Written by Magaret Sorrel, DO, FCA for the Cranial Academy
For centuries, in many parts of the world, highly trained birth attendants have seen it as part of their job to correct the stresses that birth has placed in the body of the newborn. This constitutes an acknowledgement that birth is a difficult process and that measures can be taken after birth to assist the baby in its recovery. In the industrialized nations of Northern Europe and North America, birth has been seen as an event that either leaves no negative impact upon the baby or one whose complications, whatever they might be, must be accepted and endured by both child and family.
Many older children experiencing learning or behavioral difficulties have a history of traumatic birth or early childhood blows to the head which went uncorrected. Children who suffer from recurrent ear or sinus infections frequently have similar medical history. Although it is most useful to address the structural problems originating in the birth process shortly after birth, much improvement in the childís condition can be seen if treatment is initiated much later.
Birth often results in harmful structural changes. The likelihood of trouble increases when the labor and delivery is prolonged or augmented by pitocin or when forceps or vacuum extractions are necessary. In vaginal delivery, the infantís skull is asked to make its passage through too small a space. In response, the bones of the skull overlap to decrease the size of the head, and sometimes do not return to their natural positions after delivery. In order to travel through the birth canal, the infantís head must bend markedly backwards. This puts pressure on three nerves (vagal, hypoglossal and glosspharyngeal) which can result in the colic and sucking disturbances often seen in the newborns.
Although C-section babies are spared some of the complications of vaginal deliveries, they are also robbed of some of the benefits. The transit down the birth canal applies a variety of pressures on the infantís head which help to free it from the shape it was molded to in utero. The transit through the birth canal also compresses and re-expands the chest wall preparing the baby to breathe and clear fluid from the lungs.
Once the baby is born, osteopathic physicians hope to hear a fairly immediate and powerful birth cry. Fetal life would be fraught with low oxygen levels if it were not for the motherís higher hemoglobin levels and the babyís faster heart rate. The transition from life in utero to life outside is a critical time in which the baby loses its maternal support and must provide for its own oxygen. A strong birth cry probably serves two crucial functions. It opens the alveolar air sacs throughout the lungs, thereby ensuring adequate levels of oxygen so essential to brain development. It also increases the internal pressure within the skull helping to re-expand those bones and membranes which were compressed in the birth process.
The infant will often communicate the presence of a problem by being irritable or difficult to calm. In addition, excessive wakefulness at night or reluctance to fall asleep, spitting up or vomiting can have their origins in structural disturbances. A parent or a health care professional may notice visual signs of a structural problems, such as overlapping of joint lines on the infantís skull which do not level out during the first week of infantís life. Visual asymmetries, such as one side of the forehead further forward than the other, the two ears positioned differently or the neck held to one side, can and should be corrected.
As the baby gets a little older, a parent may notice developmental delays. Although there are many reasons that children fall behind a normal developmental time table, some can be successfully addressed through Osteopathic treatment. The brain does rapid and critical development in the first year of life. The nerve pathways are designed to lay themselves down in precise geometric relationships. Even slight distortions in the structure of the skull can impair the development of the nervous system. These can manifest in developmental delays early in childhood and potentially more serious learning difficulties later.
Some children suffer from medical conditions for which conventional medicine has very little to offer, conditions such as Downís syndrome or cerebral palsy. Osteopathic treatment does not alter the underlying genetic defect or birth injury factors, but it can be very effective in improving general health and quality of life for the child and family by optimizing the childís ability to functions.
Cranial Osteopathy for the newborn is a safe, gentle, non-invasive form of manipulative treatment. Babies often fall asleep during treatment or fall into deep restful sleep thereafter. Sometimes babies fuss or squirm during treatment, actions that can help release the troubled areas. It is safe and ideal to see babies shortly after birth, but it is still quite feasible to resolve the effects of a difficult birth anytime in the first months or even years of life. Depending on the severity of the birth experience and the structural findings, anywhere from a single treatment to a series of four to eight may be indicated. In complicated cases further follow-up care may be needed.
