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Osteopathic Treatment of Infants in Their First Year of Life: A Prospective Multicenter Observational Study (OSTINF Study)
Abstract
Introduction:
In Germany in recent years, a growing number of parents are seeking help from osteopaths for the perceived health complaints of their infants and children. However, reliable evidence for the effectiveness of osteopathic interventions for this group of patients is largely lacking.
Objective:
To observe and document changes in the symptoms of certain health disturbances, as perceived by parents, during the course of an osteopathic treatment of their baby, and associated side effects.
Methods:
A single-arm, prospective, multicenter, observational study was chosen as the study design. Parents who contacted an osteopathic practice with any of the following 5 health disturbances were invited to include their baby into the study: idiopathic infant asymmetry (IA), deformational plagiocephaly (DP), feeding disorders (FD), excessive crying (EC), and sleep disorders (SD). Osteopaths performed osteopathic treatment as usual for these conditions, and the parents were asked to rate the perceived severity of symptoms on standardized forms including numerical rating scales (NRS 0-10). In DP, the head circumference of the child's skull was measured with a craniometer, and the cranial vault index (CVAI) was calculated.
Results:
230 osteopaths agreed to participate, 151 osteopaths returned parental ratings. 1,136 infants were treated 2.8 ± 1.1 times (mean ± SD). IA was the most prevalent disturbance (48%), followed by EC (18%), FD (15%), DP (14%), and SD (4%). In IA, perceived asymmetry as rated on the NRS improved from 6.1 to 1.1, a mean improvement of 82%. In DP, the CVAI improved from 8.0 to 4.0%, a mean improvement of 51%. FD improved by 77%, EC by 70% (from 7.7 to 2.3 on the NRS) and SD by 56%. Adverse reactions with a timely association with osteopathic treatments were reported in 3.5% of all treatments, probably reflecting typical day-to-day variations in symptoms. In a total of 3,212 treatments, there was not a single serious adverse reaction affecting infant health.
Conclusions:
This is one of the largest studies worldwide to date on the osteopathic treatment of infants. Osteopathic treatment was associated with major positive changes in the severity of perceived health complaints as assessed by parents, which in most cases were resolved as a matter of concern, and was proved to be a safe treatment modality among a large number of therapists. Based on these results, confirmatory intervention studies can and should be planned and conducted.
... So far, only a few RCTs that have investigated IC/ EC exist (e.g., Hayden and Mullinger [23]). In a recently published observational study [24], 219 infants with IC/ EC were treated osteopathically, resulting in an improvement of symptoms of approximately 70% within three 3 weeks. Based on these findings, the following research question was formulated for investigation in a RCT: ...
... The selected number of osteopathic treatments was determined according to the results of the OSTINF study [24]. ...
... The results of this study were confirmed by the results of the downstream osteopathic intervention in the control group as well as by the results of other studies on this subject. In the observational study OSTINF [24], for instance, the level of stress parents perceived due to their baby's crying was assessed (using NRS; 0-10) in 219 infants with IC/EC before and after 3 osteopathic treatments. The results there showed an improvement of 67%, (from 7.0 to 2.3), which is quantitatively matching the results of this study. ...
Background
Colic in infants is defined as excessive crying in an otherwise healthy and thriving baby. Colic is a common but poorly understood and often frustrating problem for caregivers.
Objective
To study whether osteopathic treatments of infants with infantile colic / excessive crying (IC/EC) have an impact on the subjectively perceived psychological stress of caregivers compared to usual care.
Methods
The study was designed as a prospective, multicenter, randomized controlled trial. Infants aged 1 week to 3 months and who met Rome IV criteria for IC/EC were included. By means of external randomization, infants were allocated to an intervention group or a control group. Infants in the intervention group received three osteopathic treatments at intervals of one weeks. The treatments were custom-tailored and based on osteopathic principles. Controls received their osteopathic treatment after a 3 week untreated period. The primary outcome parameter was the assessment of parental psychological stress (three questions), measured using a numeric rating scale (NRS; 0–10). Furthermore, the average daily crying time (measured using the Likert scale), the crying intensity (measured using the NRS) and the parents' self-confidence (measured using the Karitane Parenting Confidence Scale) were assessed.
