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Early Evaluation Prevents Future
Problems
by Viola Frymann, D.O., F.A.A.O., F.C.A.
 Dr. Viola Frymann,
President of the Board and O.C.C. Medical
Director of the Osteopathic Center for
Children & Families, believes that every
child should be evaluated and treated
immediately after birth. That is preventive
medicine at its best. The sooner the child can
be treated the sooner optimal motion can be
established in the body. The sooner the
respiration and circulation can be optimized,
as well as the movement of the central nervous
system, the sooner the ill effects that may
have occurred during the birth process will be
reduced. This does not mean that problems may
be totally eradicated if they are sufficiently
severe, but they can be reduced.
First of all, I would like to talk a little
bit about Osteopathy in general. I would like
to enlighten you about the differences between
the way in which a medically trained physician
thinks and the way an osteopathically trained
physician thinks about a problem.
When your child was born it was, first of
all, evaluated by the pediatrician. He was
looked at to make sure there was no congenital
defect, either externally visible or
invisible, such as perhaps in his lungs or the
heart or the digestive tract, and also to make
sure that all the systems were functioning
efficiently as they should be.
As osteopathic physicians we are looking at
something more when your baby is born, because
we recognize that the process of being born is
probably the most traumatic experience that
most people ever have.
In the study of 1250 newborn babies it was
demonstrated that 10% have a healthy freely
movable cranial mechanism. In other words, all
of the bones of the head are in correct
relationship and moving as they should. This
is a figure that has been consistent in
several studies which have been done on
newborn babies.
The number of babies that have a gross,
visible disturbance in the cranial mechanism -
the sort of deformity that you can see across
the room - that number may be somewhere about
8% or 10%.
What about the other 80% of babies born --
that group in which the problem can be
detected by an osteopathic physician trained
to feel these minor difficulties within that
mechanism. They may not be presenting major
clinical problems at this age.
The child may be spitting up. The child may
have had a little difficulty learning to suck,
a difficulty that passed in 24 to 48 hours
perhaps. The spitting up may continue for days
or weeks sometimes, and very often the story
we hear is, "Well, it was assumed that
the milk didn't agree with the baby,"
so perhaps the mother decided to stop breast
feeding and try a formula. In many instances
that didn't solve the problem, and after
several tries, some cereal was put into the
formula to make it a little thicker, and often
that appeared to solve the problem.
The fact that the baby was spitting up in
that early period after birth, or that the
baby did have difficulty learning to suck, is
very important to us from a diagnostic
viewpoint because it tells us that there was a
degree of compression within the baby's
head that irritated two of the important
nerves that come out of the base of the skull
-one being the 12th nerve, the hypoglossal
nerve, which is responsible for the activity
of the tongue and therefore is important in
the sucking process, and the other the 10th
cranial nerve that is very much concerned with
the activity of the digestive tract at this
age. Those two symptoms may be very important
pointers to the problem at that time.
During the years from birth to five years,
the child is checked regularly by the
pediatrician concerning his ears, throat,
eyes, heart, lungs, digestive tract. In other
words, is this child's body functioning
efficiently?
Many children get ear infections. The ears
are examined and if the infections have
occurred a number of times there may be a
hearing test performed, and various tests that
zero in on the ears. But the ear isn't
something sitting out there in space. The ear
is part of a total mechanism in this body. For
example, the ear itself is held in what we
call the temporal bone. (If you feel just
behind your ear you will feel a somewhat
pointed bone, which is the mastoid
process.)
From the inner part of the ear, what is known
as the middle ear, there is the Eustachian
tube which extends into the throat. Therefore,
what goes on in the throat has a bearing on
what goes on in the middle ear, and vice
versa. Not infrequently the problem may begin
as a sore throat, a cold, and it progresses to
an ear infection. Therefore, the state of the
throat and the state of the ear are very
intimately related.
Let's come back to the temporal bone for
a moment. The temporal bone articulates, or is
connected to most of the other bones of the
head, directly or with one bone in between.
So, if this child has had a fall on the back
of the head in which the articulation between
this bone and the occipital bone at the back
of the head has been jammed, the bones cannot
move freely, one in relationship to the
other.
Perhaps at the time of the injury the child
cried for a little while, had a bruise there
or a swelling, and it passed. A few weeks
later an ear infection develops. If you stop
to think about it, you will find the ear
infection has developed on the same side on
which the head injury occurred.