Some neurodevelopmental problems are associated with genetic syndromes, and some originate from known or unknown insults to the developing nervous system in utero. The vast majority, though, cannot be attributed to any traditional diagnosable condition. It is in these cases that we must look to the role of birth injury.
A traumatic birth can have a role in neurodevelopmental problems either trough direct injury to the central nervous system or through insufficient oxygen at birth. The infantís central nervous system is irritated by the compression of its moldable head against the hard bones of the motherís pelvis both before and during birth. In more difficult births this impact may be severe enough to cause neurodevelopmental problems. At birth the infant loses the maternal source of oxygen and must obtain its oxygen by breathing. Poor color or a birth cry which is delayed or weak can signal too little oxygen to the brain at this critical time.
In some cases the observed neurodevelopmental problems fit a particular pattern, and we find it helpful to use a label such as cerebral palsy, autism or ADHD. For many children, though, we have to accept the limitations we see without a diagnostic label. In either case oxygen compromise and/or birth trauma are frequently seen factors.
Osteopathic treatment can improve the childís neurological function by resolving the effects of the compressive forces of a traumatic birth. Osteopathic medicine is based on the philosophy that structure and function are dynamically interrelated. Improvement in the structural relationships of bone, membrane, muscle and tissue is necessary to foster improved physiologic function.
Structural trauma to the infantís skull, which can compromise central nervous system function, may be the result of prolonged forces of labor or the effects of instrumentation such as forceps and vacuum extractors. Such instrumentation is sometimes necessary to facilitate a more rapid delivery when fetal distress is present. The forces inherent in their use, though, may take their toll in the relationship of one bone to another or in irritation and tension on the membranes which surround the brain and spinal cord. Although the neurodevelopmental consequences of these structural problems may not be seen until later in childhood, some newborn difficulties may be the first sign of a neurodevelopmentally troubled child. These may include vomiting, colic, restlessness, agitated sleep, difficulty sucking and spastic muscles. The earlier osteopathic treatment is begun, the more likely a positive outcome, though treatment later can be of substantial benefit.
Osteopathic treatment helps the body use its inherent abilities to heal by correcting structural disturbances. A few examples will help to demonstrate the principles involved in the treatment for neurodevelopmental problems. When the compression of the babyís head distorts the foramen magnum, where the brain stem leaves the skull to become the spinal cord, the resultant pressure and irritation on the pyramidal tracts may cause spasticity in the limbs and the muscles of the back. Gentle release of these compressive forces corrects the distortion and the muscles can return to a normal tone.
The forces of labor can leave the newborn with overlapping cranial bones which irritate the meningeal membranes lying between the bones and the brain itself. Tremors, twitches and irritability often result and can be resolved when osteopathic treatment releases these membranes and bony restrictions. Seizures are commonly seen when there is an area of abnormal electrical activity on the surface of the brain. Osteopathic physicians have often found that these abnormally firing electrical centers are also sites of membrane restriction and/or cranial trauma. Addressing these sites can result in a lessening or cessation of seizure activity.
Improving the ability of oxygen to reach and nourish the nervous system is an essential component of osteopathic treatment for neurodevelopmental problems. Several factors influence oxygen supply to the brain. The respiratory center of the brain requires the unimpeded fluctuation of cerebrospinal fluid to function well. The bony and muscular components of the rib cage must be free of restrictions to allow for deep respirations. Both arteries and veins must be unimpeded in their flow through the muscles, bones and tissue. Finally, the bones and membranes surrounding the brain itself must move normally for oxygen to reach the tissue. Osteopathic treatment addresses and treats all of the above components to maximize oxygen delivery to the brain thus optimizing its function.
A child with neurodevelopmental problems often responds best to a variety of interventions. Although providing more than one approach at one time makes evaluation of benefits of each impossible, the importance of early intervention minimizes this drawback. Depending on the nature of the neurodevelopmental problem, any of the following approaches may be useful adjunct to osteopathic treatment: Physical Therapy, Occupational Therapy, Speech Therapy, Sign Language Instruction, Constitutional Homeopathy, Sensory integration, Auditory Training, Neurodevelopmental Training, Developmental Optometry, Nutritional Counseling, and Vitamins/Minerals/Supplements.
