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					The osteopathic link between the respiratory and digestive
                   system on newborn
           Presented by Bruno Ducoux DO on November 24 2007-11-25 in Berlin
                    at the International conference of pediatric osteopathy
                       Danke Schön Sabine Hansen DO for corrections

Résumé :
Le lien osteopathique entre le système respiratoire et digestif du nouveau-né


Un système digestif en bonne santé à la naissance, quand il devient réellement fonctionnel, est
nécessaire pour prévenir les problèmes respiratoires et neuro sensoriels.
Les expériences viscérales et les informations venant du système digestif suivent les fibres
afférentes viscérales le long de la moelle épinière, le tronc cérébral et le système limbique;
puis, les informations sont envoyées à travers le système neuro végétatif suivant une approche
systémique du corps à la recherche de l’homéostasie. Les mêmes peptides sont retrouvés dans
le système respiratoire.
Pendant les premières années de la vie, le nombre des alvéoles pulmonaires passe de 20
millions à 200 millions, intégrant les informations envoyées par le système nerveux, immature
également.
L’ostéopathe peut être un fulcrum, écoutant et envoyant les informations vibratoires, aidant la
maturation du système respiratoire et des différents systèmes, contribuant à améliorer le
système immunitaire du bébé.




Abstract

A healthy digestive system at birth, when it is really functional, is necessary to prevent
respiratory and sensory-nervous problems.
The visceral input and in formations from the digestive system follow the afferent visceral
fibbers through the spinal cord, the brain stem and limbic system; then in formations are sent
through the autonomic nervous system in a systemic way to the body in order to maintain
homeostasis. These same peptides are found in the respiratory system.
During the first years of life, the number of respiratory cells grows from 20 to 200 millions
integrating the in formations sent by the nervous system.
The osteopath can be a fulcrum, listening and sending vibratory in formations and helping the
maturation of the respiration, the different systems and enhancing the immunology of the
baby.




                                                                                             1
Introduction:
Osteopathic treatment of newborn: a study from the French Academy of Osteopathy
Critical analysis of the risk factor attributed to osteopathic care of the 0-9 months infants1
No accident in literature
No accident for insurance companies offering professional insurance to osteopaths
220.000 babies treated in France in 2005 for 400 000 treatments and much more in 2006 and
2007!
But, the decrees of application for the French law on osteopathy of March 2002 have stated
that osteopaths can’t treat babies under 6 months unless they have a certificate from a medical
doctor saying there are no counter indications; or, French MDs don’t know about indications
of osteopathy on newborn and the medical organisations told their members not to do these
certificates.

A few facts concerning the respiratory and digestive systems at birth:
- Both are poorly developed and vulnerable: their structure is not fully developed, so their
function is fragile.
- Tension in the gastrointestinal tract after birth may decrease venous and lymphatic
circulation and exaggerate troubles in other systems later.
- The lungs and the gastrointestinal tracts are one of the main places for immune activity
- Viscero-visceral reflex through the vagus nerve: Irritation of gastric mucosa will stimulate
mucus production in the lungs (German 1982)2 in Sergueff 3
Vital force in a newborn
On a newborn, nothing is stable in the whole body; normality is movement, death is non
movement.
Everything can change and move regarding the information received
Life and felt senses can accommodate what seems hard and non moving (like bones).
Vibrations are transmitted through the connective system to the whole body 4
Motion takes place in the fluids in a contiguous system
The respiratory and digestive systems are not really effective before birth; the nervous system
is also not mature after birth
New informations will change the matter if the informations move thru the fluids




1
         Academie d’Osteopathie de France AO www….
2
         German V 1982 Reflex stimulation of tracheal submucosa gland secration by gastric irritation in cats
Journal of Appied Physiology 52;1153 in Carreiro Jane Elsevier Osteopathic treatment of children 2003 p.80
3
         Sergueef Nicette Cranial osteopathy for children Elsevier 2007
4
         Swedenborg E. On tremulations 1715


