Chiropractic history and examination forms for the infant, pre-school, and school-aged child

By Sue Weber DC, MSc, FEAC, FRCC, and Amy Sarah Miller MSc, PhD, FEAC

The assessment of the pediatric patient is a specialized area of chiropractic practice, requiring additional knowledge and skills. In recognition of this, European Academy of Chiropractors’ special interest group for Pediatrics have developed basic history and examination forms for the infant, pre-school, and school-aged child. The aim of these forms are to assist the chiropractor to identify red flags and to triage musculoskeletal and non-musculoskeletal complaints in these age groups. The process of development of the forms is outlined, and the three forms are presented in this article.

Key Words: infant examination, pre-school examination, school age child examination, chiropractic, pediatric history form, pediatric examination form, pediatric red flags.

Chiropractic education typically includes a cursory level of education within pediatrics1 which varies from institution to institution. Practitioners interested in pediatrics can pursue additional education through continuous education courses (continuing professional development), a diplomate, or a Master’s degree, through a range of providers. Surveys have shown that the majority of practitioners see children of all ages, but feel they have inadequate skills in assessment and treatment.1

Triaging musculoskeletal (MSK) and non-MSK complaints is of the highest priority when assessing the pediatric patient.2 Some apparently-MSK presentations have serious red flag causes, such as bone or joint infection, malignancy, or non-accidental injury.2 Other conditions which appear to be MSK at first glance may be due to potentially disabling pathology, including orthopedic hip conditions, rheumatological diseases, or neuromuscular diseases.2 Ability to triage is therefore a vital skill and knowledge base for practitioners to develop when seeing the pediatric patient, as differential diagnosis and treatment vary significantly from the adult patient.3 Children, and particularly infants, are not small adults. There are specific and different concerns which must be addressed with an appropriate history and examination.

The European Academy of Chiropractic (EAC) is working to provide post-registration education for practitioners. One of the EAC’s special interest groups (SIGs) is pediatrics, where members are working to advance education around pediatric practice. The pediatric SIG is a team of four, each with advanced education within chiropractic and/or pediatrics (post-graduate Master’s degree or PhD), and each with expertise in clinical practice, research, or education.

Fungible pediatric history and examination forms for chiropractors and other manual therapists have not yet been made available. Consequently, a key initiative of the SIG over the past year has been to provide basic history and examination forms for the infant, pre-school, and school-aged child, for use by practitioners with limited education in this area. The forms presented with this article have been designed to organize the pediatric history (Tables 1, 4, and 7) and examination (Tables 3, 6, and 9), giving it form and consistency, aiding the practitioner in undertaking a thorough assessment. The primary focus is on triaging common musculoskeletal (MSK) and non-MSK presentations in the three pediatric age groups, and on identifying red flags which are indications for referral (Tables 2, 5, 8). In highlighting non-MSK and red flag presentations,4,5 there is an emphasis on safety, particularly identifying and referring the ill child for medical assessment and care. These forms are helpful in reaching the goal of arriving at the correct diagnosis or diagnoses, in order that the proper management can be recommended.

The pediatric history and examination forms have been reviewed by all members of the SIG in an extensive, iterative process spanning 18 months. Within the SIG and for each age group, an initial draft was created, multiple iterations were developed, and meetings were held to discuss and resolve disagreements by consensus. In total, six meetings were held between members of the SIG. Once agreed upon within the group, the forms were then discussed at length with a pediatrician (MD), and recommendations adopted. This iteration was then shared with and reviewed by chiropractors with expertise in the pediatric patient, and their comments were reviewed by the authors.

Recommendations for chiropractors
The authors recommend adopting these forms in clinical practice. Just as these forms reflect the fact that the child is growing and developing, treatment is also adjusted based on age and development. That said, our recommendations include referring the neonate to another chiropractor with more education and experience as this patient group has special considerations not all covered in the infant form. The age group delineations are not ideal as the 13-month-old is not developmentally the same as the 5-year-old. We will be working to develop more optimal forms. The toddler is difficult to evaluate and because of this, may require advanced skills in evaluation and treatment. The 6-year-old presents challenges, for example, as they may refuse to undress for proper evaluation as developmentally, blossoming self-awareness may result in shyness with strangers.

For those practitioners with additional education and experience with these age groups, there may be additional information you wish to seek in the history and assessment you will carry out in the examination. Using these forms as a foundation will provide a safety net, highlighting non-MSK conditions and red flags for the different age groups within the pediatric patient.4,5

These forms will be available to download from the European Academy of Chiropractors’ website. Accompanying ‘add-on’ history and examination forms for common presenting complaints, such as the crying infant, childhood headache, and scoliosis, are currently being developed. A series of recorded lectures to accompany these forms are in progress, discussing key aspects of the history and examination of the pediatric patient. These will also be available through the European Academy of Chiropractic and the General Education Network for Chiropractic (GEN-C).

These forms represent a minimum standard for assessing pediatric patients to ensure safe and effective management. The implementation of these forms should not only raise competence of practitioners, but with widespread use, enable data collection on a large scale for future research. This is a starting point in a series of work, aimed at elevating the safety and quality of musculoskeletal care provided by chiropractors to babies, children, and their families.

These forms were developed with significant contributions from Prof Lise Hestbaek (DC, PhD), Dr Aurelie Marchand (DC, MSc), Dr Ulf Wike Ljungblad (MD), Prof Joyce Miller (DC, PhD), Dr Sharon Vallone (DC, FICCP).

Editors Note: The forms included below can be easily downloaded by using the links at the right. Some of the forms are too long to fit on a standard 8.5x11" paper, so we have provided both the full form on a single page (noted as FULL SIZE) and also the form on two pages for printing on a standard printer.

Table 01

Table 02

Table 03

Table 04

Table 05

Table 06

Table 07

Table 08

Table 09


1. Porcino A, Solomonian L, Zylich S, Gluvic B, Doucet C, Vohra S. Pediatric training and practice of Canadian chiropractic and naturopathic doctors: a 2004-2014 comparative study. BMC Complementary and Alternative Medicine, 2017; 17(1):512. doi: 10.1186/s12906-017-2024-5.

2. Smith N, Mercer V, Firth J, Jandial S, Kinsey K, Light H, Nye A, Rapley T, Foster HE. RightPath: a model of community-based musculoskeletal care for children. Rheumatology Advances in Practice. 2020;4 (2). doi: 10.1093/rap/rkaa057.

3. Association of Paediatric Chartered Physiotherapists MSK Specialist Committee, 2019. A Paediatric Musculoskeletal Competence Framework for Physiotherapists Working in the UK. Chartered Society of Physiotherapists: London, England. Available from:

4. Leboeuf-Yde C, Hestbæk L. Chiropractic and children: Is more research enough? Chiropractic and Osteopathy. 2010; 18 (11). doi: 10.1186/1746-1340-18-11.

5. Zablotsky B, Black LI, Maenner MJ, Schieve LA, Danielson ML, Bitsko RH, Blumberg SJ, Kogan MD, Boyle CA. Prevalence and Trends of Developmental Disabilities among Children in the US: 2009–2017. Pediatrics. 2019; 144(4):e20190811.