Boys were more commonly presented than girls. This may be due to the prevalence of musculoskeletal health problems which have previously been shown to be more common in boys . The patient proportions in that study (57.4% male) versus girls (42.6%)  were virtually the same as in our clinic (57% male and 43% female). At birth, boys are often larger than girls and intra-uterine constraint may result in biomechanical imbalance or asymmetries in their cranium, spine or extremities .
It is not surprising that musculoskeletal problems were the most common presentation of the pediatric patient to our clinic. First, chiropractors are known to specialize in the musculoskeletal system and second, musculoskeletal pain affects a significant number of children . Further, these conditions carry a significant economic burden due to time lost at school, lost time from work for parents and diagnostic procedures and referrals and consultation with multiple practitioners . What may be surprising is that parents have heightened awareness to recognize musculoskeletal pain in the very youngest children, particularly neonates. A common complaint of early infancy is that the baby "refuses" to lie on his/her back (shows pain behaviours when lying supine) . The "back to sleep" program is required for cot death prevention . Manual therapy might be considered useful to treat the infant to help the infant to sleep comfortably . Manual therapy was the most commonly chosen therapy by parents for their child in a USA study . In a recent UK survey, clinicians (pediatricians, orthopedists, primary care (both new trainees and experienced) and emergency medicine doctors were asked how confident they felt dealing with pediatric musculoskeletal (pMSK) problems. Seventy-four percent had "no" or "some confidence" . It is possible that clinicians with little confidence to treat pMSK problems may refer these cases to manual therapists. In a London study of general practitioners, 83% had referred for CAM therapies or influenced such referral , although this study was not specific to pMSK.
Referrals to this chiropractic teaching clinic from medical professionals were common. Children under three months of age had the highest (83%) referral rates. It is not surprising that medical professionals referred pediatric patients to this clinic for musculoskeletal conditions such as torticollis and other postural preferences that cause difficulty and perhaps even pain when the infant is moved out of their antalgic posture. However, crying and feeding problems were also commonly referred. These early "quality of life" problems such as excess crying (previously known as infant colic) and feeding problems as well as sleep dysomnias may be considered to be amenable to biomechanical attention . However, the efficacy of chiropractic care for these conditions has not yet been proven or disproven . There are some suggestions that feeding problems in the neonate may be biomechanical in nature  and one study suggests that multidisciplinary care which included chiropractic may be helpful . There may also be benefit to ruling out a simple musculoskeletal lesion which could be corrected quickly with little risk before the child undergoes more invasive testing or procedures.
The population most commonly presented by their parents for care in this study were young, under 12 weeks of age. These results are similar to a Danish study that found the most common pediatric patients to present to chiropractors were under four months of age .