Danish chiropractors have, for the first time, a set of national recommendations describing the minimum requirements for history taking, examination and clinical management of infants aged 0 to 12 months in chiropractic practice. The recommendations were commissioned by the Danish Society of Chiropractic, initially developed in 2020 and updated in 2025, and are reported in the journal Chiropractic & Manual Therapies with consideration of the RIGHT Statement, a reporting framework intended to improve transparency and completeness in describing how practice guidelines are produced. According to the development team, the recommendations aim to support safe, consistent and transparent clinical care while making communication with parents and other healthcare professionals easier.
The need for such guidance is grounded in how common infant patients are in Danish clinics. In 2018, children younger than one year accounted for approximately 3.5 percent of all patients seen by Danish chiropractors, corresponding to around 13,000 consultations annually, although the authors note considerable variation between individual practitioners. The reasons parents bring their infants to chiropractors are relatively consistent across Scandinavia and other Western countries. Danish and Norwegian studies have identified infantile colic or excessive crying, asymmetrical movement patterns, musculoskeletal concerns, breastfeeding difficulties and sleep disturbances among the most common reasons for seeking care, with similar findings reported elsewhere in Europe.
Many of these presenting complaints are non-specific and may reflect a broad spectrum of underlying conditions, ranging from benign musculoskeletal dysfunction to serious medical pathology. The authors argue that this makes a thorough medical history and physical examination essential, both to identify children who require referral and to ensure that infants appropriate for conservative care receive consistent assessment and management. Despite infants representing an important patient population, existing publications have mainly described patient characteristics and presenting complaints, broader best-practice recommendations for paediatric chiropractic care, or evidence relating to individual treatment approaches. Practical recommendations specifically describing minimum requirements for history taking, physical examination, recognition of red flags, referral and subsequent clinical management have remained limited.
The development process combined several complementary sources of input. A literature search was conducted in PubMed without restrictions on publication year, focusing on studies relevant to medical history taking, physical and musculoskeletal examination, red flags, referral and clinical management for infants. The authors emphasise that this was a targeted review intended to identify and summarise available evidence, not a formal systematic review, and no formal exclusion criteria were predefined. Recommendations concerning general medical history taking and physical examination were based primarily on a Danish paediatric medical textbook and considered alongside previously published international consensus recommendations describing best practice for chiropractic care of children. Recommendations relating to musculoskeletal assessment and management were developed through a subsequent expert review process.
Practice-based input came from a national knowledge-sharing workshop organised by the Danish Society of Chiropractic and attended by 71 chiropractors with a special clinical interest in paediatrics. The workshop consisted of invited presentations followed by facilitated small-group discussions and plenary sessions, in which participants discussed clinical experiences, identified important elements of history taking and examination, highlighted areas of uncertainty and suggested additional considerations. The purpose was to gather practice-based knowledge rather than to achieve formal consensus. Notes from all discussion groups were synthesised by the authors, circulated to participants for verification, and informed subsequent revisions of the recommendations.
An expert panel of seven Danish chiropractors with extensive paediatric experience then critically reviewed successive drafts. The panel had a mean age of 42 years, a range of 30 to 65 years, and an average of approximately 20 years of clinical experience, with members representing different regions of Denmark. The panel did not develop the recommendations from scratch; instead, a first review round evaluated overall structure, scope, completeness and clinical relevance, while a second round focused on section-specific feedback, clarity of wording and clinical applicability. Revised drafts were then distributed for external consultation to professional and healthcare organisations including the Danish Chiropractic Association, the Danish Health Authority, the Danish College of General Practitioners, the Danish Midwives Association, the Danish Society of Health Visitors and the Danish Paediatric Society. All feedback was reviewed jointly by the first and senior author, with final editorial decisions made by the first author.
