Why Some Kids Need Green and Violet Before Red and Infrared
When we talk about photobiomodulation, the instinct is usually to reach for red and infrared. More energy, deeper penetration, more coverage. That instinct is not wrong, but I keep seeing a pattern in practice that pushes against it: some kids come off the table after a red or infrared session more irritable, more dysregulated, off for the rest of the day. That is not a sign the laser was too weak. It is often a sign it was too much.
The Overstimulation Problem
This idea came out of a conversation with one of our functional medicine doctors who also works in hyperbaric oxygen. His framing was that the deeper you go with hyperbaric pressure, the more you risk overstimulating a system with existing mitochondrial impairment. You cannot push a compromised system into a high-pressure environment and expect it to respond the way a healthy one would.
The same logic applies to light. Infrared penetrates the deepest. Red, green, and violet penetrate progressively less. If a child's mitochondria are already inefficient, driving photons deep into that tissue can overactivate a system that does not have the capacity to use that stimulus well. We are trying to give the mitochondria energy, not overload them.
What Uncoupling Looks Like Clinically
I think of inefficient mitochondria like a smoky fire. It is producing a lot of smoke, but it is not burning hot or clean. That is mitochondrial uncoupling: energy production is happening, but it is not converting efficiently. The goal of good rehab, exercise, and stimulation is to move toward recoupling, which is anti-inflammatory and far more productive for the nervous system. You do not force that shift. You build toward it.
Matching Wavelength to Mitochondrial Function
We have started running myto swabs on more of our kids, and a pattern has shown up consistently, though I want to be clear this is not an exact science yet. Kids with a deficiency in a lower complex, complex II for example, tend to respond better to green and violet. Kids with more of a complex IV issue tend to respond better to red and infrared. It is worth tracking in your own caseload rather than treating as an established protocol, but it has been consistent enough for me to pay attention to it.
Practical Wavelength Selection
Violet is where I go for GABA production, bacterial infections, Lyme presentations, and wound healing. Green is underused. It helps release oxygen more efficiently from hemoglobin, so I use it over areas with dense capillary beds close to the surface: up the nose, the palms, the feet, the carotids, the top of the head, inside the mouth. Put a pulse ox on a kid with low oxygen saturation and laser those areas, and you can watch the number climb in real time.
For home laser plans, we typically start with a higher ratio of green to infrared and shift that ratio slowly over about a month. That titration has noticeably reduced the "he seems off" or "she was irritable all day" feedback we used to get more often. In office, for kids who are especially sensitive, we cap infrared at around thirty seconds and lean on green, violet, and red, which do not penetrate as deep, for the rest of the session.
What Actually Moves the Needle
The shift here is treating wavelength and dose as a question of what a child's system can actually absorb and use, not defaulting to maximum penetration because it seems like more is better. Titrating up toward red and infrared, rather than starting there, gives an inefficient system room to build capacity instead of getting pushed past it.
Final Thoughts
Wavelength selection is not only a question of how deep you need the light to go. It is a question of how much energy the mitochondria in front of you can actually convert without getting overwhelmed. Once you start looking at it that way, dosing decisions stop being about protocol and start being about the individual system on your table.
P.S. If you want to learn how to scale your clinic, email Jon at jon@drjoshmadsen.com. I only take three new coaching clients a month.