Among the 1175 members of the OCQ in 2021 invited, 261 participants completed our survey. The average completion time was 30 minutes. Sixteen participants did not meet the inclusion criteria. The final response rate was 21% with 245 OCQ respondents (Fig. 1).
The demographic data, practice characteristics, and collaborative practices are presented in Table 1. When compared to the available statistics on all licensed chiropractors in Quebec, our sample included more women (63% vs. 46%) and the same number of years of experience (16 years vs. 16 years).21
Table 1
Demographics, practice characteristics, and collaborative practices (N = 245)
| | N | % |
Demographics |
Sex | | | |
| Women | 154 | 62.9 |
| Men | 91 | 37.1 |
Years in practice | mean = 15.7 | SD = 11.3 |
Practice Characteristics |
Average number of pediatric consultations per week |
| [0–5] | 112 | 45.7 |
| [6–10] | 63 | 25.7 |
| [11–15] | 36 | 14.7 |
| [16–20] | 21 | 8.6 |
| [21 +] | 13 | 5.3 |
Average number of new pediatric patients per week |
| [0–5] | 243 | 99.2 |
| [6–10] | 2 | 0.8 |
Age groups most frequently treated (2 answer required) |
| [0–6 months] | 85 | 34.7 |
| [7–23 months] | 68 | 27.8 |
| [2–5 years] | 40 | 16.3 |
| [6–12 years] | 140 | 57.1 |
| [13–17 years] | 133 | 54.3 |
Types of practice | | |
| Sole practitioner | 94 | 38.4 |
| Group of chiropractors | 108 | 44.1 |
| Multidisciplinary with MD | 7 | 2.9 |
| Multidisciplinary without MD | 33 | 13.5 |
| Other | 3 | 1.2 |
Main objective of chiropractic treatment | |
| Improve function | 116 | 47.3 |
| Reduce pain | 29 | 11.8 |
| Prevention | 18 | 7.3 |
| Remove subluxations | 25 | 10.2 |
| Improve lifestyle | 1 | 0.4 |
| Improve quality of life | 41 | 16.7 |
| Other | 15 | 6.1 |
Collaborative practices |
Sources of referrals to the chiropractor |
| Pediatrician | 16 | 6.5 |
| Pediatric hospital | 4 | 1.6 |
| Physiotherapist | 25 | 10.2 |
| Speech therapist | 9 | 3.7 |
| Occupational therapist | 9 | 3.7 |
| Psychologist | 6 | 2.4 |
| Family doctor | 78 | 31.8 |
| Medical Specialist | 6 | 2.4 |
| Another chiropractor | 68 | 27.8 |
| Nurse | 67 | 27.3 |
| Midwife | 43 | 17.6 |
| Nutritionist | 7 | 2.9 |
| Naturopath | 11 | 4.5 |
| Parents/siblings/other family member | 232 | 94.7* |
| By acquaintance/not family | 222 | 90.6* |
| Publicity | 83 | 33.9 |
Most common group age referred by medical doctors (2 answers required) |
| [0–6 months] | 90 | 36.7 |
| [7–23 months] | 67 | 27.3 |
| [2–5 years] | 32 | 13.1 |
| [6–12 years] | 87 | 35.5 |
| [13–17 years] | 100 | 40.8 |
Referral frequency to family physician or nurse practitioner | |
| Never | 28 | 11.4 |
| Rarely (< 1/month) | 145 | 59.2 |
| Few times (1–3/month) | 51 | 20.8 |
| Often (1–2/months) | 9 | 3.7 |
| Frequently (> 2/week) | 0 | 0.0 |
| Does not apply | 12 | 4.9 |
Referral frequency to pediatrician or another medical specialist |
| Never | 45 | 18.4 |
| Rarely (< 1/month) | 147 | 60.0 |
| Few times (1–3/month) | 39 | 15.9 |
| Often (1–2/months) | 2 | 0.8 |
| Frequently (> 2/week) | 0 | 0 |
| Does not apply | 12 | 4.9 |
Written report to patient’s pediatrician | |
| Never | 69 | 28.2 |
| Rarely (< 1/month) | 139 | 56.7 |
| Few times (1–3/month) | 21 | 8.6 |
| Often (1–2/week) | 4 | 1.6 |
| Frequently (> 2/week) | 3 | 1.2 |
| Does not apply | 9 | 3.7 |
Knowledge transfer activity to mainstream providers about pediatric care |
| Never | 111 | 45.3 |
| Rarely (< 1–2 times) | 80 | 32.7 |
| Few times (1/2–3 yeas) | 27 | 11 |
| Often (1/year) | 11 | 4.5 |
