Osteopathy Australia’s position
Clinical risk is higher in babies, infants, and children. Risk is also influenced by the training, experience and competence of a practitioner. Clinical practice with babies, infants and children requires osteopaths to have current knowledge, skills and ongoing commitment to developing further knowledge of:
- Paediatric assessment and assessment approaches.
- Working with parents, caregivers, babies, infants and children in clinical settings; managing issues of informed consent and
- patient safety with these patient groups.
- Recognising complex health conditions and their trajectories, with particular reference to paediatric red flags.
- Recognising a child in distress, trauma or need, with particular reference to paediatric yellow flags.
- Child physiology, development and physiological variations within and between babies, infants, children, as well as differences to the maturing body.
- Normal physiological development, including normal range of movement and neurological development, and how to distinguish atypical development.
- Health services, referral pathways and broader supports for parents, caregivers, babies, infants and children; as well as when and how to engage them.
- Contraindications to manual therapy and other management approaches, and current scientific debates/considerations in use of specific modalities in babies, infants and children.
- Appropriate forces for application to growing bodies, irrespective of technique or modality applied.
Osteopathy Australia recommends against the use of spinal manipulative techniques on babies, infants or children aged under 12 years, given limited systematic evidence of clinical benefit for these patient groups. Further considerable public and regulatory concern has been raised in relation to the practice (AMA 2013; Ahpra 2016, Safer Care Victoria 2019).
A range of other clinical management approaches can be used to encourage range of movement, physical mobility and age- appropriate skill growth while managing potential clinical risk. Where relevant to a differential diagnosis, management options could include soft tissue manual therapy approaches, positional or postural advice, aids, toy or appliance prescription, play activity prescription and/or exercise programming.
Practitioners should reflect on their own level of experience, current knowledge or training and confidence in working with paediatric populations. Where there is any doubt, caution should be exercised and an appropriate referral made. Practitioners need to consider these to uphold their own professional indemnity and regulatory obligations (OBA 2017).
The responsibility falls on the practitioner to explain contraindications to caregivers so that informed health care choices can be made through agreed partnership. Use of any clinical management approach needs to be grounded in clinical evidence, clinical reasoning and aligned with the training and experience of a practitioner.
Practitioners are reminded that inappropriate use of a therapeutic technique can lead to regulatory and legal action, up to an including loss of registration were deemed suitable by the Australian Health Practitioner Regulation Agency (Ahpra).
Osteopathy Australia is committed to supporting members to apply clinical risk management practices to babies, infants and children through clinical guidelines, resources and professional education.
Note: other health practitioners and consumers may see reference to osteopathic manipulative therapy (OMT) in publications, including those on paediatric treatment. It is important to understand that OMT is a general term collectively used to describe many dozens of osteopathic manual therapy techniques, including but not limited to spinal manipulation. In addition to skilled clinical exercise programming, manual therapies are a broad class of therapies offered by osteopaths. An osteopath may talk about OMT and have no intention of using spinal manipulation. If caregivers have any concerns, they should discuss this directly with the osteopath.
Authorisation
This position statement was informed by review of current research and a peer consultative process involving Osteopathy Australia’s titled Advanced Paediatric Osteopaths.