Results
A total of 103 infants (average age 39.4 ±19.2 days) were included, 52 in the intervention group and 51 in the control group. An inter-group comparison of changes revealed clinically relevant improvements in favor of the intervention group for the main outcome – parameter psychological stress – for all 3 questions (e.g., for question 2 respectively 3, NRS: between group difference of means 3.5; 95% CI: 2.6 to 4.4; p < 0.001). For the secondary outcome parameters of crying intensity and crying time/day, the changes were of similar magnitude.
Conclusion
Three osteopathic treatments given over a period of two weeks led to statistically significant and clinically relevant positive changes of parental psychological stress.
Trial registration
German Clinical Trials Register: DRKS00025867, registration date 10.08.21.
... Die Studienergebnisse stehen im Kontext der bestehenden Literatur. (Peschke, 2010;Philippi et al., 2006b;Schwerla et al., 2021). Die von Spiertz&Klemm (im Druck) dargestellte Verbesserung der infantilen Haltungsasymmetrie ging zudem mit einer Verringerung der hochzervikalen Dysfunktionen einher. ...
... Um isoliert den Therapieeffekt einer OMT zu betrachten, wäre eine Kontrollgruppe asymmetrischer Säuglinge mit nichtsynostotischer Plagiozephalie ohne Behandlung und ebenfalls ohne oben genannte Empfehlungen denkbar. Dies ist allerdings ethisch fragwürdig, da bereits für beide Therapieformen (OMT und ebenso Vojta) Wirksamkeitsnachweise vorliegen (Peschke, 2010;Philippi et al., 2006b;Schwerla et al., 2021;W. Jung et al., 2017). ...
... Sowohl die fehlende Verblindung der Therapeuten als auch die Größen der Vojta-und symmetrischen Säuglingsgruppe lässt vorerst nur eine zurückhaltende Interpretation der Ergebnisse zu. Die beschriebenen Therapieeffekte für die OMT-und Vojta-Gruppe in der vorliegenden Studie liegen allerdings in vergleichbaren Rahmen zu bestehenden Arbeiten, welche hierüber den Ergebnissen der vorliegenden Arbeit zusätzliches Gewicht verleihen Peschke, 2010;Philippi et al., 2006b;Schwerla et al., 2021;Wilhelm Jung et al., 2017). Trotz fehlender Randomisierung waren die Gruppen bezüglich der anthropometrischen Daten, der Geschlechterverteilung und des primären Zielparameters zu T1 vergleichbar. ...
Infantile Haltungsasymmetrie mit lagebedingter Plagiozephalie. Eine kontrollierte, nicht-randomisierte, klinische Studie. Zusammenfassung Hintergrund: Die Studienlage bezüglich osteopathisch manipulativer Therapie (OMT) bei nichtsynostotischer, lagebedingter Plagiozephalie und infantiler Haltungsasymmetrie ist aktuell als spärlich zu bezeichnen. Ziel der vorliegenden Arbeit war es, den Therapieeffekt von osteopathisch manipulativer Therapie (OMT) gegenüber einer Verumgruppe nach dem Vojta-Konzept auf den Grad der Plagiozephalie zu vergleichen. Material/ Methoden: In einer multizentrischen klinischen, kontrollierten, nichtrandomisierten Studie wurden insgesamt n= 45 Säuglinge mit bestehender infantiler Haltungsasymmetrie und Plagiozephalie untersucht. Nach einer standardisierten, klinischen Untersuchung wurden als Zielparameter der Asymmetriescore nach Phillipi sowie der Severity Assesment for Plagiocephaly erhoben. Die OMT-Gruppe (n=33) erhielt innerhalb der ersten vier Wochen drei befundorientierte, osteopathische