Systematic Review of Effects of Manual Therapy in Infants with Kinetic Imbalance due to Suboccipital Strain (KISS) Syndrome

The goal of this systematic literature review was to establish the effects of manual therapy, chiropractic, or osteopathic treatment of the kinetic imbalance due to suboccipital strain (KISS) syndrome in infants with positional preference, plagiocephaly, and colic. We searched PubMed, Embase, and the Cochrane Library for articles on the effects of manual therapy, chiropractic, and osteopathy for the KISS syndrome. In addition, experts in the field of manual medicine and osteopathy were asked to provide relevant articles, and the bibliography in a textbook of manual therapy for children was hand-searched for additional references to the syndrome. This search strategy located no clinical trials that evaluated the effects of manual therapy or osteopathy on either the KISS syndrome or its symptoms. However, pooled analysis of two randomized clinical trials on the effects of chiropractic in infantile colic showed no statistically significant difference between active and control treatments. In addition, we found that 22% of infants showed short episodes of apnea during manual therapy of the cervical spine and that one case has been described in which apnea after Vojta therapy resulted in death. Given the absence of evidence of beneficial effects of spinal manipulation in infants and in view of its potential risks, we conclude that manual therapy, chiropractic, and osteopathy should not be used in infants with the KISS-syndrome outside the context of randomized double-blind controlled trials.