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A Pilot Study: Osteopathic Treatment of Infants with a Sucking Dysfunction

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A Pilot Study: Osteopathic Treatment of Infants with a Sucking Dysfunction -13 m m I m A pilot study: m Osteopathic treatment of infants m with a sucking dysfunction by Maxwell M.P.R. Fraval DO, M. Osteo. Sc. (Paed.) 0 Editor's Note: Dr. Manvell is an affiliate member Acknowledgments of the American Academ y of Osteopath y as well as This research ninth not have been possible without The Cranial Academ y. He currently is in practice in the support of a grant from the Frank and Janet Australia. Williams Charitable Trust through the kind assistance of Mrs. Man Terracall. Abstract The estimation of the fat content of breastmilk, by I particularly wish to acknowledge the early simple centrifuge method, is a reliable measure that encouragement received from Dr John Harakal is easily obtained. Estimations from six infants who (now deceased), Orme) . President of the Sutherland were feeding normally demonstrate that it provides Cranial Teaching Foundation and Professor of a gold standard against which patient outcomes can Osteopathic Manipulative Medicine at the Texas be measured. College of Osteopathic Medicine. A pilot study of six infants is reported on. At the time of first measurement. the difference Thanks are also due to Di: Viola Ervinatm, Director between pre- post feed fat estimations of breastmilk of the Osteopathic Childrens Centre in San Diego was small in infants with a dysfunctional suck. California and Dr. Edna Lay, Vice President of the Following osteopathic treatment the difference Sutherland Cranial Teaching Foundation. between pre- post feed fat estimations were comparable with the fat estimations from the I am also much indebted to Professor Peter breastmilk of infants who were feeding normally. Hartmann of the Department of Biochemistr y at the The results are encouraging enough to warrant University of Western Australia who so freely extending this to an age- and sex-matched case- provided me with information about his research. control study. The estimation of fat concentration in breastmilk was one of the measurement techniques to whirl he Key words drew m y attention. Breastmilk fat estimation, sucking dysfunction, lactation and osteopathic treatment. * 51 Learmonth Drive. Kambah 2902 A.C.T. Australia: Telephone +61 2 6231 911 1; Facsimile +61 2 6231 9195: E-mail [email protected] Supported by a grant from the Frank and Janet Williams Charitable Trust through the kind assistance of Mrs. Mary Terracall. Introduction or up to hourly), an increase in milk secretion occurred only Osteopaths has been reported as effectively delivering in the gland that had been milked more frequently:" paediatric care. 1 -1-3A-5'.7." This study assumed that. as pro- It is accepted that fat content of human milk is greater posed by Sutherland." there is a pattern of normal motion in the hind milk than in the fore milk:T=1'3 An infant that in the cranium that is present throughout life and that the is feeding effectively will take both fore milk and hind hirth process may produce strain patterns within the cra- milk at each feed. One way of measuring the extent to nium which may alter normal physiology. The scientific which the breast is emptied is M measuring the fat con- basis for this was recently reviewed by Myers." The study tent before and after each feed. The assumption that an further assumed that these strain patterns can be recognised infant with a dysfunctional suck, will on lc effect a small and accurately recorded by, careful palpation:: variation in the pre- and post-feed breastmilk fat estima- At parturition the tentorium cerebelli and falx cerebri tions was tested in this pilot study. The greater the differ- can sustain tremendous strain" with consequent defor- ence between pre-post fat concentrations, the more the mation: 4i Initiall y . the head presents in the transverse infant would demonstrate the ability to effectively empty diameter of the pelvic brim with the occiput to the left the breast of milk and attain the fat-rich hind milk. side of the maternal pelvis. Rotational forces affect the The aims of this pilot study were to establish the feasi- occiput which engages eccentrically with one part lead- bility of utilising the estimation of the concentration of ing first ( asynclitism 1. I breastmilk fat as a standard for measuring performance Particularly in the case of a prolonged second stage or outcomes in infants with a dysfunctional suck. The pre- other complication, the resulting micro- or macro-trauma post feed fat concentrations in the breastmilk of six moth- has been postulated ( within the osteopathic profession) to ers whose infants were feeding normally was measured. cause distortion of function in both the bony and soft tis- The results are described and analysed to assess whether sues as well as related fluid (vascular, lymphatic and cere- a standard had been established against which the