Ages
Newborns |
Premature (<38 weeks)
Term (>38 weeks) |
Neonate |
0-30 days |
Infant |
Early (1-12 months),
Late (13-24 months) |
Young child/toddler |
2-6 years |
Child/school child |
6-12 years |
Adolescent |
12-18 years |
General MSK in utero conditions
MSK from intrauterine environment |
Pathologies, uterus differences, growth restriction and arthrogryposis |
Congenital contractures |
AROM + PROM reduced with structural and or functional abnormalities of soft tissues |
Congenital anomalies |
Malformations, disruptions, deformations, dysplasia |
Arthrogryposis: Abnormal contracture of joints - curved joints
Signs that a child needs manual therapy
Signs of a neck problem |
Decreased cx ROM |
Decreased neck tone + strength |
Asymmetric head shape |
Difficulty sleeping supine |
Palpable lesion in joints/muscles of the cx spine |
Swaddling
Increases risk of SID - more likely to be prone |
Negative effect on mother-infant relationship compared to skin to skin |
Later breastfeeding |
Developmental hip dysplasia |
Acute respiratory infection |
Vitamin D deficiency |
Decreases pain scores |
Decreases spontaneous awakening and arousability, greater quality sleep |
Increased risk of hyperthermia |
Pain in later life
Pain - increased heart rate |
Hypothalamic pituitary adrenal axis reprogramming |
Higher risk of maladaptive responses to anxiety & stress provoking stimuli |
Anxiety, depression, OCD, panic & PTSD |
Cognitive functioning |
Reduced cognition and visual motor integration |
Increased size of amygdala |
Periaqueductal grey |
Immediate & permanent changes |
Increased endorphin & encephalin protein |
Prevention:
Non pharma therapies : Kangeroo care, massage, skin to skin contact, breastfeeding, NNS, oral sweeteners
Parents:
Increase emotional sensitivity
Increase education
Lower parental stress
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Foetal akinesia
Lasting >3 weeks: |
Lack of normal muscle stretching |
Reduced compliance of the capsule and peri-articular ligaments |
Causing: |
Fibrosis and contractures of the affected joints |
Assessed by: |
PROM |
Was your baby moving all throughout the pregnancy or staying still?
Movements are important for normal MSK development
Risk factors for intrauterine constraint
Primigravida ( first pregnancy) |
Small maternal size |
Uterine malformation |
Uterine Fibromata |
Early Pelvic engagement of the foetal head |
Aberrant foetal positioning |
Oligohydramnios (too much amniotic fluid) |
Multiple gestations |
Birthing injuries
Forceps + perineal pressure |
Nasal septal deviation |
Mild injuries |
Head Asymmetry |
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Facial asymmetry |
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Torticollis |
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Mandibular asymmetry |
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Spinal, rib, clavicular dysfunction |
Moderate injuries |
Clavicular f# |
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Facial nerve injury |
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Bruising & tearing spinal nerve root |
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Brachial plexus |
Severe injuries |
Extra/sub-dural haemorrhages into joint capsules, torn ligaments, dura |
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Haemorrhages of vertebral arteries |
Types of birth interventions + Risks
Vaginal Birth |
Clavicular f# |
Forceps |
Skull f# |
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CN palsy |
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Brachial plexus injuries |
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Facial nerve palsy |
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Torticollis |
Ventouse |
Cephalohaematoma |
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Cranial f# |
Risks |
Male (larger) |
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First born |
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Assisted delivery |
Ventouse: Cup like suction device, attaches to the baby's head
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Non-pharma pain management
Environment |
Feeding methods |
Other |
Skin to Skin contact |
Non-Nutritive sucking (NNS) |
Acupuncture |
Swaddling(?) |
Breast Feeding |
Sucrose |
Tucking |
Touch, massage |
Music |
Non-Nutritive sucking:
Sucking not for the purpose of feeding
Benefits:
Improved digestion
Behavioral organization (able to settle down after crying)
Pain management
Prevention of aspiration
Decreased risk of SIDs
NNS if baby resists
Consider: |
Because of early breast weaning? |
Shortened breastfeeding duration? |
Nipple confusion |
Otitis media |
Dental malocculusions |
Suffocation |
Allergies |
Poisoning |
Infection |
Recommended:
Minimise pacifier use
Delay introduction up to 1 month of age
Limit use for soothing
Wean from pacifier from 2-6 months of age
NP & NC pain
Neuropathic (NP)
Nociceptive (NC)
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