Behandlungen, die Vojta-Gruppe (n=12) erhielt 1-2 Behandlungen wöchentlich über den gesamten dreimonatigen Zeitraum der Studie. Zum Vergleich wurde eine Nullgruppe symmetrischer Säuglinge (n=8) mittels oben aufgeführter Assessments untersucht. Ergebnisse: Beide Behandlungsmethoden zeigten zum follow-up T4 eine signifikante Verbesserung des Severity Assessment Scores (OMT-Gruppe, p=0,000; Vojta-Gruppe, p=0,015). Die OMT-Gruppe erreichte im Zwischengruppenvergleich zudem zum Zeitpunkt T2 (p=0,031) sowie zu T3 (p=0,000) Signifikanz. Die Therapieeffekte näherten sich wiederum zum follow-up T4 an. Schlussfolgerung: Eine dreimalige OMT verbessert ebenso wie eine durchgängig 1-2x wöchentlich durchgeführte Physiotherapie nach dem Vojta-Konzept bei Säuglingen unter 6 Monaten den Schweregrad einer lagebedingten, nichtsynostotischen Plagiozephalie. Abstract: Purpose: Currently, studies on osteopathic manipulative therapy (OMT) for nonsynostotic positional plagiocephaly and infantile postural asymmetry are scarce. The aim of the present study focusses on the therapeutic effect regarding the degree of plagiocephaly, comparing osteopathic manipulative therapy (OMT) and treatment according to the Vojta concept. Material/Methods: In a multicenter clinical, controlled, nonrandomized study, a total of n=45 infants with existing infantile postural asymmetry and plagiocephaly were examined. After a standardized clinical examination, the Phillipi asymmetry score and the Severity Assesment for Plagiocephaly were used as outcome parameters. The OMT group (n=33) received three findings-oriented osteopathic treatments within the first four weeks, while the Vojta group (n=12) received 1-2 treatments weekly over the entire three-month period of the study. For comparison, a zero-group of symmetric infants (n=8) were examined using the assessments listed above. Results: Both treatment methods showed a significant improvement in the severity assessment score at follow-up T4 (OMT group, p=0.000; Vojta group, p=0.015). The OMT group also reached significance in the between-group comparison at T2 (p=0.031) and T3 (p=0.000). The treatment effects of both groups converged at follow-up T4. Conclusion: Three findings-based OMT, as well as continuous physiotherapy 1-2 times a week according to the Vojta concept improved the severity of positional non-synostotic plagiocephaly in infants under 6 months of age. Hintergrund:
... The gradual achievement of symmetry is associated with the maturation of the nervous structures and, therefore, with the acquisition of mid-line orientation. Infantile asymmetry is certainly a condition that requires detailed evaluation by a clinician [8][9][10]. The aim of the study was to determine the relationship between idiopathic asymmetry in infants and body posture in children at an early school age. ...
... Often, idiopathic asymmetries are wrongly perceived as a trivial problem that a child will grow out of with time. However, there is a need to start rehabilitation or at least to inform parents about the principles of proper infant care [8][9][10]. A large number of infants who are referred to a physical therapist due to abnormal postural and movement patterns was the reason to investigate this relationship. ...
