Neurologic Considerations in Pediatrics

by Sheldon C. Yao, DO

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    00:01 So there are different pediatric patient presentations that potentially lend itself to the osteopathic approach utilizing the neurologic model.

    00:10 So remember the goal of this treatment model is to try to balance autonomic tone and to remove facilitated segments.

    00:17 We also want to address musculoskeletal restrictions that may be compressing nerves.

    00:23 So reviewing viscerosomatic reflexes, our organs are very sensitive oUr local nociceptors really pick up information.

    00:34 It's a warning sign to try to tell our body that something's going on with the organ.

    00:39 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.

    00:59 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 causing compression of cranial nerves.

    01:53 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.

    02:19 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.

    02:38 Cranial nerve XII is the hypoglossal.

    02:41 Again it exits the hypoglossal canal next to the occipital condyle.

    02:46 It also provides motor function to the tongue.

    02:50 Spigns of dysfunction include a tongue thrusting or stiffness and/or a weak suck.

    02:57 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.

    03:08 the nose and chin is touching the breast, the lips are outflared.

    03:14 There's no biting or chomping, No clicking and you want to listen for the swallowing as the baby is nursing.

    03:21 If there's any signs of improper latch, then we have to suspect possible problems with the cranial nerve entrapment, possibly also contributing to the difficulty in suck and swallowing So it's important to assess proper infant swallow.

    03:39 Kids that have difficulty with reflux, feeding, gaining weight - there might be a problem going on with how either their latching or their swallowing.

    03:49 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.

    04:00 and what you want to see is either it's a relaxed motion the tongue kinda moves up and back without any tongue thrusting.

    04:06 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.

    04:24 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 nerve function.

    04:51 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.

    05:04 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 jugular foramen, one of the techniques that we utilize is called the V spread.

    05:17 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.

    05:30 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.

    05:44 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.

    06:02 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.

    06:15 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.

    About the Lecture

    The lecture Neurologic Considerations in Pediatrics by Sheldon C. Yao, DO is from the course Osteopathic Treatment and Clinical Application by Specialty.

    Author of lecture Neurologic Considerations in Pediatrics

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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