Osteopathy is an emerging field of clinical research. Here we present a protocol to assess the efficacy of an osteopathic intervention coupled with lactation consultation, in infants with biomechanical issues impeding breastfeeding.
The use of osteopathic techniques for breastfeeding biomechanical difficulties is widely spread in practice, but until this trial, there's been no empirical evidence that it works. Breastfeeding difficulties are encountered by many mothers during the first weeks of the postpartum period. The collaborative setup of this intervention is very pragmatic for these parents.
On the first appointment following the referral, welcome the mother and infant and explain the full study process. After obtaining written consent, administer a baseline questionnaire for sociodemographic data, breastfeeding data, and maternal perceptions of biomechanical difficulties. Next, ask the mother to give one breast and observe the infant's suckling rhythm.
Right at the beginning of the feed, have the lactation consultant use the latch assessment tool to assess the infant's baseline ability to latch and request that the mother complete a visual analog scale right at the beginning of the feed. When the suckling movement begins to slow, have the mother remove the infant from the breast. Before you perform the osteopathic assessment, open the sealed and opaque envelope with the corresponding study number for the mother-infant dyad.
Assigning the dyad to the control or treatment group, and ask the mother to sit on a couch with a cushion on her knees and the infant lying back on it. Sitting next to the mother, connect with the infant by making eye contact and talk to the infant before putting hands on their body. Begin with a general observation of the infant's posture, tone, and any asymmetries.
Next, use a goniometer to assess the infant's passive left and right head rotation, noting any discomfort manifestation or limitation. Assess any osteopathic lesions for each part of the body regardless of the allocation group, using the standardized grid as described in the table. Begin with the pelvic area, assessing the tissue texture and tone in the lower limbs fascia, sacroiliac joints, sacrum and hips, as well as the range of motion of the pelvic sphere versus the lumbar spine and the structures up to the skull.
Move the hands from the infant's pelvis to the skull and similarly assess the tissue texture and tone, and as appropriate, the range of motion of the abdominal cavity, spine, diaphragm, thorax, and cervical spine. Pay careful attention to the first cervical vertebrae and assess the anterior structures of the neck, hyoid bone, and sublingual muscles. Move forward from the base of the skull to the occipital, temporal, parietal, sphenoid and frontal bones, and features of the face including the jaw.
As infants yawn frequently, observe the jaw movements and the symmetry of the face. For each structure, record the observations of the texture, tone, straining, and quality and range of motion on the standardized grid. For osteopathic treatment of the pelvic area, place hands on each side of the infant's pelvis, covering the iliac bones with the thumbs on the anterior part of the iliac bones and the fingertips at the sacroiliac joints on each side.
Using the indirect technique, place the restricted structure in a comfortable position and use continuous feedback until a complete loosening of the structure is achieved. For treatment of the upper cervical spine, place the fingers of both hands around the occipital bone with the tips of the ring fingers contacting the condyles area, the index fingers contacting the mastoid area, and the middle fingers between the occipital bone and the first cervical vertebra. Then gently separate the fingers in the various spacial planes until the tissues soften and the condyles move freely.
For treatment of the neurocranial region, place one hand under the occipital bone and the other on the frontal and sphenoidal bones, avoiding the eyes. In a frontal occipital hold, place the occiput and sphenoid in their position of least resistance, monitoring the decrease in resistance and readjusting the positioning of the structures until the release occurs. For treatment of the jaw region, cup one hand under the occipital bone and the first three cervical vertebrae, and the index finger and thumb of the other hand on each side of the hyoid bone.
Wait until the release of the hyoid bone is felt through the structures of the other hand, monitoring and reassessing as for the myofascial release technique. End the osteopathic treatment by placing one hand on the pelvic area, and the other on the skull. To perform a sham intervention, place the hands on the areas far from those with detected dysfunctions without any intention of treatment, and answer any questions from the parent about osteopathy and the infant's psychomotor development.
For either treatment, postpone the infant feed until the end of the intervention using a pacifier or the mother's finger as necessary to soothe the infant. Then assess the infant's left and right passive head rotation with the goniometer, and leave the room to record the details of the performed treatment in the standardized assessment grid. In this representative study, 97 mother-infant dyads were recruited and randomly assigned to one of the two study groups.
Only one third had an intervention-free birth, and all of the infants had skull lesions. Make sure that the lactation consultant is well-trained to use the assessment tools and to respect the rhythm of the mother-infant dyad. Sometimes appointments will need to be rescheduled if the baby's too sleepy.
Although we've demonstrated the most common techniques, additional treatments can be used for a moderate approach of the suckling dysfunction. One thing we haven't been able to assess with our trial is whether a single osteopathic treatment is sufficient. It will be useful to determine whether it is a dose-response effect.
