Would you know when NOT to adjust a child?

5 Sept

You Don’t Have to Be a “Kids Chiro” to Know Your Paediatric Red Flags

There are chiropractors who absolutely love seeing children. That’s me obviously 😊. We have toys in the adjusting room, a suspiciously large collection of dinosaurs, and can perform an examination while a four-year-old is simultaneously wearing the reflex hammer as a hat.

And then there are chiropractors who would quite happily leave all of that to someone else.

Both are perfectly reasonable life choices.

But even if seeing kids is not your thing, children still have an uncanny ability to appear in chiropractic practices.

A long-term practice member brings in their teenager with a sore neck after football. A mum asks you to “quickly have a look” at her toddler who has started limping. A 12-year-old presents with headaches. Someone’s baby is brought along to an appointment and suddenly the conversation turns to torticollis, feeding or why the baby seems unusually unsettled.

And at that point, one skill becomes enormously valuable:

Knowing when something doesn’t fit.

Red flags aren’t about finding reasons NOT to treat

Red-flag screening can sound terribly dramatic. Mention the words paediatric red flags and suddenly everyone imagines fever charts, flashing lights and an ambulance parked permanently outside the practice. But good red-flag screening is really about clinical confidence.

The question isn’t simply: “Can I adjust this child?”

A much better question is: “Is this child safe for chiropractic care today - and if so, what kind of care is appropriate?”

Sometimes the answer is straightforward chiropractic management.

Sometimes it is: yes, but modify the technique.

Sometimes: I’d like this investigated first.

And occasionally: this child needs medical assessment now.

That distinction is part of good clinical care, irrespective of whether children make up 2% or 80% of your practice.

Children are inconveniently different from small adults

Apart from being much harder to negotiate with; their nervous systems are developing, their bodies are changing rapidly, their communication varies enormously. They may not be able to explain dizziness, weakness, visual changes or the quality of their pain.

And serious illness does not always arrive wearing a convenient badge saying SERIOUS ILLNESS.

Sometimes it looks like:

an infant who is “just really unsettled”
a child who suddenly refuses to walk
a headache that has changed character
unexplained vomiting
a child who is unusually difficult to rouse
new weakness, altered gait or poor coordination
developmental regression, rather than simply delayed development
unexplained fever, weight loss or systemic symptoms.

The recent chiropractic best-practice recommendations emphasise comprehensive history-taking, age-appropriate neurological and musculoskeletal examination, developmental assessment, red-flag recognition and appropriate referral or co-management. You can learn more about this in the Switched-on Kids and Babies programs.

In other words, assessing the child starts long before anyone puts their hands on the child.

One of the most useful red flags: “This doesn’t make sense”

You probably already use this instinct every day with adults:

The pain pattern is odd.
The mechanism doesn’t match the severity.
The child is deteriorating rather than improving.
The neurological findings don’t fit your working diagnosis.

That same clinical antenna is invaluable with children.

Sometimes the red flag isn’t a single symptom, it is a mismatch.

A useful little mental checklist is:

Does the child look well?
Does the story make sense?
Is the neurological/developmental picture stable?
Is the tissue I’m about to adjust safe to load?
Is the child progressing as expected?

If one answer makes you uncomfortable, slow down.

Refer. Pause. Modify.

Rather than thinking of red flags as one enormous list to memorise, I like three simple decisions:

REFER — this requires medical investigation or urgent assessment.

PAUSE — I need more information before proceeding.

MODIFY — care may still be appropriate, but technique, force, region or management needs to change.

That is not cautious chiropractic. It is good chiropractic!

And perhaps the best part?

You don’t need a reception room full of Lego, a postgraduate paediatric qualification or the ability to identify every member of Paw Patrol. You simply need to recognise when the child in front of you deserves a closer look. Because the great majority of the time the most valuable thing we do for a patient is adjust them. But sometimes it is knowing when not to.

References:

Keating GM et al. 2024

Henderson VK et al. 2026