Over the past twenty five years in New Zealand, the awareness of osteopathic treatment for babies has increased, however we are still often asked when to seek treatment for a baby. We also often see older children who could have benefited from treatment as a baby. We are keen that all babies and children who need help, receive it in a timely fashion.

This article is to inform parents when to seek osteopathic treatment for their baby and what to look for in an osteopath.

​A baby will often communicate there is a problem by being unsettled, irritable or wakeful.
​Symptoms in a newborn baby to be aware of are:

• colic
• excessive wind
• continuous crying
• difficulty feeding or a preference to feed from one breast
• sticky eyes
• sleeping difficulties
• stiffness of the neck muscles
• favouring the head to one side 
• a misshapen head
• tongue tie or jaw restriction

What education do Osteopaths have?

Osteopaths train for forty hours per week for five years full-time at university and are required to competently pass well over one hundred exams and undergo clinical competency training and exams.

Osteopaths are government regulated and registered with the Osteopathic Council of New Zealand and must partake in ongoing professional education each year. We are also ACC treatment providers.

Osteopaths who treat babies and young children ought to have done extra post graduate study in addition to their undergraduate paediatric study.
​

Why would a newborn baby have anything wrong with them that is needing help by an osteopath?
A baby's passage through the birth canal is usually a difficult process however nature ensures that the bones of the skull are pliable enough to overlap to enable this to happen. Sometimes the bones do not return to their normal positions after delivery. This can happen if the labour is unusually long or fast, if there is a large baby passing through a small pelvis, if a baby has a large head or if intervention is necessary for example a forceps delivery or ventouse extraction. A baby may suffer a cranial base, neck, shoulder or back strain during the birth process. Pre-term babies may have strain from being out of the uterus too early and there is also likely to be alterations in nervous system function.

A Caesarian birth may involve trauma to the baby who is stuck in the mother's pelvis. Alternatively, problems can occur in utero if there is insufficient amniotic fluid.

Very often your midwife or lead maternity carer will refer you and your baby to see an osteopath for assessment and treatment, particularly if the birth has been difficult. We also work with Lactation consultants to help with feeding issues. This can include jaw and cranial base problems that may be affecting the baby's ability to latch, or to treat the tongue and surrounding structures in cases where a posterior tongue tie is affecting baby's function.

How soon should my baby see an Osteopath?
If there is nothing particularly troublesome going on for your baby then we recommend two weeks after the birth is a good time to have made an appointment as that gives you time to feel settled at home and also figure out how to get out of the house and travel with a new baby.
If the birth has been difficult or your baby is very upset and won't settle, then we recommend bringing them in to see a cranial osteopath as soon as possible.
​
What does the assessment and treatment look like?
First a medical history of the mother and baby is taken relating to the pregnancy and birth and any concerns you may have. Then your baby is gently assessed from their feet up to their head. Findings and treatment process are explained and then treatment will take place with your consent.
The treatment looks calming and is very gentle for your baby. If necessary we can treat your baby while they are being breast fed or sucking on a finger to help soothe them. Osteopaths use their hands to gently help the baby undo strains in the fascia (the connective tissues of the body), to help restore better alignment and function. We are also able to assist the autonomic nervous system of the body, calming the sympathetic and boosting the parasympathetic nervous system. This is very relaxing and helps the digestion to settle and ideally the whole body to be in self healing mode. Please note cranial osteopathy is not just to do with the head, any tissue in the body can be  treated with this gentle approach. Our clients find it is surprisingly effective.

Afterwards your baby may be more hungry than usual and be a bit unsettled or sleep for longer periods as their body works with the treatment to undo strains and find better alignment and health. 

Ideally all pregnant mums would be assessed and treated at around 35 weeks pregnant to help balance up the pelvis and ready the connective tissues of the body for birth.
Research shows 
http://jaoa.org/article.aspx?articleid=2092759) that this results in a better birth with fewer interventions. This also means post birth we can see you for a one hour 'Mother and baby' check up together.

