ICOM YEAR 4 · PAEDIATRIC OSTEOPATHY

Paediatric Osteopathy

Year 4 Exam Key Takeaways — Visual Revision Guide

📊 20–25% plagiocephaly 🧬 CN9/10/11/12 ⏱ 6 months segmental motion ✅ HVT post-puberty only 🦴 Occiput = #1 dysfunction ⚠️ Never aspirin in kids

👶 Children ≠ Small Adults

Fryette's Laws DO NOT apply to infants
Segmental motion absent until 6 months
Bones cartilaginous and unfused at birth
Sutures mobile — cranial mechanics unique
Rapid tissue response to treatment
Ligamentous laxity greater than adults

🦴 Anatomical Differences

Occiput in 4 parts at birth
Sphenoid in 3 parts
Sacrum in 5 segments (fuses 18–30 yrs)
Growth plates present and vulnerable
Immune system immature
Eustachian tube more horizontal

💡 REMEMBER: Fryette = Adults Only. Segmental motion = 6 months+

⚠️ Birth Trauma Risks

Prolonged labour
Breech presentation
Forceps delivery
Ventouse extraction
Caesarean section
Multiple birth

🔴 Compressive Effects

Colic (CN11/vagal)
Torticollis (SCM/OA)
Poor suckling (CN9/CN12)
Excessive vomiting (CN10)
Otitis media (temporal)
Plagiocephaly

✅ Natural Decompression

Crying
Kicking
Suckling / breastfeeding
First breaths
Yawning

💡 Neonatal bones = cartilaginous + unfused. Best treated in FIRST FEW DAYS of life.

No Suture Fusion

🟢 Plagiocephaly — FUNCTIONAL

20–25% of back-sleeping infants

Posterior flattening from sustained position
Asymmetric ear position
Associated with torticollis
Treat: osteopathy + exercises + position changes
Rule out craniosynostosis

Premature Suture Fusion — Surgical

🔴 Craniosynostosis — STRUCTURAL

Suture	Head Shape	Frequency
Sagittal	Scaphocephaly (long narrow)	MOST COMMON
Coronal (unilateral)	Anterior plagiocephaly	2nd most common
Bicoronal	Brachycephaly (short wide)	Less common
Lambdoid	Posterior plagiocephaly	Rare
Metopic	Trigonocephaly (triangular)	Rare

🦴 Occiput = Most Common Dysfunction Site

🔵 Jugular Foramen

CN	Name	Effect
CN9	Glossopharyngeal	Poor sucking
CN10	Vagus	Excessive vomiting
CN11	Accessory	Colic + torticollis

🟡 Hypoglossal Canal + Temporal

CN/Structure	Effect
CN12 Hypoglossal	Poor sucking + tongue weakness
Temporal internal rotation	Eustachian tube narrowing → otitis media

🧠 MNEMONIC: 9 = Suck | 10 = Vomit | 11 = Colic | 12 = Tongue

🔴 Infants & Preschool

Articular mobilisation + soft tissue ONLY — No HVLA

🟡 School Age

Modified adult techniques — Still no HVLA

🟢 Post-Puberty

HVT / HVLA safe when growth plates fused

📋 Technique List

MFR BLT Ligamentous Articular Strain FPR MET (scoliosis) Counterstrain Craniosacral Lymphatic Galbreath Cervical Stroking Ear Pull Rib Raising Ribs Still/BLT Diaphragm MFR Sacral Shotgun Thoracic/Lumbar FPR

🚫 CONTRAINDICATIONS
Intracranial haemorrhage | Skull fracture

⛔ NO HVT EVER

• Down Syndrome (AAI risk)
• Rheumatoid Arthritis (odontoid erosion)
• Pre-puberty (open growth plates)
• Osteogenesis Imperfecta

👂 ENT Techniques

Rocking temporal bones
Eustachian tube twist
Lymphatic pump
Sinus drainage
Cervical stroking
Ear pull
OA/AA release

💨 Asthma Targets

PARASYMPATHETIC

OA AA C2 Occipitomastoid

SYMPATHETIC

T2 T3 T4 T5 T6 T7

MOTOR

C3–C5 Phrenic Scalenes SCM

📊 RCT EVIDENCE: Osteopathy significantly improves pulmonary function in paediatric asthma.