progress brospinal) systems.":":":" of infants with sticking problems could he compared. Magoun states that a commonly occurring distortion re- Further, six infants who were feeding normally were sulting from the birth process is an approximation of the assessed to establish the difference between pre- post feed anterior ends of the condylar parts which "may have the ef- fat concentrations. A pilot study of six treated babies (each fect of putting increased tension through the slip of dura mater of which was treated for 4 weeks) then assessed whether, that divides the jugular foramen and thereby irritating the when first measured, the difference between pre- post feed cranial nerves (Glossopharyngeal. Vagus and Accessory fat concentrations was less than normal babies. It was then nerves) passing through the area. In addition the petrosal considered whether osteopathic treatment of these infants and sigmoid sinuses are vulnerable to distorted function as improved their pre- post feed fat concentrations to a level they exit through the jugular foramina carrying 95 percent that compared favorably with normal infants. of the drainage from the head. Circulatory retardation may result in ischaemia- (Magoun 1975: p2501. The literature The irritation of the vagus nerve as it passes through The current interest in autocrine control of lactation, the jugular foramen or of the hypoglossal nerve as it passes and the interest in the fat component of milk, has high- through the hypoglossal canal" may affect the infants lighted the possibility of fat concentration as a marker for ability to suck or swallow. Infants have been treated to effective feeding. It has been noted that the fat concentra- resolve cranial strains in the United States of America since tion in breastmilk varies over 24 hours. 21 " When milk the 1940s where the clinical effectiveness of osteopathic that was stored in a goats gland was not milked, but di- treatment has been observed." luted with an inert solution, the secretory rate in- Considerable interest in the fat content of milk has been creased.26.27.28 This suggests that it is not the mere empty- seen in recent years. It has been postulated" that milk se- ing of the gland. but the concentration/dilution of sub- cretion is modulated by local chemical feedback inhibi- stances within it, that determine milk production. This view tion, and that there is some mechanism operating. within was strengthened by the observation that the goats gland the breast tissue, that is additional to hormonal control that had been milked three or more times daily had a greater ( via prolactin. growth hormone and oxytocin). The inhibi- number of secretory cells than the gland that had only tor is thought to be present in the milk itself and to have a been milked twice daily:".":" More recently it has been regulatory effect. shown that it is the extent to which the breast is emptied. In one study it was shown that if only one of the glands of rather than the frequency of feeding, that is important in goats were milked more than twice daily (three times daily the short-term control of the human milk supply." Milk synthesis in the alveoli of the mammary glands is a com- Strain means sufficient force to cause deformation of tissue. 26/AAO Journal Summer 1998 plex process involving at least four secretory mechanisms. may cause their mothers to experience nipple pain." It is These include exocytosis, fat synthesis and transfer, se- important, where such pain persists, to exclude the possi- cretion of ions and water and immunoglobulin transfer bility of Candida albicans as a cause,' rather than assume from the extracellular space.'' The average lipid content that the pain is caused by the infant's sucking. However, of human milk ranges from 3.2 - 3.5g/100m1" whereas having excluded this possibility, it is certainly recognised colostrum, which is the initial fluid released during the that pain can result from an infant's dysfunctional suck first few days of lactation, contains about 2.9g fat/100ml." (which invariably leads to exquisitely tender, cracked and/ The fat in human milk occurs as microscopic globules 2-, or bleeding nipples of the breast-feeding mother) and that 3 pm in diameter and coated with a membrane derived from this alters the milk composition or secretion." This ma- the mammary epithelial cell that secreted it. Fat, which con- ternal nipple pain resulting from an infant's dysfunctional stitutes 50 percent of the total energy value of human milk, sucking can be severe." The maternal record of pain on a plays an essential role in infant nutrition since it is vital to visual analog scale can be a useful indicator of improve- normal brain development, the structure and function of cell ment in the infant's sucking. membranes and for prostaglandin synthesis.' Woodward has noted that a far more dramatic increase Method in fat content occurs if an infant feeds from only one breast A simple technique for estimating fat concentration has at any one feed.
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