Children's Health

Cranial Care for Infants and Children

Reprinted from Mother to Mother, Dec/Jan '89/90

How often have you heard remarks like these? "Martha will grow out of it." "All babies get colic." "Ignore Johnny. He's just trying to get your attention." "Mary's not trying hard enough in school." "Billie's hyperactive." "Ear infections are an inevitable part of childhood."

Infant Cranial AdjustmentPictured: Doctor Richards performing a cranial adjustment on one of her patients.

We are part of a society that delights in generalizations, almost unconsciously categorizing, labeling and pigeonholing everything we run into in life. Doctors, in particular, have been taught to name diseases, rather than treat individuals. And, while this too is a generalization, it is an unfortunate by-product of our educational process for doctors.

The difficulty is that naming a problem does nothing to alleviate it. And labels are very destructive when applied to human beings. When applied to children, the results can be devastating. This can be clearly seen in the medical approach to a myriad of childhood problems, like those referred to in the introduction, that have a common source. Most medical therapy is directed toward suppression of symptoms, not correction of the underlying cause.

A simple example of this approach is the myriad of children who become caught up in the cycle of ear infections leading to treatment with antibiotic and decongestant therapy, resulting in continuous rounds of antibiotic/recurrent infection/antibiotic. For many children, as the infections continue and the immune system becomes more and more depressed by the antibiotics they are given, the eventual result is a surgery, with the placement of tubes in the ears. Both of these therapies are now being called into serious question by current medical information. According to the December, 1987 issue of Healthfacts, the publication of the Center for Medical Consumers:

  1. 70% of children treated with either antibiotics alone or antibiotics combined with decongestants still had fluid in the ear after four weeks of treatment.

  2. Antibiotics benefited some children: twice as many children (30%) who had antibiotic treatment were better at four weeks than those given the placebo only (l4%).

  3. However, half of these antibiotic-treated children whose fluid was successfully eliminated at four weeks experienced a recurrence within 3 months.

  4. And, finally, one expert cited feels that "Once you put in the tubes, you may render the ears more susceptible to trouble thereafter. After the tubes are extruded [the eardrum heals around the tubes and pushes them out - in an average of 6-9 months], the child is more likely to need them again."

Another example of controversial medical treatment is the prescribing of Ritalin for children who have been labeled as "hyperactive." There has been much in the news lately about parents being coerced into giving their children this powerful drug by the school systems. The argument is that the children are too disruptive in the classroom without medication. Yet now the medical community itself is at odds over the benefit of this powerful drug. However, it is still listed as the treatment of choice in the medical texts. And, the average doctor wants to help; after all, that's her job and what she was trained to do. Therefore, he or she prescribes what is currently believed to be the best available therapeutic agent.

What I want you to consider is an entirely different concept of "disease," that of dysfunction. In America, we adhere to the notion that a given problem is caused by a particular organism. However, hyperactivity clearly does not fit that model. In fact, there are a myriad of childhood conditions which have a common biomechanical defect, a disarrangement in the craniosacral mechanism. These conditions are on a continuous spectrum from commonly accepted irritations of childhood (for example, the incessantly crying baby who demands to be rocked and nursed constantly) through mild problems (ear infections, temper tantrums) to severe (autism). In those cases where the problem can be "diagnosed," symptomatic treatment is rendered, with varying degrees of success, while nothing is done about the underlying biomechanical insult. Treating that basic defect is the premise of cranial care for infants and children.

I am constantly astounded by the wide range of conditions which are accessible to cranial treatment. In my office, I regularly see children with wide-ranging problems and with truly astounding results. Let me share a few case studies with you to illustrate the diversity:

Case 1: A newborn, adopted child was brought to me at 5 weeks of age. She was born prematurely to an alcoholic, crack and cocaine addicted mother and was given multiple antibiotics at birth. She was constantly fussy, didn't sleep more than 2 hours at a time, and was very hypertonic. She would regularly arch back on her heels and the back of her head, pulling back into total rigidity. She had been assessed by the adoption agency's doctor, who recommended continuing physiotherapy. It was felt that the hypertonicity was secondary to neurologic damage from the mother's cocaine and crack addiction and alcohol consumption. A series of cranial adjustments eliminated the hypertonicity.


Case 2: Another case involved a 3-year old with severe irritability, who couldn't stand to have his hair brushed, who was easily upset to the point of tantrums, disrupting the entire family. In fact, the family had sought help from a family therapist, but were unable to have the evaluation until after the first three cranial treatments. At that time the therapist could find no trace of the problem behavior. It had spontaneously corrected. In fact, his mother reports that after the first couple of months of therapy, his preschool teacher asked, "What have you done? He's a different child."

