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FR Specialty: Pediatric

  • What Actually Helps a Child With ADHD, Ranked by Evidence Instead of Popularity

    Medically reviewed by Dr. Jason Forward, DC, July 2026

    Search this question and you get omega-3 five times over. The evidence ranks omega-3 fifth, and the intervention with the best evidence barely appears at all.

    Start with the finding nobody states

    No trial in this literature tested whether any of these interventions lets a child stop medication. They measure symptom improvement, executive function, or emotional regulation. Not one measures successful discontinuation as an endpoint.

    That matters because almost every parent-facing page on this topic implies otherwise. The honest answer to "what can we do instead of medication" is that several things reduce symptoms and build capability, and none of them has been shown to replace a prescription, because nobody has run that study.

    Everything below is framed as what improves symptoms and capability. Not as a route off medication. The difference is the whole article.

    The ranking

    RankInterventionWhy it sits here
    1SleepThe only one tested in children already taking stimulants. Benefits sustained to 6 months.
    2Behavioural parent trainingGrade A guideline recommendation. Builds capability that persists.
    3Cognitively engaging exerciseLarge effects, but the TYPE matters far more than the amount.
    4MicronutrientsLargest single effect in the set, but 8 weeks and an unmedicated cohort.
    5Omega-3Small, needs 4 or more months, and only if the child is actually low.
    6Elimination dietsSubsets with food sensitivity only. High family burden.
    7Gut-lining protocolsNot supported. See the last section.

    1. Sleep, and why it outranks everything

    Answer first: a brief behavioural sleep intervention modestly improved ADHD symptom severity, and most benefits were still present six months later.

    Hiscock and colleagues ran a randomised controlled trial across 21 general pediatric practices in Victoria, Australia, with 244 children aged 5 to 12. The detail that makes this study different from everything else on this list: most participants were already taking stimulant medication. It is the only intervention here tested in the population most parents are actually asking about.

    The delivery burden is almost nothing. Two fortnightly consultations plus one follow-up phone call.

    Two appointments and a phone call, tested in medicated children, with benefits that held at six months. Nothing else on this list has that combination, and it is nearly invisible on the first page of search results.

    2. Behavioural parent training, the half that gets skipped

    Answer first: for children aged 6 to 12 the American Academy of Pediatrics recommends medication along with parent training in behaviour management, behavioural classroom interventions, or both. Both arms carry Grade A evidence and a strong recommendation.

    This is not an alternative treatment. It is the other half of the standard of care, and it is the half most often left out.

    The Multimodal Treatment of ADHD study, funded by the National Institute of Mental Health and running from 1994 to 2014, found that by 36 months none of the randomly assigned groups differed on any of five outcomes. For academics and other outcomes sitting alongside the core symptoms, medication and behavioural treatment came out equivalent, with combined treatment looking stronger than either alone.

    Behaviour management builds skills and structures that do not stop working when a dose wears off.

    3. Exercise, where the type matters more than the amount

    Answer first, and this is the most actionable finding in the set: plain aerobic exercise showed no benefit to cognitive flexibility. Cognitively engaging exercise showed a large one.

    Across 2024 and 2025 meta-analyses of randomised trials, exercise that requires continuously monitoring other people and adapting a strategy, meaning team sports and water sports, produced large improvements. In 9 studies with 301 children the effect on cognitive flexibility was large. In 11 randomised trials with 388 children it was medium to large. In 9 trials with 398 children the effect on working memory was large.

    Running laps did not do this. Soccer did.

    Nobody tells parents that the treadmill and the soccer team are not interchangeable. On this evidence they are not.

    The honest counterweight: one broader meta-analysis found a non-significant effect on executive functioning overall, g = 0.492, p = 0.215, 95% CI -0.286 to 1.269. That interval is wide and crosses zero. The field is not unanimous, and the specific finding about exercise type is stronger than the general claim that exercise helps.

    4. Micronutrients, the biggest single number with the biggest caveats

    Answer first: in a fully blinded placebo-controlled trial, 54 percent of children on a 36-ingredient micronutrient formula were rated treatment responders versus 18 percent on placebo.

    That is the MADDY study, a three-site 8-week randomised trial of 126 children aged 6 to 12 with ADHD plus at least one impairing irritability symptom. A separate analysis found response was independent of baseline diet quality, which undercuts the assumption that only poorly fed children benefit.

    The caveats are load-bearing. Eight weeks is short. Enrolment required irritability, so it does not generalise cleanly to children without it. And critically, the cohort was not medicated, so this tells you nothing about what adding it to an existing prescription does.

    5. Omega-3, the one everyone writes about

    Answer first: pooled across all randomised trials the effect was not statistically significant, SMD -0.16, 95% CI -0.34 to 0.01, p = 0.07.

    Duration is what separates the trials that worked from the ones that did not. Trials running at least four months showed SMD -0.35, 95% CI -0.61 to -0.09, p = 0.007. Short trials fail.

    Two practical points that contradict how these products are sold:

    • Baseline status is the modifier. Children with the lowest starting EPA and DHA showed the largest improvements. A child who is already replete has less room to gain.
    • Neither a high EPA dose nor a high EPA to DHA ratio improved outcomes. Paying more for a higher-EPA formula is not supported by the data.

    Omega-3 is the most written-about intervention for childhood ADHD and the fifth strongest on this evidence. That gap between coverage and evidence is the reason this article exists.

    6. Elimination diets, deliberately demoted

    Effects concentrate in subsets of children with food sensitivity or atopy, these trials are difficult to blind properly, and the burden on a family is high relative to what the evidence supports. Worth discussing with your prescriber if there is a specific suspicion. Not worth running on spec.

    7. The gut-lining claim, and why it is not a target

    Answer first: the claim that ADHD is caused by a damaged gut lining, and that healing it resolves symptoms, is not supported.

    The evidence usually cited traces to a single small case-control study of zonulin, a marker of intestinal permeability, where the group difference was marginal and the variation within each group was nearly as large as the difference between groups. A larger 2023 study specifically in children with ADHD found no difference in zonulin at all.

    Every study in this area is case-control or cross-sectional, which means none of them can establish cause even in principle. Intestinal permeability is a legitimate research question. It is not a treatment target.

