Osteopathy and the unsettled baby
Osteopaths are widely known for treating back pain. Whilst this is true and for myself personally, I see a lot of back pain in clinic, I also treat a wide range of other conditions and people of all ages, including children and babies. When I tell people that I can treat babies, I often get surprised responses and the first thing generally asked is ‘why do babies need treatment?’ or ‘what can you do for them?’ It’s quite a complex part of osteopathy, so much so, that some osteopaths choose to go on to complete a post-graduate course which takes a further two years to complete and is solely about further learning how to treat children and babies. Children are not just smaller versions of adults and they can present with a wide variety of issues that have occurred through problems during labour, growth as well as injuries. Whether osteopaths choose to do this extra course or not, all osteopaths are still trained to treat children and babies. The youngest patient I have ever treated was just four days old! In this blog, I’ll explain the basics of how osteopathy can be beneficial for our little ones and some advice on what you can do at home for unsettled babies.
There are many issues and disorders that can make babies unsettled. Many of these babies, especially in the first three months present with what appears to be digestive problems. The first signs of digestive issues may be:
· A failure to latch onto the breast or bottle
· Sucking problems/tongue tie
· Failure to burp
· Trapped wind or excessive flatulence
· Constipation or straining bowl movements
· Milk allergy/lactase insufficiency
Failure to latch/feeding difficulties
There can be many reasons why a baby has difficulties latching. These include:
· Illness/prematurity of baby or mother
· Poor feeding position/technique
· Not enough milk being produced
· Nipple shape
· Problems with the correct functioning of the baby’s jaw, tongue, face, neck or chest. Signs that this is the case include noticing that the baby’s head is always rotated to one side, baby only pokes tongue out to one side, baby dribbles from the mouth when feeding, baby is unable to open mouth wide enough for nipple, baby swallows a lot of air on feeding, or if baby latches on, starts feeding, then stops and seems to lose interest or gets frustrated.
Suckling is a primitive reflex which means that all full term babies should have the ability to suck at birth. (It does however usually take a few days for both the baby and mother to get the hang of it). Premature babies, born before 32 weeks, are usually tube fed because they can’t produce an effective suck. The sucking action in babies is very different to how adults suck. In babies, the tongue has to elevate rapidly against the palate until milk is pulled through the mouth and involves a complex co-ordination of many muscles and bony structures.
The lower oesophageal sphincter, the sphincter that sits between the oesophagus and the stomach is weak in babies and opens frequently. Although this is useful because it allows as an escape route for swallowed air, it can also cause stomach acid to regurgitate into the oesophagus causing an irritation to the oesophageal lining. As when this occurs with adults, it can cause a certain level of discomfort, normally felt as a burning sensation in the chest. Babies are also prone to reflux because of poor stomach emptying. In adults, a liquid meal will leave the stomach within 30-60 minutes whereas in babies, it takes 2-3 hours. At six weeks following birth, the sphincter reaches adult strength. Signs of reflux include:
· Baby coughing/gagging
· Frequent hiccoughs
· Feeding problems – feeds lasting more than an hour, baby may not be interested in feeding, or may scream or arch backwards away from breast or bottle
· Baby may be more agitated lying on their back so screaming may be worse at night
I have seen many babies with reflux in clinic and therefore know how much it can distress parents. It is really important to stress that reflux is a normal part of baby physiology and it does usually get better with time. There is absolutely no correlation to how distressed the baby appears to be and the seriousness of the reflux. Some babies are just naturally more ‘distressed’ than others. However if your baby is suffering from reflux, a couple of tips to try are to keep the baby vertical for 20-30 minutes after a feed or elevate the head of the crib or use a baby pillow to lift the head slightly.
Lower digestive tract
The gut is fairly immature at birth and remains so until about two years old. The gut walls mature in response to feeding. Diarrhoea is a common symptom in babies and small children and is often a natural process of a maturing gut. It is most common between four months and three years. Babies are particularly flatulent because of inefficient lactose breakdown. Undigested lactose enters the small intestine where it ferments and produces gas. Constipation in babies is often difficult to define because there are large variations in toilet habits amongst babies. It is therefore much better to check the consistency of the baby’s stool and how difficult a time they have passing it than focusing on how often they pass a stool.
Colic is not actually a condition, but a description which is usually diagnosed when no other pathology can be found. Colic is a term to describe an unsettled baby when all other causes have been ruled out. It can affect up to 40% of babies and usually resolves within the first year. Symptoms of colic normally start around week two. Some studies have suggested that colic may be a form of migraine similar to migraine seen in children.
Milk protein allergy
A milk protein allergy will cause inflammation in the digestive tract. 5% of all babies have some degree of milk protein allergy. The protein responsible is normally either casein or whey which is found in cow’s milk. Formula often uses cow’s milk. If breast fed babies react to breast milk, it is not necessarily because they are allergic to the mother’s breast milk, but potentially something that she is eating. Signs of milk protein allergy include bleeding or mucous in the baby’s stool and screaming or distress with bowel movements. If the baby is formula fed but showing signs of milk protein allergy, the formula can be switched to a hypo-allergenic formula where milk proteins are further broken down than in standard formula.
How osteopaths can help with babies
At birth, the baby’s skull is significantly different to the adult skull. The new born skull is made up of thin islands of free floating bones separated by fibrous sutures. This makes the skull quite soft and flexible. Having a flexible skull like this is important, because it allows the head to squash down a bit as the baby comes through the birth canal when they are born. The brain volume also doubles in the first year of life so having the extra flexibility allows the brain to grow properly. The neck can be a vulnerable region in early life because the head is relatively big and heavy and the muscles weak. During birth, particularly if the baby becomes stuck or there are other issues, the head and neck is therefore vulnerable to strains which can affect the future development of the jaw, ability to suck, bite, hear and talk.
Osteopaths can work using different gentle techniques around the baby’s head and neck in order to ‘unwind’ these early strains and help with the development of the baby’s growth. Other techniques can help to improve the mechanics of the baby’s face, chest, and pelvis, all working towards improving baby’s ability to feed and digest more efficiently.
Having a distressed baby who cries a lot is often a natural part of early life. That said, I know that it can also place a lot of extra stress on parents. In clinic, I've spoken with parents who have told me that have felt guilty or like bad parents for not being able to calm their own child. I promise you, that you should feel no guilt at all and you will not be the only one who has a baby that cries a lot. However, if you are concerned, it is important to speak to your GP or health care advisor. Osteopathy can also be a wonderful tool for managing babies with distressed symptoms.