The resulting recommendations cover five main areas: medical history, general physical examination, musculoskeletal examination, recognition of red flags and referral, and management considerations following assessment, with minimum and supplementary assessment components presented in structured tables. During history taking, parents’ observations and concerns should be taken seriously, and the chiropractor should observe the infant’s general condition, including whether the infant is awake, attentive, responsive and visually engaged. The general examination should focus first on the infant’s health and on identifying signs of serious illness or findings requiring referral, with instruments such as a stethoscope warmed before use and the most uncomfortable parts of the examination left until last. When serious illness is not indicated, the chiropractor may proceed to a musculoskeletal examination assessing movement, tone, symmetry and age-appropriate neuromusculoskeletal function.
The red flag and referral section specifies that fever in an infant younger than three months, defined as a rectal temperature of 38.0 degrees Celsius or higher, should be regarded as a potential sign of serious illness and requires immediate assessment by the child’s general practitioner, an emergency department or another appropriate medical service. Febrile infants should be assessed for petechiae, neck or back stiffness and, where relevant, a tense fontanel, with differential diagnoses including airway infections, otitis media, childhood viral illnesses, gastroenteritis, urinary tract infections, meningitis and encephalitis. Because symptoms of meningitis or encephalitis can be non-specific in infants, the recommendations urge close attention to parental concerns about subtle behavioural changes, including apathy, unusual drowsiness, irritability, difficulty comforting the child, vomiting, convulsions or rash. If inflicted harm or neglect is suspected, chiropractors must act in accordance with national safeguarding legislation and inform the appropriate authorities.
On treatment, the recommendations state that current evidence for manual treatment of infants remains limited, particularly for specific infant complaints, and that clinical decisions should integrate the best available evidence, clinical expertise, findings from the individual assessment, parental preferences and careful monitoring. Any manual approach must be adapted to the infant’s age, size, developmental stage, clinical condition and tolerance, and must be considerably gentler than procedures used in adult care. Based on studies of the tensile strength of the vertebral column in different age groups, it has been suggested that manipulation in infants younger than four weeks should use no more than 10 percent of the force used in adults, and up to 30 percent for infants aged 2 to 23 months. Existing reviews suggest transient symptoms such as fatigue, irritability, local redness or discomfort may occur, while serious complications appear to be very rare and most often related to delayed diagnosis rather than the manual intervention itself. Data from compensation claims in Denmark and Norway from 2004 to 2012, and Australian insurance data up to July 2019, did not identify compensation claims involving children in chiropractic practice.
For common presentations, the recommendations advise caution. The evidence for manual treatment of infantile colic remains uncertain, with controlled studies reporting mixed findings and generally limited by small sample sizes and blinding challenges. For asymmetry and breastfeeding difficulties, direct controlled evidence is also limited; case series have reported improvements in latch following manual therapy, but stronger evidence is lacking. Where there are clinical indications for manual care, no signs of serious disease, and informed parental consent, a time-limited trial of care may be considered, with the management strategy reconsidered and referral or interdisciplinary collaboration considered if symptoms do not improve within a short period, generally two weeks. The authors acknowledge important limitations: the literature review was targeted rather than systematic, the evidence base for infant chiropractic care is sparse, and no formal consensus methodology such as a Delphi process was employed, meaning the recommendations should be viewed as expert-informed rather than formal consensus guidelines. Because they reflect Danish legislation, referral pathways and professional responsibilities, adaptation may be required before implementation elsewhere, and future research should evaluate their implementation and influence on clinical decision-making, referral behaviour and parent experiences.
Subject of Research: Development of national recommendations for infant assessment and management in Danish chiropractic practice
Article Title: Development of national consensus-based recommendations for history taking, examination and clinical management of infants in chiropractic practice
Article References: Overgaard, F. G., Hestbæk, L., & Davidson, E. (2026). Development of national consensus-based recommendations for history taking, examination and clinical management of infants in chiropractic practice. Chiropractic & Manual Therapies, 34(1), Article 39. https://doi.org/10.1186/s12998-026-00671-x
Image Credits: AI Generated
DOI: 10.1186/s12998-026-00671-x
Keywords: chiropractic, infants, clinical guidelines, Denmark, paediatrics, red flags, manual therapy, consensus recommendations, medical history, physical examination, patient safety, evidence-informed practice
News Source: Harold Sullivan. (October 30, 2026). Denmark Sets First National Standards for Chiropractic Care of Infants. Scienmag.
