Pediatric Craniosacral Therapy and the Neuroatypical Child
The treatment of infants and children is one of the most important aspects of health care. Pediatric Craniosacral Therapy is foundational to this care. The aim of Craniosacral Therapy is to normalize the bones, sutures, and underlying membranes of the head and spine. The goal, additionally, is to assist in balancing aspects of the nervous system. For decades, the treatment of infants and children was relegated behind that of adults. In recent times, practitioners of Pediatric Craniosacral Therapy have proved the importance of this work and have refined its theory and technique.
Why do we treat babies and infants? The best answer was given by an osteopath who said, “When we look at a child, we never know who or what that child could be. And when we look at an adult, we never know who or what that adult could have been.”
Dr. William Sutherland, the founder of Cranial Osteopathy, had a favorite expression. He said, “As the twig is bent, so grows the tree.” If we are able to correct or at the very least improve lesional patterns caused by internal or external factors, we are able to forestall many conditions that may plague the individual throughout life. We can assist in preventing learning disabilities, sensory disorders, structural problems, and behavioral and personality issues. It is an honor to work with these children and one of the sweetest things we can do as practitioners.
A Child-Centered Approach
This work is child-centered. Establishing trust and safety are primary before we can think of doing anything clinical with our hands. This is crucial because very often the child has lost the sense of this security, not only because of the diagnosed condition but often because of prior medical intervention that may have disturbed their sense of safety. By the time that the child may present to the therapist, the child may not only have clinical conditions but an apprehension due to past experiences. The goal is that the practitioner is able to meet and resonate with the child in a way that the child can optimally integrate the treatment. Pediatric Craniosacral Therapy not only brings the best out in the child, but it can also bring out the very best in those treating the child, as well.
Children, even newborns, give us many cues to guide us in our work. They often show us when they are deeply accepting the work and can express to the therapist how it is best to work at any given moment. The therapist constantly looks for cues to make certain that their touch is nurturing, not intrusive, and that the child can integrate the work and is not activated by it.
The skilled therapist works not only with the infant but also with the family. Simultaneously maintaining the contact and bond with the child and family is an art. It is like Tai Chi as the therapist navigates, moment-to-moment, all of those in the room, the changes that occur, what is needed, and the pre-existing dynamics surrounding the child. It is both a guiding of things to be and an allowing of things to happen.
When we work with a baby, there are principles we always consider before a session begins. Among the most important principles is to offer the child respect. Treat the child as we would hope to be treated. We also want to offer the child an environment of trust and safety. This is of fundamental importance. And as we treat, we want to have an ongoing conversation with the child, even if it is in our own thoughts. We want to constantly be asking the child if it wants more space and more possibilities where we are working. That way, the treatment is something that is done with the child, rather than on the child.
Developing Your Child’s Resources
When a child comes in for treatment, we want to use as many of the child’s resources as we can. Keeping the parents in close view of the child; adjusting our voice and tempo to soothe the child; and having the temperature, light, and sounds comfortable to the child is important. It is our goal that, as we work with care, that the child will begin to embrace both the therapy and the therapist as resources, as well.
Special focus is dedicated to the evaluation and treatment of children using an understanding of the autonomic nervous system. The autonomic nervous system guides our fight or flight response, provides rest and repair for our body, ensures the proper functioning of our organ systems, as well as influences our emotional responses. The goal is to help the child cycle through chronic stress and hyperactivity, as well as chronically held depression and withdrawal. Another goal is to bring into balance the autonomic nervous system and give the child greater access to more positive, socially engaged states. With treatment, if we are able to normalize possible debilitating conditions and bring the child into balance, we may improve that individual’s life in untold ways.
If this ability is to socially engage is unavailable or overwhelmed, due to traumatic internal or external events, a child may default to a less evolved manner of dealing with stress. This level is sympathetic activation or what we know as “fight or flight.” But all children may not have the ability to fight or to flee, so often they may default to the least evolved manner of handling stress, which is parasympathetic immobilization, shock, withdrawal, and/or dissociation.
These states that are created at such an early age can create an autonomic set point that can, if untreated, remain with the individual their entire lives. They can form the foundation of how we react to stress, even the types of illnesses we get. In utilizing Pediatric Craniosacral Therapy, we assist the infant to attain a more optimal state of structural and autonomic balance. We can realize an immediate effect on many clinical conditions and prevent many conditions from developing in the future.
How Pediatric Craniosacral Therapy Works
Many Pediatric Craniosacral Therapists understand that the treatment of brain anatomy and function is crucial along with the treatment of bones, sutures, and membranes. The Pediatric Craniosacral Therapist is in a unique position to address these issues.