The blood supply to the ear by way of the
arteries, the venous drainage from the ear by
way of the veins, and the lymphatic drainage
is impaired if that normal, rhythmic mobility
of the temporal bone is interrupted. If there
has been an injury it has interfered to some
degree with the inherent mobility of that
bone. Furthermore, if the child fell on the
back of the head, that fall may have disturbed
the alignment of the bones of the neck, and
the blood supply passes through the neck up
into the temporal bone.
 So the ear problem is
not confined to the ear. It may be related to
certain things that have happened in levels
below the ear. Now we begin to see that we
cannot localize ear infection in an ear
because it is tied in to other parts of the
body. Of course, the circulation begins at the
heart and ends at the heart, so anything
between the heart and the temporal bone may be
a factor in that circulation. The lymphatic
drainage is associated with certain structures
in the neck, going all the way down to below
the collar bone. Anything in this area may
have a bearing upon that ear infection.
It is not uncommon to get the story that this
child has had ear infections over and over
again. Perhaps the first ear infection
occurred when he was six weeks of age. He was
treated with an antibiotic, he got over it;
two months later there was another ear
infection. He was treated with antibiotics, he
got over it and six weeks later there was
another ear infection, and so it has gone on,
perhaps for several years, one after
another.
At some point the parents decide there must
be some other way. Also, by this time the
child may have reduced hearing in one or both
ears, so they are looking for some other
answer.
This is the time we go back structurally and
inquire whether there had been any evidence of
injury at birth which may have started the
process, and had there been any injuries since
then to which the child is now responding with
this susceptibility to infection.
 This brings us to the
first aspect of the osteopathic concept, the
osteopathic approach towards the patient, and
that is that we are looking at a whole
patient. We are not just looking at the point
which is producing symptoms and calling your
attention to it. What is there in this whole
child which is resulting in manifestation in a
local area? The manifestation may be a
neurological disturbance. This may be the
hyperactive child who can't sit still
through a meal, who can't sit still in
school, who can't sit still period. The
more the parents or the teachers say,
"Sit still or you will go to the
principal if you don't sit still!"
All that does is make matters worse.
I wonder if any of you have a condition which
is known by the title, "restless
legs?" Have you ever sat in a theater and
thought you just couldn't keep your legs
still? And if someone had said to you,
"Don't you dare move!" that
would have made you much more susceptible to
moving. So it is with this child who has an
inherent neurological dysfunction which makes
it impossible for him to be still. The more we
try to pressure him to be still, the more
restless he becomes.
There are many measures used to help these
children. One may be to give them some
medication, but the medication doesn't
make them sit more quietly, it dulls their
intellectual awareness. They may sit still and
therefore learn more to some degree, but they
are not functioning at their capacity because
the drug is dulling their awareness. That is a
stop-gap measure. It hasn't done anything
about the hyperactivity itself. In fact, the
longer the child takes the drugs the more
difficult it is to break the habit because
when the drug is stopped the child becomes
more hyperactive than when the drug was
introduced in the first place.
What is the cause of the hyperactivity? Why
does the child have to keep moving as if he is
driven? Because he utilizes an external
activity to make up for severe restriction in
the inherent motion of these cranial bones and
therefore all the structures that are related
to them. They have to produce outside activity
in order to make up for lack of internal
activity.
It is not one area of the central nervous
system that is involved, but the brain is in
contact with every part of the nervous system
in the body, and therefore we are concerned
with the whole patient and not just one little
area.
What we really are talking about is whole
people, whether they be little people or big
people, and recognizing that the
structure of the body is intimately related to
the way it functions. We might
compare the body to a watch - not one of the
electronic ones but the old fashioned variety
that had a lot of wheels and gears in it. If
your watch started losing or started gaining,
or perhaps even stopped, and you took it to
the watchmaker you didn't ask him,
"Which wheel is it that is causing the
trouble?" He probably would say to you,
"Well, your whole watch needs overhauling
so we can put it together so that every part
works properly."
The body is like that too. It isn't just
one piece that needs to be oiled and put back.
The whole body needs to be integrated. The
structure of the body is causative, it is
integrated.