The aim of the study was to determine the relationship between idiopathic asymmetry in infants and body posture in children at an early school age. The study included 45 girls aged nine. The Diers Formetric III 4D device was used to assess body posture, which allows photogrammetric registration of the back surface using the raster stereography process. For the purposes of the re-search project, the examination was performed via DiCAM using the “Average measurement” mode. Despite physiotherapy, these children had more postural defects later on compared to the control group due to asymmetry. They mainly concerned pelvic skewness, scoliosis angle, deviation from the vertical line and lateral deviation, as well as surface rotation. Positive correlations were observed between direction of asymmetry and pelvic skewness (r = 0.40), and between the location of asymmetry and the location of curvature (r = 0.39). Significant negative correlations were also found between the age of treatment initiation and trunk length (r = −0.42). There was also a negative correlation between the number of physiotherapeutic appointments and deviation from the vertical line, which means that along with an increase in the number of physiotherapeutic visits, the value of deviation from the vertical line decreased (p = −0.40). For scoliosis angle, the most important predictor was the direction of asymmetry (p = 0.05). For the location of the curvature, the most important predictor was the direction of asymmetry (p = 0.04), as well as the number of physiotherapeutic appointments (p = 0.04). Additionally, regression analysis allowed us to show that the number of physiotherapeutic visits (p = 0.03) was the most important predictor of curvature direction. The applied physiotherapy probably contributed to the occurrence of a smaller number of postural defects in these children at a later age. Physiotherapy as a specific and targeted form of physical activity among infants with idiopathic asymmetry should play a very important role in the prevention of body posture defects.
... The hypothesis that maternal nipple pain and damage results from abnormal tongue movement which pinches or rubs the nipple against the palate or upper alveolar ridge has resulted in widespread overtreatment of breastfeeding infants with frenotomy and bodywork exercises. 11,12,[14][15][16]69 This hypothesis is not supported by ultrasound or magnetic resonance imaging of the biomechanics of infant suckling, nor anatomic dissection of the infant floor of mouth fascia. [70][71][72] Studies of breastfeeding women with nipple pain have been interpreted as showing that nipple pain is due to either particular tongue contour and movement attributed to infant oral connective tissue tightness, or innately high vacuum generation. ...
... [94][95][96] No requirement for wound stretching or bodywork exercises post-frenotomy, which are not supported by the evidence. 69,97,98 Nipple-areolar complex wounds The gestalt method is currently the only fit and hold intervention which offers an evidence-based model for eliminating conflicting intra-oral vectors of force during milk removal. 9,26,27 Distribute mechanical load over a larger area of nipple and areola surface, by eliminating conflicting intra-oral vectors of force during suckling or mechanical milk removal. ...
Nipple pain is a common reason for premature cessation of breastfeeding. Despite the benefits of breastfeeding for both infant and mother, clinical support for problems such as maternal nipple pain remains a research frontier. Maternal pharmaceutical treatments, and infant surgery and bodywork interventions are commonly recommended for lactation-related nipple pain without evidence of benefit. The pain is frequently attributed to mammary dysbiosis, candidiasis, or infant anatomic anomaly (including to diagnoses of posterior or upper lip-tie, high palate, retrognathia, or subtle cranial nerve abnormalities). Although clinical protocols universally state that improved fit and hold is the mainstay of treatment of nipple pain and wounds, the biomechanical parameters of pain-free fit and hold remain an omitted variable bias in almost all clinical breastfeeding research. This article reviews the research literature concerning aetiology, classification, prevention, and management of lactation-related nipple–areolar complex (NAC) pain and damage. Evolutionary and complex systems perspectives are applied to develop a narrative synthesis of the heterogeneous and interdisciplinary evidence elucidating nipple pain in breastfeeding women. Lactation-related nipple pain is most commonly a symptom of inflammation due to repetitive application of excessive mechanical stretching and deformational forces to nipple epidermis, dermis and stroma during milk removal. Keratinocytes lock together when mechanical forces exceed desmosome yield points, but if mechanical loads continue to increase, desmosomes may rupture, resulting in inflammation and epithelial fracture. Mechanical stretching and deformation forces may cause stromal micro-haemorrhage and inflammation. Although the environment of the skin of the nipple–areolar complex is uniquely conducive to wound healing, it is also uniquely exposed to environmental risks. The two key factors that both prevent and treat nipple pain and inflammation are, first, elimination of conflicting vectors of force during suckling or mechanical milk removal, and second, elimination of overhydration of the epithelium which risks moisture-associated skin damage. There is urgent need for evaluation of evidence-based interventions for the elimination of conflicting intra-oral vectors of force during suckling.
