Sunday, August 24, 2008

Colic - Osteopathic Approach


Colic is a common disorder in infants. It is defined as distress or crying in infants that lasts more than 3 hours a day, for more than 3 days a week for at least 3 weeks in an infant which is otherwise healthy.

Many infants "grow-out" of their colic after about 4 months of age but it is the infants whose discomfort continues beyond this period are the ones that often find their way into osteopathic clinics. Colic affects between 15-40 % of infants, a somewhat confusing statistic considering its wide range but 40 % being the more mild cases and 15 % the more severe cases.

Crying is a common criterion of colic and more likely to occur in the evenings with observation of discomfort, restlessness and flatulence. In an infant the digestive system is still immature and so gut motility and transit time is slow relative to an adult. This may lead to the production of intestinal gases and antigen build up causing discomfort and possible inflammation of the gut.

After the case history has been completed by the osteopath it is time for the physical examination. The osteopath may discover a feeling of tension in the soft tissues. Colic can be associated with a number of different causes.

Osteopathic theory suggests that one of the causes of colic in infants is difficulty during labor. The osteopathic theory is that compression at the base of the skull due to the pressure from passing through the birth canal may compress the bones of the cranium specifically the hypoglossal canal and jugular foramina. The central nervous system and its meningeal coverings are particularly sensitive to mechanical pressure. It is an interesting coincidence that colic often starts between the second and fourth week of life – just around the time of the beginning of the development of the voluntary control of the posterior cervical muscles. It is at this age that infants start to lift the head when placed in the prone position. Osteopaths believe that irritation of the vagal nerve, which exits the cranial base and supplies the gut may contribute to colic and the sudden engaging of the posterior cervical muscles of the neck may irritate an already susceptible vagal nerve.

As with most osteopathic treatments, the approach is to integrate the body. In addition to examining the cranial base, the osteopath will need to examine the musculo-skeletal system checking for tension in the rest of the body with a focus on the gut, thorax and the nerve supply of these areas. It is important that the osteopath considers the possibility that gastric reflux may be associated with colic. For this reason the osteopath must pay attention to the mechanics of the diaphragm and ribs (please see post on gastric reflux for more information).

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