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Navarro et al aimed to evaluate the efficacy of cranial osteopathy in 30 children with congenital nasolacrimal duct obstruction (CNLDO); 15 infants received 1 session of cranial osteopathy, and 15 received 1 sham treatment (light touch only). The authors reported significant post treatment improvements (P , .05, no CIs) and no between groups differences at 14 weeks follow-up (P .05, no CIs) in the fluorescein disappearance test (FDT) and the modified Jones test in the OMT group compared with controls and concluded that cranial OMT is an effective short-term therapy for CNLDO. Nemett et al28 aimed to determine whether OMT plus UC improves dysfunctional voiding (DV) more effectively than UC alone. Of the 21 children studied, 10 received 4 sessions of OMT, and 11 received UC, which included medi-cations, establishment of timed voiding and evacuation schedules, dietary modifications, behavior modification, pelvic floor muscle retraining, biofeedback training, and treatment of constipation. At 3-month follow-up, the authors reported significant improvement in DV symptoms in the OMT group compared with controls (P = .008, no CIs) and concluded that OMT can improve short-term outcomes in children with DV. Five of the RCTs included here had a high ROB with regard to adequate sequence generation. Nine trials had a high ROB with regard to allocation concealment. Twelve RCTs had high ROB with regard to patient blinding. Nine RCTs had high ROB with regard to assessor blinding. Six RCTs had a high ROB with regard to addressing of incomplete data and selective outcome reporting. All 17 RCTs had an uncertain ROB from other sources. Thus, the overall quality of the RCTs was poor, and no RCT was free of major methodological limitations. Also, 4 RCTs failed to provide any details about the OMT, making them impossible to be replicated. Four RCTs mentioned that no AEs had occurred. Philippi et al16 re-ported that 4 patients had had aggra-vation of vegetative symptoms after OMT. Two AEs reported in the study by Wahl et al30 were related to Echinacea and placebo and not to OMT. The aim of this article was to summarize and critically evaluate the evidence for or against the effectiveness of OMT in pediatric conditions. Seventeen trials were found; 7 of them favored OMT, whereas the remaining 7 revealed no effect, and 3 did not report between-group comparisons. In general, small and biased RCTs favored OMT, whereas the largest and most methodologically sound studies failed to reveal effectiveness. The evidence from RCTs of OMT for treating pediatric conditions is thus limited, weak, and contradictory. Independent replications were available for 2 conditions only: OM and CP; and in both cases the results were contradictory. Independent replications could not be found for any other conditions. Thus there is no indication for which the effectiveness of OMT has been shown by more than 1 RCT. This SR reveals serious methodological limitations in almost all of the RCTs. For instance, only 3 (17%) RCTs had reasonably large sample sizes. Three trials employed patient blinding, and 7 (41%) used blinded assessors.

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