... Die geplante Folgestudie ObiH 3 wird hier durch ein angepasstes Design und eine größere Stichprobe belastbarere Daten bringen. Die beschriebenen Therapieeffekte für die OMT-und Vojta-Gruppe in der vorliegenden Studie liegen allerdings in vergleichbaren Rahmen zu bestehenden Arbeiten, welche hierüber den Ergebnissen der vorliegenden Arbeit zusätzliches Gewicht verleihen [16], [19], [23], [27]. ...
Zusammenfassung
Hintergrund
Die Studienlage bezüglich osteopathisch manipulativer Therapie (OMT) bei nicht-synostotischer, lagebedingter Plagiozephalie und infantiler Haltungsasymmetrie ist aktuell als spärlich zu bezeichnen. Ziel der vorliegenden Arbeit war es, den Therapieeffekt von osteopathisch manipulativer Therapie (OMT) gegenüber einer Verumgruppe nach dem Vojta-Konzept auf den Grad der Plagiozephalie zu vergleichen.
Material/Methoden
In einer multizentrischen klinischen, kontrollierten, nicht-randomisierten Studie wurden insgesamt n = 45 Säuglinge mit bestehender infantiler Haltungsasymmetrie und Plagiozephalie untersucht. Nach einer standardisierten klinischen Untersuchung wurden als Zielparameter der Asymmetriescore nach Phillipi sowie das Severity Assessment for Plagiocephaly erhoben. Die OMT-Gruppe (n = 33) erhielt innerhalb der ersten 4 Wochen 3 befundorientierte osteopathische Behandlungen, die Vojta-Gruppe (n = 12) erhielt 1–2 Behandlungen wöchentlich über den gesamten 3-monatigen Zeitraum der Studie. Zum Vergleich wurde eine Nullgruppe symmetrischer Säuglinge (n = 8) mittels oben aufgeführter Assessments untersucht.
Ergebnisse
Beide Behandlungsmethoden zeigten zum Follow-up T4 eine signifikante Verbesserung des Severity Assessment Scores (OMT-Gruppe: p = 0,000; Vojta-Gruppe: p = 0,015). Die OMT-Gruppe erreichte im Zwischengruppenvergleich zudem zum Zeitpunkt T2 (p = 0,031) sowie zu T3 (p = 0,000) Signifikanz. Die Therapieeffekte näherten sich wiederum zum Follow-up T4 an.
Schlussfolgerung
3× OMT verbessert ebenso wie eine durchgängig 1–2× wöchentlich durchgeführte Physiotherapie nach dem Vojta-Konzept bei Säuglingen unter 6 Monaten den Schweregrad einer lagebedingten, nicht-synostotischen Plagiozephalie.
Immer mehr Eltern gehen aus Eigeninitiative mit ihrem Kind zum Osteopathen. Vor dem Hintergrund, dass die Osteopathie eine wachsende Beliebtheit erfährt, stellt sich auch bei der Versorgung von Säuglingen die Frage, ob sich osteopathische Behandlungen positiv auf Gesundheitsstörungen auswirken können. In der vorliegenden Studie wurde dieser Frage nachgegangen.
Osteopathic manipulative treatment (OMT) is used in both inpatient and outpatient settings. Evidence suggests that OMT can reduce both patients’ recovery time and the financial cost of their acute medical treatment and rehabilitation. Multiple studies from neonatal intensive care units (NICUs) are presented in this article that demonstrate infants treated with OMT recover faster, are discharged earlier, and have lower healthcare costs than their non-OMT-treated counterparts. Data clearly show that adjunctive OMT facilitates feeding coordination in newborns, such as latching, suckling, swallowing, and breathing, and increases long-term weight gain and maintenance, which reduces hospital length of stay (LOS). Osteopathic techniques, such as soft tissue manipulation, balanced ligamentous tension, myofascial release, and osteopathic cranial manipulation (OCM), can reduce regurgitation, vomiting, milky bilious, or bloody discharge and decrease the need for constipation treatment. OMT can also be effective in reducing the complications of pneumonia in premature babies. Studies show the use of OCM and lymphatic pump technique (LPT) reduces the occurrence of both aspiration and environmentally acquired pneumonia, resulting in significantly lower morbidity and mortality in infants. Based on published findings, it is determined that OMT is clinically effective, cost efficient, a less invasive alternative to surgery, and a less toxic choice to pharmacologic drugs. Therefore, routine incorporation of OMT in the NICU can be of great benefit in infants with multiple disorders. Future OMT research should aim to initiate clinical trial designs that include randomized controlled trials with larger cohorts of infants admitted to the NICU. Furthermore, a streamlined and concerted effort to elucidate the underlying molecular mechanisms associated with the beneficial effects of OMT will aid in understanding the significant value of incorporating OMT into optimal patient care.