Some research:
Meta-analysis of research shows Osteopathic treatment reduces length of stay and costs in preterm infants. March 2017 insights.ovid.com/crossref?an=00005792-201703240-00043
Osteopathic treatment of children with cerebral palsyjaoa.org/article.aspx?articleid=2093549#72971939
Research evidence for cranial bone mobility:
http://www.icnr.com/articles/radiographic-evidence-of-cranial-bone-mobility.html
​Research on cranial rhythmic impulse and the Traube-Hering-Mayer oscillation:
http://jaoa.org/article.aspx?articleid=2092406 
Research on measuring intracranial wave form pulsatility:
http://www.ncbi.nlm.nih.gov/pubmed/9779147
Pre-term-infants(Research:http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127370 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648440/)
Research on treatment of colic http://​www.sciencedirect.com/science/article/pii/S1744388105001350
Research on plagiocephaly www.sciencedirect.com/science/article/pii/S174438811100020X
Research evidence on safety of Cranial Osteopathy: http://jaoa.org/article.aspx?articleid=2093194

The specialist was very happy with the changes so took the baby off the omeprazole, removed the nasogastric tube and cancelled the stomach tube surgery. The baby started to put on weight as the intake of solids was increased and has continued to improve.

The baby needed a couple more osteopathic treatments to help as he started to grow. The baby has had no more reflux and the cheeks are normal healthy skin. I have recently followed up with the mother and now a year on, the baby is doing well, eating well and has had no more oral aversion or reflux.

In Australia and New Zealand, Osteopaths study intensively for five years full-time at University, are  required to be registered by the their respective professional councils and do ongoing postgraduate study each year.

Only some osteopaths treat babies as it takes time, aptitude and practice to develop the skills. The treatment is safe and very gentle. Osteopaths learn to use their hands to gently treat strains in the body. Facilitating blood supply, nerve supply and venous and lymphatic drainage enables the body to heal as well as possible and as quickly as possible.

Please note, not all babies with reflux will respond as rapidly as this baby did. Reflux is usually multi-factorial so other management strategies may also be necessary.

​There is a growing body of global research to support our work. Our practice would be happy to participate in further research studies.
​
Here is a link to information on gastro-oesophageal reflux disease (GORD)
Also a link to a very small scale osteopathic research paper on treatment of GORD

Thank you to the parents who permitted me to write up their baby's case. These photos are not of their baby but are a fair representation.

​While particular attention should be directed towards the pelvis, osteopaths try to make sure the whole body is able to adapt efficiently to the incredible changes that happen on many levels during pregnancy. Some things we focus on pre-conception are improving blood flow and lymphatic circulation in the pelvis and abdomen. This is so important these days when most people spend hours sitting at their desks or in vehicles. Balancing the autonomic nervous system (which usually means reducing the effects of stress by calming the sympathetic nervous system) is another area that often needs help and can make for a very different experience once a woman becomes pregnant, for both herself and the baby.

While sorting out dysfunctions that can be dealt with pre-conception is ideal, treatment in pregnancy is very beneficial and often needed. Pregnancy is a very dynamic state where the body undergoes some profound changes in a relatively short space of time.



​​I will touch on a few of those below and mention briefly what osteopaths can do to help “support the change” or reduce discomfort if the changes are not happening as smoothly as they should:

1) Postural/mechanical changes: as the body’s centre of gravity shifts for obvious reasons, the posture changes dramatically. It is of vital importance to ensure that there are no major restrictions so the structure is able to adapt to new demands. One very important aspect is to ensure normal mobility of the sacrum so that it can move during labour thus making it easier for the baby to pass through the birth canal. But it’s not just about the pelvis. Chronic sitting in desk workers often leads to tension and sometimes constant pain in the shoulders/neck or between the shoulder blades. Not only is this uncomfortable and stressful, restrictions there would prevent a woman from achieving a deep squat with good form - which is one of the most useful exercises in pregnancy as well as a great position during labour that helps the baby descend. Having a mobile thoracic spine and ribcage also means you can breathe more efficiently getting more oxygen for yourself and the developing baby, have more energy and a clearer head! 

Some research on Osteopathic treatment in Pregnancy:
Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis.www.ncbi.nlm.nih.gov/pubmed/25175885 
Acute improvement in hemodynamic control after osteopathic manipulative treatment in the third trimester of pregnancy. https://www.ncbi.nlm.nih.gov/pubmed/24280470
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​Aydan Hajiyeva Honours Diploma in General Medicine, DO M.Ost. Reg. Osteopath MONZ
Aydan has an Integrated Master’s Degree course from the European School of Osteopathy (UK).
Having previously completed six years medical doctor training, she really appreciates the holistic nature of the osteopathic approach. She has been exposed to a variety of treatment approaches at university, including classical, cranial and visceral osteopathy and has undertaken post graduate education, including biodynamics of osteopathy, primitive reflexes and pregnancy care, which have helped her develop her vision of osteopathy. Aydan regards osteopathy as a philosophy allowing her to create a positive change in a patient, by facilitating the expression of the inherent wisdom of the body.
www.cityosteopaths.co.nz 
​Phone 04 4991439

Babies were born to breastfeed. However there are many instances when breastfeeding is very difficult and painful for mother and baby. 

