Cranial Osteopathy for 'niggly' baby??

[jollijojo]

Hi, my dd is 3.5 months now. She was born 4 weeks prem with a C-section. I don't think she has colic, as she does not cry all the time. But she has quite a lot of wind (usually farts, cannot get her to burp easily). This is my first baby and because I have nothing to compare the experience to, I was under the impression that all babies do what she does I have taken her to Baby Massage classes and it was only there that I realise that she is quite a 'tense' baby... I cannot do the massage routine without her becoming niggly, needing me to pick her up and having to sit with her through the whole class, observing how the others massage their contented, gurgling, happy babies!! She also does not allow me to practice much of the massaging with her at home, even though I've tried to do only short bits at different times of the day. She sleeps well, but when she is awake, she often seems a bit niggly and unsettled. This really did not bother me, but a few people have commented on this, so I'm beginning to wonder whether something is amiss?
Someone at the massage class suggested Cranial Osteopathy. Is it worth considering, especially since I'm not even sure what causes my dd's niggles?

[faverolles]

Al my dc had CO. I would highly recommend it, but it could be that she is that type of baby.
My fourth baby is my first to be happy, gurgling and contented.
CO definitely helped with my older three, but don't expect miracles!

[DBennett]

As has been said on other threads, Craniosacral therapy is biologically implausible and when studied well has been shown to have no effect beyond placebo.

Details can be found here.

As regards this case, not all babies enjoy/benefit from massage.
This is almost certainly nothing to worry about.

If you are concerned about your babies behavior in general, talk to your G.P. or H.V. but, from what you've posted, I don't think that is warranted.

[mrsravelstein]

all my 3dc have had it too, as do myself and my husband. ds1 and ds2 only had 1 session each. dd has had lots as responds very well to it and has massively helped her with sleeping/settling etc.

[Lizcat]

My DD had it and it was my HV and one of the top paeds ENT consultants in the country who both suggested it. DD's tear ducts did drain for the first time in her life after the treatment and never blocked again. However, to put this in context having had my baby nearly die a few weeks before I would have tried ritual goat slaughter if someone had suggested it would help.

[DBennett]

"I would have tried ritual goat slaughter if someone had suggested it would help"

You'd be surprised how strong the evidence base for goat slaughter is.

(Facetious emoticon...)

[sneezecakesmum]

Having read the 'rationale' behind CO it states that when babies are born vaginally the skull bones overlap (which they do) etc. and CO aims to manouvre these into the correct positon.

If a baby is born by c section then obviously this process does not occur! Therefore even this 'rationale' isn't very rational.

Prem babies and babies with a difficult birth, are notoriously awkward/colicky etc and mums often stressed following the birth, so maybe in part a tension in the mother? In which case the placebo effect of CO when mum feels something is being done causes a relaxation in mums tension rather than the baby's?

[jollijojo]

Hi. Thanks for your comments! Although I believe that CO helped many babies (and their mothers!) - whether through placebo effect or not - I will probably not pursue this for now. I also thought that CO is usually offered to babies born vaginally or who had a particularly traumatic birth (which one isn't? ) I agree that maybe my DD is just this type of baby and tbh, it does not bother me that much. I'll rather spend the money and go for a massage myself ! And stop comparing my DD to other babies...

[allthefires]

Can't recommend CO highly enough.

It has made my ds much better- he is nearly 4.

[mrsravelstein]

in fact CO is more likely to be helpful to babies who have had a difficult vaginal delivery and therefore may have had their heads/back/neck compressed in a bad position for a long period of time, or c-section babies who have not gone through the birth canal and therefore haven't undergone the moulding which would happen in a straightforward vaginal birth.

[mrsravelstein]

ds2 had one shoulder completely hunched up (very large baby in very small mum, 42 hour labour with his head stuck in transverse arrest)... had lots of feeding problems because he couldn't settle comfortably lying on the hunched side. he had one session with the CO, who straightened out the shoulder, and there was never another problem with it. granted my CO does lots of other disciplines too and therefore tends to use several different techniques, so it may not have been 'pure' CO

[allthefires]

See I thought that was the case with c sections but wasnt sure.

[DBennett]

Once again,

There is no good evidence that restriction/misalignment of the cranial bones is associated with ill health.

No study has ever managed to show that manipulation can alter the cranial bones position.

The best quality studies show that groups of Craniosacral practitioners are not able to agree on diagnosis of patients better than random chance.

The bulk of the research findings do not support the idea that Craniosacral therapy has any effect beyond placebo, with the higher quality studies tending towards no effect.

It is clear that many people firmly believe in it's benefits.

But no individual can account for all the confounders and cognitive biases which could effect their impression of how well an intervention works.

Which is why we do clinical trials.

[allthefires]

Well research or not my cynical mind has well and truely been changed after work on me, dp and ds.

[CurlyhairedAssassin]

DBennett, could you explain how the placebo effect could possibly take place in a baby?

I was a massive sceptic but DS2 was terrible with colic, you could hear the wind just bubbling and gurgling round his stomach and he would scream for hours every night. He would fart for England then settle down a bit, then the bubbling would start up in his tummy, tnen a big fart etc.

He also would never sleep during the day unless on his tummy which meant that he was on me as I was paranoid about letting him sleep on his tummy when I wasn't there. He would also only sleep with his head to a certain side which was starting to cause a severe wierd head shape problem! So when he was 9 weeks, I gave in and thought I'd give anything a try, even mumbo jumbo hippy dippy cranial osteopathy.

