1. Newborn OMT Module American College of Osteopathic Pediatricians
Robert Hostoffer, DO,FACOP, FAAP
edited by
Eric Hegybeli, DO, FACOP

2. 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.

3. 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.

4. 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.

5. 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

6. Newborn OMT

7. 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

8. Review Neuroembryology
Neural ridge
Neural tube
Dematomal development

9. Review Neuroanatomy

10. 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)
Adult
Pediatric

11. Note differences of adult and infant skull:

12. 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

13. Blood-Brain Barrier

14. Review CSF circulation

15. 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

16. Osteopathy in the Cranial Field
ReminderS
Cranial Bone Movement
Midline: Flexion/Extension
Paired: External/Internal Rotation
Common Patterns of Cranial Plagiocephaly
Flexion (Fat Head)
Extension (Cone Head)
LATERAL SBS Strain (Parallelogram Head)

17. Cranial Somatic Dysfunction Affects Function
Ophthalmologic
CN II, III, IV, VI
Gastrointestinal
CN IX, X, XII
Respiratory
CN X
Musculoskeletal XI
Parasympathetics with III, VII, IX, X

18. CN IX - Glossopharyngeal Nerve
Jugular Foramen

19. CN IX - Glossopharyngeal Nerve
Motor to muscle; Parasympathetic to glands; Sensory to palate
Jugular foramen
Difficulties swallowing, excessive gag reflex
Trauma to occiput &/or temporals
Test gag reflex
Evaluation of temporals, occiput, occipitomastoid suture
Function
Structure
Dysfunction
History
Physical examination

20. CN XI - Accessory Nerve
SCM
Foramen Magnum

21. CN XII - Hypoglossal Nerve
Hypoglossal canal

22. CN XII - Hypoglossal Nerve
Function
Structure
Dysfunction
History
Physical examination
Motor to Tongue
Hypoglossal canal
Dysphagia, tongue function (latch-suckle)
Occipital condyle trauma; intraosseous strain
Test tongue motions
Test neonatal suck
Evaluate occiput (condyles), top cervicals

23. 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

24. Prevalent Pediatric Problems
Musculoskeletal System
Torticollis
Scoliosis

25. 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

26. Torticollis SBS & CN XI
Parallelogram Pattern
Lateral Strain Deformity

27. 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

28. 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.

29. Demonstrate the procedure on patient in front of director

30. Innervation Table Organ/System Parasympathetic Sympathetic
Ant. Chapman's
Post. Chapman's
EENT
Cr Nerves (III, VII, IX, X)
T1-T4
T1-4, 2nd ICS
Suboccipital
Heart
Vagus (CN X)
T1-4 on L, T2-3
T3 sp process
Respiratory
T2-T7
3rd & 4th ICS
T3-5 sp process
Esophagus
T2-T8
---
Foregut
T5-T9 (Greater Splanchnic)
Stomach
5th-6th ICS on L
T6-7 on L
Liver
Rib 5 on R
T5-6
Gallbladder
Rib 6 on R T6
Spleen
Rib 7 on L T7
Pancreas
T5-T9 (Greater Splanchnic), T9-T12 (Lesser Splanchnic)
Rib 7 on R
Midgut
Thoracic Splanchnics (Lesser)
Small Intestine
T9-T11 (Lesser Splanchnic)
Ribs 9-11
T8-10
Appendix
 T12
Tip of 12th Rib
T11-12 on R
Hindgut
Pelvic Splanchnics (S2-4)
Lumbar (Least) Splanchnics
Ascending Colon
 Vagus (CN X)
T9-T11 (Lesser Splanchnic)
R hip
T10-11
Transverse Colon
Near Knees
Descending Colon
Pelvic Splanchnic (S2-4)
Least Splanchnic
L hip
T12-L2
Colon & Rectum
Pelvic Splanchnics (S2-4)
T8-L2

31. 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 Proceeds benefit the AAO and its programs.
The Viscoplastic and Viscoelastic Axes of Motionin the Cranium/Documenting Cranial Dysfunction in Children

32. Print out the answer sheet to use with the following questions.

33. 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.

34. 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

35. 2. Which nerve when in dysfunction will cause dysphagia, poor tongue function (latch-suckle):
A. CN XI
B. CN XII
C. CNV
D. CN VI
E. CN VII

36. 3. Which pattern of Cranial Plagiocephaly will present with a “flat head”:
A. Flexon
B. Extension
C. SBS strain
D. Torsion
E. Rotation

37. 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.)

38. Congratulations