used to treat infantile colic A total of 13 interventions were found from Sweden, Norway, Russia, Italy, Turkey, Iran and Finland; the U.S. and U.K. were not included. Acupuncture, various aromatherapy oils (topical or inhalation) and massage therapy were all found to be effective at reducing symptoms, with no adverse effects noted. No studies of spinal manipulation were included (due to the limited regions from which studies were selected). ABSTRACT

A 2021 randomized controlled trial evaluated the effect of osteopathic manipulation of the T9–T10 vertebrae on the evolution of tonsillitis. The patients, evaluator and data analyst were all blinded to treatment group assignment. Patients in the control group (CG; n=40) underwent a “sham” manipulation. High-velocity, low-amplitude manipulation was applied to the T9–T10 vertebrae for patients in the osteopathic manipulative group (OMG; n=80). The number of days needed to resolve the tonsillitis was significantly lower (p = 0.025) in the OMG (2.03 ± 0.95 days) than the CG (2.39 ± 0.82 days). In the OMG, 60.8% had no recurrences of tonsillitis, compared to 22.5% of the CG, in the following year. No patients reported adverse effects. FREE FULL TEXT

A 2021 systematic review evaluated the effectiveness of physical therapy interventions in the management of non-synostotic positional head deformities in infants. Interventions included education to parents about positioning, manual therapy, and motor stimulation. The authors concluded that physical therapy interventions may be useful for infants with non-synostotic head deformities at improving cranial asymmetries and motor development. However, the validity of such conclusion is limited as most trials included had a high risk of bias. ABSTRACT

• A 2020 study evaluated the correlation between spinal coronal balance and static baropodometry in children with AIS. It found that coronal balance is correlated with plantar pressure distribution with a positive correlation with the larger surface of the forefoot than rear foot and a heavier load ratio on the forefoot than the rearfoot. FREE FULL TEXT
• A 2020 retrospective chart review of 10 Chinese children showed, after an average treatment period of 10 months, a change in curve deformities. Treatments consisted of massage, flexion-distraction and spinal manipulation. The average pretreatment Cobb angle was 29.7˚ and improved to an average of 23.4˚. Curve changes were significantly less for older adolescents with more advanced curves. FREE FULL TEXT

• A 2020 systematic review of reviews and guidelines compared common interventions for colic and found reduced crying time following manual therapy and probiotic treatments. Regarding manual therapy, evidence quality was low to moderate and unclear as to the quantity or specific manual therapies. Evidence was strong for probiotic (Lactobacillus reuteri). Both treatments carried a low risk of AEs. FREE FULL TEXT
• A 2020 systematic review evaluated the efficacy and safety of complementary and alternative therapy methods used to treat infantile colic. Two randomized and controlled trials found acupuncture therapy to be effective and one found it ineffective. A variety of aromatic oils have been used orally, by inhalation and topically. Massage was been found to effectively reduce the symptoms of infantile colic. No serious side effects were reported in these studies. ABSTRACT

A 2020 systematic review of systematic reviews and guidelines investigated the effectiveness and safety of manual therapy, repositioning and helmet therapy for positional plagiocephaly (PP) and manual therapy and repositioning for congenital muscular torticollis (CMT). For PP, manual therapy was more effective than repositioning including tummy time (moderate to high evidence) but not better than helmet therapy (low evidence). Helmet therapy was better than usual care or repositioning (low evidence); and repositioning better than usual care (moderate to high evidence). The results for CMT showed that manual therapy in the form of practitioner-led stretching had moderate favorable evidence for increased range of movement. Advice, guidance and parental support was recommended in all the guidance to reassure parents of the favourable trajectory and nature of these conditions over time. FREE FULL TEXT