Osteopathic Treatment and Management of Children with Down syndrome {guest post}

I consider the fact that Nicholas has had osteopathy treatments from a very early age a ‘happy accident’. My sister is an osteopath and one of her friends and colleagues, Sharnie, asked if she could treat Nicholas as part of a university assignment. Nicholas and I both fell in love with Sharnie and happily continued having regular appointments, and it was only later I read more about the benefit of osteopathy for patients with Down syndrome. Our whole family receives and loves osteopathy treatments, but I have been particularly impressed with very visible results for both Nicholas and Sam, whose post-Leukaemia limp significantly reduced after his first osteopathy treatment post starting chemo. As well as being so lovely, Sharnie is super clever and I am grateful that she is able to share some of the scientific background behind osteopathy treatment for children with Down syndrome. ~ Annie x

Osteopathy is a form of manual healthcare that has a holistic approach in assessing, treating and managing the structure of the body and the way it functions. Osteopaths are five years university trained primary health care workers, with a thorough understanding in anatomy, physiology, pathology, general medical diagnosis and osteopathic technique. Using skilled evaluation, diagnosis and a wide range of hands-on techniques, osteopaths can identify important types of physical difficulties in the body.

A paediatric osteopath uses the application of the these osteopathic principles to practice and promote the health and wellbeing of babies, children and adolescents. Using specific knowledge of the child’s developing body structure and function, and psychosocial considerations, a paediatric osteopath understands that a child develops best through the interactions between their primary caregivers and other key persons, such as health professionals.

Osteopathic treatment has been shown to be an effective therapy for children with Down syndrome. While it is understood that Down syndrome is a growth disorder due to an additional 21st chromosome, affecting all systems of the body, it presents fundamentally as a disorder of the nervous system. More recently, it has been thought that postnatal hypoxia (a reduction of oxygen to the body, after birth) as a result of upper airway obstruction, contributes to many of the developmental difficulties associated of Down syndrome, rather than a direct impact from the additional chromosome. Osteopaths consider the implications of this new information to help formulate their therapy for babies and toddlers with Down syndrome at this important time in their development.

The effect of the extra chromosome slows the growth of the baby during weeks 6-12 of pregnancy. This slowing of growth causes a shortening of the front-to-back measurement in length at the base of the skull, a region referred to medically as the cranial base. In a child with Down syndrome, two of the bones that make up the cranial base are shorter and more vertically inclined. This near vertical angle affects some of the tissues that attach to these bones and form the throat. The position of these tissues and bones shortens the airway passage from the nose and mouth. This often increases the airway resistance and likelihood of hypoxia. Children born with Down Syndrome can also have a flatter palate within the mouth, a shorter chin, and a smaller septum that divides the nostrils within the nose. These changes can contribute to the obstruction to the upper airway. As a result, children with Down syndrome tend to breathe through their mouth. These differences can also contribute to feeding difficulties.

Other physical differences that are common for children with Down syndrome include absent or narrowed sinuses within the bones of the face. When this happens, it leads to poor drainage of mucous. This provides an environment for middle ear and upper respiratory infections, which can further contribute to additional difficulties in breathing. The narrowing of their airway can also lead to a condition called sleep apnoea, where the walls of the throat close during sleep and reduce the oxygen supply. This lowers the amount of oxygen within the bloodstream. It is thought that when the body does not receive enough oxygen over a sustained period of time, altered development can occur to the nerves within the brain that affect behaviour. This may be why these children can experience learning difficulties, hyperactivity and/or aggression.

While it is unlikely that postnatal hypoxia alone is the complete cause of this pattern of developmental difficulties found in a child with Down syndrome, it is probable that it has some part to play. Osteopathic treatment may be used effectively to reduce hypoxia, by offering a safe, non invasive and effective means of maximising and maintaining an open airway.

In the mid 20th century, osteopathic physician William Sutherland suggested that the bones of the skull and face were flexible, allowing some movement against each other; later, Retzlaff & Mitchell demonstrated that the joints between the bones of the skull and face contain connective tissue, blood vessels and nerves; and Viola Frymann later demonstrated that the cranial bones do move. This movement, or reduced movement, of these bones, especially the cranial base, can be detected and gently manipulated by an osteopath whom is adequately trained in Sutherland’s development of osteopathic medicine. This form of treatment is referred to as cranial osteopathy.

Not all osteopaths treat with cranial osteopathic technique, so it is recommended to request this treatment technique at the time of booking the initial consultation. While not all osteopaths treat with cranial technique, other gentle osteopathic techniques applied to the neck and chest can assist the drainage of the sinuses, further assisting with the breathing difficulties that children with Down syndrome can experience. Osteopaths can also help with the development of muscle tone, through a combination of movement therapy and manual osteopathic technique, in assisting children with Down syndrome to reach their motor milestones. This can be a useful addition to the other therapies children with Down syndrome may receive.

Osteopaths are covered by most private health funds and also by the Medicare Chronic Disease Management (CDM) scheme. To locate an osteopath, either access the Osteopathy Australia website and enter your postcode, or the Southerland Cranial Teaching Foundation.

Sharnie McCooke graduated from RMIT University Melbourne with a Bachelor and Masters in Osteopathy. With a passion for paediatric and perinatal osteopathy she is also an internationally qualified Lactation Consultant. Sharnie is the Director of The Brisbane Family Clinic at New Farm, Brisbane. Outside Osteopathy, Sharnie enjoys yoga, gardening and swimming.

Photography credit: Jess Nicholls