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?