Newborn OMT Module


American College of
Osteopathic
Pediatricians
Robert Hostoffer,
DO,FACOP, FAAP
edited by
Eric Hegybeli, DO,
FACOP
Background:
Andrew Taylor Still, was born in Virginia in 1828, the son of a
Methodist minister and physician. At an early age, Still decided to
follow in his father's footsteps as a physician. After studying medicine
and serving an apprenticeship under his father, Still became a licensed
M.D. in the state of Missouri. Later, in the early 1860's, he completed
additional coursework at the College of Physicians and Surgeons in
Kansas City, Missouri. He went on to serve as a surgeon in the Union
Army during the Civil War.
Background:

After the Civil War and following the death of three of his
children from spinal meningitis in 1864, Still concluded that the
orthodox medical practices of his day were frequently
ineffective, and sometimes harmful. He devoted the next ten
years of his life to studying the human body and finding better
ways to treat disease.
Background:
His research and clinical observations led him to believe that the
musculoskeletal system played a vital role in health and
disease and that the body contained all of the elements needed
to maintain health, if properly stimulated. Still believed that by
correcting problems in the body's structure, through the use of
manual techniques now known as osteopathic manipulative
treatment, the body's ability to function and to heal itself could
be greatly improved. He also promoted the idea of preventive
medicine and endorsed the philosophy that physicians should
focus on treating the whole patient, rather than just the disease.
 http://www.aacom.org/OM/history.html
Osteopathic Tenets (there are 4 main
ones)




The body’s inherent ability for self-repair
The interrelatedness of body systems
The body possesses self-regulatory healing
mechanisms
The interrelatedness of structure and
function
Newborn OMT
Review of Structural Basis

Neuroembryology
–
–
Neural ridge
Neural tube

Neuroanatomy
–
–
–
–
–
–
–
–
–
Ventricles
Central spinal canal
Choroid plexus
CSF
Cauda equina
Dura mater
Arachnoid villi
Individual cranial bones
Skull
Review Neuroembryology

Neuroembryology
–
–
–
Neural ridge
Neural tube
Dematomal development
Review Neuroanatomy
Review Bones and sutures of the Skull
(make note of the difference in angle from horizontal of the
cranial base (a line from the eye socket to base of occiput) – it
is about 30 degrees in child (more horizontal) and 50 degrees
in the adult)
Pediatric
Adult
Note differences of adult and infant
skull:
Physiological Basis








Blood-brain barrier
Primary respiratory mechanism
Craniorhythmic impulse
Circulation of the CSF
Axes of motion in the cranium
Axonal transport
“The rule of the artery is supreme.”
Active labor, transition and delivery
Blood-Brain Barrier
Review CSF circulation
Developmental Relationship
Structure↔Function
“Ram’s Horn” Shape Embryologic:
CNS grows faster than cranium
Foramina: Cranial Bones are in
multiple parts at birth (nerves
don’t poke through bones)
Suture types for motion develop as
plates meet
Wolff’s Law: Cartilage is laid down
along lines of stress
Osteopathy in the Cranial Field
ReminderS
Cranial Bone Movement

Midline: Flexion/Extension

Paired: External/Internal Rotation
Common Patterns of Cranial Plagiocephaly
LATERAL SBS Strain
(Parallelogram Head)
Flexion (Fat Head)
Extension (Cone Head)
Cranial Somatic Dysfunction
Affects Function

Ophthalmologic
–

Gastrointestinal
–

CN IX, X, XII
Respiratory
–

CN II, III, IV, VI
CN X
Musculoskeletal
–
XI

Parasympathetics with
III, VII, IX, X
CN IX - Glossopharyngeal Nerve
Jugular
Foramen
CN IX - Glossopharyngeal Nerve

Function

Motor to muscle;
Parasympathetic to glands;
Sensory to palate

Structure

Jugular foramen

Dysfunction


History

Difficulties swallowing,
excessive gag reflex
Trauma to occiput &/or
temporals

Physical examination


Test gag reflex
Evaluation of temporals, occiput,
occipitomastoid suture
CN XI - Accessory Nerve
SCM
Foramen
Magnum
CN XII - Hypoglossal Nerve
Hypoglossal
canal
CN XII - Hypoglossal Nerve
Motor to Tongue
Hypoglossal canal
Dysphagia, tongue function
(latch-suckle)


Function
Structure
Dysfunction

History

Occipital condyle trauma;
intraosseous strain

Test tongue motions
Test neonatal suck
Evaluate occiput (condyles),
top cervicals



Physical
examination




Prevalent Pediatric Problems

Musculoskeletal System
– Scoliosis
– Torticollis

Respiratory System
–
–
–
–
Otitis Media (Acute vs.
Serous)
Pharyngitis
Bronchiolitis
Asthma & Reactive
Airway Disease (RAD)

