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Chiropractic Controversy in a Growing Childhood Market

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April 19, 2000 -- Children make up a growing percentage of visits to chiropractors, according to a new study out of Harvard Medical School, but the care they receive may be inconsistent with traditional medical guidelines.

One main area of concern is what a chiropractor should and should not treat. "I don't feel that a chiropractor replaces a pediatrician at all; we have completely different scopes of practice and care for different conditions," says chiropractor Rich Pistolese. "Chiropractors have a limited scope of practice, which is the care of the spine. The [traditional medical] community has a much wider spectrum of care, and we don't presume to overstep our bound and treat infirmity or disease." Pistolese, DC, is research director at the International Chiropractic Pediatric Association (ICPA), one of two organizations that specialize in chiropractic care for children.

The Harvard study, published in the journal Archives of Pediatric and Adolescent Medicine, found that some chiropractors do, on occasion, treat patients who should have been referred to a traditional doctor -- for example, a two-week-old baby with a fever.

"Whenever the parent feels that there is a need to see an MD, I would say certainly take them," says Pistolese. "We don't advocate delaying or preventing proper prudent medical care for any condition that requires it."

Pistolese says parents who are considering sending their child to a chiropractor should find a well-qualified and well-respected chiropractor who takes "a responsible approach" to the care of children.

"Chiropractors who are members of a chiropractic pediatric organization -- I think that is a very good place to start," says Pistolese. "Also, look for somebody who has had postgraduate training in chiropractic pediatric care." Pistolese says the ICPA has a web site and a referral database to help parents find qualified pediatric chiropractors.

Chiropractors' positions on childhood vaccinations are another bone of contention in the medical community -- and within the chiropractic community itself.

"The vaccine issue is not a chiropractic issue, it is an issue of freedom of health care and informed consent," says Pistolese. He says the ICPA's official position on vaccinations is not to advise against vaccination, but to educate parents about its possible risks and benefits.

Referring to the ICPA's vaccination policy statement, Pistolese says that the loss or damage of some children's lives from vaccinations is not an acceptable risk to the ICPA. "We therefore do not support the concept of mandatory vaccination, regardless of risk. The ICPA fully supports the right to informed consent and the right of each parent to choose the type of health care that is best for their child," says Pistolese.

In contrast, various government and medical associations -- such as the CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians -- recommend most, if not all, children be vaccinated.

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