There can be a range of reasons for this and may be due to problems with the nerves that supply the tongue of the baby, affecting how it can move forwards and upwards to cup the nipple.

This may be due to compression of sensitive areas of the baby’s soft skull when they are in the uterus or during childbirth. The passage down through the birth canal is estimated at 60 pounds per square inch on the baby. Vulnerable nerves include the vagus, the hypoglossal and glossopharyngeal nerves.

Babies also can have trouble breastfeeding if they are unable to open their jaw fully to take in a large area of breast around the nipple. This wide mouth opening is important in order to get a good lip seal so they are not sucking in air. It also helps the tongue cup the breast and create a good suction vacuum for milk to be drawn down from the breast milk glands. 


The jaw also needs to be able to move forwards. If there has been compression or traction forces in this area affecting the temporal bones which the jaw joints sit in at the temporomandibular joints or TMJ, then this may adversely affect breast feeding.

The babies neck needs to be comfortable feeding both sides, we often see babies who like to feed on one side only and fuss on the other breast. Our highly trained osteopaths are able to gently treat the baby’s neck and sort out the problem. The treatment is very gentle so there is no risk to baby.

Sometimes, in about 5% of babies there is a posterior or submucosal tongue tie, this can be hard to see and at times may only be diagnosed by an experienced assessor. A submucosal tongue tie will affect the tongue’s ability to cup the breast and draw down milk. 


If you suspect your baby may have a problem with their tongue you can see an experienced lactation consultant (we recommend Cheryl Ganly-Lewis in Wellington). 


Initially you can self- assess it in the following way:

1) Does your baby's tongue poke out of the mouth, beyond the bottom lip?
2) Are they able to poke it to either side?
3) Can they cup your finger with their tongue and create a good coordinated sucking motion?
4) If you gently sweep your finger under their tongue, can you feel a strong central band?
If you answered no to any of the first three questions and yes to the last question then it would be a good idea to get your baby assessed as they can be helped!

Our osteopaths at City Osteopaths in Wellington are trained to work gently with a gloved hand inside the mouth. 
We have found that by sensitively treating the tension in the tongue and surrounding tissues, this will often sort out the breastfeeding problem. We treat where the tongue connects into the connective tissue/fascia of the neck, throat and right down into the sternum or breast bone. Then about fifty percent of the time, there may no longer be a need for a snipping or lasering of the tissue under the back of the tongue.

We find that if a snip or laser is still required, then the results are much more effective as the tissues that have been tight in the area around the tongue due to the way the tongue tie formed embryologically, are already released.

It is also ideal to have 2-3 osteopathic sessions after a tongue tie release to help all the surrounding tissues come into balance with the newly freed up tongue.

Ideally a tongue problem is picked up and treated early in a newborn baby so they are able to breastfeed successfully. However we have also had very good results from osteopathic treatment of toddlers and preschool children who usually have had a big problem with breastfeeding as a baby and present to our practice with drooling and having difficulty speaking clearly due to the tongue tightness near the base. Often just a couple of treatments will sort out the problem for the young child and their family, in a non-traumatic way.

With the increasing awareness of tongue tie still present  in adults, we have helped many a chronic or long term tight neck and jaw, just by gently releasing the tongue and associated tissues. Usually these adults were unable to be breastfed as babies and may have had a tight neck, jaw, head and even chronic sinus problems for most of their life.

With growing awareness of gentle cranial osteopathic treatment, we hope fewer babies are missed, breastfeeding is successful and long term problems such as neck and jaw tightness are avoided.


References:
‘An Osteopathic Approach to Children’ Carreiro, Jane. Churchill Livingstone 2003
‘Supporting Sucking Skills in Breastfeeding Infants’ Watson Genna, Catherine 2013
‘The Cutting Edge’ Tongue Tie Conference notes Brisbane 2014

Melanie Young B.A., B.App.Sc. (Clin.Sc.), B. Osteo.Sc. Reg. Osteopath, MONZ ​
Registered Osteopath
Director City Osteopaths
Level Four 166 Featherston St
Wellington
www.cityosteopaths.co.nz