Brain waves and brain function can be entrained through external influences. We know that stimuli, such as music, as well as a toning sound, such as the “om” that is used in certain cultures, can affect brain activity and that there is a measurable effect on brain function as a result. If sound can have a profound influence on brain function, it is very possible that touch and manual therapy may have a direct influence. The Pediatric Craniosacral Therapist offers treatment that can incorporate this in our work to facilitate improvement.
Pediatric Craniosacral Therapy can have positive influences on physiological and behavioral dysfunctions including abnormal fears, aggressiveness and violence, anger, anxiety, attention deficit disorder (including hyperactivity), digestive and elimination issues, bipolar disorder, cognition, sociability, concentration, depression, hallucinations, impulsiveness, memory, obsessive-compulsive disorder, dizziness, and balance, fatigue, panic disorders, paranoia, post-traumatic stress disorder, schizophrenia, and Tourette’s Syndrome.
Pediatric Craniosacral Therapy can also have a positive influence on physical and genetic manifestations including autism, biological clock disorders, brain injury, cerebral palsy, Down syndrome, dyslexia, Fetal Alcohol Syndrome, Seasonal Affective Disorder, sleep disorders, and stroke.
One of the most rewarding aspects of Pediatric Craniosacral Therapy is the treatment of neuroatypical children. It’s important to remember that each presentation is unique and that the child is not defined by his or her condition. The beauty of this work is that there are tangible results as well as unexpected benefits that accrue.
The goal, once again, is to establish with gentle touch a sense of trust and safety…internally within the child, with the therapist, and with the therapy. Often, we cannot reverse an injury, but we can assist in integrating that part of the brain with other, unaffected regions of the brain. Injuries can often sequester the affected area, and the child will benefit from greater connection throughout the nervous system.
The Pediatric Craniosacral Therapist will help in balancing the autonomic nervous system, relieving and normalizing compensatory patterns, and assisting in the healthy tissue adjacent to the injury to re-establish normal function. It is important to remember the wonderful neuroplasticity of the brain. The brain undergoes countless changes each moment. It is like shifting sand, and what our brain is at this moment will be changed the next moment. The work of the Pediatric Craniosacral Therapist is to facilitate continual positive changes.
Craniosacral Therapy and Neuroatypical Conditions
I have been a Craniosacral Therapist for almost 40 years. During these years, numerous cases of children with challenged brains such as Down syndrome, autism, and cerebral palsy have been presented. These individuals have aided me in the knowledge and refinement of my work as much as my treatment may have benefited them. The following are examples of what I as a Pediatric Craniosacral Therapist might look for, how I view and treat these conditions, and how I would treat them in my practice. It is meant as a personal discussion and not intended as a scientific research study or medical advice.
Down syndrome is caused by extra genetic material (trisomy) on chromosome 21. The effect of this condition causes the slowing of development between the sixth and twelfth week of intrauterine life. It is the effect on this stage of intrauterine life that is responsible for many of the features associated with Down syndrome.
Cranially, these features include the under-development and shortening of the cranial base. This results in the cranial base being straight and having a very steep (45 degree) angle. It is this steep angle that decreases the volume of the mouth and causes the tongue to characteristically protrude.
As the sphenoid bone is affected, the sphenoid sinus is absent. This causes the presentation of a flat forehead and the decreased anterior/posterior dimension. The growth of the ethmoid, nasal bones, maxillae, and mandible are also affected.
Because of the deficiencies in this area of the cranium, and along with the angle of the hard palate extruding the tongue, the individual often has great difficulty breathing through the nose. They also can exhibit apnea during sleep hours because of the tongue obstruction. This can result in an overall lack of oxygen (hypoxia), and it is this hypoxia that can be the cause of many significant postnatal conditions.
The goal of Pediatric Craniosacral Therapy for individuals with Down syndrome would be to work with the bones of the cranial base, the hard palate, the nasal, ethmoid, zygoma and frontal bones to maximize the ability to breathe. In treatment, we respect that this condition affects the stability of the second cervical vertebra, it causes a thinning of the cranial vault, and there is often a significant separation of the cranial sutures, particularly the sagittal suture between the parietal bones. In these instances, Pediatric Craniosacral Therapy works with the intention of enhanced breathing, greater comfort, and to affect the progression of conditions caused by reduced oxygenation to the tissue and nerves.
It is challenging to discuss autism as a particular condition, as there are as many presentations as there are cases. It is my belief that autism is a spectrum disorder that is the delicate and unique interaction between internal and external influences. However, we often see certain anatomical, physiological and behavioral similarities.
