The authors acknowledge Ost&#233;opathie Qu&#233;bec for a grant to publish this paper.

This randomized controlled trial protocol was approved by the Comit&#233; d&#8217;&#233;thique et de la recherche en sant&#233; de L&#8217;humain at the Centre hospitalier Universitaire de Sherbrooke and the Comit&#233; d&#8217;&#233;thique et de la recherche at the Centre int&#233;gr&#233; de sant&#233; et services sociaux de la Capitale Nationale in Qu&#233;bec City, Canada.
1. Identification of Collaborators and the Preparation of Recruitment
<ol>
	<li>Network with LCs and/or a local moth...

<ol>
	<li>World Health Organization. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Global Strategy for Infant and Young Child Feeding. , (2003).</li><li>. Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months &#8211; Canada.ca Available from: <a target="_blank" href="https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/infant-feeding/nutrition-healthy-term-infants-recommendations-birth-six-months.html">https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/infant-feeding/nutrition-healthy-term-infants-recommendations-birth-six-months.html</a> (2015)</li><li>Haute Autorit&#233; de Sant&#233;. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Favoriser l&#39;allaitement maternel: Processus - &#201;valuation. , (2006).</li><li>. Your breastfeeding questions answered - NHS. How long should I breastfeed for? Available from: <a target="_blank" href="https://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx#howlongshould">https://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/your-breastfeeding-questions.aspx#howlongshould</a> (2017)</li><li>Victora, C. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Breastfeeding+in+the+21st+century:+epidemiology,+mechanisms,+and+lifelong+effect.">Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect.</a> The Lancet. 387 (10017), 475-490 (2016).</li><li>Turck, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Plan d&#39;action: allaitement maternel. Propositions d&#8217;actions pour la promotion de l&#8217;allaitement maternel. , (2010).</li><li>Homdrum, A. K. S., Miller, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Maternal+report+of+feeding+practices:+a+cross-sectional+survey+of+1753+mothers+presenting+infants+to+a+chiropractic+teaching+clinic.">Maternal report of feeding practices: a cross-sectional survey of 1753 mothers presenting infants to a chiropractic teaching clinic.</a> Journal of Clinical Chiropractic Pediatrics. 15 (1), 1198-1202 (2015).</li><li>Genna, C. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Supporting Sucking Skills in Breastfeeding Infants. , (2013).</li><li>Jensen, D., Wallace, L., Kelsay, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=LATCH:+A+breastfeeding+charting+system+and+documentation+tool.">LATCH: A breastfeeding charting system and documentation tool.</a> Journal of Obstetrics, Gynecologic and Neonatal Nursing. 23 (1), 27-32 (1994).</li><li>Matthews, M. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessments+And+Suggested+Interventions+to+Assist+Newborn+Breastfeeding+Behavior.">Assessments And Suggested Interventions to Assist Newborn Breastfeeding Behavior.</a> Journal of Human Lactation. 9 (4), 243-248 (1993).</li><li>Barry, C., Falissard, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Evaluation de l&#8217;efficacit&#233; de la pratique de l&#8217;ost&#233;opathie. 669, (2012).</li><li>Aubin, A., Gagnon, K., Morin, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+seven-step+palpation+method:+A+proposal+to+improve+palpation+skills.">The seven-step palpation method: A proposal to improve palpation skills.</a> International Journal of Osteopathic Medicine. 17 (1), 66-72 (2014).</li><li>Carreiro, J. 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I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> L'ost&#233;opathie Dans la Sph&#232;re Cr&#226;nienne. , (1994).</li><li>Frymann, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relation+of+disturbances+of+craniosacral+mechanisms+to+symptomatology+of+the+newborn:+study+of+1250+infants.">Relation of disturbances of craniosacral mechanisms to symptomatology of the newborn: study of 1250 infants.</a> Journal of the American Osteopathic Association. 65 (10), 1059-1075 (1966).</li><li>Lalauze-Pol, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Le Cr&#226;ne du Nouveau-n&#233;. , (2009).</li><li>Sergueef, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Cranial Osteopathy for Infants, Children and Adolescents: A Practical Handbook. , (2007).</li><li>Frymann, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> L&#39;oeuvre de Viola M. Frymann, D.O. L&#39;ost&#233;opathie en hommage aux enfants. , (2000).</li><li>Cornall, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+review+of+the+breastfeeding+literature+relevant+to+osteopathic+practice.">A review of the breastfeeding literature relevant to osteopathic practice.</a> International Journal of Osteopathic Medicine. 14 (2), 61-66 (2011).</li><li>Wescott, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+cranial+osteopathy+in+the+treatment+of+infants+with+breast+feeding+problems+or+sucking+dysfunction.">The use of cranial osteopathy in the treatment of infants with breast feeding problems or sucking dysfunction.