Paediatrics

Paediatric Osteopathy can be divided into three age groups:

Paediatric Cranial Osteopathy (0-2 years)
Most babies need between 3 to 8 treatments. The number of treatments depends on:
– The severity of the problem e.g. Moderate to Severe Skull Asymmetries require the most treatment. Mild Flat Areas / Strain Patterns require the least
– The age at presentation – the earlier a baby is brought in, the better. Earlier presentation usually means less treatment.
– Most babies with reflux, colic, or who are unsettled, require 3 to 4 treatments
Toddlers, pre-school and primary school age children (2-12 years)
Adolescents (12-18 years)

See below for more info.

Our osteopath’s training and experience:
Our principal osteopath, Dr Ben Robins, has been treating children from one-day-old to high school age for almost 15 years. Ben has completed many years of undergraduate and post-graduate study in order to treat this age group, including:

Bachelor of Science (University of Melbourne, 1998-2000)
Bachelor of Clinical Science, Master of Health Science (Osteo) (VU, 2001-2006)
Balanced Ligamentous Tension, Sutherland Cranial Teaching Foundation, Sydney, 2008
Fundamentals of Osteopathy in the Cranial Field, SCTF, Sydney, 2010
Paediatrics, Caroline Stone, Melbourne, 2010
Follow up to Fundamentals of OCF, SCTF, Sydney, 2011
Rule of the Artery I (Cranial), Melbourne, 2012
Rule of the artery II (Cranial), Melbourne, 2013
Graduate Diploma of Neonatal and Infant Manual Therapy (One year course, VU, 2012)
Osteopathic Cranial Academy Annual Conference, Naples FL (USA), 2015
Osteopathic Cranial Academy Annual Conference, Redondo Beach CA (USA), 2016
Osteopathic Cranial Academy, Robert Fulford Course, Portland OR (USA), 2018
Osteopathic Cranial Academy Annual Conference, (USA), online 2020
Osteopathic Cranial Academy Annual Conference, (USA), online 2021
Osteopathic Cranial Academy Annual Conference, (USA), online 2022
Orofacial Myofunctional Therapy, Melbourne, 2023

Dr Ben also has a 16-month-old son (as at March 2023) who endured a three-day labour. This meant he was born with a crooked nose, misaligned jaw and a flat area on the back left side of his skull. As he grew a little, he also had one eye slightly higher than the other (a common finding). After receiving treatment from Dad along the way he is now looking symmetrical and importantly functioning well in the jaw, nose and base of the skull. Dad has also learned a bit more seeing the development on a daily basis, but is yet to figure out how to avoid 3am wake ups from teething!

Paediatric Cranial Osteopathy (0-2 years)

What is Paediatric Cranial Osteopathy?
Paediatric Cranial Osteopathy is a gentle approach to alleviating problems with the skull of babies that may have emerged in the womb, during the birth process or in their early development.

Things that we treat
Skull shape

Flat areas on the skull – Plagiocephaly and Brachycephaly
Having an unusually shaped or asymmetric head

Neck Issues

Not turning their head evenly both ways (torticollis). Neck strain, known as torticollis when muscle spasm occurs, is common in newborns and infants and can easily be treated with gentle osteopathy.

Parents commonly bring in newborns and infants who have vague symptoms and signs such as:

Being unsettled, crying a lot, colic
Not sleeping well
Not feeding well
Painful reflux
Excess / painful wind
Not turning their head evenly both ways
Being unhappy in certain positions e.g. in a capsule, in a car seat
Seeming irritated / in pain whilst being dressed or moved

If there is a structural issue such as a neck strain, strain between the soft plates of the skull or a tongue tie, this may be contributing to such symptoms.

Or congenital conditions such as:

Tongue and lip tie (Note: at times some children need to be referred for a frenectomy, or tongue/lip tie release. If so, it is recommended seeing Dr Ben before and after the procedure.
Hip dysplasia (Note: infants should be assessed via ultrasound for the need for a brace before commencing osteopathic treatment if this is suspected)
Talipes (Club or turned-in foot)

How problems with the skull occur

The infant skull
The newborn and infant skull is made up series of plates that fit together in a way that allows some movement between them. We say ‘plates’ here as they are not yet bone, but rather cartilage (lower skull) or membrane (upper skull) from which the bone will form.