Ear infections are the cause of more pediatric doctor visits in the first three years of life than any other medical problem. One child in three develops chronic fluid accumulation in the middle ear making the child prone to recurrent ear infections, and potentially causing minor hearing loss as well as speech development problems. There are many reasons for the prevalence of this medical problem. Due to the immaturity of the immune systems, young children have frequent colds, and ear infections can follow as a complication. Some previously healthy children begin to have ear infections when undergoing orthodontic correction. Some children have dairy or other nutritional sensitivities which contribute to the frequency or severity of infections. The most common predisposing factor, however, is early childhood trauma to the head, occurring either in the birth process or in early childhood injuries. Even C-section babies can be affected. When the structural restrictions caused by these traumas are resolved, the vast majority of children have a significantly reduced incidence of infection and noticeable improvement in hearing.
The presence of fluid in the middle ear offers a hospitable environment for the growth of the organism which causes ear infections. If the middle ear is free of fluid, ear infections are rare. Medical opinion differs on the solutions to fluid retention. The standard medical approach is to treat ear infections with antibiotics. If fluid remains after the infection has cleared, a low level of antibiotic is often prescribed preventatively over a long period of time. If infections or hearing loss persist, ventilating tubes are surgically placed. This constant over utilization of antibiotics is contributing to an alarmingly growing incidence of bacterial resistance to many antibiotics. Also, mostly due to wiping out the normal and necessary intestinal bacterial flora, antibiotics have side effects like bloating, abdominal cramping and diarrhea. The Osteopathic approach is to correct the cranial restrictions which are causing fluid retention and impeding fluid drainage.
The small amount of constant rhythmic motion present in the joint lines and membrane structures of the cranium (skull) has been well documented in osteopathic and other scientific sources. As the temporal bones (the bones that house the middle and inner ears) of the cranium move in a normal manner, they assist the drainage of fluid from the middle ear through the Eustachian tubes to the back of the throat. This normal mobility, however, can be disturbed as a result of birth trauma or early childhood injuries. Osteopathic manipulative techniques can restore normal motion of the temporal bones as well as the whole cranial mechanism, and thus improve fluid drainage from the middle ear. If fluid is not present, ear infections are rare. Osteopathic treatment also facilitates lymphatic drainage in the neck and chest and can improve arterial blood supply and venous drainage. Through assisting the immune system this way, the improved overall health of the body also prevents future infections.
Children who suffer from recurrent ear infections often require weekly osteopathic treatment for a period of four to eight weeks. The duration and specific types of treatment offered vary with the individual child. Follow-up treatment on a periodic basis may be needed to maintain appropriate motion of the cranial mechanism. Osteopathic manipulative treatment addresses what is for many children the underlying cause of chronic ear infections. In a review of all of the child ear infection cases in our office it was found that 94% of patients had complete resolution of the ear infection within four visits. These were babies treated only with Osteopathic manipulation and without any antibiotics. The treatments themselves are very gentle. If children cry or complain while getting treated, it is rarely because of pain. More often it is because they donít want to be lying down. Most can be entertained successfully with songs, stories or toys.
Just as ear infections are sometimes a complication of the common cold, so are the inflammation and infection of the sinus cavities. The same mucous membrane which lines the nose and the back of the throat extends into the sinus cavities, out to the middle ear as the Eustachian tube and down into the lungs (where inflammation results in bronchitis). The sinus cavities, though fewer and smaller in children, serve to warm, filter and moisten the air we breathe. They too can fill with fluid and be unable to perform their function. Their ability to function normally is dependent on unrestricted mobility of the bones and membranes of the cranium, especially the bones of the face. By the same principles that underlie the osteopathic treatment of ear infections, osteopathic manipulation can help restore normal sinus function.