Health is a broad concept and it relies on the understanding of many different spheres of someone’s life. Osteopathy claims to approach the patient and its assessment in a global way (Parsons & Marcer, 2006) making a practitioner able to deal with almost the totality of dysfunctions within the osteopathic field. However, many specialities have developed through the years and now many osteopaths practice within a specific area of expertise. Examples are given by obstetrics, sports care and paediatric osteopathy. We present a small review about paediatric osteopathy within the multidisciplinary healthcare context.
Paediatric osteopathy has recently largely developed. A UK survey by McCann and Newell (2006), has shown that osteopathy is increasingly chosen by parents with children suffering from chronic diseases such as asthma, chronic otitis and traumatic delivery associated with postural asymmetries of the baby. The study reports that a considerable number of families seek, independently from the medical practitioner, the care of complementary medicine for their children, although only a small percentage of them make their general practitioners aware of this. The interpretation of this finding reveals that paediatric osteopathy has probably gained popularity in the general public more recently, although not many medical practitioners tend to refer their paediatric patients for osteopathic treatments yet.
Paediatric osteopathy is also identified with cranial and fascial practice within the traditional osteopathic manipulative treatment (OMT), based on the same inherent principle of structure influencing function and vice versa (Fur, 2014). The cranial paediatric approach uses gentle techniques in which the osteopath uses palpation to diagnose and treat dysfunctions around the skull bones and throughout the whole body. This happens in a non-invasive way and it is claimed to restore the inherent mobility of the cerebro-spinal fluid within the central nervous system (Frymann, 1976), potentially altered by a specific pathology or a traumatic delivery. It involves gentle pressure and articulation to achieve the same coherent functionality which is sought from traditional structural osteopathy (Fur, 2014). Not enough high quality evidence is present in literature proving whether cranial osteopathy or OMT has good results in the paediatric field (Posadzky at al. 2013) and the majority of them are mainly based on the experience of osteopaths and expert opinion. Although positive trends associated with the addition of cranial osteopathy in the paediatric area have been shown (Wyatt et al. 2011), the findings were mainly subjective and relying on families’ personal experience, therefore were not statistically significant or representative of the whole population. This may partially explain why many orthodox medical practitioners do not suggest it to their patients within the multidisciplinary healthcare context.
As mentioned before, OMT is thought to be effective in paediatric patients with chronic diseases (McCann & Newell, 2006). Asthma is a common chronic condition which has long plagued the paediatric patient population, being the cause for increased school absenteeism, hospitalisation and mortality (Guiney et al. 2006). In their randomised controlled trial (RCT) they showed a statistically significant improvement of patients suffering from asthma who received OMT, compared to those ones following only the traditional medical treatment. The study concludes that OMT is suitable for treating paediatric asthma and has an effect among this patient population, reducing mortality and morbidity rates among this group.
Also premature or traumatic deliveries are possible causes for increased mortality in newborns and infants. Osteopathy has been found helpful and is currently used for the treatment of dysfunctions derived from forceps deliveries, such as plagiocefalia, or delays in the transition from naso-gastric tube feeding to nipple feeding in premature babies. In a case report by Lund at al. (2010), the author presents the case of premature hospitalised twins with marked delay in the development of breast feeding, about to undergo surgical placement of gastrostomy. Before the surgery, the osteopathic manipulative medicine team was consulted and the babies underwent several sessions of therapy, which developed their nipple feeding skills to full oral feeding, avoiding surgery and allowing the discharge from hospital. It is arguable that the noticeable improvement achieved could be partially due to a placebo effect on parents, related to the fact that a new approach towards the babies’ feeding had been undertaken. Although positive results have been reported by this case analysis, this is only a specific case report, therefore not valuable to represent the whole population of premature babies and with no statistical significance. However, it still helps in understanding the potential application of OMT in the paediatric field, highlighting the need for osteopaths to undertake further evidence based research.
The application of OMT in the paediatric area has also been investigated for the treatment of otitis media, another chronic issue often associated with childhood (Mills et al. 2003). This RCT study observed the therapeutic outcomes of the study group, receiving traditional paediatric care for otitis media plus OMT compared to the control group receiving only traditional paediatric care. According to tympanogram measurements, taken by an audiologist at baseline and post intervention, the study group showed statistically significant increased frequency of more normal tympanogram types with decreased acute episodes of otitis, and reduced incidence of surgical intervention and antibiotic therapy.
These findings show a consistent applicability of osteopathy for the treatment of specific illnesses of paediatric age.
The study by Mills et al (2003) referred to articulation, myofascial release, balanced membranous tension, balanced ligamentous tension, facilitated positional release and strain/counterstrain treatments. This list of techniques represents a mixture of structural osteopathy, such as articulation, myofascial release and strain/counterstrain, and cranio/fascial osteopathy, such as balanced membranous and ligamentous tension, according to teachings of Sutherland. A broader investigation into the specific range of techniques applicable during a paediatric osteopathy treatment should be addressed to demonstrate the role of the two different approaches on the treatment outcomes.
Although more robust research is needed to investigate the applicability of osteopathy in paediatric care, several studies have been undertaken that show some beneficial effects of osteopathy in this field. Osteopathic practice should therefore be aiming towards an informed evidenced base to fill the gaps present in the literature, whilst acknowledging the importance of subjective experience of practitioners and patients (Herbert et al, 2001). This would help to increase the applicability and reliability of paediatric osteopathy within the multidisciplinary healthcare context.
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