[Lecture] OAT Pediatric [Nichols]

Question 1

Which treatment technique is generally unnecessary in young children?

Answer 1

HVLA

Question 2

Which treatment technique may be difficult to perform in children due to decreased ability to follow directions?

Answer 2

Muscle energy

Question 3

Which treatment techniques are useful in children regardless of age?

Answer 3

ART, MET, FPR, lymphatics, BLT, cranial

Indirect, may be able to use direct as they get older

Question 4

Compression of the jugular foramen may cause dysfunction of tongue motion, resulting in ______ in kids. Which CNs?

Answer 4

Compression of the jugular foramen may cause dysfunction of tongue motion, resulting in poor suck in kids

CN 9, 12

Question 5

Compression of the jugular foramen may cause dysfunction of intestinal peristalsis, resulting in ____, _____, and ________ in kids. Which CNs?

Answer 5

Compression of the jugular foramen may cause dysfunction of intestinal peristalsis, resulting in constipation, GERD, and contribute to colic in kids

CN 10

Question 6

Compression of the jugular foramen may cause dysfunction of SCM/trapezius motion, resulting in ______ in kids. Which CN(s)?

Answer 6

Compression of the jugular foramen may cause dysfunction of SCM/trapezius motion, resulting in torticollis in kids

CN 11

Question 7

Which spinal curvature is developed in infants? Which curvatures develop later?

Answer 7

C-Spine has slight lordosis, increases as baby supports own head

Thoracic kyphosis and lumbar lordosis develops later

Question 8

When do the anterior fontanelles close?

Answer 8

12-36 mo

Question 9

When do the posterior fontanelles close?

Answer 9

2-3 months

Question 10

When do the sphenoid fontanelles close?

Answer 10

6 mo

Question 11

When do the mastoid fontanelles close?

Answer 11

6-18 mo

Question 12

Which cranial bone is most commonly dysfunctional in infants?

Answer 12

Occiput (compressed)

Question 13

Dysfunction of which cranial bone affects the most cranial nerves?

Answer 13

Temporal

Question 14

Infants have increased likelihood of otitis media if temporal bone is rotated how?

Answer 14

Internally rotated

Question 15

Operative vaginal delivery cause palsies in which cranial nerves?

Answer 15

CN 6 - lateral rectus palsy

CN 7 - Facial palsy

Question 16

Why might internal rotation of the temporal bone cause otitis media in children?

Answer 16

Eustachian tube is flatter in infants than adults

Rotation blocks drainage of tube => increased risk of infection

Question 17

How can you tell synostosis from positional plagiocephaly on physical exam?

Answer 17

Synostosis - symmetrical forehead and eyes

Positional plagiocephaly - forehead protrudes on one side/parallelogram-shaped head

Question 18

What is craniosynostosis?

Answer 18

Abnormal fusion of head sutures

Question 19

What kind of cranial somatic dysfunction causes plagiocephaly?

Answer 19

Lateral strain

Parallelogram head

Question 20

What positional head deformity is frequently associated with torticollis?

Answer 20

Plagiocephaly

Question 21

What kind of cranial somatic dysfunction causes brachycephaly?

Answer 21

Vertical strain/Flexion strain

Head is wider than it is long, flat back of the head

Question 22

What kind of cranial somatic dysfunction causes scaphocephaly?

Answer 22

Extension strain

Head is long and narrow

Question 23

What CN may be irritated to cause torticollis? What muscle does this affect?

Answer 23

CN 11 (spinal accessory)

SCM - short and ropy

Question 24

Where would OMT be localized to treat torticollis?

Answer 24

OA region

Clavicles

Use MFR, BLT, MET, chapman’s points…etc

Question 25

How are most cranial somatic dysfunctions in infants treated?

Answer 25

Self-treated through crying and sucking

Question 26

3 techniques to use to treat cranial somatic dysfunction in infants?

Answer 26

Condylar decompression Balanced membranous OR ligamentous tension Venous sinus release *Indirect treatments!! Can also do MFR, suboccipital release, lymphatics*

Question 27

_Bone development in school-age children_ Cranium? Sinuses? Epiphyseal plates?

Answer 27

Cranium - **fully ossified** Sinuses - **fully formed** Epiphyseal plates - **Still developing**, may develop length discrepancy =\> short leg syndrome/functional scoliosis

Question 28

School-age children have avg of _____ URIs per year

Answer 28

Avg 6-8 URIs a year * Risk from school, smoke exposure* * Do lymphatics, viscerosomatics*

Question 29

Which sinuses are present at birth?