Well, I tell you what, I was totally converted. The first thing I noticed was that he did the biggest poo he had ever ever done during the session, (was a nightmare to change his nappy afttwards as they didn't have nappy changing facilities in the clinic so I just had to do it on one of the massage bed things in another room! I can't tell you how much there was, it was like he'd just had a massive clear out).

Then, that night, he just went to sleep gently and peacefully in my arms like "normal" babies. None of the usual screaming and stomach gurgling and farting before falling asleep with exhaustion. He slept all night. It was like a miracle, I tells ya!

Unfortunately after a couple of days it seemed to be slipping back tko how it was. We had a second session and after that session that night he was screaming the place down worse than he ever had and I thought "Shit, what have I done? Bloody quacks, he's never going back there again!" Eventually he went to sleep though.

And guess what - he slept all night. I went in to wake him next morning (ME wake HIM!) and there he was sleeping peacefully with his head facing the OTHER way (i.e. not his usual side). I was really amazed, and then was re-converted back to C.O. as he continued to face both ways after that and his funny shaped head just developed normally then as he grew.

As he was coming up to 12 weeks old I cancelled the third session as they are not cheap and I thought that the 12 week mark would mean he'd suddenly outgrow his colic. Well, he still had it - unsettled in the evening and needing cuddles so I can't say the C.O. got rid of it totally. He probably SHOULD have had more sessions, but I just decided to wait till he grew out of it eventually. Which he did, but he's still VERY farty at age 5!

[DBennett]

@Curly Haired Assassin

I can have a go at answering your question, mainly because it's quite common and it's been answered many times before, but the answer does tend to lead to another question and some people get upset when that one is answered.

There is almost certainly no placebo effect on babies as the individual being treated.
The placebo effect requires an expectation of result, which a baby would not have.

However, there are numerous other effects that can create a false impression of a placebo effect.

Conditioning is one way that a baby might seem to demonstrate an improvement.
Human touch is often comforting and I've no doubt that Craniosacral therapy can be relaxing.
A baby can, after enjoying a session or two, learn to anticipate such pleasure and as such would be more likely to simulate comfort in and around future sessions.

This effect is magnified by the care-giver and practitioners expectation of result.
This expectation often leads to behavioral changes that babies would be likely to pick up on.
This is of course more likely to occur in a lengthy and extended social interaction and not in a 5min appointment slot.

So having dealt with the idea that babies can improve through the placebo effect, we move on to the question of why you think Craniosacral therapy had an effect when such an effect can't be replicated when carefully studied.

If I can recap your post briefly, your DS had colic and the beginnings of posistional plagiocephaly at age 9weeks.

After 3 sessions of Craniosacral therapy you percieved there to be an improvement (although not total) in the colic and you felt the plagiocephaly had started to improve.

Apologies if I have misrepresented you in anyway.

Now the first thing worth noting is that both of these conditions are self-limiting, that is they go away by themselves.
Following the links above we can see the NHS says that colic normally resolves by 18weeks, and 26weeks at the latest and that plagiocephaly becomes normalised by the end of the first yr.

So regardless of whether you took your DS to those sessions he would still be very likely to have got better.
And on some level, you thought that this therapy might work, however unlikely, otherwise you wouldn't have spent money on it.

Now it might be reasonable to ask whether Craniosacral therapy speeds up this progress but I hope you agree we can't tell from this one case whether that would be true.
And it strays farther from your question.

So what factors could, even in the face of chronic (that which time doesn't cure) illness could make a therapy seem to be effective when it's not.

This is a big subject (excellent if brief overview here) but it comes down to the fact that humans are not good at weighing up the evidence on these things.

We are prone to all sorts of bias and confounders and each could be discussed in massive detail which would defy anyone's patience.

But if you'll forgive me making this post even longer, I'd like to talk about two specifically: regression to the mean and mistaking correlation for causation.

Regression to the mean occurs where a chronic condition is cyclical (it goes through good and bad phases).
We have a tendency to seek help during the bad times (as you did) but good times naturally follow bad.
Assigning this improvement to the treatment effect, without considering the natural history of an event is mistaking correlation for causation.
Just because something happened after an event doesn't mean an event caused it.

These are the pitfalls humans fall into every day.
It's only by using the scientific method, a method honed to eliminate bias and confounders, can you get past them to the truth.

And it's unfortunately why an individuals experience is of little use when assessing therapies.

As a last note before I stop typing this epic post, I should point out that these same cognitive biases would predict this has little or no effect on anyone who already has an opinion.
Information that supports one's beliefs is remembered, that which opposes is rationalised and discarded.

That is very human as well.

I hope that was reasonably clear.
If I have been unclear, please post again.

[sneezecakesmum]

There would be no placebo effect on the baby as such, but a parent spending out a significant sum of money, regardless of their perceived expectation of the therapy not working - lets face it, if you really didn't think it would work, you simply would not do it, so there clearly is some expectation of it working!

I can see therefore, a mum believing the therapy had worked, becoming more relaxed and at ease with the baby, and the baby simply responding to the mothers more calm outlook. And before anyone disagrees, its accepted in all areas that babies pick up on their mother's distress/anxiety.