| Frequently (> 1/year) | 14 | 57 |
| Does not apply | 2 | 0.8 |
Knowledge transfer activity to CAM providers about pediatric care |
| Never | 115 | 46.9 |
| Rarely (< 1–2 times) | 64 | 26.1 |
| Few times (1/2–3 yeas) | 37 | 15.1 |
| Often (1/year) | 12 | 4.9 |
| Frequently (> 1/year) | 15 | 6.1 |
| Does not apply | 2 | 0.8 |
Invitation to present about chiropractic pediatric care |
| Never | 207 | 84.5 |
| Rarely (< 1–2 times) | 22 | 9 |
| Few times (1/2–3 yeas) | 7 | 2.9 |
| Often (1/year) | 5 | 2 |
| Frequently (> 1/year) | 2 | 0.8 |
| Does not apply | 2 | 0.8 |
CAM: Complementary and alternative medicine, MD: Medical doctor, SD: Standard deviation |
* Among the two most frequent sources of referral for 85% of the respondents |
Regarding practice characteristics, 45.7% of the participants reported that pediatric patients visited the clinics 0–5 times per week. A total of 99.2% of participants reported seeing 0–5 new pediatric patients per week in their clinics, and the most common pediatric age group was 6–12 years old (57.1%), followed by 13–17 years old (54.3%) and 0–6 months (34.7%). Group practice (44.1%) was the most frequent type of practice. When asked to identify the main objective of their chiropractic treatment, 47.3% responded to improve function. A total of 24.9% held a “Certified Pediatric Doctor of Chiropractic’’ (CPDC) certification as postgraduate training after passing their board examination; furthermore, 54% were active members of the Pediatric Association (AQCPP), and 50.4% defined themselves as general practitioners.
With regard to referral patterns, sources of referrals from “parents, siblings or other family members” and by “word of mouth/ non-family patients’ referrals” were most common. In contrast, referrals from pediatric hospitals, psychologists, medical specialists, and other chiropractors were less frequent (Table 1). Furthermore, the most common age for referrals to the clinic were 13–17 years old followed closely by 0–6 months old. The least common was the 2–5 year-old age group. The frequency of chiropractic referrals to a nurse/a family doctor or to a pediatrician was rare (< 1/month) in both cases. The frequency of written communication with other health care professionals was reported as rare (< 1/month).
The conditions treated by Quebec chiropractors by age group are presented in Fig. 2, and the level of certitude concerning pediatric diagnosis and frequency of different pediatric advice are presented in Table 2. Our respondents were “neutral” when surveyed about their confidence in the diagnosis of non-MSK disorders in newborns, preschoolers, and children. However, they agreed that they were confident with the diagnostic non-MSK disorders of young teens; however, they strongly agreed that they were confident with the diagnosis of MSK disorders in all age groups.
Table 2
Confidence with diagnostic categories and frequent recommendations [N = 245]; N (%)
Are you confident with the following categories of diagnosis? |
| Strongly disagree | Disagree | Neutral | Agree | Strongly agree | Missing |
MSK disorders in newborns | 5 (2.0) | 8 (3.3) | 40 (16.3) | 74 (30.2) | 116 (47.3) | 2 (0.8) |
MSK disorders in preschoolers | 2 (0.8) | 4 (1.6) | 11 (4.5) | 86 (35.1) | 140 (57.1) | 2 (0.8) |
MSK disorders of children (elementary school) | 1 (0.4) | 0 (0.0) | 8 (3.3) | 69 (28.2) | 165 (67.3) | 2 (0.8) |
MSK disorders of young teens (high school) | 0 (0.0) | 0 (0.0) | 2 (0.8) | 57 (23.3) | 184 (75.1) | 2 (0.8) |
