Osteopathic Medicine and Psychiatry

00:01 Osteopathic manipulative medicine in Pediatrics.

00:05 So, when we apply OMM in pediatrics, we have to consider that pediatrics is a unique field and not just treating little adults.

00:13 They present with their own unique set of possible presentations, and a unique differential that affects children rather than adults.

00:24 Often, there's different manifestations that osteopathic manipulation could be integrated to help them to heal.

00:30 Osteopathic manipulation could be a very helpful adjunct to treat children and help address musculoskeletal dysfunctions that prevent optimum health.

00:38 So there's a quote "just as the twig is bent, the tree's inclined" So just like the photo that you see here, when you have any sort of potential musculoskeletal assymetries, muscle imbalances, restrictions when you are little, as you continue to grow, those dysfunctions may continue to become more severe and lead to more assymetry So there was a study done at one of the osteopathic medical schools that has a pediatric clinic and so this slide just shows you that they were able to utilize osteopathic manipulation in a wide range of patient ages.

01:18 So about 15 percent of their total patients were infants from zero to eleven months, about 30 percent were preschool, about 31 percent were school age, and then 22 percent were adolescents.

01:32 so you could see how osteopathic manipulation could be applied to a wide range of ages It was further broken down to demonstrate what sort of problems pediatric patients may present with and so this was the most commonly billed diagnosis for these patients who are seen between the ages of zero to eleven months: torticollis, plagiocephaly, otitis media, feeding problems, muscle spasms - those were the more common ones.

02:05 also GI upset, colic, abdominal pain, respiratory infection, failure to thrive rounds up the top ten.

02:12 so as you can see, it was a broad range of different presentations that osteopathic manipulation was integrated with for the care of these kids.

02:24 So as a general approach to pediatric patients, the first is to really treat them as individuals, speak to them as you would speak to an adult, treat them as individuals, give them that respect try to clearly explain obtained consent when age-appropriate so obviously if it's an infant, a child, you want to make sure you explain what you're trying to do to the parents and obtain consent from them.

02:49 But once the kid start to approach an age where they could understand what you're trying to do, it's important to speak to them again like an individual.

02:59 Explain to them what you're trying to do.

03:01 In my office, the kids usually enjoy coming to me cause I don't treat them like a child, I treat them like an individual and I explain to them what I'm trying to do and most of the time, they'll cooperate and actually even help at times.

03:18 Try to demonstrate to the parents to help them understand.

03:20 So osteopathic manipulative medicine can be easily explained through the tenets, the principles, explain to them what you're trying to accomplish with the treatment in terms of addressing different musculoskeletal complaints.

03:33 Parents usually won't understand that I am trying to treat the musculoskeletal system to decrease muscle spasm, to improve motion and movements at the joints, trying to decrease some of the compressions in the nerves.

03:45 And so if you talk to the parents and they have a better understanding of what you're trying to do, they're usually more confident in trusting you with whatever you need to do with the kids.

03:56 A lot of times, I'll also ask the parents to kind of hold out their hand in a fist and I'll put my hand over their fist and demonstrate how much pressure I'm actually using when I'm treating the baby with gentle techniques.

04:08 and that helps alleviate their fears cause sometimes their children might be crying and appear uncomfortable but if they know that I'm not really putting a lot of force into these techniques, it will help reassure them that their baby is safe and the child is not getting harmed.

04:28 So one of the things that you want to try to do, is to try to integrate your structural exam while you're examining the child So when you're listening to the heart, when listening to the lungs, utilize your hands to quickly screen and scan One of the things I try to do is I try to make my exam as part of kind of like playing with the child So sometimes I'll tell them to kind of raise their arms up over their head or I'll take their arms and move their arms around saying that, "Hey, we're gonna do some 'Simon says'" So sometimes, you've got to engage the child, make them interested and have them perform different joint motions and mobilities for you to kind of check and screen for osteopathic somatic dysfunctions.

05:09 So there are different models that we could follow in terms of osteopathic treatment.

05:13 So the pediatric patient, what we'll look at first, is the structural model.

05:18 Remember that the structural model is to try to optimize biomechanical motion and movement of the joints.

05:24 We want to try to address bony somatic dysfunctions, treat the myofascial structures and soft tissue to maximize mobility.

05:34 So some of the treatments that we use in the structural model include counterstrain, muscle energy, facilitated positional release, articulatory techniques and balanced ligamentous tension.

05:45 Obviously, if the child cannot follow instructions, then muscle energy might be a more difficult technique to utilize.

05:53 Counterstrain also if the child can't be patient and relaxed for 90 seconds to get to point to relax.

06:00 and then sometimes you may have to utilize a different technique when trying to treat using the structural model.

06:08 So here we see an image of a newborn skull.

06:10 and what we're trying to illustrate here is that you can see how there's space between the cranial bones - the sutures are not formed yet.

06:17 So the cranial bones at birth are plates that are in parts.

06:22 The cranial bones are generally formed in membrane.

06:25 The sutures are open to allow for molding.