Zusammenfassung
Osteopathische Medizin (OM), kurz: Osteopathie, ist in den letzten vier Jahrzehnten ein fester Bestandteil der Gesundheitsfürsorge in Deutschland geworden. Mit wachsendem Zuspruch vonseiten der Patientinnen und Patienten wurden auch Stimmen lauter, die eine erhebliche Diskrepanz zwischen dem Anspruch der OM und der Wirklichkeit sehen. Dieses Essay stellt einige originelle Beiträge zu der nicht endenden Diskussion um alternative Heilmethoden und Evidenz aus den letzten 50 Jahren vor.
Objective: The aim of the study was to determine the intra-and inter-reliability for measuring infants with plagiocephaly and brachycephaly with a craniometer when using a marked headband as landmarks. Subjects: Six physiotherapists and eight infants participated in the study. Methods: The physiotherapists measured all infants twice; each infant was measured with the same headband and craniometer. The physiotherapists were blinded to measurements carried out by their colleagues. The infants with their parents changed places in the room to minimize the possibility that the physiotherapists would remember their first measurements of any infant. Results: There was a high intra-and inter-reliability, for intra-reliability ICC 0.96 to 0.99 and for inter-reliability ICC 0.98. Conclusion: It is possible to achieve a high intra-and inter-reliability when using a headband and craniometer when measuring cranial vault asymmetry for plagiocephaly and cephalic ratio for brachycephaly.
Researchers investigated the effectiveness of patient controlled analgesia for patients presenting to emergency departments with pain from traumatic injuries. A randomised controlled trial with a parallel groups study design was used. The control treatment was usual care, with analgesia titrated by nurses according to hospital guidelines. The participants were patients aged 18-75 years presenting to the emergency department who required intravenous opioid analgesia for the treatment of moderate to severe pain resulting from traumatic injuries, and who were expected to be admitted to hospital for at least 12 hours. In total, 200 adults were recruited and randomised to the intervention (patient controlled analgesia; n=99) and control (routine care; n=101) treatment groups.1
The primary outcome was total pain experienced over the 12 hour study period, recorded using a visual analogue scale. Secondary outcomes included total amount of morphine used. The mean total pain experienced by the intervention group was lower than that experienced by the control group, although the difference was not significant. Participants in the intervention group used significantly more morphine than was administered in the usual care group. It was concluded that patient controlled analgesia provided a reduction in pain, albeit not significant, compared with routine care for emergency department patients with traumatic injuries. The researchers commented that the results of the trial may have been influenced by the Hawthorne effect.
Which of the following statements, if any, are true?
Background
In Germany, more parents have been seeking help from osteopaths for their infants and children in recent years. This implies an increasing demand of reliable evidence regarding the effectiveness of osteopathic intervention for this group.
Objective
To identify the ‘typical’ (most common) health concerns of parents when presenting their infants (age 0–12 months) in pediatric osteopathic practices.
Methods
For the purpose of this survey, well-trained osteopaths who specialize in the treatment of children and infants were selected. A documentation form containing a list of the likely most common infant health problems, developed by means of systematic literature analyses, was provided to experienced osteopaths to assess which health problems were seen most frequently.
