OAT Pediatric Patient Flashcards
Describe selection of treatment modalities in children by age
HVLA rarely necessary in young children — also relatively contraindicated in anyone with hypermobile joints
ME may be difficult to perform in young children (ability to follow directions)
Articulatory (including Stills), MFR, indirect, FPR, lymphatic, and cranial are all very useful regardless of age
As children age, use of other modalities may increase (e.g., use of HVLA in adolescents is common)
Common childhood complaints
Poor suckling Colic Torticollis Otitis media Sinusitis Croup Asthma GERD “Growing pains” Back pain Joint pain Dysmenorrhea
Cranial treatments are highly useful in infants with poor suckle, constipation, and birth “trauma” (may manifest as vomiting, excessive crying, etc.). What are the 2 main techniques to use in these infants?
Condylar decompression
Balanced membranous tension
OMT considerations for pediatric MSK complaints
Evaluate AT LEAST the joints above and below
Remember to perform orthopedic exam as well as osteopathic eval
Treat with any appropriate modality
Don’t forget to send pts home with exercises
Describe infant MSK considerations in terms of spinal curvature, joints, bone flexibility, and cranial sutures
Spinal curvatures are very immature — C-spine has slight lordosis, which increases as baby can support his/her own head; thoracic kyphosis and lumbar lordosis not yet developed
Most joints/articulations are cartilaginous
Bones are at maximum flexibility
Sutures have not formed; cranial bones are at their freest
It is estimated that 88% of infants have cranial SD — most of which resolve through infant’s crying and suckling. The most common cause of this is _____ ______.
______ is the cranial bone most susceptible to dysfunction
Birth trauma
Occiput
The occiput is the cranial bone most susceptible to dysfunction; what cranial nerves may be affected and what are the related manifestations?
CN XII, IX —> poor suck
CN X —> reflux, vomiting, colic
CN XI —> colic, muscular dysfunction
Cranial dysfunction of what bone affects the most cranial nerves?
Temporal
[internal rotation —> increased likelihood of otitis media]
What cranial nerves might be affected by an operative vaginal delivery (forceps, vacuum), and what are the related manifestations?
CN VI —> lateral rectus palsy
CN VII —> facial palsy
Overall useful OMT techniques in infants
Indirect treatments, when possible, are preferred! — utilized in short but frequent sessions
BMT on cranial SD
Condylar decompression
BLT
MFR to diaphragms and junctions; suboccipital release
Osteopathic considerations for toddlers (1-4 yrs) in terms of presenting complaints
Ossification increases; some bones become fused
Increased falls, learning to walk, more head injuries
In school-age children, the cranium is fully ossified, but the epiphyseal plates are still open. What are the possible complaints associated with this?
Rapid growth in long bones —> “growing pains”
May develop leg length discrepancy during this period
Short leg syndrome
Functional scoliosis
USPSTF guidelines regarding scoliosis
Recommends AGAINST screening asymptomatic children/adolescents for scoliosis
[Grade D recommendation]
Rationale — USPSTF found that screening asymptomatic individuals did not identify significant disease better than screening only when clinically indicated
American Academy of Pediatrics Guidelines regarding scoliosis screening
AAP do not support any recommendation against scoliosis screening
Thus screening for scoliosis is performed by most PCPs for children and adolescents — screening consists of forward bending test
Osteopathic considerations for adolescents in terms of presenting complaints
Epiphyseal plates closing/closed
Innominates fuse by age 20
Sacrum fuses in late adolescence
Adolescent athletes are particularly susceptible to somatic dysfunction — watch for hypermobility
OMT for GERD complaints
Cranial — may be particularly useful in infants with GERD
Viscerosomatics — OA, AA, T5-T9
OMT for constipation
Tx dysfunction at viscerosomatic levels
Also treat any pelvic (innominate/sacral) dysfunction
Mesenteric release
OMT for rhinosinusitis
Sinus milking techniques
Cranial lifts
OMT for otitis media
Ear pull
Galbreath
Muncie technique
Asthma OMT
Rib raising
MFR
Assess for and tx any inhalation, exhalation SDs
An 11 y/o female with hx of asthma presents to the clinical with SOB. She has been using her daily inhaler only sporadically, but has had to use her rescue inhaler daily, often 2-3x per day. What dysfunction would you presume to find in this pt?
A. Inhalation SD of ribs 2-10
B. Exhalation SD of ribs 2-10
C. Chapman’s point at lateral proximal humerus
D. Chapman’s point at tip of 12th rib
A. Inhalation SD of ribs 2-10
A 17 y/o male distance runner complains of knee pain, particularly after running, and foot pain that is worse when he gets up in the morning. On exam, he has a positive Ober’s test and is acutely tender upon palpation of his anterior calcaneus. With what would you diagnose him?
A. Plantar fasciitis B. Iliotibial band restriction C. Probable stress fracture D. Both A and B E. Both A and C F. Both B and C
D. Both A and B
5 models approach to asthma
Neuro: b2-agonist —> bronchodilation
Immune: ICS —> blunts airway inflammation
Biomechanical: tx rib dysfunction —> improved respiratory mechanics
Behavioral: avoid triggers, use meds prior to known exposure
Resp/circ: rib raising, lymphatics —> improved pressure differentials in thoracic cage
Acute OM is the #1 reason for abx use in pediatric population. 50% of kids have >3 occurrences by age 3. MCC is S. Pneumo, followed by H.influenzae and M.catarrhalis. What are indications for abx use in cases of acute OM?
Ear pain non-responsive to analgesic meds
Age <6 mos
Exclusive formula feeding
Fever > 102.2 (39C) or non-responsive to anti-pyretics
Change in eustachian tube angle in kids vs. adults
Younger age = decreased eustachian tube angle
Angle increases with age —> improved drainage