Gastrointestinal System
– Constipation
– Poor Feeding/Sucking
– GER & GERD

Neuro-Psycho-Social
–
–
Learning Disorders
(ADD/ADHD)
Strabismus
Prevalent Pediatric Problems

Musculoskeletal System
–
–
Torticollis
Scoliosis
Torticollis = Twisted Neck



Common positioning in utero
Prolonged or difficult labor
exacerbates dysfunction
Risks
–
–
–
–
–
–

Primiparous mother
LGA
Male
Breech
Multiples
Maternal uterine
abnormalities
“Back to Sleep” effect
Torticollis
SBS & CN XI

Parallelogram Pattern

Lateral Strain Deformity
Gastrointestinal System:
Poor Feeding/Sucking

Goals & Considerations
–
–
–
Patients present with poor growth or irritability
Prolonged or difficult labor; eventual c-section
preventing initial gasp
Improve restrictions impinging on responsible
cranial nerves by decompressing surrounding
sutures
Occipital Release Technique for
Newborns and Infants






Support the patient’s body by cradling it with your forearm
Support the head and palpate for motion with the ipsilateral
hand
Support the sacrum and palpate for motion with 2 or 3 fingers of
the contralateral hand
Grasp the cranium with fingers evenly splayed “as firmly as you
would a ripe tomato so as not to leave impressions”
Feel subtle release of muscles and watch newborns face
content.
Give newborn back to parent and observe improvement with
feeding.
Demonstrate the procedure on
patient in front of director
Innervation Table
Organ/System
EENT
Parasympathetic
Sympathetic
Ant.
Chapman's
Post.
Chapman's
T1-T4
T1-4, 2nd ICS
Suboccipital
Heart
Cr Nerves (III, VII, IX,
X)
Vagus (CN X)
T1-T4
T3 sp process
Respiratory
Vagus (CN X)
T2-T7
T1-4 on L,
T2-3
3rd & 4th ICS
Esophagus
Vagus (CN X)
T2-T8
---
T3-5 sp
process
---
Foregut
Vagus (CN X)
T5-T9 (Greater Splanchnic)
---
---
Stomach
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Liver
Vagus (CN X)
Gallbladder
T6-7 on L
T5-T9 (Greater Splanchnic)
5th-6th ICS on
L
Rib 5 on R
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Rib 6 on R
T6
Spleen
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Rib 7 on L
T7
Pancreas
Vagus (CN X)
Rib 7 on R
T7
Midgut
Vagus (CN X)
T5-T9 (Greater Splanchnic), T9T12 (Lesser Splanchnic)
Thoracic Splanchnics (Lesser)
Small Intestine
Vagus (CN X)
T9-T11 (Lesser Splanchnic)
Ribs 9-11
T8-10
Tip of 12th Rib
T11-12 on R
Appendix
Hindgut
Ascending Colon
Transverse Colon
T12
Pelvic Splanchnics (S24)
Vagus (CN X)
Vagus (CN X)
Lumbar (Least) Splanchnics
T9-T11 (Lesser Splanchnic)
T5-6
---
---
---
--T10-11
T9-T11 (Lesser Splanchnic)
R Femur @
hip
Near Knees
L Femur @ hip
T12-L2
Descending Colon
Pelvic Splanchnic (S2-4)
Least Splanchnic
Colon & Rectum
Pelvic Splanchnics (S24)
T8-L2
---
---
---
References:

Is their room for OMT therapy in your practice during the era of evidence-based medicine?
–
The Collected Papers of Viola M. Frymann, D.O.:
Legacy of Osteopathy to Children
Individual copies are priced at $75 for the hardbound edition and $65 for the softbound edition. The
shipping and handling for mail orders is $7. Orders should be sent to: AAO, 3500 DePauw
Boulevard, Suite 1080, Indianapolis, IN 46268-1136. Proceeds benefit the AAO and its programs.
–
The Viscoplastic and Viscoelastic Axes of Motionin the Cranium/Documenting Cranial
Dysfunction in Children
Print out the answer sheet to use
with the following questions.
Circle the correct answer and review
with director:



Question1: A, B, C, D, E.
Question2: A, B, C, D, E.
Question3: A, B, C, D, E.
1.
Which nerve if in dysfunction will cause
difficulties in swallowing and excessive
gag reflex:
A. CN VII
B. CN XI
C. CN XII
D. CN IX
E. CN VI
2. Which nerve when in dysfunction will cause
dysphagia, poor tongue function (latchsuckle):
A. CN XI
B. CN XII
C. CNV
D. CN VI
E. CN VII
3. Which pattern of Cranial Plagiocephaly
will present with a “flat head”:
A. Flexon
B. Extension
C. SBS strain
D. Torsion
E. Rotation
Certificate of Completion
I, _________________________,
successfully completed the Pediatric OMT
Module on __ __ 20__
Signatures:
 Pediatric Resident ____________________
 Pediatric Residency Director____________


( Please print and give to program director.)
Congratulations