    What this means for you

    1. Ask about sleep first. It has the best evidence in medicated children and the lowest burden of anything here.
    2. Ask whether behavioural parent training is actually in place. It is a Grade A guideline recommendation, not an optional extra, and it is the piece most often missing.
    3. If your child is going to do a sport, favour one requiring constant reading of other players. Team and water sports outperformed plain aerobic work on the outcomes that matter for learning.
    4. Treat supplements as a prescriber conversation, not a purchase. Dosing and interactions are real, and this article deliberately names no doses.
    5. Do not read any of this as a plan to stop medication. That question is answered separately, and the honest answer is that nobody has studied it.

    What we do not know

    The single largest gap is the one at the top of this article. Not one of these trials used discontinuation as an endpoint, so the question parents most want answered has not been asked in a study design capable of answering it.

    Beyond that: the sleep trial is one RCT in one country. The micronutrient result is 8 weeks in an unmedicated, irritability-selected cohort. The exercise literature disagrees with itself at the general level even while the type-specific finding holds. And effect sizes across all of this are modest next to stimulant medication, which is the comparison most families are actually weighing.

    Reader questions

    Can these replace ADHD medication?
    No trial has tested that. Every intervention here was measured against symptom or function outcomes, never against successful discontinuation, so there is no evidence base for using them as a replacement.

    Which single change has the best evidence for a medicated child?
    Sleep. A brief behavioural sleep intervention is the only one of these tested in a population where most children were already taking stimulants, and its benefits were sustained to six months.

    Does exercise help ADHD?
    It depends on the type. Plain aerobic exercise showed no benefit to cognitive flexibility, while cognitively engaging exercise such as team and water sports showed large effects across multiple meta-analyses.

    Is omega-3 worth trying?
    Pooled results were not statistically significant, p = 0.07. Trials of four months or longer did show benefit, and children with the lowest baseline EPA and DHA improved most. Higher EPA doses and ratios did not perform better.

    Do micronutrients work for ADHD?
    A placebo-controlled trial found 54 percent responders versus 18 percent on placebo, but over only 8 weeks and in children who were not taking medication, so it does not tell you what adding it to a prescription does.

    Should we try healing my child's gut to treat ADHD?
    The evidence does not support it. The zonulin finding rests on a small case-control study, a larger 2023 study in children with ADHD found no difference, and all of the research is cross-sectional and cannot establish cause.

    Citations

    1. Hiscock H, Sciberras E, Mensah F, et al. Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial. BMJ. 2015;350:h68.
    2. Johnstone JM, Hatsu I, Tost G, et al. Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial. Journal of the American Academy of Child and Adolescent Psychiatry. 2022;61(5):647-661.
    3. Wolraich ML, Hagan JF, Allan C, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4):e20192528.
    4. National Institute of Mental Health. Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study. 1994 to 2014.
    5. Asbjornsdottir B, et al. Zonulin-Dependent Intestinal Permeability in Children Diagnosed with Mental Disorders: A Systematic Review and Meta-Analysis. Nutrients. 2020;12(7):1982.
    6. Lee SY, Li SC, Yang CY, Kuo HC, Chou WJ, Wang LJ. Gut Leakage Markers and Cognitive Functions in Patients with Attention-Deficit/Hyperactivity Disorder. Children (Basel). 2023;10(3):513.

    This article is educational and is not medical advice. Decisions about starting, changing, or stopping any prescription, supplement, or diet belong to you and the physician who treats your child. I am a chiropractor. I do not prescribe or manage ADHD medication, and nothing here should be read as a recommendation to alter your child's treatment. Chiropractic care is not a treatment for ADHD and this article makes no such claim.

  • About One in Three Children Can Stop ADHD Medication Without Relapse. Almost Nobody Checks.

    Medically reviewed by Dr. Jason Forward, DC, July 2026

    If your child has been on the same ADHD prescription for two years, has anyone actually tested whether he still needs it?

    The short answer

    A 2021 review in Frontiers in Psychiatry found that roughly 30 percent of young people on stimulant medication for ADHD tolerated stopping it without relapse or worsening symptoms. Clinical guidelines support periodically testing whether medication is still needed. In practice that test is rarely run, so a child can stay on a prescription for years without anyone checking.

    What the researchers studied, and what they found

    Lohr and colleagues reviewed the published evidence on intentionally stopping stimulants in children and teenagers. Not stopping because a family gave up, or because a prescription lapsed, but stopping on purpose to find out whether the medication was still doing something.

    Their central number: about 30 percent tolerated discontinuation without relapse or symptom deterioration. In one observational study, 11 of 42 children showed no clinical deterioration at all when medication was stopped.

    Roughly one in three or four medicated children may no longer need the medication, and the only way anyone finds out is if somebody deliberately checks.

    The review also described how a proper test is run. A one week drug free trial, with the child assessed in more than one setting, because rebound at home and rebound at school do not look the same. If that week is inconclusive, a placebo controlled trial over three to four weeks. Most relapse shows up within two weeks, which means a family does not wait long to get an answer.

    The review supports considering these trials annually, lasting several days to a week.

    Who is most likely to succeed, and who is not

    Answer first: the strongest predictor in the data was being older. Youth above a median age of 13.8 years showed no worsening when switched to placebo.

    That matters, and it cuts against younger children. If you are the parent of a second grader, the evidence favouring successful discontinuation was largely generated in kids considerably older than yours. That is not a reason to skip the conversation. It is a reason to have realistic expectations going into it.

    The other predictors were:

    • No recent need for a dose increase
    • No deterioration when doses were missed, or during previous drug holidays
    • Symptom free for longer than a year

    The one predictor a parent can observe without any help from a clinic is whether a missed dose or a skipped weekend actually made things worse.

    If your child has gone Saturday and Sunday without medication and nothing fell apart, that is real information. Write it down. It is the single most useful thing you can bring to the prescribing physician.

    The part about school, which is not what most parents are told

    This is where the research gets uncomfortable, and where most articles stop short.

    The Multimodal Treatment of ADHD study, funded by the National Institute of Mental Health, ran from 1994 to 2014 and is the largest trial of its kind. Children were randomly assigned to medication management, behavioural therapy, both, or routine community care.

    By 36 months, none of the randomly assigned groups differed significantly on any of five clinical and functional outcomes. Reading achievement was one of them.

    The early advantage did not hold. Once the study interventions ended and medication was used less intensively, the differences between the groups dissipated.

    Parents are routinely told that medication will help with school. The largest long term trial found the between group difference in reading achievement was gone by three years.