                                                                                                                2
The digestive system
As a structure, the gastrointestinal tract is exposed to the outer environment. Physiologically,
it is not ready to function completely at birth.
In order to have a good digestion lifelong, the head needs to be in the right position regarding
the spine. 5
Parasympathetic stimulation, mainly through the vagus nerve and the parasympathetic fibers
of the sacrum, increases blood flow to the stomach and lower colon (Carreiro p.89)
Orthosympathic fibers come from T4-L1 and give rise to the viscerosomatic reflex. It slows
down the digestive mechanisms.
The enteric nervous system can also function without autonomic nervous system intervention
(Gershon 1999 in Carreiro p.94)
Sleep is the best time for digestive motility and sleepless babies have more difficulties with
digestion and have respiratory troubles when they get older.
The whole gastrointestinal tract contains cells all along the gut wall; they secrete peptides
whose function is similar to the neurotransmitters in the brain; the same peptides are found in
the developing lungs (Murphy 1996 in Carreiro p.95). These peptides are multifunctional and
have immune regulatory properties. These peptides are present everywhere and have an
inflammatory effect through the small afferent fibers from the antero lateral system of the
medulla. These fibers have a dynamic connection with the tissues and send information to the
brain stem, the respiratory and cardiac centres, thalamus, limbic system and cortex; they help
to maintain homeostasis6

The immunity system of the baby is not mature at birth7.; the immune cells of the mother (IgA
lymphoblast) travel from the mouth, the gut, the lungs to the breast in order to protect the
sucking baby.
The sensory informations from the food are sent to from the gut to the ganglia but not to the
spinal cord; if necessary, peptides are sent everywhere in the body through the lymphatic
system; the visceral system is also called our second brain. These immune cells were called
“seed” by A.T.Still; they sow the blood: that’s the way I understand the “blood seed” evoked
by A.T.Still. “ The circulation of blood cells and lymphoid tissues in the mucous tissue may
explain the interaction between these different territories”8
The very first food absorbed by the baby after birth and the conditions of this “first supper”
are critical for the evolution of the digestive system and the respiratory system. Then, babies
fed with formula have significant differences in the production of the mentioned peptides
during the first 9 months (Murphy and Aynsley-Green 1996 in Carreiro p.98)
The mother’s stress, during the pregnancy and after birth may have consequences on the
digestive system of the baby but a study by Barr9 showed that the mother’s behaviour doesn’t
influence colic on babies.
 Colic resolves itself at the age of 4 months and can be in relation with vagal irritation, tension
in the cervical area, immaturity of the central nervous system.
Caesarean births need to receive vagal stimulation to compensate the passage through the
birth canal.


5
          Alexander Matthias reported by Bozzetto Marc DO
6
          Willard F Notes from teaching in Paris November 10 2003 french Academy of Osteopathy AO
7
          Bjorksten B and al Allergy deveiopt and intestinal microflora during the first year of age J Allerggy
clin Immunol 2001;108(4);516-20 in Sergueef 2007 p.345
8
          Braunstahl GJ The unified immune system :respiratory tract-nasobronchial interaction mechanisms in
allergic airway disease J Allergy Clin Immunol 2005;115(1):142-8 in Sergueef 2007 p;345
9
          Barr 1990 in Carreiro 2003 p.178


                                                                                                                  3
Gastro oesophageal reflux is considered when the product of the stomach is coming back in
the oesophagus. It can be physiological in the first two months (positing) and can be present
on 64% of the babies but only 5 % have regurgitations at the age of 14 months.10
After gastric positing, a bronchial irritation appears and may be a vago-vagal reflex.
An anatomical explanation may be in relation with the ligament phreno oesophageal; the
angle of His, at the junction between intra thoracic and intra abdominal oesophagus, is less
acute on the newborn.
High intra abdominal pressure are caused by stress or birth (Carreiro 176).
In gastro oesophageal reflux, production of saliva is a response to the irritation of the
oesophagus through the autonomic nervous system; the same sympathetic fibbers are devoted
to bronchus and intestines11

Magoun12 states that a vagal irritation is in relation with an imbalance at the base of the
cranium.


