Incidence of iatrogenesis associated with osteopathic manipulative treatment of pediatric patients.

CONTEXT: Although studies have been published documenting the safety and efficacy of osteopathic manipulative treatment (OMT) in adults, no studies exist documenting the safety of OMT in pediatric patients. OBJECTIVE: To determine the incidence of iatrogenesis (ie, aggravations and complications) derived from OMT in the pediatric patient population. DESIGN: A retrospective review of medical records was conducted looking for documentation of aggravations or complications subsequent to OMT. Treatment-associated aggravations were defined as worsening of symptoms or complaints after treatment. Treatment complications were defined as cerebrovascular accidents, dislocation, fracture, pneumothorax, sprains and strains, or death as a treatment outcome. The authors documented all occurrences of treatment-associated aggravations or complications recorded at each office visit, as well as the timing of an aggravation between office visits. SETTING: Medical records of pediatric patients receiving OMT and being seen more than twice at osteopathic manipulative medicine offices in Pennsylvania and Virginia were reviewed. PATIENTS: Of 502 pediatric patients' medical records reviewed, 346 met the inclusion criteria of two or more office visits for which adequate follow-up data were available. RESULTS: No treatment-associated complications were documented. Thirty-one (9%) patients had documented treatment-associated aggravations. There was no significant difference between the proportion of male and female patients considered in the study, relative to a 50/50 distribution (females, 48%; males, 52%). CONCLUSIONS: Osteopathic manipulative treatment appears to be a safe treatment modality in the pediatric population when administered by physicians with expertise in OMT. Future studies should be prospective and include larger numbers of patients to document the safety of OMT in this clinical application.

Pediatric choking.

Choking episodes and foreign body aspiration can be life threatening or result in significant morbidity. Choking continues to be a direct cause of death among children, most commonly occurring between the ages of one and four years. Various strategies have been used to decrease choking risks and prevent adverse outcomes. These have included alterations in product design and public education campaigns. Although education has been partially successful, primary care physicians can play a critical role in increasing education efforts during each well child office visit through anticipatory guidance of choking risks. Management of a choking child often involves collaborative efforts from the primary care physician, emergency room physician, otolaryngologist, pulmonologist, and radiologist. The purpose of this brief review is to provide an overview of the epidemiology and pathophysiology of choking and foreign body aspiration in children and to highlight important aspects of prevention and patient education.