Case 3: A 3 1/2-year-old who was having fits of inconsolability, quite different from his ordinary self, and who wanted to be rocked and suckled incessantly for comfort. He had had dental work on his front teeth resulting in the facial bones being jammed up into the cranium. Relieving the jamming allowed him to return to his usual disposition.
Case 4: A newborn infant referred in by the midwife because the child had had a dif-ficult delivery. The shoulders had gotten stuck in the birth canal. The mother reported the baby seemed uncomfortable when she was awake, that she was very startlable when sleeping, jerking awake and wanting to be walked or rocked for comfort. On examination, the baby's limbs were very stiff and tense and her face looked pinched together between the eyes. A minimal course of three cranial treatments resulted in a relaxed, comfortable baby.
As you can see, the variety of conditions and scope of effectiveness of cranial care is quite astonishing. However, it becomes less remarkable when you consider that the craniosacral mechanism nourishes and supports the proper functioning of the nervous system. After all, the entire body is controlled by the nervous system, and every organ, gland, bone and muscle is dependent upon nervous transmission for its proper functioning. Therefore, the craniosacral mechanism is basic to the body's ability to function, and restrictions in the cranium, sacrum and/or dural tube can result in far distant effects. As already noted, these effects are as diverse as lack of coordination, hyperactivity, chronic ear infections, generalized irritability and autism.

Reasonable questions at this point might be: "Just what is involved in cranial care? How is it accomplished? Is it invasive? Will it hurt my child?" All parents are understandably concerned about any treatment their children are going to undergo, and particularly so if that treatment is somewhat unfamiliar.

Simply put, cranial therapy is the manual correction of any restriction of motion in the body's craniosacral rhythm. It is totally non-invasive and is accomplished with fingertip pressure. The amount of pressure used on newborns is approximately equal to the amount of force required to hold a nickel on the end of your finger. To make this process more meaningful, let me describe the anatomy and physiology of the craniosacral system and its rhythmic pulsation.

The body has a number of intrinsic rhythms. We're all familiar with the heartbeat. Well, that is the driving force of the cardiovascular rhythm. Anywhere you can feel the pulse, you are palpating the cardiovascular rhythm. Another familiar rhythm is the respiratory motion, driven by the expansion and contraction of the diaphragm. A third, intrinsic rhythm of the body, and one quite independent of the other two, is the craniosacral rhythm. It is generated by the cyclic production and reabsorption of the cerebrospinal fluid. It, too, can be palpated anywhere on the body, although it is very subtle.


The cerebrospinal fluid pump is composed of the cranium at the top, the sacrum at the bottom and the dural tube (enclosed in the spinal column and enclosing the spinal cord) in between. The entire mechanism can be visualized as a semi-closed hydraulic system where restrictions (or trauma) are transmitted from one site to another via fluid pressure. A complex system of membranes in the cranium divides the brain into its functional parts, supporting and shaping it. Without the membranes, the brain would simply be a gelatinous, formless mass. So, distortions and abnormal forces transmitted through the membranes alter the brain's structure and the interconnections between the neurons. The cerebrospinal fluid is channeled through this same membranous system, nourishing the tissue. The constant supply of fresh cerebrospinal fluid washes away stagnant metabolic waste products and, via hormonal factors in the fluid, enables the nervous system to coordinate itself via biochemical communication.

The brain's membranous system is continuous with the dural tube that encloses the spinal cord, the sheath that encloses every peripheral nerve and the dura inside the sacrum. Furthermore, it is continuous with the scalp, extending through the sutures of the skull to cover the cranial bones both internally and externally. The continuity of the system promotes ease of correction.

Corrections are accomplished with the fingertips, using the bones as handles to untwist the craniosacral membranes. Some adjustments are accomplished using the soft palate as a lever to move the individual cranial bones. But, again, force is never used. Only gentle pressure, beneath the body's resistance level, is required to make the corrections. There can be slight discomfort, particularly if the distortion is severe. In fact, the tension in the membranes creates specific point tenderness, which is one of the indications of the need for correction. So, some babies will cry when the adjustments are first made. However, one of the indications that all the corrections have been made is a state of total relaxation, almost bliss, that comes over the child. Seeing a child reach that point is one of the greatest rewards in my practice.

