OPP Flashcards
Most frequent diagnosis among 0-11 months
Congenital muscular torticollis
Most frequent diagnosis 1-4 years
Otitis media
Plagiocephaly
Abnormal head shape when viewed from above
Synostotic plagiocephaly (craniosynostosis)
due to premature closure of one or more cranial sutures
Nonsynostotic plagiocephaly (deformational or benign positional)
due to external forces causing deformation
Prenatal cranial pressure
- Uterine compression or constraint
- Multiple gestation
Postnatal cranial pressure
Prolonged time in the same position
- Sleeping with head always turned to same side
- Sitting in a car seat with head to same side
- Bottle fed in the same position as opposed to changing sides with breast feeding
Risk factors for plagiocephaly
- Male sex
- Firstborn child
- Multiple gestation
- Developmental delay
- Supine sleep position from birth to 6 weeks
- Bottle feeding only (previous slide explanation)
- Tummy time <60 minutes/day
- Same position for prolonged time
- Co-morbid torticollis
Long-term sequelae of plagiocephaly
- Learning disorder
- Stabismus
- Difficulty in fitting glasses
- TMJ
- Orthodontia
What cranial strain is associated with benign positional plagiocephaly?
Lateral strain
Treatment of plagiocephaly
- Rule out synostosis
- Observation (if doesn’t resolve w/i 2-3 years, probably won’t)
- Identify and remove source of prolonged external pressure on head
- Active counter positioning
- Alternate side of head at nap time
- Alternate sides for bottle feeding
- Supervised tummy time 1 hr/day
- OMT
- infant massage
- orthoses (by 6 months of age, no later than 12)
Plagiocephaly protocol
-Eval and treat SBS w/occipital condylar decompression
-Eval and treat sutures with V-spread or lifts
-Eval and treat cranial strain pattern
-Mold the head
-Eval/treat the rest (torticollis, thoracic inlet,
abdomen, lumbar spine)
Congenital muscular torticollis
- SB towards weak SCM/scalenes
- chin rotated opposite
- most common form
- males more common
- associated with plagiocephaly and facial asymmetry
- constrained intrauterine position (multiple gestation)
- increased birth weight or length
- breech
- difficult birth (vacuum or forceps-assisted)
- birth injury including shoulder dystocia
Ocular torticollis
Postural torticollis adapted to compensate for visual disturbance such as strabismus
Neurogenic torticollis
Tumor in the cranial posterior fossa or brainstem
Syringomyelia or Arnold-Chari malformation
Benign paroxysmal torticollis of infancy (spastic torticollis)
> Recurrent episodes lasting a few hours to a few days, commonly accompanied by
- Vomiting, irritability, or drowsiness
- Pediatric migraine or vestibular dysfunction (may switch sides)
Otitis media caused by
- Immaturity
- Allergies
- Structural (Eustachian tube more horizontal in infant)
- SD (cranial base strains can lead to impaired Eustachian tube drainage)
OMT protocol for middle ear effusion
- Balanced ligamentous tension (BLT) to SI joints
- MFR to thoracolumbar junction & abdominal diaphragm
- MFR or BLT of rib cage
- MFR C/T (thoracic inlet)
- BLT of cervical area
- Suboccipital release
- Venous sinus drainage technique
- Occipital decompression
- SBS decompression
Galbreath mandibular drainage contraindicated in…
TMJ dysfunction
Colic
Rule of 3’s “cry 3 hours/day at least 3 days/week around 3 PM”
Proposed causes of colic
- Entrapment neuropathy of CN IX, X and XII from cranial base strains
- Carreiro: pull of cervical muscles against cranial base and upper cervical spine causing pain
- Pottenger: parasympathetic overstimulation causing constriction and secondarily, to dilation.
OMT for colic
- Occipital decompression (CN IX, X, XII)
- MFR of abdominal valves and plexi
Feeding disorders and GERD proposed cause
entrapment neuropathy of CN IX, X and XII from cranial base strains
Feeding disorders and GERD treatment
- Occipital decompression (CN IX, X, XII)
- MFR of abdominal valves & plexi