</a> Australian Journal of Holistic Nursing. 11 (1), 25-32 (2004).</li><li>Lund, G. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Osteopathic+Manipulative+Treatment+for+the+Treatment+of+Hospitalized+Premature+Infants+With+Nipple+Feeding+Dysfunction.">Osteopathic Manipulative Treatment for the Treatment of Hospitalized Premature Infants With Nipple Feeding Dysfunction.</a> Journal of the American Osteopathic Association. 111 (1), 44-48 (2011).</li><li>Summers, J., Ludwig, J., Kanze, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pierre+Robin+Sequence+in+a+Neonate+With+Suckling+Difficulty+and+Weight+Loss.">Pierre Robin Sequence in a Neonate With Suckling Difficulty and Weight Loss.</a> Journal of the American Osteopathic Association. 114 (9), 727-731 (2014).</li><li>Fraval, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+pilot+study:+osteopathic+treatment+of+infant+with+a+sucking+dysfunction.">A pilot study: osteopathic treatment of infant with a sucking dysfunction.</a> Journal of the American Academy of Osteopathy. 8 (2), 25-33 (1998).</li><li>Woodward, D. R., Rees, B., Boon, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+fat+content+of+suckled+breast+milk:+a+new+approach+to+its+assessment.">The fat content of suckled breast milk: a new approach to its assessment.</a> Early Human Development. 20 (3-4), 183-189 (1989).</li><li>Herzhaft-Le Roy, J., Xhignesse, M., Gaboury, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+an+osteopathic+treatment+coupled+with+lactation+consultant+for+infants'+biomechanical+sucking+difficulties.">Efficacy of an osteopathic treatment coupled with lactation consultant for infants' biomechanical sucking difficulties.</a> Journal of Human Lactation. 33 (1), 165-172 (2017).</li><li>Jensen, D., Wallace, L., Kelsay, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=LATCH:+a+breastfeeding+charting+system+and+documentation+tool.">LATCH: a breastfeeding charting system and documentation tool.</a> Journal of Obstetrics, Gynecologic and Neonatal Nursing. 23 (1), 27-32 (1994).</li><li>. Management of acute malnutrition in infants (MAMI) Project. Technical Review Available from: <a target="_blank" href="https://reliefweb.int/sites/reliefweb.int/files/resources/8A7E77D26B35660F492576F70010D7DF-mami-report-complete.pdf">https://reliefweb.int/sites/reliefweb.int/files/resources/8A7E77D26B35660F492576F70010D7DF-mami-report-complete.pdf</a> (2010)</li><li>Chapman, D. J., Kuhnly, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lactation+Assessment+Tools:+A+Qualitative+Analysis+of+Registered+Nurses'+Perceptions+of+Tool+Limitations+and+Suggested+Improvements.">Lactation Assessment Tools: A Qualitative Analysis of Registered Nurses' Perceptions of Tool Limitations and Suggested Improvements.</a> Journal of Human Lactation. , (2018).</li><li>Kuhnly, J. E., Chapman, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Qualitative+Analysis+of+Registered+Nurses'+Perceptions+of+Lactation+Assessment+Tools:+Why+and+How+They+Are+Completed.">Qualitative Analysis of Registered Nurses' Perceptions of Lactation Assessment Tools: Why and How They Are Completed.</a> Journal of Human Lactation. 34 (1), 32-39 (2018).</li><li>Sowjanya, S. V. N. S., Venugopalan, L. L. A. T. C. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Score+as+a+Predictor+of+Exclusive+Breastfeeding+at+6+Weeks+Postpartum:+A+Prospective+Cohort+Study.">Score as a Predictor of Exclusive Breastfeeding at 6 Weeks Postpartum: A Prospective Cohort Study.</a> Breastfeeding Medicine. 13 (6), 444-449 (2018).</li><li>Riordan, J. 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C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sternocleidomastoid+pseudotumor+and+congenital+muscular+torticollis+in+infants:+a+prospective+study+of+510+cases.">Sternocleidomastoid pseudotumor and congenital muscular torticollis in infants: a prospective study of 510 cases.</a> The Journal of Pediatrics. 134 (6), 712-716 (1999).</li><li>Farooq, M. N., Mohseni Bandpei, M. A., Ali, M., Khan, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+the+universal+goniometer+for+assessing+active+cervical+range+of+motion+in+asymptomatic+healthy+persons.">Reliability of the universal goniometer for assessing active cervical range of motion in asymptomatic healthy persons.</a> Pakistan Journal of Medical Sciences. 32 (2), 457-461 (2016).</li><li>Schaal, J. -. P., Riethmuller, D., Maillet, R., Uzan, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> M&#233;canique et Techniques Obst&#233;tricales. , (2012).</li><li>Chila, A. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Foundations of Osteopathic Medicine. , (2011).</li><li>Pierce-Talsma, S., Pena, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Condylar+Decompression+Technique+for+Infants.">Condylar Decompression Technique for Infants.</a> Journal of the American Osteopathic Association. 117 (11), (2017).</li><li>Tornese, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+the+LATCH+score+assessed+in+the+first+24+hours+after+delivery+predict+non-exclusive+breastfeeding+at+hospital+discharge?.">Does the LATCH score assessed in the first 24 hours after delivery predict non-exclusive breastfeeding at hospital discharge?.</a> Breastfeeding Medicine. 7 (6), 423-430 (2012).</li></ol>

