Young people accounted for a small but notable share of chiropractic workloads in Australia and Canada, and the reasons their families gave for seeking care did not always match what chiropractors wrote down as diagnoses. A secondary analysis of two large observational studies of chiropractic practice, published in Chiropractic & Manual Therapies, pooled data from nearly 8,000 patient encounters and extracted the 670 encounters involving patients aged 17 or younger. The findings offer one of the most detailed pictures yet of how children and adolescents are actually managed in chiropractic clinics, drawn from records completed at the time of each visit rather than from retrospective surveys.
The underlying datasets came from the Chiropractic Observation and Analysis Study (COAST), conducted in Victoria, Australia between December 2010 and September 2012, and the Ontario Chiropractic Observation and Analysis Study (O-COAST), conducted in Ontario, Canada between August 2014 and November 2015. In each study, participating chiropractors recorded details of up to 100 consecutive patient encounters on standardised forms, capturing patient characteristics, up to three reasons for the encounter, up to three diagnoses, and the techniques and treatments delivered. COAST recruited 52 chiropractors and O-COAST recruited 39, with response rates of 33 percent and 35 percent respectively. For the secondary analysis, researchers at Macquarie University and collaborating institutions identified all encounters with patients aged 17 or younger, excluded a small number of records where height, weight and occupation were illogical for the calculated age, and pooled the two datasets because their designs and measurement methods were comparable.
The 670 paediatric encounters came from 605 discrete patients and represented 8.4 percent of all encounters in the pooled data, with a 95 percent confidence interval of 7.8 to 9.0 percent. The researchers divided the patients into three age strata chosen to reflect neurodevelopmental and musculoskeletal maturation stages: infants aged 0 to 23 months, children aged 2 to 9 years, and adolescents aged 10 to 17 years. Adolescents dominated the caseload, accounting for 47 percent of paediatric encounters, followed by children at 33 percent and infants at 20 percent. This contrasts with similar studies in the United States and Scandinavia, where babies under 12 months formed the largest paediatric group presenting to chiropractors. The authors suggest the difference may reflect their sample of predominantly general-practice chiropractors, few of whom reported additional paediatric-specific training.
Most young patients were infrequent users of chiropractic services during the study windows. Ninety-two percent attended a single encounter, only 2 percent attended three or more, and 10 percent were new patients to the chiropractor. Boys outnumbered girls, making up 56 percent of paediatric patients. Co-morbidities such as food allergies, asthma, diabetes and cystic fibrosis were recorded in 10 percent of encounters. Imaging was requested in just 11 encounters, or 2 percent. The most common referral source in every age group was other patients of the practice, cited in 60 percent of cases, followed by family and friends at 5 percent. Nurses, midwives and lactation coaches were the second largest referral source for infants under two, accounting for 14 percent of referrals within that stratum and 5 percent overall. Physicians referred young people in only 13 encounters, 12 of which involved adolescents.
The single most striking result concerns why families sought care at all. Health maintenance, a category that grouped terms such as wellbeing, wellness and check-up, was the leading reason for encounter in all three age strata, at rates of 61.4 per 100 encounters for infants, 58.2 for children and 34.7 for adolescents. Beyond that, the profile of presentations shifted sharply with age. In infants, sleep problems at 19.3 per 100 encounters and feeding issues at 10.7 were unique to the youngest group. Among children, neck problems at 8.5 and back problems at 5.6 per 100 encounters were the most common reasons after health maintenance, followed by psychological complaints at 4.7 and ear and respiratory problems at 4.2 each. In adolescents, musculoskeletal complaints took centre stage: back problems at 34.1, lower extremity problems at 14.8 and neck problems at 11.7 per 100 encounters, with headache at 6.9 the most frequent non-musculoskeletal reason.
Diagnoses told a different story. Chiropractors recorded 906 diagnoses across the 670 encounters, and back problems, a category encompassing low back, pelvis and thoracic complaints, was the most common diagnosis in every age stratum, at 38.6 per 100 encounters for infants, 62.0 for children and 66.6 for adolescents. The authors identify this as an incongruence between what patients or parents reported as the reason for the visit and what chiropractors recorded as the working diagnosis. They note a possible mechanical explanation: the data collection form requested a working diagnosis for each encounter, which may have prompted chiropractors to record a specific problem such as a back problem even when the stated reason for the encounter was health maintenance. How a diagnosis of health maintenance alters the treatment actually delivered, compared with a diagnosis of a back or neck problem, remains unclear and is flagged as a question for further study.
Treatment patterns were consistent across ages. Manual adjustment was the most frequently reported technique, used in 51 per 100 encounters with infants, 63 per 100 encounters with children and 88 per 100 encounters with adolescents, rising steadily with patient age. Chiropractors commonly reported multiple techniques per encounter, and the analysis categorised modalities into nine groups, including mechanically assisted adjusting tools such as activators, and electrical or thermal treatments. The authors attribute the age gradient partly to skeletal maturity and musculature, and to the higher prevalence of back pain among adolescents, which clinicians may manage similarly to adult patients. Because dedicated research and guidelines for child and adolescent spinal pain are scarce, the paper notes, chiropractors often have limited options and may fall back on adult-oriented approaches.
The findings carry several caveats that the authors address directly. The data were collected more than a decade ago and may not reflect contemporary practice patterns. The original questionnaires were not designed to capture paediatric-specific detail, so the results are broad and lack nuance for each age stratum. The studies did not record the type of manual therapy used, whether techniques were modified for younger patients, or any adverse events. Participation was voluntary, and although participating chiropractors appeared broadly representative of the wider workforce in Australia and Canada, selection bias cannot be excluded. There is also a regulatory context worth noting: in Australia, the Chiropractic Board currently restricts chiropractors from manipulating children under two years of age, and the COAST data collection predates that interim ban.
The study’s contribution lies in describing practice rather than evaluating benefit. The authors are explicit that comparisons of the effectiveness of chiropractic and conventional paediatric care for conditions such as colic, sleep disturbance and musculoskeletal complaints are premature, and that priority should go to understanding the clinical course, prognosis and aetiology of these conditions in young people before targeted, evidence-based treatments can be developed. They also highlight the prevalence of non-musculoskeletal presentations, particularly in infants, despite limited research evidence supporting spinal manipulation for such conditions, and call for research into what components of care are directed at the infant versus the parents. Understanding these patterns of presentation and treatment, they argue, will help design relevant research, inform clinical teaching and support evidence-based health policy, while prospective studies are needed to clarify the role of chiropractic services for young patients and help families make informed decisions.
Subject of Research: A secondary analysis of chiropractic practice data describing paediatric patients, their reasons for care, diagnoses and treatments across three age groups
Article Title: The profile of young people seeking chiropractic care: a secondary analysis of data
Article References: Neave, M., Swain, M., Downie, A., de Luca, K., Hogg-Johnson, S., Mior, S., & French, S. (2026). The profile of young people seeking chiropractic care: a secondary analysis of data. Chiropractic & Manual Therapies, 34(1), Article 54. https://doi.org/10.1186/s12998-026-00677-5
Image Credits: AI Generated
DOI: 10.1186/s12998-026-00677-5
Keywords: chiropractic, paediatric care, health maintenance, musculoskeletal, manual adjustment, COAST study, O-COAST study, adolescents, infants, cross-sectional study, Australia, Canada
News Source: Ophelia Keating. (October 28, 2026). Health maintenance tops reasons young patients visit chiropractors in Australia and Canada. Scienmag.