    Two things are worth saying carefully here. Treatment did improve long term outcomes compared with untreated ADHD, though generally not all the way to typical levels. And for the outcomes that sit alongside the core symptoms, including academics, medication and behavioural treatment came out equivalent, with combined treatment looking stronger than either one alone.

    So the honest version is not "medication does not help him learn." It is that medication alone is not the thing that carries academic gains forward, and the trial that looked hardest for that effect did not find it at three years.

    What the guidelines already say, and what usually gets skipped

    The American Academy of Pediatrics clinical practice guideline for children aged six to twelve does not recommend medication on its own. It recommends FDA approved medication along with parent training in behaviour management, behavioural classroom interventions, or both. Both arms carry Grade A evidence and a strong recommendation.

    The guideline also asks clinicians to reassess and document the response four to six weeks after starting a medication, using rating scales from more than one informant plus a side effect checklist, and to manage ADHD as a chronic condition rather than a solved problem.

    The behavioural half of the guideline is the half that builds capability the child keeps. It is also the half most often left out.

    That is the connection to everything above. Behaviour management and classroom supports are skills and structures that do not stop working when a pill wears off. They are also what makes a discontinuation trial more likely to hold rather than merely possible.

    Why this is your prescriber's job and not a home experiment

    Answer first: stopping is not risk free, the effects are specific, and they need someone watching who can prescribe.

    Documented withdrawal and rebound effects in the review included vomiting, headaches, light sensitivity, muscle cramps, rapid weight gain, movement disorders, and psychiatric symptoms including depression and a psychotic like presentation. Acute dystonia was reported when stimulants were combined with antipsychotics.

    There is also timing. A discontinuation trial run during a move, a school change, or any other period of upheaval will produce an answer you cannot trust, because you will not know what caused what.

    None of this is an argument against asking. It is an argument for asking the physician who prescribes the medication, and letting them design the trial.

    What this means for you

    If you are wondering whether your child still needs his prescription, here is what the research supports you doing.

    1. Write down what you have already observed. Missed doses, skipped weekends, school holidays. Did anything actually get worse? That is predictor data and you already have it.
    2. Ask the prescribing physician directly about a planned trial off medication. Use those words. You are not asking to stop the medication, you are asking whether a reassessment is appropriate.
    3. Ask whether the behavioural half of the guideline is in place. Parent training in behaviour management and classroom interventions are Grade A recommendations for this age group, not optional extras.
    4. Expect to be assessed in more than one setting. Home and school separately. His teacher's observations are part of the data, not a courtesy.
    5. Do not run it during a transition. Not during a move, not the first month of a new school year.

    What we do not know

    This is a review of existing studies, not a single large trial of discontinuation, and the studies it drew on differ in method and quality.

    The 30 percent figure is a proportion across a body of research, not a prediction about any individual child. Nothing in this literature tells you which group your child is in. The strongest predictor available, older age, works against younger children specifically.

    The MTA result is also frequently over read in both directions. It does not show that medication is useless, and it does not show that behavioural treatment is superior. It shows that by three years the randomly assigned groups had converged, in a study where treatment fidelity naturally dropped after the trial phase ended.

    One more thing worth addressing, because parents encounter it constantly online. The claim that ADHD is caused by a damaged gut lining, and that healing it will resolve symptoms, is not supported. The evidence usually cited traces back to a single small case control study of zonulin, a marker of intestinal permeability, where the group difference was marginal and the variation within each group was nearly as large as the difference between them. A larger 2023 study specifically in children with ADHD found no difference in zonulin at all. Every study in this area is case control or cross sectional, which means none of them can establish cause. Intestinal permeability is an interesting research question. It is not a treatment target.

    Reader questions

    Can a child safely stop ADHD medication?
    About 30 percent of medicated young people tolerated stopping without relapse in the reviewed evidence. Whether any individual child is in that group is not predictable in advance, which is why the decision and the monitoring belong to the prescribing physician.

    How is a discontinuation trial actually run?
    A one week drug free trial with the child assessed in more than one setting, home and school separately. If that is inconclusive, a placebo controlled trial over three to four weeks. Most relapse appears within two weeks.

    Which children are most likely to succeed at stopping?
    Older children, those with no recent dose increase, those who did not deteriorate during missed doses or previous drug holidays, and those symptom free for longer than a year.

    Does ADHD medication improve school performance long term?
    The MTA study found no significant difference between randomly assigned groups on five outcomes including reading achievement by 36 months. Medication and behavioural treatment came out equivalent on academic outcomes, with combined treatment stronger than either alone.

    Is a damaged gut lining the cause of ADHD?
    No. The zonulin evidence traces to a small case control study with a marginal difference, and a larger 2023 study in children with ADHD found no difference at all. All of this research is cross sectional, so none of it can establish cause.

    Should I stop my child's medication on my own?
    No. Documented withdrawal and rebound effects include vomiting, headaches, movement disorders, and psychiatric symptoms. A trial needs a prescriber designing and watching it.

    Citations

    1. Lohr WD, Wanta JW, Baker M, Grudnikoff E, Morgan W, Chhabra D, Lee T. Intentional Discontinuation of Psychostimulants Used to Treat ADHD in Youth: A Review and Analysis. Frontiers in Psychiatry. 2021 Apr 20;12:642798.
    2. Wolraich ML, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4):e20192528.
    3. National Institute of Mental Health. Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study. 1994 to 2014.
    4. Asbjornsdottir B, et al. Zonulin-Dependent Intestinal Permeability in Children Diagnosed with Mental Disorders: A Systematic Review and Meta-Analysis. Nutrients. 2020 Jul 3;12(7):1982.
    5. Lee SY, Li SC, Yang CY, Kuo HC, Chou WJ, Wang LJ. Gut Leakage Markers and Cognitive Functions in Patients with Attention-Deficit/Hyperactivity Disorder. Children (Basel). 2023 Mar 5;10(3):513.

    This article is educational and is not medical advice. Decisions about starting, changing, or stopping any prescription belong to you and the physician who prescribes it. I am a chiropractor. I do not prescribe or manage ADHD medication, and nothing here should be read as a recommendation to alter your child's treatment.

  • Back Pain in Teenagers Is Rising: What Parents Should Know
    Home›The Forward Review›Back Pain in Teenagers
    The Forward Review Live Commentary Vol. I · Issue 10 · July 2026
    Population Study Volume 1 · Issue 10 Adolescent Health Back Pain

    Back Pain in Teenagers Is Rising: What Parents Should Know

    Back pain in teenagers is no longer a rare adult problem borrowed early. A 2025 analysis of the Global Burden of Disease 2021 study counted 38.5 million new cases of low back pain in kids aged 10 to 19 in a single year, with girls affected more than boys. Here is the honest read of the evidence, what actually causes it, and the warning signs that mean a doctor, not a chiropractor.