Non-MSK disorders of newborns | 20 (8.2) | 49 (20.0) | 77 (31.4) | 53 (21.6) | 43 (17.6) | 3 (1.2) |
Non-MSK disorders of preschoolers | 17 (6.9) | 41 (16.7) | 80 (32.7) | 62 (25.3) | 42 (17.1) | 3 (1.2) |
Non-MSK disorders of children (elementary school) | 14 (5.7) | 32 (13.1) | 78 (31.8) | 77 (31.4) | 42 (17.1) | 2 (0.8) |
Non-MSK disorders of young teens (highschool) | 13 (5.3) | 28 (11.4) | 72 (29.4) | 79 (32.2) | 50 (20.4) | 3 (1.2) |
MSK = musculoskeletal |
Bold = mode |
Descriptive statistics of the screening/management of red flags are presented in Table 3. The six most common presentations in pediatric patients who would prompt a chiropractor to make an immediate referral to a medical doctor or hospital were as follows:
Table 3
Management of selected signs and symptoms [N = 24]; N (%)
| Immediate referral to hospital | Exclusive chiropractic care | Comanagement | Prefer not to answer | Missing |
Absence of primitive reflexes | 95 (38.8) | 9 (3.7) | 123 (50.2) | 17 (6.9) | 1 (0.4) |
Weight loss of more than 5% | 123 (50.2) | 4 (1.6) | 105 (42.9) | 12 (4.9) | 1 (0.4) |
Impaired mental state, dehydration, abdominal pain, or abnormal breath of a diabetic child | 232 (94.7) | 1 (0.4) | 10 (4.1) | 1 (0.4) | 1 (0.4) |
Ataxia | 164 (66.9) | 3 (1.2) | 72 (29.4) | 5 (2.0) | 1 (0.4) |
Vomiting bile | 200 (81.6) | 4 (1.6) | 30 (12.2) | 9 (3.7) | 2 (0.8) |
Bulging or sulking fontanelle | 189 (77.1) | 7 (2.9) | 39 (15.9) | 7 (2.9) | 3 (1.2) |
Fracture or dislocation | 224 (91.4) | 0 (0.0) | 19 (7.8) | 1 (0.4) | 1 (0.4) |
Chest discomfort of low to medium intensity | 105 (42.9) | 21 (8.6) | 105 (42.9) | 12 (4.9) | 2 (0.8) |
Cold or white lower limbs and/or cyanosis of the lips | 222 (90.6) | 1 (0.4) | 15 (6.1) | 5 (2.0) | 2 (0.8) |
Convulsions with no prior history or associated with cranial traumas | 216 (88.2) | 2 (0.8) | 25 (10.2) | 1 (0.4) | 1 (0.4) |
Dizziness | 53 (21.6) | 28 (11.4) | 160 (65.3) | 3 (1.2) | 1 (0.4) |
Dyspnea combined with nasal flairing or significant increase of breathing rate | 206 (84.1) | 2 (0.8) | 28 (11.4) | 8 (3.3) | 1 (0.4) |
Blood in stool | 185 (75.5) | 0 (0.0) | 55 (22.4) | 2 (0.8) | 3 (1.2) |
Fever over 38°C (rectal) in a child of more than 90 days of age | 85 (34.7) | 20 (8.2) | 125 (51.0) | 11 (4.5) | 4 (1.6) |
Fever, pain in chest, impaired mental state, or other neurological findings | 228 (93.1) | 1 (0.4) | 13 (5.3) | 1 (0.4) | 2 (0.8) |
Fever equal or above 40°C, particularly by rapid increase | 216 (88.2) | 3 (1.2) | 24 (9.8) | 243 (99.2) | 2 (0.8) |
Tilt of the head | 14 (5.7) | 130 (53.1) | 94 (38.4) | 5 (2.0) | 2 (0.8) |
Joints that are warm, swelled and sensitive, especially if child refuses weightbearing | 176 (71.8) | 2 (0.8) | 63 (25.7) | 2 (0.8) | 2 (0.8) |
Incapable of waking up a baby | 233 (95.1) | 0 (0.0) | 9 (3.7) | 1 (0.4) | 2 (0.8) |
Delay in motor development | 43 (17.6) | 8 (3.3) | 190 (77.6) | 190 (77.6) | 1 (0.4) |
Loss of sense of smell | 143 (58.4) | 1 (0.4) | 82 (33.5) | 16 (6.5) | 3 (1.2) |
Muscle weakness | 56 (22.9) | 15 (6.1) | 167 (68.2) | 4 (1.6) | 3 (1.2) |
Nystagmus | 101 (41.2) | 8 (3.3) | 125 (51.0) | 7 (2.9) | 4 (1.6) |
Pallor | 97 (39.6) | 8 (3.3) | 119 (48.6) | 18 (7.3) | 3 (1.2) |
Suspicion of substance abuse from parents | 184 (75.1) | 0 (0.0) | 50 (20.4) | 9 (3.7) | 2 (0.8) |
Legg-Calve-Perthes | 115 (46.9) | 5 (2.0) | 117 (47.8) | 6 (2.4) | 2 (0.8) |
Persistent diarrhea | 157 (64.1) | 3 (1.2) | 78 (31.8) | 5 (2.0) | 2 (0.8) |