Of particular interest for Pediatric Craniosacral Therapy is how the brain in certain conditions of autism is wired. We can think of the brain as being similar to a phone company. There is a local service and a long-distance service. In many cases, the local areas tend to be overconnected and the long-distance connections (between more distant regions of the brain) are weak. The over-connectedness of the local areas can possibly result in hyper-focus on details and obsessive behavior. The poor connections of the hemispheres and distal areas of the brain may account for the difficulty in analytical, motor, and sensory integration.
In terms of brain development, it is often discovered that the frontal lobes are greatly enlarged, mainly due to excess white matter (myelinated axons). It is not unusual for a young child to have excess axons in the frontal lobes, but there is a “pruning” process that normally occurs that helps to organize thought and movement. With autism, often this pruning process is absent.
The corpus callosum links the two hemispheres of the brain. With autism, this is often undersized and underdeveloped, and the hemispheres of the brain can be poorly connected.
The amygdala, which plays a role in emotional and social behavior and in determining danger, can be enlarged in the individual with autism. This may be a reason for an elevated level of anxiety.
The hippocampus has to do with storage of memory. This is often enlarged, and one theory is that, with poor connection throughout the brain, the individual must rely on memorizing activities in a particular way.
The goal of Pediatric Craniosacral Therapy with individuals who have autism is to attempt to assist in the connectivity of the brain. The goal is also to downregulate the levels of anxiety and to assist the individual to achieve the greatest degree of social integration.
Cerebral palsy is due to an injury to the brain, most often associated with the birthing process. It is most commonly caused by a lack of oxygen to a distinct area of brain cells. Because the damage is to a distinct area, it is considered “non-progressive”, in that the damage does not increase. However, the injury may appear more severe depending on the developmental stage of the child. The injury usually involves the motor system.
There are several presentations of cerebral palsy, mostly dependent on what part of the brain was affected. Spasticity is the most common symptom. Difficulties with speech, balance, and motor control of the arms and legs may be present.
There can be a condition referred to as “pseudo” cerebral palsy in which there are many of the symptoms of cerebral palsy but without damage to the brain. This is often associated with cranial bone dysfunction and is often due to cranial bones overlapping at their sutures. This is most common if the parietal and frontal bones overlap at the coronal suture, possibly creating impingement of the motor cortex. A Pediatric Craniosacral therapist can aid in the normalization of these bones, particularly in infants.
My thoughts for the hope of individuals with cerebral palsy are similar to the hope one has for victims of stroke. With a stroke, there is an injury to a distinct area of the brain. It may be due to hemorrhage, but most commonly due to blockage of a blood vessel preventing oxygen from reaching the brain cells. There may be primary damage, followed by secondary damage around the primary site, but it is distinct.
What one can consider is that approximately one-third of stroke victims, even without the aid of therapy, recover fully. Approximately one-third will have a partial recovery, and another third will show little improvement. The question is…what occurs in the one-third that fully recovers? It is an injury and damage to a distinct part of the brain, similar to injury and damage to the brain in cerebral palsy. If these victims of stroke can recover, why not those individuals suffering from cerebral palsy?
It would be the goal of Pediatric Craniosacral Therapy to help entrain the health of the brain. It is not likely that those cells that have died due to anoxia will come back to life. However, we can work with the goal of the healthy tissue to uptake some of the functions of the damaged tissue, as the brain may accomplish in recovery from stroke.
Finding Your Practitioner
Pediatric Craniosacral Therapy is an extraordinary blend of science and art. In seeking a practitioner, one should consider depth of education, experience, and empathy. One can seek recommendations from other parents, pediatricians, birthing centers, midwives, and doulas. Each practitioner will bring into the treatment her or his unique talents and gifts.
Not every child may need treatment. However, I do feel that every child should have the benefit of evaluation. Intervention at an early age may a turning point that can create greater ease throughout that individual’s life. It is my goal as a practitioner that this work is a positive light for both the child and the family.
Biography: Dr. Benjamin Shield
In my practice, I continue to seek refined solutions to physical problems. It is my quest to help individuals get out of pain, stay out of pain, and have the most ease and comfort in their bodies. The purpose of each session is to achieve the greatest amount of choice possible in structure, function, movement, and emotion.
One emphasis in my practice that is close to my heart is the evaluation and treatment of infants. I feel that this is the best form of preventative care. To paraphrase Dr. William Sutherland, the pioneer of cranial osteopathy, “As the twig is bent, so grows the tree.” My work with infants is child-centered and based on trust, safety, and respect.
It is of particular importance to normalize an infant’s structure before a dysfunction becomes a template for possible structural, behavioral, sensory, learning, and developmental issues later in life. I was recently honored to write the forewords to the books Craniosacral Therapy for Children by Daniel Augustoni (2013) as well as Accessing the Healing Power of the Vagus Nerve by Stanley Rosenberg (2017).