NEW YORK (Reuters Health) - A new research review suggests that chiropractic spinal adjustments in children carry a risk of injury, with sometimes severe consequences.

Though researchers found only a handful of serious injuries among 13 published studies, they believe that there's still too little known about the safety of spinal manipulation in children.

Until more is learned, they suggest that parents be cautious about seeking this therapy for their children.

The review, which is published in the journal Pediatrics, included 13 reports published in the medical literature. Only two were based on clinical trials that tested the effects of spinal manipulation on children; the rest were reports on individual cases of injuries.

In all, the researchers found 14 significant injuries, 9 of which were serious, and 2 children died. In one of the fatal cases, the child died from a brain hemorrhage after receiving a neck manipulation; in the other, the child died after a suspected neck fracture.

Some children suffered paralysis, while others had less serious or minor problems, such as severe headache and back pain.

A chiropractor performed the adjustments in most cases, though other health professionals -- including medical doctors, physical therapists and osteopaths -- sometimes offer the therapy.

"I think parents should consider potential risks and potential benefits when making treatment decisions for their children," Dr. Sunita Vohra of the University of Alberta, Edmonton, Canada told Reuters Health.

However, she said, that's hard when it comes to spinal manipulation because of the lack of safety information on children -- including the true rate of injuries.

Perhaps more concerning than the potential for direct injury is the chance that the true cause of a child's symptoms will go undiagnosed.

"We found more harms associated with delayed diagnosis and/or treatment than with manipulation itself," Vohra explained.

Of those 20 cases identified, 7 involved a delayed diagnosis of cancer. Another 2 children died because of delayed treatment for meningitis, a neurological infection with symptoms that include headache and neck stiffness and pain.

Vohra stressed that parents should be aware that symptoms of back and neck pain may often have a different cause in children than in adults. While body aches are common in adults, they are unusual in children and can be signals of serious illness.

Parents should first talk to their child's pediatrician about any symptoms, in order to rule out any serious problem, according to Vohra.

Spinal adjustments are also sometimes advocated by some for common childhood conditions such as asthma, ear infections and bedwetting, but there's no proof the approach is effective.