The authors have nothing to disclose.

This study is one of the first randomized controlled trials to assess the efficacy of an osteopathic treatment for infants with biomechanical suckling difficulties. When performed promptly, this intervention might reduce the risk of stopping breastfeeding earlier than originally intended.
With no prior models, this trial was designed pragmatically, including the need to act quickly to address breastfeeding difficulties and nipple pain that may be experienced with a newborn. The protocol also m...

An erratum was issued for: <a href="https://www.jove.com/video/58740/assessment-efficacy-an-osteopathic-treatment-infants-with">Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling</a>.&#160; An author name was&#160;updated.
One of the authors&#39; names was corrected from:
Juliette&#160;Herzaft-LeRoy
to:
Juliette Herzhaft-Le Roy

An erratum was issued for: <a href="https://www.jove.com/video/58740/assessment-efficacy-an-osteopathic-treatment-infants-with">Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling</a>.&#160; An author name was&#160;updated.

Erratum: Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling

Over the last thirty years, international recommendations from the World Health Organization1, followed by national recommendations in many countries2,3,4, have advocated for breastfeeding. Its health benefits are now well-known5,6 and breastfeeding exclusively for the first six months of the infant&#39;s life and maintaining it for two years or longer is described as the norm1.
As highlighted by Homdrum and Miller7, more than half of the mothers who stop breastfeeding within the first month reported biomechanical difficulties. Suckling biomechanical issues typically include suboptimal head extension and rotation, restricted mouth opening or jaw stiffness, biting the nipple, restricted tongue mobility, and inefficient mouth vacuum to stimulate the release of milk from the mother&#39;s breast8. Any neurological impairment also affects the optimal function of the normal primitive reflexes, crucial to an optimal latch.
The emergence of LCs worldwide has provided a great source of breastfeeding support for mother-infant dyads and has contributed to increasing the scientific knowledge in this specific field. For example, LCs have studied extensively the biomechanics of suckling from birth to weaning. In parallel, they have created tools to assess the function of breastfeeding and to efficiently detect dyads with special needs9,10.
Osteopathy is a manual practice meant to restore normal functions of the human body, based on the body&#39;s capacity for self-regulation11 and structure-function relationship1. During an osteopathic consultation, various palpation techniques are used, based on thorough knowledge of human anatomy and physiology12. Some scholars have linked physical restrictions with suckling dysfunction13,14,15,16,17. Restrictions of skull sutures or motility of skull bones have also been described to impact an infant&#39;s ability to latch13,14,15,16,17,18. However, research on the efficacy of osteopathy techniques on biomechanical suckling difficulties is scarce19,20.
Aside from a few case reports describing an osteopathic intervention to improve an infant&#39;s ability to latch21,22, only one pilot study23 documented the impact of such interventions. Six infants between three to six weeks of age were recruited and assessed by an LC. Mothers were given breastfeeding advice and then met the osteopath. Four treatments (once a week for four weeks) were performed. Treated infants were compared with six control infants whose mothers received only LC support. The authors found improvement in the milk fat content, which has been shown to be a marker for effective feeding24. Due to its small sample, these pilot study results are not generalizable but established the feasibility of a randomized controlled trial coupling the expertise of LCs and osteopaths.