Results
Eighty-one osteopaths were contacted, of which 64 (79 %) responded and returned the documentation form. Nine documentation forms could not be evaluated. The remaining 55 documentation forms included information on 2833 health concerns. Quantitatively, there was no dominant health problem, but five problems were found to be common: 21 % of the cases were idiopathic infant asymmetry, 17 % were plagiocephaly, 16 % were excessive crying, and 14 % were feeding and sleep disorders. All other problems were observed as far less frequent. In addition, osteopaths reported 423 other health concerns that were not specified in the documentation form.
Conclusions
In this survey, infants that were presented in osteopathic practices often had one or more of those five health problems mentioned above. A large observational trial is currently underway (‘part two’ of the OSTINF study) to document changes observed during osteopathic treatment of these health problems.
Objective: Deformational plagiocephaly (includes plagiocephaly and brachycephaly) is a common
pediatric condition. Infants who present with altered head shape often experience developmental delay.
It is uncertain how common developmental delay is in infants with plagiocephaly and how sustained this is,
when present. This review explores the association between plagiocephaly and developmental delay to guide
clinical practice. Study Design: A systematic review was conducted. MEDLINE, EMBASE, CINAHL, and PEDro
databases were searched. Data from relevant studies were extracted regarding study: sample, follow-up,
design, and findings. Methodological quality of each study was rated using a critical appraisal tool. Results:
The search recovered 1315 articles of which 19 met the inclusion criteria. In the included studies, the
children’s ages ranged from 3 months to 10 years. Study limitations included selection bias, non-blinding of
assessors, and reuse of the same study population for multiple papers. Most papers (11/19) rated “moderate”
on methodological quality. A positive association between plagiocephaly and developmental delay
was reported in 13 of 19 studies, including 4 of 5 studies with “strong” methodological quality. Delay was
more frequently in studies with children £24 months of age (9/12 studies) compared with >24 months of age
(3/7 studies). Motor delay was the most commonly affected domain reported in high-quality papers (5/5
studies). Conclusion: This review suggests plagiocephaly is a marker of elevated risk of developmental
delays. Clinicians should closely monitor infants with plagiocephaly for this. Prompt referral to early intervention services such as physiotherapy may ameliorate motor delays and identify infants with longer term
developmental needs.
Background:
Positional plagiocephaly is a common problem seen by pediatricians, pediatric neurologists, and pediatric neurosurgeons.
Objective:
To create evidence-based guidelines for the treatment of pediatric positional plagiocephaly.
Methods:
This guideline was prepared by the Plagiocephaly Guideline Task Force, a multidisciplinary team made up of physician volunteers (clinical experts), medical librarians, and clinical guidelines specialists. The task force conducted a series of systematic literature searches of PubMed and the Cochrane Library, according to standard protocols for each topic addressed in subsequent chapters of this guideline.
Results:
The systematic literature searches returned 396 abstracts relative to the 4 main topics addressed in this guideline. The results were analyzed and are described in detail in each subsequent chapter included in this guideline.
Conclusion:
Evidence-based guidelines for the management of infants with positional plagiocephaly will help practitioners manage this common disorder. The full guidelines documents can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly.
The Numerical Rating Scale-11 (NRS-11) is one of the most widely used scales to assess self-reported pain intensity in children, despite the limited information on its psychometric properties for assessing pain in pediatric populations. Recently, there has been an increase in published findings regarding the strengths and weaknesses of the NRS-11 as a measure of pain in youths. The purpose of this study was to review this research and summarize what is known regarding the reliability and validity of the NRS-11 as a self-report measure of pediatric pain intensity.
A literature search was conducted using PubMed, PsycINFO, CINAHL, and the Psychology and Behavioral Sciences Collection from their inception to February 2016.
A total of 382 articles were retrieved, 301 were screened for evaluation, and 16 were included in the review. The findings of reviewed studies support the reliability and validity of the NRS-11 when used with children and adolescents.
