When treating children, creating a safe environment is ever more important. In general, parents should be present during the treatment, and the child's facial expressions and physical behaviour should be observed closely throughout to ensure comfort and safety.

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Parents should be informed prior to the treatment about what to expect such as assessment of the pelvis, cranial work, and spinal manipulations.

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Both assessment and treatment generally follow the same principles as for adults. Osteopathic techniques are executed gently but with a firm and stable hold thereby responding to the delicate structures of the child's body. Understanding the four stages of development in children (sensorimotor, preoperational, concrete operational and formal operational) is crucial for providing proper assessment and treatment.