These studies have paved the way for a single-blind randomized controlled trial to assess the efficacy of an osteopathic treatment coupled with lactation consultations on infants&#39; ability to latch. The protocol for this trial is presented herein. The trial took place in a mother-to-mother support group, where LCs provided lactation consultations three days a week, free of charge for parents25.
Assessment tools for the trial included 1) the LATCH Assessment Tool to measure the main aspects of the biomechanics of suckling26; 2) a VAS to assess the mother&#39;s nipple pain; 3) a goniometer, a soft plastic instrument to measure the rotation of the infant&#39;s head&#39;s angles; and 4) de novo questionnaires to assess the mother&#39;s perception of her infant&#39;s ability to latch, as well as sociodemographic data and potential intervention side-effects.
The LATCH Assessment Tool was chosen amongst several others for its specific assessment of the biomechanics of the suckling structures and the global ability of the mother-infant dyad to position themselves comfortably27. While breastfeeding assessment tools are currently discussed in the international lactation community28,29, the tool is easy to use in the clinic, reliable, and widely implemented among this community to detect early breastfeeding difficulties30. The choice of the tool also enables comparisons with other studies on breastfeeding. Each letter in &#34;LATCH&#34; corresponds to an item to assess an element of the biomechanics of suckling. &#34;L&#34; is for the ability of the infant&#39;s tongue, jaws, and lips to sustain the actions and vacuum, and to activate the milk let-down reflex efficiently (Latch). &#34;A&#34; is for Audible swallowing as it is evidence of suckling effectiveness, &#34;T&#34; is for the Type of the nipple at the end of the feed (inverted, flat, or everted), &#34;C&#34; is for the Comfort of the breast and nipple, and &#34;H&#34; is for the assessment of the ease with which the infant is Held in a comfortable and effective position at the breast. The result is a five-item score out of 10 (normal is 10 out of 10) with an interrater reliability of 0.9431,32.
The VAS is a 10 cm line to estimate the severity of pain felt by mothers, from 0 (no pain) to 10 (maximum pain). For this trial, the VAS was completed at the beginning of the feed, once the infant was latching on, and once the milk let-down had started.
A soft plastic goniometer was used to assess the passive rotation of the infant&#39;s head,&#160;as described by Cheng33. Assessments were completed immediately before and following the osteopathic assessment for the control group, and before the assessment and following the osteopathic treatment in the treatment group. Intrarater reliability has been reported to range from 0.83 to 0.98 for the head rotation assessment34.
Finally, a standardized assessment grid was completed by the osteopath for every infant involved in the study, documenting all of the areas exhibiting osteopathic lesions. Osteopathic lesions are areas with lack of mobility or motility, with excess rigidity, or with a lack of tone in the structure. Lesions are classified in three levels of severity, ranging from a structure with limited mobility to a stiff structure with no mobility. In the osteopathic treatment group, all structures addressed during the treatment were documented (Table 1).
Data were analyzed with an intention-to-treat analysis using descriptive statistics. Chi-square tests were used to explore potential correlations between all identified lesion sites and a one-point or more improvement on the LATCH Assessment Tool.