Childhood is a time of falls, injuries. We
are not only concerned with falls that broke
bones or locked the child out or put him in
the hospital. We are concerned with any injury
that happens to affect a critical part of this
moving mechanism, and the only sign you may
notice that it did that is that your child is
less amenable to your directives. The tendency
is to think he's naughty. As one
osteopathic physician used to say ,
"Don't punish your children; treat
them." You will find that when you treat
them they change, and sometimes they change in
an instant.
 Some of the children
come into the treatment room acting as if
everything is wrong, they don't want any
toys, don't want to play, don't want
anything done. All of a sudden, when that
mechanism begins to move, "Can I have a
toy, please?" It is absolutely phenomenal
because it happens so fast. Once the key turns
and the mechanism begins to move freely the
child becomes himself once more. It isn't
always as simple as that because it may not
have been just the last injury. It may have
been an accumulation of injuries that have
occurred, one after another, over several
years, so it doesn't always resolve
immediately. But the principle is the same. It
is that interrelationship of structure and
function and the unity of the body functioning
as a whole. It is not a series of isolated,
independent parts.
The body has within it the process which
heals itself. If that is true why haven't
all your children been healed long ago?
I'm sure you have all had the experience
of a cut on your hand. Perhaps it was a deep
cut, perhaps it required some suturing and a
dressing put on it. Then you were told to come
back in five days for the doctor to take out
the stitches. The doctor didn't heal the
cut. Who did? You did. You healed your own
cut. But sometimes, if something is not
functioning properly in your body you will go
back at the end of five days and the cut has
not healed.
The same may be true of a broken bone. The
bone breaks, the surgeon approximates the two
ends as closely together as he can and then he
mobilizes it in a plaster cast. He usually
gives the instruction to come back in six
weeks. It will probably be healed. But
sometimes it isn't healed in six weeks.
Sometimes it isn't healed in sixteen
months because something is not working in the
body to permit that inherent healing process
to take place.
As osteopathic physicians we are very
conscious of that inherent healing process.
That healing process is not only concerned
with knitting a bone together, healing a
laceration or overcoming an infection. It is
also concerned with moving the body structure.
Probably many of you have had the experience
of doing some unaccustomed hard work, such as
working in the garden once in three months. By
the time you went to bed every bone in your
body felt as if it were out of place. But you
went to bed and relaxed in sleep and by the
morning most of that was gone. Who did that
work? You did. That inherent force in your
body which is working to bring it to its
optimum function did it. But if the strain or
the restriction in that free motion has gone
beyond a certain point, then the body needs a
little help in overcoming it. However, if we
can work with what the body is striving to do
we shall get there much faster. Therefore,
much of what we do is not visible. By that I
mean we are not forcefully manipulating the
body in this way and that way. We are
detecting how that body wants to move, how it
is striving to overcome its restrictions and
then just giving it a little help to do
so.
 These are the three
primary concepts upon which our practice is
actually based. They are not just
philosophical ideas in our heads which we
agree to, they are actual working concepts -
(1) the interrelationship of structure and
function, (2) the recognition of the totality
of the body, and (3) the inherent force within
the body.
Now, how do we do it? That is the $64,000
question, isn't it?
The first process is getting acquainted.
Still in the process of getting acquainted we
are running our fingers over the various
joints between the bones in the head to find
out whether there is any over-riding of any of
the bones, whether there is any hardness or
irregularity, whether one is pushed up against
the other, and also whether there is any
asymmetry of the head, any imbalance in the
structure of the bones of the head.
Then we move down to the spinal area. We come
down the neck and then we come down through
the thoracic area, the rib cage, and the
vertebral area and down into the lumbar
area.
After that we evaluate the lower extremities,
the hip joints, knee joints and ankle joints.
Then we evaluate the sacrum. The sacrum is
that large bone that you can feel if you put
your hand behind you (it's about the size
of the palm of your hand in an adult). In the
infant that is still five bones, not just one.
The rhythmic motion of the sacrum is brought
about with breathing. Every time you breath
you move that sacrum between the pelvic bones.
I place one hand on the sacrum and my other
hand is on the pelvic bones, evaluating how
the sacrum moves within the pelvis.
This is the way in which we balance the
pelvis and sacrum and we can balance the
lumbar spine at the same time. This area is
very important because as the baby is
descending through the birth canal the head is
opening the birth canal but the pelvis, the
buttocks, gets the pressure as the uterus
contracts down on the baby. If for some reason
the baby doesn't descend smoothly and
progressively through the birth canal as the
baby's spine has to negotiate its way
around the mother's spine, and if it gets
held up in that position this may tend to
produce a sidebending in that lumbar spine.
