In a video posted on Facebook in August of 2018, an Australian chiropractor hangs a two-week-old newborn upside down by the ankles. After a few seconds, he lays the baby on a table and begins to apply spinal and neck manipulation treatments. With a spring-loaded device called an “activator,” on what he says is “the lowest setting,” he repeatedly delivers pulses of pressure to the baby’s tailbone and neck, and then continues to push and prod various parts of the infant’s body. This lasts for three minutes. As the baby screams and tries to wriggle away, the chiropractor reassures the parents that “a bit of a cry is a good thing.”

The video prompted Harry Nespolon, president of the Royal Australian College of General Practitioners, to call for a ban on chiropractors treating infants. The concept of manipulating a baby’s back was unnecessary, unacceptable, and “horrifying,” he told The Sydney Morning Herald in February.

In the U.S., critics of complementary and alternative medicine have also taken issue with the efficacy and safety of chiropractic treatment for infants and are calling for improved regulation, but chiropractors stateside are currently free to treat infants — and many do, including national franchise chain The Joint. Proponents argue that chiropractic manipulations are harmless and can help with everything from colic to constipation. But while the evidence for the efficacy of infant chiropractic is shaky, the potential harms are very real.

Ever since it was founded more than a century ago by “spiritist” Daniel David Palmer, who claimed to have received its wisdom from the ghost of a deceased doctor, the chiropractic profession has been rife with evidence-scarce and even made-up claims. (There remains a strongly vocal sect of pediatric chiropractors who staunchly oppose vaccines, a stance rooted in Palmer’s own opinion that “it is the very height of absurdity to strive to ‘protect’ any person from smallpox or any other malady by inoculating them with a filthy animal poison.”)

Despite its popularity, the practice is controversial to its core: Chiropractic adjustments hinge on correcting vertebral subluxations, or misalignments, despite the fact that these misalignments may not show up in X-ray images and their existence is widely questioned by mainstream physicians. (Chiropractic subluxation is not to be confused with orthopedic subluxation, a well-established medical condition in which a joint partially dislocates.)

As chiropractors tell it, humans engage nearly every day in activities that misalign their vertebrae, and these subluxations can disrupt the proper functioning of the nervous system, manifesting as a variety of ailments. And they say the trouble can start at birth, whether with a traumatic trip through the birth canal, or an “unnatural” entry via C-section.

Pathways magazine, published by the International Chiropractic Pediatric Association, claims that a whopping 90 percent of newborns suffer birth trauma — strain through the neck and head sustained during labor and delivery. Core Chiropractic, which bills itself as one of Houston’s most trusted chiropractic offices, goes so far as to suggest that “traumatic birth syndrome” can lead to nerve dysfunction even when there are no symptoms or detectable injuries. This trauma, chiropractors assert, must be treated in order for the baby to “grow, develop, and function at its highest potential.”

But the astonishing rate of birth trauma cited by Pathways Magazine is based on a highly questionable interpretation of a single, 50-year-old study. Other estimates suggest the rate of mechanical injuries related to birth is less than 3 percent.

Clay Jones, a pediatrician at Newton-Wellesley Hospital and a regular contributor to the blog Science-Based Medicine, is even more skeptical: “There is no basic science research that supports the notion that spinal misalignment occurs during or after birth and impairs any aspect of infant health,” he says.

Birth trauma aside, chiropractors argue that even the mere act of getting a diaper change can misalign a baby’s spine. And they claim that spinal manipulations to treat such misalignments can help with colic, ear infections, sleep problems, gas, difficulty latching to the breast for feeding, and far more.

Katherine Pohlman, a chiropractor and director of research at Parker University in Texas, sees potential benefits to the treatments. “Using the best available information currently, there is a scarcity of evidence for harm and some evidence of potential positive effects for chiropractic care in the pediatric population,” she says. For example, she references three randomized controlled trials on the effects of manual spinal manipulation on ear infections in young children. In two of the studies, groups that received manipulation in addition to standard medical care showed either fewer recurrent ear infections or less fluid buildup over time than the groups that received routine pediatric care alone. A third study found no link between manipulations and the risk of recurrent ear infections. Pohlman points out that the findings are “inconclusive due to the need for more rigorous study designs,” but adds that “this is the best empirical evidence that we have at this time.”

Despite the evidence being so questionable, parents can’t seem to quit chiropractors. Indeed, a retrospective study published in 2008 based on data from a chiropractic college in England found that 85 percent of parents reported improvement in their children’s symptoms. “Parents who bring their children to a doctor of chiropractic are highly satisfied with the care and experience,” says the American Chiropractic Association in a June 2016 statement.

The problem is that most of the pediatric conditions chiropractors treat involve subjective symptoms, and a parent’s perception — often shaped through the lens of exhaustion and frustration — is sensitive to numerous placebo effects. Or as Jones puts it, “patient satisfaction is a poor stand-in for quality of care,” because chiropractors can “provide reassurance that their interventions are safe and effective and then take credit when the natural course of the child’s symptoms results in a resolution.”

Take colic. These bouts of frequent, prolonged and intense crying or fussiness are common in healthy infants but poorly understood. They tend to peak around six weeks after birth and decline significantly between three and four months of age. If a chiropractor adjusts a colicky infant’s spine and their crying bouts improve shortly thereafter, the parent may believe that the chiropractor cured their little one’s colic.

To be fair, most infant chiropractors don’t apply the kind of aggressive adjustments that would cause a baby to shriek in pain. Rather, the vast majority do little more than indent the skin a bit; they commonly compare the applied pressure to the force one might use to check a tomato for ripeness. So even if the treatments aren’t as effective as chiropractors claim them to be, is there any harm?

While it’s reassuring to know that chiropractors are extremely unlikely to break an infant’s neck or otherwise cause physical injury, the concern is that parents who take their children to a chiropractor will do so in place of seeing a traditional primary care physician, which could delay the diagnosis and treatment of potentially serious conditions. Says Jones, a growing number of chiropractors are claiming primary care status, but “chiropractic education simply does not prepare chiropractic students to recognize the wide variety of presentations of serious illness and to appropriately refer to proper medical professionals.”

If more parents are relying on chiropractors to know when to refer their child to a medical professional, “kids are going to be harmed,” Jones says. And that’s a risk we should all be worried about.

I personally have never seen a chiropractor, nor have I taken my children to see one. But I can understand why some parents would. If I’ve learned one thing about infants, it’s that they’re ornery, needy little people who, prior to several months of age, aren’t really capable of self-soothing. As an added stressor for new parents, an infant’s bouts of crying aren’t easy to attribute to anything specific, especially if they’re still crying after being fed, rocked, and changed.

For parents with established relationships with chiropractors, the idea that a gentle adjustment could alleviate colic, gas, or whatever else a chiropractor suggests could be happening, must sound pretty compelling. But sometimes the best remedy is simply to take a deep breath and accept that babies cry a lot and you can’t always fix it. And if a baby shows signs that something might be wrong, nothing can stand in for a trip to the doctor’s office.

Kavin Senapathy is a freelance writer covering science, health, parenting, and food, based in Madison, Wisconsin. She’s the co-founder and contributing editor at SciMoms.com and the co-host of the Point of Inquiry podcast. Find her on Twitter @ksenapathy.