You might now be wondering: What disarranges the system? Often, the initiating factor is the birthing process. In all of my newborn examinations, I have found only a handful of children with normal craniosacral mechanics. The multiplicity of factors attending even a normal birth makes this less startling than it might at first appear. The important question is: How severe is the restriction? When is it essential that it be corrected as early as possible to prevent future developmental complications? The rule of thumb is: The more difficult the delivery, the greater the intervention employed, the greater the likelihood that there will be significant, possibly multiple restrictions. Dr. Upledger's research has indicated a positive degree of statistical correlation between restriction in the craniosacral rhythm and a history of an obstetrically complicated delivery. His criteria for classifying a delivery as obstetrically complicated include one or more of the following: 1) Cesarean section, 2) high forceps delivery, 3) induction of labor for reasons other than convenience, 4) fetal distress in utero, 5) breech delivery, 6) prolonged labor, 7) precipitous labor, 8) toxemia of pregnancy and 9) severe trauma during pregnancy which resulted in pelvic fracture. (Craniosacral Therapy, Upledger and Vredevoogd, 1983, Eastland Press, pp. 336 and 343).

In my practice, without exception, both Cesarean section children and children born extremely rapidly have needed extensive care. This is because the normal process of labor and delivery stimulates the normal development of the craniosacral mechanism. It primes the pump. With Cesarean sections, particularly those which were "scheduled" and where the mother never labored, the cranium has a peculiar lack of resilience. Rather than feeling like pliable, living tissue, the skull has the consistency of a plastic billiard ball. One four-year-old that I saw was extremely bright, but had been labeled as a "difficult" child. He didn't want to be touched or held; he was very opinionated and inflexible and had a monumental temper. His cranium was totally inflexible and rigid. Cranial therapy resulted in a marked change. He became more approachable and affectionate, with a much more equable disposition.


In cases of extremely rapid birth, more serious problems develop. The cranium isn't rhythmically and gradually molded. Instead of being gradually overlapped (as is normal during delivery), the bones jam together with great force and fail to come apart post-partum. These babies are often inconsolable, wanting to be nursed and rocked in an attempt to put some motion into a system that is locked down into immobility.

Another key factor in disarranging the cranial system is trauma. While we might expect severe blows to cause problems, sometimes relatively minor trauma can cause severe distortion. In one case, I treated a three-year-old who had a facial distortion. His mother had stumbled while holding him and bumped his head into the corner of a house. The examining doctor at that time found no skull fracture. But, as he grew up, his face was extremely distorted. On ear was actually behind the other; his mouth was twisted; and his eyes were not on the same level. In addition, he salivated excessively and constantly, and he couldn't swallow, indicating irritability of the cranial nerves. He also had asthma. After treatment, all of these problems resolved and he's a handsome and mellow little boy, with a much greater attention span. His mother monitors his behavior as an indication of when he needs occasional follow-up care.

In summary, what clues should parents look for to determine whether their child needs attention? All children with severe neurological deficits should be treated cranially. While cranial care may not totally correct the deficit, the quality of function improves dramatically. Children with cerebral palsy and autism, in particular, benefit from cranial treatments. Dr. Upledger has seen much of the self-abusive behavior in autism, such as head-banging and hand- or wrist-biting either abate entirely or greatly reduce its severity. The improvement is spontaneous; and he postulates that long-standing, internal head pain has been relieved by cranial decompression. He believes that the child may have been blocking uncontrollable, external pain. (Ibid., p. 263) In children with cerebral palsy, I have seen a marked decrease in spasticity and improved coordination, speech and motor skills.

For less severe problems, there are a wide range of behaviors to look for, depending upon the child's age and the severity of the restriction. In a newborn, hyperirritability of any kind should be a warning sign. The child who cries excessively, is excessively wakeful, who is very startlable and jerky, who wants to nurse incessantly, or who has suckling difficulties should be checked as soon as possible. In the older infant, incessant rocking, thumb sucking, head banging, recurrent ear infections, ear and hair pulling should be noticed. The child who fights and cries over hair combing or washing is a likely candidate as well. As children get older and enter school, the school authorities are likely to label them as "problem" children or "behavior problems." Popular terminology presently includes "attention deficit disorder," "learning disabilities," "dyslexia" and "hyperactivity."

Personally, I feel very strongly about applying labels of this sort to children. So much harm is done to the child's sense of self-worth by ignorance. Very young children tend to act out our expectations of them. And, older children begin to feel defeated by the school system and begin to regard themselves as failures. So much good can be accomplished by viewing children with understanding and compassion. Put yourself in their place. If you were born with a congenital cranial restriction and had never known anything but stress, tension and pain, how would you know what is "normal"? Children can't express that something "hurts" if they've never been pain-free. So, they use what tools they have: they kick and scream; or they are disruptive; or they don't want to be touched in sensitive areas. Just how crabby are you when you have a severe headache? Let's give our children the most positive start we can, giving them every opportunity to be the best that they can be. That's my commitment to children.

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