So there are different pediatric patient
presentations that potentially lend itself to
the osteopathic approach
utilizing the neurologic model.
So remember the goal of this treatment
model is to try to balance autonomic tone
and to remove
We also want to address musculoskeletal
restrictions that may be compressing nerves.
So reviewing viscerosomatic reflexes,
our organs are very sensitive
oUr local nociceptors really
pick up information.
It's a warning sign to try to tell our body
that something's going on with the organ.
This signal converges on to the spinal
cord and sometimes they will cross talk
with different other nerves which then can cause
referred pain and also facilitated segments
And so, with OMM we'd want to try and
treat the facilitation, reduce the pain
and try to break that cycle.
Looking specifically more at children, one
of the things that really can be compressed
in the cranium is
the jugular foramen
And so the jugular foramen is located
between the temporal bone and the occiput
This foramen is really important because cranial
nerves IX, X and XI pass through that region
We also want to take a look at
cranial nerve XII - the hypoglossal
as it passes through the hypoglossal
canal next to the occipitocondyles
So remember talked about how the
occiput at birth is at four parts,
as the condylar parts are
separate parts from the squama
And because at birth, the parts are separate,
sometimes the birth trauma can cause compression
either at the jugular foramen or
also at the hypoglossal canal
of cranial nerves.
So cranial nerve IX or glossopharyngeal
exits at the jugular foramen
This cranial nerve provides motor
innervation to the stylopharyngeus muscle
Cranial nerve X also exits
the jugular foramen
The vagus nerve provides a motor function
to all of the other pharyngeal muscles
and it also is important
with proper swallowing.
The vagus nerve also provides parasympathetic
innervation to the esophagus,
the stomach and the intestines so
any sort of dysfunction may cause
problems with the increased gag reflex, possible
gastroesophageal reflux, and potentially colic.
Cranial nerve XII is the hypoglossal.
Again it exits the hypoglossal canal
next to the occipital condyle.
It also provides motor
function to the tongue.
Spigns of dysfunction include a tongue
thrusting or stiffness and/or a weak suck.
So at birth, it;s important to assess whether
or not the baby is having a proper latch
So a proper latch includes the baby being
able to encompass the nipple and the areola.
the nose and chin is touching the
breast, the lips are outflared.
There's no biting or chomping,
No clicking and you want to listen for
the swallowing as the baby is nursing.
If there's any signs of improper latch,
then we have to suspect possible
problems with the cranial
possibly also contributing to the
difficulty in suck and swallowing
So it's important to assess
proper infant swallow.
Kids that have difficulty with
reflux, feeding, gaining weight -
there might be a problem going on with how
either their latching or their swallowing.
So proper swallow physiology includes when the
infant is swallowing the lips are together,
the teeth are slightly apart, the tongue is resting
about half an inch away from the top front teeth.
and what you want to see is
either it's a relaxed motion
the tongue kinda moves up and
back without any tongue thrusting.
So if you note any sort of
pathology with the infant swallow
then it's cause for concern and you should
definitely screen for somatic dysfunctions
in the cranial base looking at potential nerve
compression on the cranial nerves IX, X and XII.
Another region to
look at is the sacrum
The reason why we want to look at the sacrum is
if infants have issues with digestion and colic,
that might be due to irritation of nerves of the
sacrum coming up innervating the lower GI tract
or if there's issues
with the bladder
So overall, our treatment goal is to
try to remove the somatic dysfunctions
that may impair cranial
We want to treat any sort of musculoskeletal
restrictions that contribute to feeding problems
We want to take care of any restrictions
of the fascia in the muscles of the neck
including the hyoid, the
clavicle and the sternum.
We want to look for any possible
restrictions of the respiratory diaphragm
and also treat any sort of
restrictions at the sacrum and pelvis
In order to treat the
one of the techniques that we
utilize is called the V spread.
So here what we want to do is to contact the
occipital mastoid suture on either side
at the mastoid and the occiput
and apply a gentle spreading
to try to increase the
space between the suture.
We could also utilize a contact
called the base spread
to again assess for occipital or temporal restrictions
and to try to decrease any restrictions there,
we want to treat the OA suboccipital
area in the cervical region.
This will help to treat any sort of mild
fascial restrictions that might be compressing
surrounding the jugular foramen and
also compressing on the nerves
For the sacrum and pelvis, we
can do some gentle techniques
or you coul do SI joint releases on the kids
relatively easy since they're so small.
Oftentimes you can just kind of get your
fingers on both sides of the innominate
and apply a gentle inhibitory pressure
and a little lateral traction
to release any sort of strains in the ligaments
between the sacrum and the innominate.
You could perform balanced
ligamentous tension in the sacrum
You could also do some lumbosacral
decompression and also gentle inhibition
over the muscles in that region could help
get the sacrum and pelvis moving better.