Osteopathic Treatment of Newborns, Infants and Children

by Robbie Estey-Willick

I like working with babies and children. I have a gentle method of assessing and treating newborns, babies and children for joint and soft-tissue related problems that doesn't involve the concept of adjustment. I assess babies by holding them in various positions of comfort or having them lie on the treatment table to gently observe and test the ability of a baby to move its head and neck, arms and legs. I use very gentle mobility tests to determine how all the joints of the body are able to move. If a baby is more comfortable being held by the parent or care-giver for treatment, I go with whatever the baby wants. There are many ways to modify treatment approach for babies and they're always the boss during treatment.

Newborns, babies and young children often have slightly misplaced bones, stiff joints, and soft tissue (muscle, fascia, tendons and ligaments) tension associated with those bone and joint related problems. The joint problems for newborns and infants are likely due to position and compressive forces in utero or during labour that can create either a malposition of one bone in relation to its articulating partner bone, or excessive compression of two adjoining bones that leads to restricted mobility, compromised function (e.g. movement), and sometimes discomfort. These bony problems and soft-tissue restrictions may compromise the blood-flow to and from surrounding tissues (organs, nerves) or may directly affect the function of the nerves themselves. For infants, these structural-biomechanical problems may be contributing factors with respect to digestive issues such as reflux and constipation, or may affect the ability of an infant to move their head and neck to achieve a good latching position, open their jaw comfortably, or engage a strong and coordinated sucking and swallowing action.

People I talk with about osteopathic treatment are often surprised that babies may need manual therapy like osteopathy; but problems of joint mobility in babies and young children are not uncommon. A joint that is moving normally has a nice suppleness, yields to gentle pressure on joint mobility testing, and moves easily and naturally with a baby's movements. A joint that doesn't move well is usually perceived as rigid, the bones have a dense texture, like a small stone, and the soft tissues surrounding and supporting the joints are felt as more tight, restricted and tense. Restricted joints and soft-tissues stand out as obvious in comparison to the rest of the body of the baby, which is generally quite fluidic and soft.

It isn’t appropriate when working with babies and children to apply intensive manipulative pressures around dysfunctional joints and soft tissues. I simply offer a mild focal support, a gentle presence with my fingertips around the area that is not moving well, and continue to provide this fulcrum of support as the baby moves in order to encourage improvements in mobility and tension, thereby easing discomfort and creating better opportunity for optimal growth and development. This approach requires a constant, focused mental and palpatory attention in order to make moment to moment changes, based on the baby’s movement, in the very gentle tension or compression applied around a joint in need of treatment. To a parent, it may look often as if I'm not doing anything; but there's a lot to pay attention to: local changes in muscle tension, local changes in joint mobility, local changes in temperature at the level of the joint problem, changes in a baby's breathing patterns, changes in a baby's disposition during treatment, and even reactive changes in other areas of the baby's body in response to changes at the local level being treated. Any or all of these changes require a subtle response by the osteopath in order to keep the baby as comfortable as possible and to optimize the potential for an effective treatment. An improvement in mobility and tension reduction is often perceived as a softening, an improved suppleness, or in the case of a more severely restricted joint, a very subtle click-like release as the joint surfaces release followed by an almost immediate easing of soft-tissue tension and an appreciable improvement in mobility at the joint level. Offering treatment with this approach, the baby has more control over the treatment since it is based upon her or his movement and respect for any expressions of discomfort. The treatment of joints and soft tissues is not forced; rather, the treatment is catered to the baby's enjoyment (many seem to like it) or tolerance, and therefore is more well-received, well-integrated, and safe.

Osteopathy can be helpful and supportive for common problems experienced by infants and young children, such as GERD (reflux), constipation, nursing issues (difficulty latching, sucking, swallowing), laboured breathing, chronic sinus and ear infections, chronic ear infections, sleep challenges and more. Osteopathy is not a substitute for medical care of problems noted above. The kinds of problems babies frequently experience are unlikely to be caused exclusively by structural-biomechanical issues and often babies will experience these problem in the absence of any positional or mobility issues of joints and soft-tissue; thus, the need for parents to work closely with their family doctors. However, in my clinical experience I’ve seen many instances in which osteopathic treatment appears to have positive influence on the issues for which parents bring their babies to my clinic. I’ve also seen instances in which babies don’t seem to experience any changes in conditions (e.g. reflux); however, areas of visible and/or palpable misalignment or restricted movement of joints seem to improve with osteopathic treatment and babies seem to be more comfortable and less distressed. Joint and soft-tissue related problems in babies and young children are important to address should their persistence begin to affect growth and development of the child.

It is important to note that we don’t make diagnoses as osteopaths, but we are able to use our knowledge and palpation skills in conjunction with information conveyed by parents and from other health care professionals to form a clinical impression that guides treatment. I believe it is of the greatest importance to work in collaboration with family physicians and other health-care practitioners to foster a team-oriented approach to health care that promotes optimal development, growth and general good health for my young patients.