Children and spinal manipulation therapy: Ask your patients about all the therapies they seek

©2009 Canadian Paediatric Society. All rights reserved Two days before his school hockey league finals, a previously healthy eight-year-old boy had a runny nose and low-grade fever. He performed well during the first game with two goals. Afterwards, he complained of difficulties in moving his neck because of pain. To prepare him for the next game, his grandfather, who previously had significant improvement of his back pain with spinal manipulation, booked an appointment with a chiropractor. The next morning, the boy felt exhausted and was a little sleepier than usual. The chiropractor found his cervical spine difficult to mobilize and recommended a return visit the next day for follow-up. Twelve hours later, the child arrived at the emergency department by ambulance after a generalized tonic-clonic seizure lasting less than 2 min. The initial assessment revealed a Glasgow coma scale of nine, with a rigid neck and normal pupils. His blood sugar and electrolyte levels were normal, and a computed tomography scan of his head was unremarkable. Because of persisting symptoms, a lumbar puncture was performed. An examination of the cerebrospinal fluid showed a white blood cell count of 7 × 106/L with 75% lymphocytes, a low glucose and a protein level of 0.63 g/L. A diagnosis of viral meningitis was confirmed by polymerase chain reaction. After a few days in the hospital, he improved and was discharged home.