    Jason Forward, DC, Vanguard Chiropractic, Tulsa, Oklahoma Published July 7, 2026
    ✓ Medically reviewed by Dr. Jason Forward, DC, July 2026. Last updated July 2026.
    Reviewing
    Wang S, Zhang S, Li M, et al. Global, Regional and National Burden of Low Back Pain in Adolescents Aged 10-19 Years, 1990-2021: A Systematic Analysis of the Global Burden of Disease Study 2021. Journal of Pain Research. 2025;18.
    DOI: 10.2147/JPR.S525330 · PMID: 40599254

    Key Points

    • The Global Burden of Disease 2021 analysis counted 38,476,826 new cases of low back pain in adolescents aged 10 to 19 worldwide in 2021, plus more than 19 million teens living with it at any given time (Wang and colleagues, 2025).
    • Girls carried higher rates than boys across incidence, prevalence, and disability. Back pain in teenagers is not evenly distributed between the sexes.
    • The rate per 100,000 actually fell slightly from 1990 to 2021, but the raw number of affected teens rose, so more real families are dealing with it now, not fewer.
    • The heavy-backpack story is mostly a myth. A systematic review of 69 studies and more than 72,000 young people found no convincing evidence that schoolbag weight or how it is carried causes back pain (Yamato and colleagues, 2018).
    • The likelier drivers are sedentary screen posture, sport overuse, and the growth spurt itself. A 2026 meta-analysis found a 26 percent rise in the odds of low back pain for each extra hour of daily screen time (Calvo-Munoz and colleagues, 2026).
    • Most teen back pain is mechanical and settles with movement and hands-on care. A short list of warning signs, including night pain that wakes the child and fever, means a physician or the emergency room, not a clinic.
    Plain Language Summary

    If your teenager keeps complaining that their back hurts, you are not imagining a trend. Low back pain in kids aged 10 to 19 is common and rising in raw numbers, and girls report it more than boys. The reflex is to blame the backpack, but the best evidence does not support that. Heavy bags are not the villain most people assume.

    The more likely causes are hours hunched over a phone, the repetitive load of a single sport, and the growth spurt, when bones lengthen faster than muscles can keep up. Each of these is mechanical, which means it responds to movement, better positioning, and time.

    Most teen back pain is not dangerous and gets better. A few signs are different: pain that wakes them at night, fever with back pain, weakness or numbness in the legs, or pain after a hard fall. Those need a doctor, not a chiropractor. Everything below explains how to tell the difference.

    Why This Question Matters

    Back pain used to be filed under adult problems. The 2021 global data breaks that assumption. With 38.5 million new adolescent cases counted in a single year and girls affected more than boys, teen back pain is now a mainstream childhood health issue, and how parents respond in the teen years shapes the adult spine that follows.

    "The question is no longer whether teenagers get back pain. It is what is driving it, and which cases are the ones to worry about."

    For a long time, back pain in teenagers was treated as a fluke. A kid who complained of a sore lower back got told to stand up straight and shake it off. The 2021 numbers make that dismissal hard to defend. In the Global Burden of Disease 2021 analysis, published in the Journal of Pain Research in 2025, researchers counted 38,476,826 new cases of low back pain among people aged 10 to 19 across the world in that year alone, with more than 19 million living with it at any given moment (Wang and colleagues, 2025). That is not a fluke. That is one of the most common health complaints of the teenage years.

    Why it matters is simple. The habits, the sport loads, and the postures that show up in adolescence do not stop at graduation. Low back pain is the single leading cause of disability in adults worldwide, and a meaningful share of adults with chronic back trouble report that it started young. Getting the teenage version right, treating it seriously without overtreating it, is one of the more practical things a parent can do for a child's long-term health. This is the same reason The Forward Review has covered the pediatric end of the spectrum too, including a companion commentary on why infants get referred to chiropractors in the first place. The through line is the same: take young spines seriously, and know exactly when the problem is not a spine problem at all.

    The Study: What the Global Data Shows

    Wang and colleagues pulled the Global Burden of Disease 2021 dataset and isolated everyone aged 10 to 19 with low back pain, across every country, from 1990 to 2021. They measured new cases, existing cases, and disability, then compared trends over three decades and between the sexes. It is the clearest picture of adolescent back pain we have.

    The Global Burden of Disease study is the largest ongoing effort to measure the world's health, pooling data from hundreds of countries into a single comparable framework. Wang and colleagues took the 2021 release and narrowed it to the 10 to 19 age band, the group most people never think of as back-pain patients (Wang and colleagues, 2025). They were not running a treatment trial. They were counting, carefully, how much low back pain exists in this age group, how that has changed since 1990, and who carries the heaviest share.

    The headline counts for 2021 are worth stating plainly. There were 38,476,826 new cases of low back pain in adolescents that year. There were 19,234,452 teens living with it at any given time. And it generated more than 4.2 million years lived with disability, a measure of how much healthy life is lost to a condition that rarely kills but often lingers. These are cited estimates with uncertainty ranges, not exact head counts, but the scale is unambiguous.

    "The rate per teenager edged down over thirty years. The number of teenagers in pain went up. Both are true, and the second one is what a parent feels."

    One nuance matters for reading the trend honestly. The age-standardized incidence rate, which adjusts for the size and age mix of the population, actually declined a little, from about 1,573 per 100,000 in 1990 to about 1,488 per 100,000 in 2021. So on a per-teenager basis, the risk did not explode. What rose was the absolute count, because the adolescent population itself grew. For a parent, the lived reality is the raw number: more kids in more households dealing with back pain than a generation ago.

    Adolescent Low Back Pain, GBD 2021 at a Glance
    Measure (ages 10-19, 2021)Finding
    New cases in 202138,476,826
    Living with it (prevalent)19,234,452
    Years lived with disability4,205,995
    Incidence rate trendFell, 1,573 to 1,488 per 100,000 (1990 to 2021)
    Sex differenceFemales higher across all measures

    The Backpack Myth, and What Really Causes It

    The single most common thing parents blame is the heavy backpack. The evidence does not back that up. A large systematic review found no convincing link between schoolbag weight or carriage and back pain. The real drivers are more mundane: long hours in a slouched screen posture, the repetitive load of one sport, and the growth spurt itself.