This does not show itself outwardly at this
age because this baby isn't standing. The
spinal curve may not show itself until the
baby begins to stand, but if we can pick it up
by feeling it, by palpating it at this age and
taking care of it (it only takes about 60
seconds) we can take out that twist which has
become locked in there through the birth
process.
Next we evaluate the head area. Sometimes, in
order to keep a little baby quiet and happy,
it either nurses or sucks on the bottle while
it is being treated. The area of the
baby's head that leads the way out of the
birth canal is the occipital area, the back of
the head. It is the area that will take the
brunt of obstruction if there is a delay in
delivery.
When there has been a long delivery, perhaps
sixteen, twenty or twenty-four hours for a
first baby, or even after twelve hours for a
later baby - and sometimes we find mothers who
have been in labor for several days, or
perhaps even more important, there has been a
period of false labor before the real thing
began. False labor can be particularly
damaging because the contraction is occurring
and the baby's head has nowhere to go
because the birth canal is not opening. So the
baby is being compressed from above and below.
It is the occipital area that takes that
impact. That is where the hypoglossal nerve to
the tongue and the vagus nerve to the
digestive tract pass out through the skull.
These are the areas that are the first to show
the stress of the birth.
One of the most important questions we can
ask is, "Did your baby have any trouble
vomiting, spitting up?" If the answer is
"yes" then we know that there was
some degree of a problem in this area at
birth.
Within the occiput also is that large opening
through which the whole brain stem becomes the
spinal cord. All of the nerve pathways that go
to every structure in your body below the base
of the skull must pass out through that hole
in the occiput. Therefore, if the occiput is
deformed by such pressures as we have
described, the damage to the nervous system,
the injury to the nervous system may vary all
the way from the child who has mild spitting
up to the child who is hyperactive, the child
who is uncontrollable, who is aggressive, who
eventually goes on to have learning problems,
behavior problems and the whole gamut. So this
is a most critical area, the area that we
always look at when we look at newborn
babies.
Then we consider the skull as a whole. The
skull is made up of some twenty-six bones. At
this age some of those bones are in several
parts. Therefore, the potential for
compression in one or more areas is quite
great if there was compression in the pelvis
on the head during birth.
An osteopathic physician's hands are
feeling hands, they are monitoring hands. They
are not pushing things around. They are
monitoring how that mechanism inside is
working and how we can go with it to permit it
to release areas of restriction.
The temporal bone, that bone which I
mentioned as carrying the ear, may also be
compressed because it is very close to the
occipital area. It is not unknown to find that
the baby has its first ear infection at a few
weeks of age. When that is so it suggests that
the problem may have arisen from the trauma of
birth. When that mechanism begins to move
freely then the child recovers from the
recurrent infections.
When the head is compressed from the front
backwards, a compressive force, which we will
find particularly if the baby was reversed in
the birth canal. It was a posterior occiput
rather than an anterior one. This sort of
compression jams the skull at the center of
its base.
At birth the occiput is not just one bone, as
it is in the adult. In the infant the occiput
is four bones because it is not yet fully
developed. That large hole of the foremen
magnum, through which the brain stem passes,
is circled by developing parts of the
occiput.ee.
The area of the base of the skull that
becomes compressed is the area we are
primarily concerned with in our small babies.
The problems we find there may continue and
cause difficulties later in life.
The sooner you treat the baby the easier it
is, but you never say "there is nothing
that can be done." No matter now much
progress is made, progress is
worthwhile.
Life is always in motion. Life is always
getting better or it is getting worse. We may
not work as frequently; we may work for an
intensive period to get over the major
problem, then watch that the progress we have
made is maintained, but let's go back
again. What we do in the process of a
treatment is just like unlocking the door so
now those who are inside can move around. In
other words, we are permitting the central
nervous system to perform to a better standard
and it will improve that standard
progressively. The treatment is only the
beginning of the process. It is now permitting
that inherent therapeutic potency to do what
it couldn't do before. Children tend to
fall, bang their heads, so we treat them at
regular intervals to make sure that none of
these things (which are relatively minor) have
been permitted to take them back one step
instead of forward one step.
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Osteopathic Center for Children &
Families
4135 54th Place • San Diego, California 92105
• 619.583.7611
information@osteopathiccenter.org
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