Putting it all together – stuttering and the developing child’s brain.

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As children grow and their brains develop the connections in the brain often have to coordinate to achieve the desired function.  Sometimes when children undertake a growth spurt these connections develop at a great rate and the coordination of these may not come together as smoothly as one would wish.  This must be frustrating for the children as they cannot do what they want, and also for parents, as frustrated children often take this out with their behaviour.  Sometimes children may display signs of this brain coordination struggle, such as stammering or stuttering with speech which may not have been evident before.

Most of these developmental changes are integrated in time and the behaviours or symptoms will change again – with stuttering or stammering it is not uncommon in children between 2 and 4 years of age to suddenly start the struggle to form their words when they have had no difficulties prior.  There is plenty of useful information available online (http://www.webmd.com/parenting/stuttering#1 and http://www.stuttering.co.nz/) and as an osteopath I like to assess the function of the developing mouth, tongue and throat to help with the integration of what is a complex brain function.  It may be useful however to consider having a child assessed by a speech language therapist.

 

Ear Infections in kids – not a lot of fun!

One of the most common childhood ailments is an ear infection.  Often these can come on pretty quickly and a child can go from happy and cheerful to screaming and feverish in a very short space of time.  Symptoms may include a fever, tugging or pulling at the ear(s) in pain, vomiting, diarrhoea and lethargy – not a lot of fun for a child.  Unfortunately children are more prone to ear infections than adults due to the shape of the bony passage which drains the middle ear called the Eustachian Tube – in adults this angles down, but in newborns and young children this is horizontal, meaning any fluid buildup in the middle ear does not have any gravitational assistance to drain.  As we grow our skull shape changes, resulting in the change of angle of this tube.  When there is a buildup of fluid bacteria and viruses can multiply, resulting in a full blown infection.  When this fluid contains pus and begins to create pressure on the eardrum it is defined as otitis media.  If this continues to buildup it can cause rupture of the eardrum.

Image from http://www.stewartmedicine.com/wp-content/uploads/2015/03/normal-ear-infected-ear.jpg

Standard medical treatment for ear infections may involve antibiotics to kill the infection, however there is concern that antibiotics may be over used and result in antibiotic resistant bacteria, therefore many guidelines indicate that if the infection is minor and only in one ear the protocol is to keep the child comfortable, which may involve assistance for a fever, and to let the body’s immune system resolve the infection.  If a child experiences several ear infections in the space of 2 years they may be referred to an Ear Nose and Throat specialist to possibly have grommets inserted in the eardrum to allow the pressure buildup to release to the external ear.

Osteopathically I like to try to avoid antibiotic use and grommets – osteopathic treatment may seek to ensure the exchange of fluid in the middle ear, moving the fluid containing the infective particles down the Eustachian tube to prevent buildup of reproducing infective agents, assisting the body’s own immune function to resolve the infection.  Gentle osteopathic treatment, usually in the form of cranial osteopathy, may be useful to try to assist in this.  Research on this condition indicates benefit from osteopathic treatment (http://www.ncbi.nlm.nih.gov/pubmed/12963590) and I have seen many children with ear infections respond well to this. I would strongly advise checking with your doctor to confirm a suspected ear infection – they will usually check temperature and have a look at a child’s eardrums using a tool known as an otoscope.  They may or may not prescribe antibiotics – in either case osteopathic treatment may be beneficial.

 

 

Are you sitting comfortably?

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Working at a computer all day can often result in aching backs, necks, and joints.  Much has been learned regarding ergonomic setup for computer workstations, and it is important to ensure that your work environment is assessed as impacting as minimally on your body as possible.  A quick checklist and diagram of good workstation setup can be found here.

Having a good desk setup, taking regular breaks and moving regularly during the work day are important, and one recent addition to the toolkit to manage this is the sit-stand desk, a height adjustable addition to office furniture allowing one to change working position regularly during the day.  I have recently added a Varidesk, a desktop unit which transforms existing office furniture to a sit-stand desk, to our home office and am enjoying experiencing the change in adjusting the desk height.

While long term benefits from adjustable height desks are yet to be proven as we have not had them for long enough, I believe they have great potential to reduce the impact of desk work on the body.  We know that long term sedentary work is damaging to our health, however computer work is now more prevalent than ever, and it is important to try to reduce the impact of this.

 

Back Pain – does the imaging reflect the cause?

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Often when patients experience back pain they are referred for diagnostic imaging – an xray or maybe a CT (computerised tomography) scan or MRI (Magnetic resonance imaging) scan. These technologies enable us to view a patient’s bony structure via xray, and the soft tissue like vertebral discs, ligaments and muscle tissue using CT and MRI. They are an essential part of diagnostics and enable doctors and other healthcare providers (like osteopaths!) to ‘look inside’ a patient to find a cause for a patient’s symptoms.