Persistent cries or faint cries with somnolence in a baby or child | 183 (74.7) | 6 (2.4) | 45 (18.4) | 9 (3.7) | 2 (0.8) |
Persistent vomiting | 208 (84.9) | 2 (0.8) | 32 (13.1) | 1 (0.4) | 2 (0.8) |
Personality change | 132 (53.9) | 3 (1.2) | 99 (40.4) | 9 (3.7) | 2 (0.8) |
Febrile petechiae or purpuric rash | 199 (81.2) | 1 (0.4) | 30 (12.2) | 13 (5.3) | 2 (0.8) |
Positive Babinski | 96 (39,2) | 21 (8,6) | 104 (42,4) | 21 (8,6) | 3 (1,2) |
Recurrent fevers | 77 (31.4) | 4 (1.6) | 157 (64.1) | 4 (1.6) | 3 (1.2) |
Redness in the nasal region | 26 (10.6) | 40 (16.3) | 152 (62.0) | 24 (9.8) | 3 (1.2) |
Nasal discharge | 10 (4.1) | 86 (35.1) | 137 (55.9) | 9 (3.7) | 3 (1.2) |
Scoliosis > 20° | 36 (14.7) | 6 (2.4) | 199 (81.2) | 2 (0.8) | 2 (0.8) |
Slipped capital femoral epiphysis | 173 (70.6) | 1 (0.4) | 66 (26.9) | 3 (1.2) | 2 (0.8) |
Dehydration signs and/or decrease of 50% of fluid intake in a 24 h period in a baby or child | 227 (92.7) | 1 (0.4) | 10 (4.1) | 5 (2.0) | 2 (0.8) |
Pressure in the sinus area | 26 (10.6) | 59 (24.1) | 153 (62.4) | 5 (2.0) | 2 (0.8) |
Speech disorders | 93 (38.0) | 2 (0.8) | 136 (55.5) | 12 (4.9) | 2 (0.8) |
Strabismus—new finding | 147 (60.0) | 3 (1.2) | 82 (33.5) | 11 (4.5) | 2 (0.8) |
Persistent abdominal pain | 189 (77.1) | 1 (0.4) | 47 (19.2) | 5 (2.0) | 3 (1.2) |
Perspiration | 63 (25.7) | 28 (11.4) | 117 (47.8) | 35 (14.3) | 2 (0.8) |
Swollen lymph nodes | 79 (32.2) | 25 (10.2) | 134 (54.7) | 5 (2.0) | 2 (0.8) |
Suicidal ideas | 197 (80.4) | 2 (0.8) | 41 (16.7) | 3 (1.2) | 2 (0.8) |
Sore throat | 25 (10.2) | 58 (23.7) | 149 (60.8) | 11 (4.5) | 2 (0.8) |
Exhaustion | 20 (8.2) | 45 (18.4) | 168 (68.6) | 9 (3.7) | 3 (1.2) |
Bruising without cause (no trauma no abuse) | 132 (53.9) | 4 (1.6) | 99 (40.4) | 8 (3.3) | 2 (0.8) |
Unexplained weight loss | 148 (60.4) | 1 (0.4) | 90 (36.7) | 3 (1.2) | 3 (1.2) |
Watering | 37 (15.1) | 35 (14.3) | 149 (60.8) | 22 (9.0) | 2 (0.8) |
Allergies | 32 (13.1) | 29 (11.8) | 167 (68.2) | 15 (6.1) | 2 (0.8) |
Acute headache | 48 (19.6) | 63 (25.7) | 127 (51.8) | 4 (1.6) | 3 (1.2) |
Chronic headache | 5 (2.0) | 80 (32.7) | 155 (63.3) | 2 (0.8) | 3 (1.2) |
Neoplasm—circumscribed lesion | 147 (60.0) | 2 (0.8) | 81 (33.1) | 13 (5.3) | 2 (0.8) |
Neoplasm- noncircumscribed lesion | 212 (86.5) | 0 (0.0) | 22 (9.0) | 8 (3.3) | 3 (1.2) |
Bold = mode |
-
Impaired mental state, dehydration, abdominal pain or abnormal breath of a diabetic child.
-
Fever, pain in chest, impaired mental state or other neurological findings
-
Fracture or dislocation
-
Signs of dehydration and/or decrease of 50% of fluid intake in a 24 h period in a baby or child, persistent vomiting
-
Cold or white lower limbs and/or cyanosis of the lips, febrile petechiae or purpuric rash
-
Suicidal ideation, neoplasms or noncircumscribed lesions
The management of these combined symptoms would result in exclusive chiropractic care: tilt of the head, nasal discharge, and chronic headache (with a low percentage). Chiropractors identified a comanagement approach to the following clinical presentations: scoliosis > 20 degrees, allergies, delay in motor development, and muscle weakness.
The test-retest assessment revealed that 92% of the responses demonstrated a percentage of agreement of more than 70%. The questions referring to activities within the preceding week, frequency of referrals to medical doctors and diagnosis of nonmusculoskeletal conditions were the items with the lowest agreement.