<table>
	<tbody>
		<tr>
			<td>sofa or armchair</td>
			<td></td>
			<td></td>
			<td>comfortable enough for a new mother with potential ceasarean section scar to stay half an hour with the infant in her arms and comfortable enough for the osteopath to perform the intervention</td>
		</tr>
		<tr>
			<td>cushion</td>
			<td></td>
			<td></td>
			<td>to put the infant on it and helpful if required,&#160; to breastfeed the infant</td>
		</tr>
		<tr>
			<td>Goniometer</td>
			<td>Dufort et Lavigne or similar</td>
			<td>ALM 324000</td>
			<td>in smooth plastic, not too long to be handle with one hand</td>
		</tr>
	</tbody>
</table>

assessment of the efficacy of an osteopathic treatment in infants with biomechanical impairments to suckling

Breastfeeding can be challenging for mother-infant dyads experiencing biomechanical suckling difficulties. Although lactation consultants (LCs) all over the world have increased their skills in this field and can provide support to help position the infant at the breast, the impact of their intervention might be limited in the presence of stiff structures in the infants. Here we present a protocol for a randomized controlled trial to assess the efficacy of osteopathic treatment, coupled with lactation consultation, for infants&#39; biomechanical suckling difficulties. It proposes a set-up and a sequence of actions to ensure an optimal context for treatment, as well as a blinding of parents and LCs to the intervention. Data such as the infant&#39;s latch ability measured with the LATCH Assessment Tool, the mother&#39;s nipple pain with a visual analog scale (VAS), and the mother&#39;s perceptions are collected by LCs four times over a 10-day period. Osteopathic lesions are documented by the osteopath, using a standardized assessment grid. Structures of interest are coherent with the anatomical zones involved in latching onto the breast. This protocol also proposes a strategy to document systematically an osteopathic profile of infants with biomechanical suckling difficulties in their first weeks of life. The implementation of this protocol confirms its feasibility for osteopathic assessment and treatment and paves the way for future trials to further explore the efficacy of osteopathic techniques for infants with biomechanical suckling difficulties.

Ninety-seven mother-infant dyads were recruited and randomly assigned to one of the two study groups. The participants&#39; characteristics and delivery mode are summarized in Table 2. Only 1/3 had a natural birth, meaning that the other 2/3 experienced epidural and vacuum (15.9%), forceps-assisted (2.9%), or C-section (18.8%) births. In this study, all infants had skull lesions (Table 3). The posterior quarter represented by the occipital and the tempora...

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Assessment of the Efficacy of An Osteopathic Treatment in Infants with Biomechanical Impairments to Suckling

Osteopathy is an emerging field of clinical research. Here we present a protocol to assess the efficacy of an osteopathic intervention coupled with lactation consultation, in infants with biomechanical issues impeding breastfeeding.

Breastfeeding can be challenging for mother-infant dyads experiencing biomechanical suckling difficulties. Although lactation consultants (LCs) all over ...