The respiratory system
The compliancy of the chest and the immaturity of the nervous system have to be considered
when looking at the respiratory system. The structures of the brain are not fully functional
until they undergo significant postnatal development.
Here are a few facts in relation with our subject:
- The alveolar development is stimulated by the accumulation of foetal fluid in the lungs and
the action of respiratory muscles in utero. If the chest is compressed in utero , there are
consequences after birth on the respiratory development13
After birth, alteration of intra abdominal and intra thoracic pressure assist lymphatic drainage
from the lungs.
- Spontaneous sighs provide a physiological modification to the respiratory system by
transiently altering the levels of the blood gases14
- During the first three years of life, the number of alveoli increases from twenty millions to
two hundred millions15; this is in relation to the development of a coating of the walls of the
alveoli with the surfactant. This fluid plays an important role in immune function.
- The first breath should occur when the baby is completely delivered; otherwise if babies take
this first breath while delivered, they suffer more often from gastric reflux.
- The postnatal maturation of the ventilatory response to O2 occurs in the first ten days of life
in relation with an increase in sensitivity of the O2 chemo receptors.16
- Jane Carreiro observed the presence of a functional fulcrum in the deep tissues at the level of
T3-T4 on the right (Carreiro 1994)17 Information from the respiratory system is sent to the



10
        Nelson SP and al Prevalance of symptoms of gastrooesophageal reflux during infancy. Arch Pediatr
Adolesc Med 1997;151 (6):569-72 in Sergueff 2007 375
11
        Elenkov IJ and al The sympathetic nerve-an integrative interface between two supersystem. Pharmacol
Rev 2000;52 (4) 595-638 in Sergueef 2007 345
12
        Magoun H. Osteopathy in the cranial field
13
        Carreiro J An osteopathic approach to children Elsevir 2003 p.68
14
        Revow M.England S.J. A model of the maturation of respiratory control in the newborn infant in
Biomedical Engeneering 1989
15
         O’Brodovich, 2001 in Carreiro 2003 p.69
16
         Bureau M.A. and Begin R. Postnatal maturation of the respiratory response to O2 in awake newborn
lambs in J.Appl Physiol.52 198 2
17
          Carreiro J Presentation on AAO March 1994 Osteopathic findings on 1600 newborns


                                                                                                            4
vagus nerves and the brainstem; but even after removal of the brainstem and spinal cord,
phrenic nerve activity can be detected18.
In the adult, the functional residual capacity of the lungs is maintained passively but the
ribcage of the newborn offers less resistance to the recoil of the lungs; during the first year,
this results in a weakness of the baby.
- Respiratory neural control during the prenatal period: Importance of the phrenic and
hypoglossal motoneurone in maturation of the newborn and the muscle properties diaphragm
development. The phrenic motoneurone can induce diaphragmatic contractions before birth.
It’s relatively depolarising membrane potential and very high input impedance. It helps to
generate the force for the diaphragmatic muscles fibers for the first breath.
Just before birth, the phrenic motoneurons and diaphragm ensure gross movement of the
ribcage despite relatively weak synaptic drive.
By the time of birth, the motoneurone and muscle properties allow for the generation of more
substantial ribcage movements.(the transmission of inspiratory drive is due to Ca2+ influx
and neurotrophic factor release) There is an increasing awareness among the scientific
community that an inhospitable in utero environment has long term consequences on
physiological function in adulthood.
- The ventilatory parameters are clearly influenced by perturbation during the newborn period,
with lifelong effect.
Impaired growth in infancy and rapid weight gain during childhood as well as impaired
prenatal growth has consequences with well being throughout life.19
Cesarian birth is also a risk factor for astma20
50 to 80% of asthmatic adults had RGO even not clinically evident21
- Sudden infant death syndrome:infant sleeping position 22
Factors increasing the risk of Sudden Infant death Syndrome : low birth weight, prematurity,
lying in prone position, parental smoking or drug use.
Babies on the back reduce SIDS risks, due to the position of the cranial base and
craniocervical junction and possibly lower the risk of mental implosion reaction (baby reacts
as if he was in the uterus and stop breathing)?
Bronchiolitis are caused by viral infections, but osteopathic restrictions can alter the immune
defense of the infant; it has been reported the importance of osteopathic traitments during
influenza epidemics23

What’s the link between these different elements that may help us to look for Health which is
the aim of an osteopath?