Additional research is needed to clarify some unresolved questions and issues, including (1) the minimum age that children should have to offer valid scores of pain intensity and (2) the development of consensus regarding administration instructions, in particular with respect to the descriptors used for the upper anchor. On the basis of available information, the NRS-11 can be considered to be a well-established measure for use with pediatric populations.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0.
Purpose:
Head orthoses offer a valuable therapeutic option for infants with positional plagiocephaly. The aim of this retrospective study was to evaluate the influence of therapy start and duration due to improvement of cranial asymmetry.
Material and methods:
A total of 102 children during the years 2009-2014 were included. The patient cohort was divided according to age at the beginning of therapy (younger/older than 7.5 months) and duration (less/more than 150 days). To evaluate the therapy, ear shift (ES), Cranial Vault Asymmetry Index (CVAI), and Cranial Index (CI) were calculated pre- and post-therapy by using three-dimensional photogrammetry measurements.
Results:
Treatment with head orthoses led to a significant reduction of CVAI in groups with less and more than 150 days of therapy (p < 0.0001). A significant reduction in CVAI was observed (p = 0.0235) in children younger than 7.5 months in short-term therapy. At the end of therapy, no significant difference was found in the groups, whether treated with short- or long-term head orthoses (p = 0.0813), although CVAI was significantly different comparing the third time point of both groups for treatment duration (p = 0.017). The major positive effect of helmet therapy has been seen after 75 days of treatment. A treatment that was longer than 150 days did not show any significant improvement concerning the cranial asymmetry.
Conclusions:
Helmet therapy is a reliable method in the treatment of positional plagiocephaly to improve cephalic asymmetries. This retrospective study indicates that an early beginning can lead to satisfying results after short-term therapy.
Background:
Feeding difficulty is common in infants younger than 6 months. Identification of infants in need of specialized treatment is critical to ensure appropriate nutrition and feeding skill development. Valid and reliable assessment tools help clinicians objectively evaluate feeding.
Purpose:
To identify and evaluate assessment tools available for clinical assessment of bottle- and breastfeeding in infants younger than 6 months.
Methods/search strategy:
CINAHL, HaPI, PubMed, and Web of Science were searched for "infant feeding" and "assessment tool." The literature (n = 237) was reviewed for relevant assessment tools. A secondary search was conducted in CINAHL and PubMed for additional literature on identified tools.
Findings/results:
Eighteen assessment tools met inclusion criteria. Of these, 7 were excluded because of limited available literature or because they were intended for use with a specific diagnosis or in research only. There are 11 assessment tools available for clinical practice. Only 2 of these were intended for bottle-feeding. All 11 indicated that they were appropriate for use with breastfeeding. None of the available tools have adequate psychometric development and testing.
Implications for practice:
All of the tools should be used with caution. The Early Feeding Skills Assessment and Bristol Breastfeeding Assessment Tool had the most supportive psychometric development and testing.
Implications for research:
Feeding assessment tools need to be developed and tested to guide optimal clinical care of infants from birth through 6 months. A tool that assesses both bottle- and breastfeeding would allow for consistent assessment across feeding methods.
Feeding is one of the most important interactions between caregiver and child in the first few years of life and even later on in handicapped children. Feeding disorders can present as food refusal or low quantity of food intake due to behavioral issues or underlying organic conditions. This situation concerns mostly infants and children below 6 years of age; however, feeding problems can appear also later on in life. Feeding disorders are a concern for over 10-25% of parents of otherwise healthy children below 3 years of age, but only 1-5% of infants and toddlers suffer from severe feeding problems resulting in failure to thrive. In case of premature infants or neurologically disabled children, this rate is much higher. Feeding disorders may appear as an isolated problem, mainly due to negative behaviors during feeding, or as a concomitant disorder with an underlying organic disease or structural anomaly. The newest classification also includes the feeding style presented by the caregiver (responsive, controlling, indulgent or neglectful) as a separate cause of feeding disorders. © 2015 S. Karger AG, Basel.