Answer 29

Maxillary Ethmoid

Question 30

Around what age do sinuses typically reach their adult size?

Answer 30

12-15, teen years

Question 31

What is the typical course that Bacterial sinusitis takes?

Answer 31

URI sx **\>10 days** =\> Sx **improve, then worsen** =\> Fever/purulent discharge **\>3 days** w/ facial tenderness/HA *Tx with lymphatics (galbreath, ear circles)*

Question 32

What division of the autonomic nervous system do you want to focus on when treating an **asthma** attack in children?

Answer 32

**Sympathetic** Focus on C3-5 (diaphragm), T2-7 sympathetic innervation T1-12 and accompanying ribs and diaphragm *Can also use for PNA treatment*

Question 33

What did the 2005 asthma study show regarding using rib raising, MET, and MFR in pediatric patients?

Answer 33

Increased peak flow by 7-19 l/m

Question 34

_Chapman's points Anterior/Posterior_ Nasal sinuses

Answer 34

_Anterior_: inferomedial clavicle, lateral to SC junction (**nasal** sinuses), 2nd sup rib at midclavicular line (**all** sinuses) _Posterior_: Mastoid process

Question 35

_Chapman's points Anterior/Posterior_ Larynx

Answer 35

_Anterior_: Superior 2nd rib, just medial to the sinus chapman's point _Posterior_: Just lateral to SP of C2 (larynx, pharynx, tongue, all sinuses)

Question 36

_Chapman's points Anterior/Posterior_ Pharynx

Answer 36

_Anterior_: Inferior 1st rib at sterno**costal** jxn _Posterior_: just lateral to SP of C2 (larynx, pharynx, tongue, all sinuses)

Question 37

_Chapman's points Anterior/Posterior_ Tonsils

Answer 37

*Just Anterior!!* Lateral manubrium

Question 38

_Chapman's points Anterior/Posterior_ Middle Ear

Answer 38

_Anterior_: Superior clavicle, about 2-3 cm lateral to SC jxn _Posterior_: Base of occiput at OA joint

Question 39

What do you always do when doing lymphatic techniques?

Answer 39

**Always open the thoracic duct 1st**

Question 40

What OMT might you want to do on a kid with rhinosinusitis?

Answer 40

Sinus milking techniques Cranial lifts

Question 41

OMT for **GERD** in kids/Adolescents includes what levels/structures?

Answer 41

OA (parasympathetic) T5-9 (sympathetic) Diaphragm Celiac ganglion (parasympathetic)

Question 42

OMT to treat **constipation** in kids/adolescents might include what levels/structures?

Answer 42

OA (parasympathetic) T10-L2 (sympathetic) Superior and Inferior Mesenteric ganglia Sacrum (**Sacral rock**)

Question 43

For musculoskeletal complaints in children, what joints must be evaluated?

Answer 43

**AT LEAST** the joints **above and below** the joint in question

Question 44

What did the 2008 JAOA study find in relation to OMT and children with cerebral palsy?

Answer 44

Statistically significant **improvements** in Gross Motor Function Measurement and Functional Independence Measure for Children

Question 45

_Bone fusion in adolescents_ Epiphyseal plates? Innominates? Sacrum?

Answer 45

Epiphyseal plates - **Closing by adolescence** Innominates - **fuse by age 20** Sacrum - **Fuses in late adolescence**

Question 46

What population of adolescents is particularly susceptible to somatic dysfunction?

Answer 46

Athletes ## Footnote *Watch out for hypermobility*

Question 47

What does the USPSTF recommend for scoliosis screening?

Answer 47

USPSTF found that screening asymptomatic individuals did not identify significant dz better than screening only when clinically indicated

Question 48

What does the American Academy of Pediatric guidelines recommend for scoliosis screening?

Answer 48

**They do not support recommendation against screening (they like screening)**

Question 49

What effect does increased **parasympathetic** tone have on peristalsis?

Answer 49

**Increased**

Question 50

What effect does increased **sympathetic** tone have on peristalsis?

Answer 50

**Decreased**

Question 51

_Chapman's Points Anterior/Posterior_ Appendix

Answer 51

_Anterior_: Tip of 12th rib _Posterior_: Transverse process of T11

Question 52

_Chapman's Points_ Intestines

Answer 52

Just below ASIS

Question 53

_Chapman's Points_ Colon

Answer 53

Along IT band

Question 54

_Chapman's Points_ Rectum

Answer 54

Near inner thigh

Question 55

In pediatric patients, treating the whole patient requires recognition of what?

Answer 55

The family unit