    "Blaming the backpack is comforting because it is fixable with a new bag. The real causes take a little more than a shopping trip."

    Let me start by clearing the most stubborn myth in this whole topic. Parents are convinced the backpack did it. It is intuitive: heavy load, young spine, sore back. But when Yamato and colleagues gathered 69 studies covering more than 72,000 children and adolescents, they found no convincing evidence that schoolbag weight, design, or how the bag is carried increases the risk of back pain (Yamato and colleagues, 2018). That does not mean a genuinely overloaded bag is fine for a small child, and comfort still counts. It means the backpack is not the cause of the trend, and swapping bags will not fix a back that hurts for other reasons. This is the kind of honest correction that matters, because chasing the wrong cause wastes time the real cause keeps using.

    So what does drive back pain in teenagers? Three mechanical stories cover most of it.

    1. Screen posture and sitting still

    The average teenager now spends much of the day folded over a phone or a laptop. Held for hours, a slouched, head-forward posture loads the discs and the muscles of the lower back in a sustained way the spine was not built to hold. The posture itself is not an injury. The problem is the dose, the sheer number of hours without a change of position. A 2026 systematic review and meta-analysis found a dose-response signal: for each additional hour of daily screen time, the odds of low back pain rose by about 26 percent (Calvo-Munoz and colleagues, 2026). I will be honest about the limits of that number in a moment, because the same paper found a weaker signal on a different analysis, but the direction lines up with what any clinician sees in the room.

    2. Sport, especially the repetitive kind

    The second driver is sport, and it cuts both ways. Active kids are healthier kids, and I never want a teenager to stop training. But some sports load the lower back in a repetitive extension pattern, arching backward again and again, and that specific load can stress the pars interarticularis, a small bridge of bone in the vertebra. Gymnastics, dance, diving, and positions in football and volleyball that involve constant back-arching are the classic examples. When that bone is stressed past its tolerance, it can develop a stress reaction or a stress fracture called spondylolysis. Back pain that is one-sided, worse with arching backward, and tied to a specific sport deserves a proper evaluation rather than a wait-and-see.

    3. The growth spurt itself

    The third driver is the one nobody can shop their way out of: growth. During the adolescent growth spurt, the long bones lengthen quickly, and the muscles, tendons, and fascia that cross the spine and hips do not stretch at the same pace. For a window of months, a teenager can be transiently tighter, less flexible, and more mechanically loaded through the lower back than they were the year before. This is a normal developmental phase, not a disease, but it is a real reason back pain in teenagers clusters around the fastest-growing years. It usually settles as the soft tissue catches up, especially with movement that keeps the hips and hamstrings mobile.

    WHO 2020 physical activity guideline (Bull and colleagues): children and adolescents aged 5 to 17 should average at least 60 minutes per day of moderate-to-vigorous physical activity, mostly aerobic, and should add vigorous activity plus muscle- and bone-strengthening work on at least 3 days a week, while limiting sedentary screen time.

    What this means in plain terms: the fix for most teen back pain is not less activity, it is the right activity, plus fewer unbroken hours in a chair. A teenager who hits the 60-minute daily target and breaks up screen time is doing more for their back than any ergonomic backpack could.

    For the full guideline: Bull FC, et al. WHO 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020.

    What This Means Clinically

    In practice, most teenage back pain I see is mechanical and self-limiting. The job is not to medicalize a growing spine, it is to screen out the rare serious cause, restore movement where a segment is stiff and guarded, and coach the family on load, posture, and pacing so the pain does not become a habit.

    When a parent brings a teenager into the clinic for back pain, my first job is not treatment. It is triage. The overwhelming majority of these cases are mechanical: a stiff, guarded lower back from too much sitting, a sport that outran the body's recovery, or a growth phase that left the hamstrings and hip flexors tight. But a small number are not mechanical at all, and the entire point of a careful exam is to catch those before anyone lays a hand on the spine. I go through the warning signs listed below on every young patient, every time.

    "With a teenager, the skill is not the adjustment. It is knowing which backs to adjust and which backs to send to a physician."

    Once the serious causes are screened out, mechanical teen back pain responds well to the same principles that help adults: restore motion to a segment that has locked up and started guarding, calm the surrounding muscle, and then get the teenager moving again in a way their body can handle. A hands-on adjustment plus targeted soft-tissue work can lower the mechanical restriction enough that a stiff, sore teen can return to walking, training, and normal life without the back talking them out of it. I want to be plain about the limits of that claim. Hands-on care does not cure a growth spurt and it does not rebuild a stress-fractured vertebra. It helps a mechanical back move better while the body does its own healing.

    I treat patients of all ages at Vanguard, including children and teenagers, and I am honest with families about where my lane ends. I am a licensed chiropractor, not a certified pediatric specialist, and there is no version of care I offer that replaces a pediatrician for anything on the red-flag list. For families who want a fuller picture of how I approach younger patients, the mechanics, the fingertip-level force used with small children, and the referral thresholds, I lay it out on the pediatric chiropractor page. The same rule governs a toddler and a fifteen-year-old: gentle, evidence-guided, and quick to refer out when the signs point somewhere else.

    Patient Translation: What to Do at Home First

    For run-of-the-mill teen back soreness, the first moves are simple and free. Keep them gently active rather than bed-bound, break up long sitting, work on hip and hamstring mobility, and scale sport load instead of stopping cold. Give it a couple of weeks. Pain that is easing is usually mechanical and on the mend.

    If your teenager has a sore lower back and none of the warning signs below, you can start at home before you book anyone. The biggest mistake I see is the instinct to put the kid on the couch. Rest feels protective, but for mechanical back pain, prolonged rest stiffens the joints and deconditions the muscles, and the pain often gets worse, not better. Gentle, tolerable movement is the better default. A daily walk, easy stretching for the hips and hamstrings, and a return to normal activity as symptoms allow will resolve most of these.

    Break up the sitting. A teenager parked at a desk or a console for three unbroken hours is asking their lower back to hold one position far too long. A stand-and-move break every 30 to 45 minutes does more than any posture lecture. And do not pull them out of sport unless a specific movement clearly provokes the pain. The fix for a sport-loaded back is usually to scale the load and fix the movement, not to quit. If a single arching or twisting movement is the trigger, that is worth an evaluation, because that is the pattern that can signal a stress reaction in the bone.