📋 Apophysitis Conditions

Condition	Site	Muscle-Tendon	Key Fact
Sever's Disease	Calcaneus (heel)	Gastrocnemius-soleus	Most common 8–14 yr
Osgood-Schlatter	Tibial tubercle	Patellar tendon	Resolves 14F / 16M
Sinding-Larsen-Johansson	Inferior patella	Patellar tendon (proximal)	Jumper's knee
Little Leaguer's Elbow	Medial epicondyle	Flexor-pronator	Throwing athletes

🦵 Hip Apophysitis

ASIS

TFL / Sartorius

AIIS

Rectus Femoris

Iliac Crests

Abdominals

Ischial Tuberosities

Hamstrings

🦴 Bone Conditions

Osteogenesis Imperfecta

Brittle bones
Blue sclera
Autosomal dominant

Osteopetrosis

Marble Bone Disease

Dense but brittle
Stem cell transplant Tx

McCune-Albright

McCune-Albright Syndrome

Café-au-lait spots
Precocious puberty

📋 History Red Flags

Age under 4 with back pain Unexplained weight loss Cancer or TB history Nocturnal pain wakes from sleep Morning stiffness >30 min No relief with rest Constant progressive pain

🔍 Physical Red Flags

Fever Asymmetric reflexes Bladder or bowel dysfunction Neurological deficit Palpable mass Abnormal gait or limp Failure to thrive

DIFFERENTIAL CATEGORIES

MSK / Mechanical Infectious Inflammatory Neoplastic Referred Pain

Trauma

Fracture, avulsion

Infection

Septic arthritis, osteomyelitis, Lyme

Inflammation

Transient synovitis MOST COMMON, JRA

Neoplasm

Leukaemia, Ewing's sarcoma

Haematologic

Haemophilia, sickle cell

Misc

Legg-Calvé-Perthes, SCFE

LCP — Legg-Calvé-Perthes

AVN of femoral head
Boys 4–10 years, 4:1 ratio
Limp + limited internal rotation

SCFE — Slipped Capital Femoral Epiphysis

Obese teenager
Obligate external rotation
Urgent referral
25% bilateral

Condition	Cause	Key Alert
Bronchiolitis	RSV	Under 1 year
Kawasaki Disease	Unknown immune	IVIG + Aspirin (coronary risk)
Reye's Syndrome	Aspirin + viral	⚠️ NEVER aspirin with flu or chickenpox
Meningitis	Viral or bacterial	Hearing loss / death
Whooping Cough	Bordetella pertussis	Fatal in young infants
Fifth Disease	Parvovirus B19	Foetal risk if mother unexposed

🚨 REYE'S SYNDROME: NEVER give aspirin to children with flu or chickenpox.

🟢 4–6 Months

Rolling front-to-back
Pull to sit
Side reach
Hands to midline
Supported sitting

🟡 7–9 Months

Unsupported sitting
Side sitting
Four-point kneeling
Commando crawl
Pivoting

🔴 9–12 Months

Half kneeling to stand
Pull to stand
Cruising furniture
Reciprocal crawling
First steps ~12 months

⭐ EXAM MUST-KNOWS

Infants respond RAPIDLY to osteopathy

HVT safe POST-PUBERTY only

Post-treatment soreness is RARE

NO cervical HVT in Down Syndrome

Do NOT over-treat children

NO HVT in Rheumatoid Arthritis

Keep sessions SHORT and FUN

NEVER aspirin with flu/chickenpox

Fryette's Laws = Adults ONLY

Kawasaki EXCEPTION = aspirin + IVIG

Segmental motion = 6 months+

Occiput = #1 neonatal dysfunction

CN Summary

🧬 Cranial Nerves

9 = Suck
10 = Vomit
11 = Colic
12 = Tongue

Apophysitis

🦴 Quick Recall

Sever's = Heel
OSD = Tibial tubercle
SLJ = Inferior patella
LLE = Medial epicondyle

Bone Conditions

🦴 Key Features

OI = Blue sclera
Osteopetrosis = Stem cell Tx
McCune-Albright = Café-au-lait