OMT for Common

Infant and Children

Complaints ARLENE O’DONNELL, DO

FEB 6, 2020

Disclosures

Nothing to disclose

Objectives

Infants Latch

Reflux

Nasolacrimal duct obstruction

Overriding sutures

Plagiocephaly

Jaundice

Torticollis

Colic

Children

URI

Otitis media

Asthma

Pneumonia/RSV

Constipation

Behavioral disorders

Scoliosis

OMT screening

Latch issues

Infant

Noisy eating

Won’t stay latched

Poor milk transfer/weight gain

Fatigue

Fussy

Mom

Painful

Cracked/bleeding nipples

Poor latch

Evaluate for

Tongue tie

Lip Tie

If Mom’s the problem:

Engorged: Reverse pressure softening

Flattened/inverted nipple: pump prior to latch, nipple

shield

Latch Issues

Latch OMT

Also evaluate hyoid, diaphragm, sacrum, SBS, clavicles

Condyles

Base of tongue

Vomer

Reflux

Prevalence

Overfeeding

Age (months) % prevalence

0-3 50%

4 67%

7 14%

Reflux

OMT

Also evaluate: SBS, OA, OM sutures, sacrum, clavicles

Diaphragm/ Thorax/ Ribs

Stomach

Nasolacrimal duct obstruction

Nasolacrimal duct obstruction

OMT

Also evaluate: Cranial strains, SBS, sacrum, diaphragm

Frontonasal

decompression

Maxilla

Overriding sutures

Frontal bone flattens

Occipital bone moves backward

Parietal bones override

Resolves in 1st few days

Plagiocephaly

Don’t miss craniosynostosis

Consider torticollis

Plagiocephaly

Significant decrease in 8 weeks

Cranial vault asymmetry P=0.02

Skull base asymmetry P=0.01

Transcranial vault asymmetry P<0.003

OMT

Also evaluate: dura, clavicle, neck-anterior/posterior, diaphragm, pelvis, sacrum

V-spread

Cranial molding

Sacrum/lumbar

Torticollis

Congenital muscular torticollis most

common

Check for

SCM mass

developmental dysplasia of hip

Torticollis

3/2016

Torticollis OMT

Also evaluate diaphragm, sacrum, SBS

Dura tent and falx Clavicles

Constipation

No pediatric studies

Colic

Normal crying

Age Time (minutes)

>6 wks 117-133

10-12 wks 68

Constipation/Colic/Jaundice

OMT

Colon Sacrum/Pelvis

Colon-peristalsis

Also evaluate: diaphragm, OA, Cranial base, thoracic, ribs

Peds

Children

URI

Otitis media

Asthma

Pneumonia/RSV

Constipation

Behavioral disorders

Scoliosis

Otitis Media/URI

Most common cause- viral

OMT

Lymphatic drainage into lymphatic/thoracic duct

Anterior cervical musculature/trachea/hyoid

Zygomatic motion

Otitis Media/URI

OMT

Also evaluate: thoracic inlet, T1-4, Ribs, diaphragm

Eustachian tube

Hyoid

Temporal bones

Zygoma

Lung issues

Asthma

Reactive airway disease

Pneumonia

Bronchiolitis

Cystic Fibrosis

Poor cough reflex

Lung issues

OMT

Also evaluate: Clavicles, Hyoid, trachea, cranium, pelvis, lymphatics

Diaphragm

Sternum/Thorax

Ribs

Behavior

OMT

Also evaluate: Cranial strains, sutures, Sternum, pericardium, pelvis, sacrum

Parietal lift Nape of neck

Sacral CV4

Scoliosis

Check

Leg length discrepancy

Cranial base

OMT

Also evaluate: Pelvis, Lower extremity, diaphragms of body, clavicles, spine

Condyles

Sacrum Fascial body

OMT outcomes

Vision

Sleep

OMT in practice

Somatic dysfunction causes more than just pain

Consider OMT for a variety of pediatric complaints

Screen, screen, screen

Treat what you find

Be active: move around the exam room/treat where they want

References

Osteopathic Manipulation in Breastfed Newborns. (ClinicalTrials.gov). ClinicalTrials.gov identifier: NCT03945474. Updated May 10, 2019.

Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med. 1997 Jun;151(6):569-72

Pacchiarotti C, Maioli F, Campisano, M, et al. Gastroesophageal Reflux in Infants and Osteophatic Manipolative Treatment: An Alternative Therapy? Arch Dis Child [307384.797]. 2014;99(Suppl 2):A291.

Burina L, Curtis S, Mancini J, Yao S. Use of Osteopathic Manipulative Treatment (OMT) to Treat Congenital Torticollis and Positional Plagiocephaly in an Infant: A Case Report. Poster presented AAO Convocation 3/2016; Orlando, FL.

Wolke D, Bilgin A, Samara M. Systematic Review and Meta-Analysis: Fussing and Crying Durations and Prevalence of Colic in Infants. J Pediatr. 2017 Jun;185:55-61.e4. doi: 10.1016/j.jpeds.2017.02.020. Epub 2017 Apr 3.

References

Carnes D, Plunkett A, Ellwood J, Miles C, Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analysis. BMJ Open. 2018;8;e010410. doi:10.1136/bmjopen-2017-019040

Blood S, Hurwitz B. Brain Wave Pattern Changes in Children with ADD/ADHD following Osteopathic Manipulation: A Pilot Study. AAO Journal. 2000; Spring: 19-20.

OMT technique resources:

Carreiro J. Pediatric Manual Medicine: An Osteopathic Approach. Churchill Livingstone, Elsevier 2009.

VanBuskirk R. The Still technique Manual. 2nd ed. Indianapolis. AAO; 2006

Seffinger M. Foundations of Osteopathic Medicine. 4th ed. Wolters Kluwer. 2018.

Questions?