    Give it a time frame. Mechanical teen back pain that is gradually improving over one to two weeks is behaving the way mechanical pain should. Pain that is not improving after a couple of weeks, or that is getting worse, is a reason to get it looked at. And any of the red-flag signs below changes the plan immediately, from home care to a doctor.

    When It Is Not a Chiropractic Problem

    Most back pain in teenagers is mechanical and safe to manage with movement and hands-on care. A short list of signs points to something that is not mechanical and needs medical evaluation, not a chiropractor. For a teenager, call a physician or go to the emergency room, do not come to the clinic, if you see any of these:

    • Back pain that wakes them at night or is constant and unrelenting, especially with unexplained weight loss (possible tumor or infection)
    • Fever, chills, or a rash together with back pain (possible infection)
    • Weakness, numbness, or tingling in one or both legs, a foot that drags, or any change in bladder or bowel control (possible nerve involvement, a medical emergency)
    • Back pain after a hard fall, a car accident, or a significant sports collision (possible fracture)
    • A history of cancer, or a teenager who is systemically unwell and not just sore

    The pediatric page this article links to covers care for all ages, including infants and young children. Because parents of younger kids read here too, the emergency signs in a baby or small child are different and must not be missed. Call your pediatrician or go to the emergency room, not the clinic, for any of these in an infant or young child:

    • Failure to thrive or poor weight gain
    • Fever in an infant under 3 months
    • Lethargy, decreased responsiveness, or unusual irritability
    • Refusal to feed lasting more than a few hours
    • A bulging soft spot on the head (fontanelle) or other signs of pressure inside the skull
    • A suspected fracture or unexplained bruising

    A careful evaluation screens for every one of these before any treatment. Honest care means knowing exactly what a spine problem is not.

    Limitations: What We Do Not Know

    The GBD 2021 adolescent analysis is a modeled burden estimate, not a head count. It pools data of varying quality across countries and fills gaps with statistical modeling, so the case numbers carry real uncertainty ranges. It tells us how much back pain exists in this age group, not what caused any individual case.

    The screen-time evidence is mixed and should not be oversold. The 2026 meta-analysis found a 26 percent rise in odds per hour on a dose-response analysis, but its pairwise analysis showed no significant association, and the authors flagged high variability between studies and risk of bias. Read it as a plausible signal, not a settled fact.

    The backpack systematic review is strong on its central point, that schoolbags are not a proven cause of back pain, but most included studies were observational, and absence of a proven link is not the same as proof of no effect for an extreme outlier load. The growth-spurt mechanism described here is clinical reasoning grounded in developmental physiology, not a single randomized trial.

    This commentary concerns ordinary, non-emergency mechanical back pain in teenagers. It does not apply to the red-flag presentations listed above, which require medical evaluation, and it is general education, not a diagnosis of any individual child.

    The Bottom Line

    Back pain in teenagers is common, rising in raw numbers, and more frequent in girls. The backpack is mostly innocent. The real drivers are screen posture, sport overuse, and the growth spurt, and all three respond to movement, better pacing, and time. Most cases settle at home. A short list of warning signs means a physician, not a chiropractor. Know the difference, and a teenager's sore back rarely becomes an adult's chronic one.

    If a Teenager's Back Is Not Getting Better

    Walk in to Vanguard Chiropractic in Brookside

    If your teenager's back pain has none of the warning signs above but is not settling on its own, a hands-on evaluation can find the stiff, guarded segment and get them moving again. I screen every young patient for the serious causes first, and I refer out fast when the signs point to a physician.

    Vanguard Chiropractic
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    Frequently Asked Questions

    Is back pain in teenagers normal or something to worry about?
    Most of it is normal and mechanical. The Global Burden of Disease 2021 data counted 38.5 million new adolescent cases in a single year, so it is genuinely common. The large majority settles with movement and time. The exceptions that need a doctor are pain that wakes them at night, fever with back pain, leg weakness or numbness, loss of bladder or bowel control, or pain after a hard fall. Those signs change the plan from home care to medical evaluation.
    Does a heavy backpack cause back pain in teenagers?
    Probably not, despite how much sense it seems to make. A systematic review of 69 studies and more than 72,000 young people (Yamato and colleagues, 2018) found no convincing evidence that schoolbag weight, design, or carriage method causes back pain in children and adolescents. Comfort still matters and a genuinely overloaded bag for a small child is worth fixing, but swapping backpacks will not resolve a back that hurts for other reasons like posture, sport, or growth.
    What actually causes most teenage back pain?
    Three mechanical causes cover most cases. First, sustained slouched screen posture, where the load is the sheer number of unbroken sitting hours. Second, sport overuse, especially repetitive back-arching sports that can stress a small bridge of bone in the vertebra. Third, the growth spurt, when bones lengthen faster than muscles can keep pace, leaving a teenager transiently tight and more loaded through the lower back. All three respond to movement, pacing, and time.
    Why do teenage girls get back pain more than boys?
    The GBD 2021 analysis found females had higher rates of low back pain than males across incidence, prevalence, and disability in the 10 to 19 age group. The data shows the difference clearly but does not pin down a single cause. Likely contributors include differences in the timing and pattern of the growth spurt, hormonal changes, and how symptoms are reported. The practical takeaway is to take a teenage girl's back pain as seriously as anyone else's, not to explain it away.
    Should my teenager rest or stay active with back pain?
    Stay active, in almost every mechanical case. Prolonged rest stiffens joints and weakens muscles, and pain often worsens with it. Keep your teenager gently moving, break up long sitting, and scale sport load rather than stopping cold unless one specific movement clearly triggers the pain. Give ordinary soreness one to two weeks to improve. Pain that is worsening, not improving, or paired with any red-flag sign is the signal to get it evaluated rather than to keep resting.
    Can a chiropractor help a teenager with back pain?
    For mechanical back pain with no warning signs, yes, once the serious causes are screened out. When a spinal segment stiffens and the surrounding muscles guard, a hands-on adjustment with soft-tissue work can restore motion and make normal activity tolerable again. It does not cure a growth spurt or heal a stress fracture. At Vanguard Chiropractic in Brookside, that evaluation is a 40 dollar walk-in visit, no contract, stop any time, and I refer out fast when the signs point to a physician instead.
    Cite This Commentary Forward J. Back pain in teenagers is rising: what parents should know. The Forward Review. 2026;1(10). https://vanguardchiro.com/research/back-pain-in-teenagers-2026/
    Related Reading
    Return to The Forward Review

    Editorial Disclosure

    The Forward Review is editorial commentary, not peer reviewed. Written and medically reviewed by Jason Forward, DC, a licensed chiropractor at Vanguard Chiropractic in Tulsa, Oklahoma. Dr. Forward treats patients of all ages but is not a certified pediatric chiropractor. Commentary reflects clinical interpretation and does not represent the views of the original study authors, the Global Burden of Disease collaborators, the World Health Organization, or any institution. It is general education, not medical advice for any individual child. Individual results vary.