The use of osteopathic techniques for breastfeeding biomechanical difficulties is widely spread in practice, but until this trial, there's been no empirical evidence that it works. Breastfeeding difficulties are encountered by many mothers during the first weeks of the postpartum period. The collaborative setup of this intervention is very pragmatic for these parents.On the first appointment following the referral, welcome the mother and infant and explain the full study process. After obtaining written consent, administer a baseline questionnaire for sociodemographic data, breastfeeding data, and maternal perceptions of biomechanical difficulties. Next, ask the mother to give one breast and observe the infant's suckling rhythm.Right at the beginning of the feed, have the lactation consultant use the latch assessment tool to assess the infant's baseline ability to latch and request that the mother complete a visual analog scale right at the beginning of the feed. When the suckling movement begins to slow, have the mother remove the infant from the breast. Before you perform the osteopathic assessment, open the sealed and opaque envelope with the corresponding study number for the mother-infant dyad.Assigning the dyad to the control or treatment group, and ask the mother to sit on a couch with a cushion on her knees and the infant lying back on it. Sitting next to the mother, connect with the infant by making eye contact and talk to the infant before putting hands on their body. Begin with a general observation of the infant's posture, tone, and any asymmetries.Next, use a goniometer to assess the infant's passive left and right head rotation, noting any discomfort manifestation or limitation. Assess any osteopathic lesions for each part of the body regardless of the allocation group, using the standardized grid as described in the table. Begin with the pelvic area, assessing the tissue texture and tone in the lower limbs fascia, sacroiliac joints, sacrum and hips, as well as the range of motion of the pelvic sphere versus the lumbar spine and the structures up to the skull.Move the hands from the infant's pelvis to the skull and similarly assess the tissue texture and tone, and as appropriate, the range of motion of the abdominal cavity, spine, diaphragm, thorax, and cervical spine. Pay careful attention to the first cervical vertebrae and assess the anterior structures of the neck, hyoid bone, and sublingual muscles. Move forward from the base of the skull to the occipital, temporal, parietal, sphenoid and frontal bones, and features of the face including the jaw.As infants yawn frequently, observe the jaw movements and the symmetry of the face. For each structure, record the observations of the texture, tone, straining, and quality and range of motion on the standardized grid. For osteopathic treatment of the pelvic area, place hands on each side of the infant's pelvis, covering the iliac bones with the thumbs on the anterior part of the iliac bones and the fingertips at the sacroiliac joints on each side.Using the indirect technique, place the restricted structure in a comfortable position and use continuous feedback until a complete loosening of the structure is achieved. For treatment of the upper cervical spine, place the fingers of both hands around the occipital bone with the tips of the ring fingers contacting the condyles area, the index fingers contacting the mastoid area, and the middle fingers between the occipital bone and the first cervical vertebra. Then gently separate the fingers in the various spacial planes until the tissues soften and the condyles move freely.For treatment of the neurocranial region, place one hand under the occipital bone and the other on the frontal and sphenoidal bones, avoiding the eyes. In a frontal occipital hold, place the occiput and sphenoid in their position of least resistance, monitoring the decrease in resistance and readjusting the positioning of the structures until the release occurs. For treatment of the jaw region, cup one hand under the occipital bone and the first three cervical vertebrae, and the index finger and thumb of the other hand on each side of the hyoid bone.Wait until the release of the hyoid bone is felt through the structures of the other hand, monitoring and reassessing as for the myofascial release technique. End the osteopathic treatment by placing one hand on the pelvic area, and the other on the skull. To perform a sham intervention, place the hands on the areas far from those with detected dysfunctions without any intention of treatment, and answer any questions from the parent about osteopathy and the infant's psychomotor development.For either treatment, postpone the infant feed until the end of the intervention using a pacifier or the mother's finger as necessary to soothe the infant. Then assess the infant's left and right passive head rotation with the goniometer, and leave the room to record the details of the performed treatment in the standardized assessment grid. In this representative study, 97 mother-infant dyads were recruited and randomly assigned to one of the two study groups.Only one third had an intervention-free birth, and all of the infants had skull lesions. Make sure that the lactation consultant is well-trained to use the assessment tools and to respect the rhythm of the mother-infant dyad. Sometimes appointments will need to be rescheduled if the baby's too sleepy.Although we've demonstrated the most common techniques, additional treatments can be used for a moderate approach of the suckling dysfunction. One thing we haven't been able to assess with our trial is whether a single osteopathic treatment is sufficient. It will be useful to determine whether it is a dose-response effect.

assessment-efficacy-an-osteopathic-treatment-infants-with

Research

JoVE Journal

Medicine

8.5K visualizações.  Entraide Naturo-Lait. O uso de técnicas osteopáticas para aleitamento materno é amplamente difundido na prática, mas até este julgamento, não há evidências empíricas de que funcione. As dificuldades de aleitamento materno são encontradas por muitas mães durante as primeiras semanas do período pós-parto. A configuração colaborativa dessa intervenção é muito pragmática para esses pais.Na primeira consulta após o encaminhamento, acolher a mãe e o bebê e explicar o processo completo de est...