Commonly reported findings from imaging regarding back pain include degeneration of the vertebrae, reduction of disc heights, tears in the discs and degeneration of the facet/intervertebral joints.
Last year a study was published by Brinjikji (http://www.ncbi.nlm.nih.gov/pubmed/25430861) which looked at studies of patients with no back pain symptoms, and the results raised serious questions regarding the findings of imaging related to the pain experienced by patients.

LBPImaging

 

From the table from the study it is apparent that, as we age, findings from imaging increase in prevalence, however the important fact to note is that these findings are from patients with no back pain – asymptomatic patients. What we can conclude from this is that findings from imaging may not be the cause of symptoms. If you are referred for imaging by a doctor or healthcare provider because of back pain and the report from the radiologist looks alarming don’t despair – many people who do not experience back pain would have similarly alarming radiology reports. Consulting an osteopath will often be helpful to see if treatment can help reduce pain and improve function, regardless of what a radiology report states.

Tongue Tie in Infants.

Tongue tie (also known as ankyloglossia) is a congenital (birth) condition which affects the range of movement of the tongue as the tissue underneath the tongue (the frenulum) is tight and prevents the tongue from elevating and protruding . This is usually detected in newborns as they may present with feeding difficulties and/or may cause damage to mother’s nipples when breastfeeding due to not being able to latch effectively. Sometimes the restricted tongue movement may result in speech difficulties in children, and in some cases it may go undetected until adulthood.

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Infant with tongue tie.(Image courtesy of www.gatewaypediatricsaz.com)

The common treatment for tongue tie involves cutting the frenulum with surgical scissors under local (gel) anaesthetic, however if the frenulum is tight further back under the tongue, known as a posterior tongue tie, the cut may require laser surgery.

My own son was born with a tongue tie which we had released (cut) when he was 2 weeks old – the cut made an improvement to his latch, however as an osteopath I recognised the function of the tongue muscles and the jaw were also affected. Post tongue tie release exercises, involving stretching the muscles and the jaw, improved his feeding even further, and should always be undertaken after having the tongue released.

If your child is causing pain or damage when breastfeeding, or if they are having latching or feeding difficulties consulting a lactation consultant to review whether a tongue tie may be present should be considered, followed by a visit to an osteopath to review the function of the tongue and jaw.

Uneven skin folds and hip problems in infants.

Hip xray of a child (image courtesy of images.radiopaedia.org/)

Whenever I treat a newborn or infant I will always assess the child’s hips – this is commonly done at birth by the attending Lead Maternity Carer (LMC) and checked regularly throughout infancy by GPs, midwives and Plunket.  When assessing hips for any kind of instability/unevenness we are checking for the potential signs of hip dysplagia, known as CDH or Congenital Dysplasia of the Hip.  This means the growth of one or both hips is not progressing well, and may lead to potential crawling or walking problems for the child.

Assessing evenness of the child’s skinfolds at the groin, thigh, knee and buttock may give an indication of this, however testing the function and stability of the hips is more important, as often skinfolds in growing children may appear uneven when there is no problem.  When assessing the function of the hip I assess range of movement and stability, determining whether there may be any instability of the hip joint – this is often referred to as ‘clicky hips’.  If any instability or dysfunction is found I will refer for xray to confirm – looking at the skinfolds only is not a very accurate method of determining the likelihood of CDH.

Plunket nurses are instructed to look for uneven skinfolds in children, however accurate functional and stability tests should be performed before referral for xray – our Plunket nurse, at our son’s last visit, advised that she estimates she has detected approximately 3 kids per month with uneven skinfolds. She reports this to the parents, advising them to seek further assessment (often from their GP) before referral for xray, and reported that in six years there have been only 2 confirmed CDH cases out of over 200 detected uneven skinfolds.

If you are advised that your child’s skinfolds are uneven don’t panic, as the likelihood of CDH without any other symptoms is small, but I recommend consulting with a health professional (such as an osteopath!) for a full assessment.

 

Digital Overload – how it affects the brain.

http://www.theguardian.com/science/2015/jan/18/modern-world-bad-for-brain-daniel-j-levitin-organized-mind-information-overload

This might seem like a strange post for a digital space like a blog, but it is important to take note of the effects of constant digital contact – via email, twitter, facebook – on the brain.

Researchers investigating brain activity have identified that trying to check digital communications while performing other activities –  multitasking (which is actually rapidly changing focus from one thing to another in the brain) – uses more energy than focussing on one activity. This affects the performance and functional ability of our brains to remember information and make clear decisions.  This multitasking also results in production of stress hormones in the body which affect behaviour, making us irritable and grumpy.

Managing ourselves in a digital world is difficult – emails, texts and messages constantly arrive at our devices or computers all hours of every day and we feel compelled to check them and reply.  Keeping up with it all is impossible, and trying to do so is detrimental to our brain function, which is especially concerning for children growing up in an age of constant contact.  Allocating set times for digital communication may be helpful – not trying to multitask continuously and focussing on one thing at a time – maintaining the discipline to do so will be harder.