    Conflict of interest: Dr. Forward is a practicing chiropractor whose clinical work includes hands-on care intended to restore movement. No financial relationships with the cited authors or publishers.

    Corrections policy: Errors are corrected with a dated correction notice appended to the article. Original text remains accessible via revision history.

    Level of evidence: One modeled global burden analysis (primary), two systematic reviews, and one international guideline. Certainty ranges from low (modeled burden and mixed screen-time evidence) to moderate.

  • Home›The Forward Review›Volume 1
    The Forward Review Live Commentary Vol. I · May 2026
    Cross-Sectional Study Volume 1 Infant Care Referral Patterns

    Why Infants Get Referred to Chiropractors: A 1,049-Baby Danish Snapshot

    Overgaard and colleagues pulled the curtain back on what actually walks through the door of a Danish chiropractic clinic when the patient is under one year old. The complaint pattern is more mechanical than most parents (and most pediatricians) would guess, and the referral pathway runs through public-health visitors more often than through the family doctor.

    Jason Forward, DC, Vanguard Chiropractic, Tulsa, Oklahoma Published May 5, 2026
    Reviewing
    Overgaard FG, Hedegaard-Johansson C, Hestbaek L. Clinical profiles and referral patterns of infants attending Danish chiropractic clinics: a nationwide cross-sectional study. Chiropractic & Manual Therapies. 2026 Feb 24;34(1):9.
    DOI: 10.1186/s12998-026-00629-z · PMID: 41736128
    Featured Definition

    Infant chiropractic referral patterns describe how babies under one year arrive at a chiropractic clinic, who sends them, and what the parents are asking about. In this Danish study of 1,049 infants, the most common reason was abnormal range of motion in the neck or spine (48 percent). About half of the babies were referred by another healthcare professional, most often a public-health visitor (44 percent of all referrals).

    Key Points

    • Nationwide cross-sectional survey of Danish chiropractic clinics, covering 1,049 infants aged 0 to 12 months seen between November 2018 and October 2019.
    • The most common primary complaint was abnormal range of motion in the neck or spine, at 48 percent. Crying or infantile colic came second at 17 percent. Feeding problems and disturbed sleep tied at 5 percent each.
    • Most complaints had been present for somewhere between one week and three months before parents sought care. This is not a same-day visit pattern. Parents tried other things first.
    • Secondary complaints showed up in 58 percent of cases. Babies rarely came in with one isolated issue. Range of motion, sleep, and feeding clustered together more often than not.
    • Healthcare-professional referrals accounted for 51 percent of visits. The single largest source was the Danish public-health visitor system at 44 percent of those referrals, not the family physician.
    • Denmark integrates chiropractors into the standard healthcare pathway in a way the United States does not. The complaint mix probably translates. The referral mix definitely does not.

    What the Researchers Did

    The team behind this paper sat at the Spine Centre of Southern Denmark, the University of Southern Denmark, the Chiropractic Knowledge Hub, and Macquarie University in Sydney. They invited every chiropractic clinic in the Danish Chiropractors' Association, all 238 of them, to take part in a national electronic survey. Clinicians pulled retrospective data from their own medical records, capturing every infant visit between November 2018 and October 2019.

    The questionnaire asked four straightforward things. What is the baby's primary complaint? Is there a secondary complaint, and if so what is it? How long has the symptom been present before this visit? Was the family referred by another healthcare professional, and if so by whom? Demographic data filled out the rest.

    By the time the data window closed in early 2020, 1,049 completed infant questionnaires were in. That is a meaningful national sample for a country of roughly 5.9 million people. The Danish Agency for Patient Safety classified the work as quality assurance, which under Health Act paragraph 42d removed the written-consent requirement. The University of Southern Denmark approved the protocol.

    What They Found

    The headline finding is the complaint mix. Abnormal range of motion in the cervical or upper-thoracic spine accounted for 48 percent of primary complaints. In plain terms, parents were noticing that the baby preferred to look one direction, struggled to turn the head fully, or held the neck in a fixed posture. Crying or infantile colic followed at 17 percent. Feeding problems and disturbed sleep each came in at 5 percent. The remaining 25 percent split across a long tail of less common reasons.

    The duration data is just as telling. Most of these complaints had been present somewhere between one week and three months before the family showed up at the chiropractic clinic. Parents were not bringing newborns in on day three. They were bringing in babies whose problems had persisted long enough to outlast the early reassurance of "this will probably resolve on its own."

    Secondary complaints showed up in 58 percent of cases. The most common secondary patterns were abnormal range of motion (41 percent), disturbed sleep (22 percent), and feeding problems (21 percent). The clinical takeaway here is that infant presentations cluster. A baby who is hard to console at night is often also a baby who turns the head one way more easily than the other. Parents may report only the loudest symptom. The clinician has to look for the rest.

    The referral pathway data is where the Danish context becomes impossible to ignore. Fifty-one percent of infants were referred by another healthcare professional. Of those referrals, 44 percent came from the Danish healthcare-visitor system, a publicly funded program in which trained nurses visit every newborn at home in the early months of life. General practitioners and other providers made up the rest of the referral pool. In other words, the system is built so that the people who already see the baby at home in the first weeks of life have a clear pathway to a chiropractor when something looks off.

    Clinical Perspective: What I See in My Practice

    The complaint mix in this Danish dataset matches what I see in my Tulsa practice when parents bring in an infant. I do treat infants. I am not a board-certified pediatric chiropractor and I do not hold the Webster certification. I want that on the record up front because parents deserve to know what credentials a clinician carries before any hands go on a baby. With that boundary stated, the work I do with infants is gentle, low-force, and focused on restoring symmetric movement of the cervical spine and pelvis using sustained light pressure rather than the higher-velocity adjustments used on adults.