18
         Carreiro J 2003 p.70
19
         Barker D The developmental origins of well beingin Philos Trans R Soc Lond B Biol Sci 2004, 359
20
         Kero J and al Mode of delivery and asthma-is there a connection ? Pediatr Res 2002 52(1); 6-11
inSergueef 2007 345
21
         Harding SM Gastrooesophagial reflux : a potential asthma trigger Immunol Allergy Clin North Am
2005;25(1):131-48 in Sergueef 2007 345
22
         Willinger 1994 in Carreiro 2003 p.162
23
         Magoun HI Jr More about the use of OMT during influenza epidemics J Am Osteopath Assoc
2004;104 (10):406-7 in Sergueef 2007 p.342


                                                                                                           5
The link in a systemic approach: the diaphragm
A.T.Still used to say that we live and die thanks to the diaphragm and that every part of the
body was linked to the diaphragm. Can we read between the lines of A.T.Still as
W.G.Sutherland recommended?
The septum transversum moves during the third week of pregnancy in a flexion mode from
the head to the centre of the chest. The central portion and the lateral portions of the
diaphragm arises from the same mesenchyme origin as the pleuroperitoneal membrane (with
relations between respiratory and abdominal fascias)
The central tendon is linked to the pericardium, which is linked too to the upper respiratory
diaphragm. The pericardium links the great vessels (aorta, pulmonary arteries and veins) to
the sternum and diaphragm.
Tensions of the diaphragm affect both respiratory, cardiac and digestive systems
The muscles of the pharynx have a particular importance on newborn because they bridge the
thoracic diaphragm to the cranial diaphragm: the pharyngeal raphe is suspended from the
sphenoid and the petrous portion of the temporals.(id p.76)
The oesophagus go trough the diaphragm next from the aorta and the two vagus nerves;
remember the other many relations of the oesophageal aperture (T10): the oesophagus, gastric
nerves, left gastric vessels and lymphatic vessels.
The movement of the diaphragm has huge repercussions on the oesophagus and the fascias
transversalis, link between the abdomen and the thorax.
If the movement of the diaphragm is not free on the baby, the acidity from the stomach can
come up in the oesophagus, with inhibition of the respiratory reflex, pain, and sometimes an
apnea24. Bronchitis is a frequent consequence of aspiration of the acid reflux.
What is the function of the osteopath then?



The osteopath: fulcrum on the way to Health
    + For Viola Frymann DO, balancing the diaphragms in a new born is essential25.
    Can we look at one of the many roles of the diaphragm:
    - the pelvic diaphragm maintains an intra abdominal pressure
    - the cranial membranous diaphragm maintains a reciprocal tension on a vertical and a
        horizontal axis
    - the thoracic diaphragm is a link between the digestive and respiratory system
  + The vertical link between the three diaphragms is the core-link: it represents a structural
and inelastic link between the cranial and sacral mechanism that you can feel in your hands.
In order to maintain the symmetry in the body of the baby it’s necessary to help the core-link
to be balanced.
 + So, the respiratory muscle efficiency may involve the scalene muscles, upper thoracic
area and the craniocervical junction. The intraosseaous, membranous and fluid balance of the
base of the cranium should be regarded as mobile and free.
This helps the circulatory drainage.
 + Remember the memory of the tissue in the whole body through the largest organ: the
connective tissue.
 +At least, the most important is the absolute necessity for new born to get a good loving
nutrition including bonding and massage.

24
       Orenstein SR An overview of reflux-associated disorders in infants:apnea,laryngospasmand aspiration
Am J Med 2001;111 Suppl 8A in Sergueff 2007
25
       Frymann V The core-link and the three diaphragms in AOA Yearbook 1968


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