Here is a short video showing the individual bones of the skull:

The forces of gestation and birth
Babies are exposed to many varied forces as they both grow in the womb and, in the case of vaginal births and some emergency caesareans, as they endure uterine contractions and the passage into and out of the birth canal.

There are commonly also interventions used to assist the birth such as vacuum, forceps and inductions which can add additional forces to the skull.

The plates in the newborn skull are designed to overlap as the baby passes through the birth canal in order to make the skull smaller. As many parents would have witnessed, in the days following the birth the baby’s head can have unusual shapes such as coning, ridges, indentations or early flat areas, and even have bruising.

Thankfully, the body is very clever, and with the help of the Reciprocal Tension Membrane (the internal connective tissues of the skull, for more info see Cranial Osteopathy tab), the plates are largely pulled back into alignment, and in most cases the skull shape takes on a more normal looking appearance within a few days post-birth.

If the early coning, ridges, indentations or flat areas are persisting or worsening, it would be a good idea to give us a call and organise an appointment for your baby, so that they can be assessed and treated.

Forces post-birth
In the case of babies born prematurely or even a little early, the skull will usually be a little softer than a full-term baby. In such cases the baby may be more prone to developing a flat area on the skull just from lying and sleeping.

It is very common for a baby to get a mild neck strain from the birth process and be restricted turning their head one way. With the favouring of sleeping on one side, this can quickly lead to the development of a flat area. If you start to see a flat area emerging that is not improving, it would be a good idea to give us a call and organise an appointment for your baby, so that they can be assessed and treated.

Strain types of the infant skull
Interosseous strains – these are strains between the plates of developing bone and can be sometimes seen and felt by parents as raised ridges where the plates meet.

Intraosseous strains – These are strains within the developing plates before they become bone. A very common example is at the occiput (the bone at the back of the skull) in cases of Plagiocephaly and Brachycephaly, or flat spots. The occiput is formed in four parts joined together by softer areas of cartilage. With the forces of late pregnancy and early life, it is very common to have strains and altered alignment between these four parts. A very common, gentle and important Paediatric Cranial Osteopathy technique for Plagiocephaly is ‘decompression of the condylar parts’ of the occiput. This valuable technique is one of the ways Cranial Osteopathy helps the body to grow out of problems.

Strains of the Reciprocal Tension Membrane (RTM) – A Paediatric Cranial Osteopath is able to assess the tension in the connective tissues of the RTM (for more info see Cranial Osteopathy tab) for symmetry and balance. If the bones of the skull are held in a neutral position by the Osteopath, strain patterns from birth or other traumas within the Reciprocal Tension Membrane can begin to unwind. The Reciprocal Tension Membrane is the access point for many cranial issues.

Strain patterns of the infant skull
Plagiocephaly – the term used to describe the common strain pattern where one side of the back of the skull appears flatter. Is often accompanied by one ear being further forward than the other, and sometimes in larger strains one eye being more forward. When the ear or eye are further forward, this is an example of a lateral strain (see below).

Brachycephaly – the term used to describe the strain pattern where the back of the head appears flat straight across.

Skull models
Dr Ben has re-created some common strain patterns by gluing plastic skulls into position. Have a look below and at ask Dr Ben to show you at your next appointment.

The cranial nerves
There are 12 cranial nerves that emerge from the base of the brain and brain stem. These nerves supply structures around the head, neck and gut and are very important for functions such as vision, hearing and feeding. As these nerves run through and between the plates of the skull, some can be irritated by strain patterns of the skull and lead to symptoms mentioned above such as reflux, colic and feeding issues.

How the consultation runs with your baby

Examination
The Paediatric Osteopath will examine the infant visually first, to note any asymmetry of head shape, neck movement or limb movement.

They will then perform a very gentle physical examination, to look for any restrictions that may be possibly causing the baby problems, throughout the whole body, including the skull.

If at any point your baby appears distressed, and this may be from the beginning of the consultation, the osteopath will encourage a parent to hold the baby on their chest or lap while the osteopath examines and/or treats. A calm baby is easier to treat, so over the years Dr Ben has figured out how to treat from almost any position!

At this age the infant is like a bag of fluid. The infant should be able to move freely and evenly like a bag of fluid, but slight restrictions can restrict their functioning. Our Paediatric Osteopaths have developed a fine sense of touch through years of training and practice to be able to gently feel these restrictions in the infant. The baby can’t tell you much themselves, and we don’t want to cause them any pain with testing, so the fine sense of touch is vital.