    The most common reason I see infants is the same thing this study found. A parent notices that the baby always turns the head one direction, has a flat spot starting on one side of the skull, fights tummy time, or refuses to nurse from one breast. Pediatricians often call this a positional preference or, when it is more pronounced, congenital muscular torticollis. Whatever the label, the underlying issue is asymmetric movement of the upper neck. The baby is not choosing the favorite side. The favorite side is the only side that moves freely.

    I also see the cluster pattern this study documented. The baby who cannot turn the head left often also struggles to nurse on one side, sleeps poorly, and arches the back when laid down. Parents typically present the loudest symptom first. My job is to ask the next three questions and look for the rest.

    What I do not see in my practice, because the U.S. system is not built this way, is referrals from a public-health visitor. There is no equivalent program in Tulsa. Most of my infant referrals come from word of mouth, from lactation consultants, from a small number of pediatricians who know my work, and from postpartum doulas. The Danish 44 percent figure is not a number I will replicate. The complaint pattern is.

    What This Means for Parents

    If you are a Tulsa parent reading this, here is the practical translation.

    First, an infant who consistently turns the head one direction more easily than the other is showing you something mechanical. It is worth getting checked. The fix may be repositioning, tummy time strategy, lactation guidance, gentle physical therapy, gentle chiropractic care, or some combination depending on what is going on. The right starting point is an honest assessment of which side moves and which does not.

    Second, the cluster pattern matters. If your baby has feeding trouble on one side, sleep difficulty, and a head-position preference, those are likely connected, not three separate problems. A clinician who treats them as one mechanical picture will get you further than one who treats each in isolation.

    Third, ask about credentials. Chiropractors in the United States are licensed to treat patients of all ages, including infants. That said, training in pediatric care varies clinician to clinician. Ask any provider you are considering, including me, what their specific experience with infants looks like, what techniques they use, and what red flags would prompt a referral out. A good answer is specific. A vague answer is a flag.

    Fourth, infant chiropractic care, when delivered appropriately, uses light sustained pressure, not the higher-force adjustments adults receive. The amount of force applied is roughly what you would use to test the ripeness of a tomato. If anyone describes anything more aggressive than that for a baby under one year, walk out.

    Vanguard Chiropractic Connection

    At Vanguard Chiropractic in Tulsa, the infants I see most often arrive with the same head-position story this Danish study describes. Parent noticed the baby always looks right, or always nurses better on the left, or has a flattening on one side of the skull. The visit usually starts with watching the baby move, palpating the cervical spine and pelvis with the parent holding, and walking through what positional changes at home might do over a one to two week trial before any hands-on work begins.

    I work with each family on the specific picture in front of me. Some infants benefit from a few gentle visits combined with home positioning changes. Others need a referral to lactation, to physical therapy, or back to the pediatrician for imaging if anything in the history or exam suggests something beyond a positional pattern. The decision tree is built around the baby in front of me, not a protocol applied to every infant who walks in.

    Parents in the Brookside and midtown Tulsa area who want to talk through whether a chiropractic visit makes sense for their baby are welcome to call or walk in. Individual results vary, and if I do not think chiropractic care is the right answer for your specific situation I will tell you so and point you toward what is.

    Limitations and What Is Not Yet Known

    Limitations

    This is a descriptive cross-sectional study. It captures who walked in the door and why. It does not measure outcomes, does not compare against any control, and cannot tell us whether any of these infants got better with chiropractic care, with anything else, or on their own with time.

    Recall and documentation depended on chiropractors pulling data from their own records. Coding of complaints was not standardized across the 238 clinics that were invited. The 1,049 cases came from a subset of clinics that returned the survey, which introduces participation bias. Practices that did not respond may serve a different patient mix.

    The Danish healthcare context limits external translation of the referral findings. The 44 percent healthcare-visitor referral rate reflects a public-health structure that does not exist in the United States. The complaint mix may translate. The referral pathway probably does not.

    Parental report drives the symptom data. What a parent calls colic, what a clinician calls colic, and what the underlying mechanism actually is may be three different things. The category is broad on purpose, but breadth limits how precisely the findings map to specific clinical pictures.

    The data window closed in October 2019. Healthcare delivery patterns since the pandemic period have shifted in ways the dataset cannot reflect.

    What this paper does not establish is whether chiropractic care helps these infants. That is a separate research question requiring a different design. Several small randomized trials and prospective cohort studies have looked at infant chiropractic care for specific complaints, with mixed and generally low-certainty results. The Danish authors are clear that their goal here was to describe the population of infants showing up at chiropractic clinics, not to evaluate the care delivered. Any reader who walks away from this paper claiming it shows chiropractic care works for babies has read more into it than the data supports.

    The Bottom Line

    Forty-eight percent of infants showing up at Danish chiropractic clinics come in for asymmetric neck and spine movement. Crying and colic are a distant second. Most have had the issue for weeks or months before the visit. Half are referred by another healthcare professional, with the public-health visitor system carrying most of that load. The complaint pattern probably describes infant presentations in any country. The referral pathway describes Denmark. Both pieces are useful.

    Cite This Commentary Forward J. Why infants get referred to chiropractors: a 1,049-baby Danish snapshot. The Forward Review. 2026. https://vanguardchiro.com/research/infant-chiropractic-referral-patterns-denmark-2026/
    Read More From The Forward Review
    Cochrane Verdict on Spinal Manipulation for Chronic LBP (de Zoete et al. 2026) PACBACK in JAMA: 1,000 Patients, Four Treatment Arms (Bronfort et al. 2026) Forty-Seven Trials of TMD Patient Education (Ferland et al. 2026) Return to The Forward Review Clinical resource: Walk-in chiropractor in Tulsa

    Editorial Disclosure

    The Forward Review is editorial commentary, not peer reviewed. Written by Jason Forward, DC, a licensed chiropractor at Vanguard Chiropractic in Tulsa, Oklahoma. Commentary reflects clinical interpretation and does not represent the views of the original study authors, the journal Chiropractic & Manual Therapies, or any institution.

    Scope of practice note: Dr. Forward treats infants and pregnant patients. He is not a board-certified pediatric chiropractor and does not hold Webster certification. Parents should always verify a provider's specific experience and training before infant care.

    Conflict of interest: Dr. Forward is a practicing chiropractor who provides infant care in his Tulsa clinic. No financial relationships with the cited authors, the publisher, or any party to this work.

    Corrections policy: Errors are corrected with a dated correction notice appended to the article. Original text remains accessible via revision history.

    Level of evidence: Cross-sectional descriptive study (n=1,049 infants, nationwide Danish sample).

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