When it comes to the skull, all parts of the skull will be assessed, including the base (lower), vault (upper), connective tissues (Reciprocal Tension Membrane), jaw and face including eye and cheekbone alignment.

Commonly the Paediatric Osteopath, with the parent’s permission, will put an examination glove on and place a finger in the baby’s mouth. This will give the Paediatric Osteopath a lot of information about the tongue, including the suck reflex and quality of suck, latch and presence of any ties.

If indicated non-invasive neurological testing / observation may be performed such as checking reflexes, pupil constriction, vision and hearing.

The Paediatric Osteopath will always keep in mind possible non-musculoskeletal causes of or contributions to issues in the baby, such as a food allergy or intolerance, or a congenital condition.

Common presentation example
Commonly the birth process can strain the neck, causing reflex muscular tightness that restricts motion one way, or can strain the fragile skull. Commonly if the neck or skull is strained, the neck will tighten, the baby will favour sleeping one side and a flat area develops on the skull. As the key nerves that supply the tongue, mouth, throat and digestive tract emerge from the base of the skull (the cranial nerves) restriction or compression in this area can potentially affect these nerves, and possibly lead to problems with feeding, digestion and settling.

Treatment
Treatment of this age group is very gentle. The pressure used by our osteopaths would not be enough to leave an indentation in a ripe tomato, so is not painful for the baby. It involves gentle positioning to release connective tissues throughout the body and within the skull, as well as the joints between the bones of the skull. As mentioned in the Cranial Osteopathy section, holding the bones of the skull in a neutral position allows the internal connective tissues of the skull to rebalance. The idea is to allow the body to grow out of any problems or strain patterns, rather than into them.

Helmet therapy
Sometimes helmets are needed in more severe cases of Plagiocephaly but this service is not provided at Central Osteopathy. The limitations of helmet therapy are that the helmet helps to improve the structure or shape of the head, but does not include assessment of the function of the bones of the skull, i.e. the individual movement of the bones. Helmets often also fail to release intraosseous strains (mentioned above) as are common in the occiput (back of the skull) in Plagiocephaly and Brachycephaly. Helmet therapy also does not address the bones of the jaw and face, which are of course connected to the rest of the skull behind them, or the alignment of the eyes.

Toddlers, pre-school and
primary school age children (2-12 years)

This is the age where any problems that have emerged in the child’s development can begin to show up. It is also an age where children become increasingly active and their developing bodies are prone to strains and other injuries.

Common conditions

Recurrent headaches – often follow small strains in the neck, or an imbalance at the pelvis. It only takes a tight muscle in the lower back to tilt the pelvis out of balance at this age. This is easily amended with osteopathy.
Gait / walking problems including knock knees
Persistent back pain – often also arise from a simple pelvic imbalance or natural anatomical variation at the base of the spine e.g. transitional vertebra, enlarged transverse process, pseudoarticulations.
Oral issues such as mouth breathing, thumb sucking, teeth and jaw misalignment. The combination of Cranial Osteopathy and Orofacial Myology is very effective in helping the child grow out of these issues.
Developmental Delay and Learning difficulties*

*Note – We cannot always help with developmental delay and learning difficulties, but can sometimes provide assistance if there is a structural problem that may be affecting the functioning of the central nervous system. Examples of structural problems include restrictions is mobility of the bones of the skull, restrictions of the internal connective tissues of the skull and restrictions in fluid movement and drainage within and from the skull.

Adolescents (12-18 years)

This age group begins to complain of many of the same conditions we do as adults, but also suffer from conditions related to the imbalance between muscles that are getting stronger, and bones that are still relatively soft as they are growing. Hence for active kids, often those doing a lot of sport or dancing, it is common to get some problems due to imbalance in the body. The good thing is it’s usually only between one and three treatments to get things on track.

With the world becoming increasingly digital and the use of phones, tablets and laptops increasing, we are seeing more and more neck and postural issues in this age group. Our osteopaths can help to correct posture and reduce strain on the neck with gentle muscular and connective release, as well as advice on posture and exercise.

Sports we see problems from include: Basketball, Netball, Football (Aussie Rules, Soccer, Rugby), Cricket, Dancing, Martial Arts, Boxing, Running, Cycling, Swimming, Gymnastics, Horse Riding and more.