What does a chiropractor do with kids? They are so young and little, what kind of back problems can they possibly have? Is it safe to get adjusted when you are pregnant, can't that hurt the baby? Can a chiropractor turn a breech baby? A chiropractor helped my friend's baby get rid of ear infections, how does that work?
Well, this is my attempt at answering all of these questions and to open up the lines of communication between curious minds and a chiropractic practitioner. My resources are my old teachers, professors, research articles, my patients, and my daughter who received her first adjustment just a few hours after birth.

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Tuesday, June 22, 2010

My 2 Cents on 2 Brands of Cloth Diapers


I am in a constant search for the perfect cloth diaper. When I was a baby in the Ukraine, cloth was the only type of barrier that existed between the baby bum and the rest of the world. And by the way, I am not talking about the pre-folded layered cloth. Parents used cut-up sheets, pillowcases, or large squares of gauze to create their unique and leak-proof barriers. So, one would think that having more choices would make this an easy item to add to your wish list or baby registry, but is not so simple.

I just wanted to share my experience with the following 2 brands of cloth diapers: G-Diapers and BumGenius, both of which I have been using on and off for about 10 months now. Keep in mind that every 2-3 days these diapers went through a rinse, wash, and dry cycle (about 100 times total)

The G-Diaper, size medium.

PROS

-Can use either an cloth or biodegradable insert
-Less bulky and lighter material
-Material touching skin is cotton if you use a cotton insert
-Baby is less likely to take it off since the velcro fastens in the back
-Soft edges around thighs that don't cut off any circulation

CONS

-Had to repair/mend the insert once
-Had to re-attach velcro once
-Velcro is not holding on any more
-Always soaks through the entire cloth
-Can't seem to get it on snug enough so that the insert doesnt' slide around with movement.


BumGenius

PROS

-One size fits all, 3 levels of adjustible buttons
-Velcro super sturdy, sticks to everything.
-Never leaked through the main lining when using the thick insert.
-The insert goes inside a pocket so it does not slide

CONS

-The inserts it comes with are very thick making the diaper bulky and the baby hot.
-The material is not breathable
-The material that comes in contact with the skin is Polyester.

Since I have both kinds, 3 of the G-Diaper and 5 of BumGenius, I decided to get the most use out of each one. The BumGenius I use during the colder months, and the G-Diapers I use during warmer days and will be using more as we continue onto the next step of Potty Training.

Saturday, May 1, 2010

How can we avoid ear infections without antibiotics?

The most frequent presenting condition in my office is "Ear Infection". This is usually not the first occurrence, but the third, or fifth. By the time I see the little one, they have been through multiple ear exams, multiple rounds of antibiotics, and even a tubal ligation surgery. At first the parents are skeptical, but are willing to try anything at this point to help ease their child’s discomfort.
"Ear infections are common in young children resulting in millions of office visits and antibiotic prescriptions annually. Acute otitis media (AOM) includes intense signs and symptoms of infection and inflammation and is the most common bacterial illness in children for which antibacterial agents are prescribed in the United States. Otitis media with effusion (OME) is even more common. About 90% of children have OME at some time before school age, most often between ages 6 months and 4 years. Otitis Media with Effusion often follows colds and viral infections or actual ear infections and will usually clear up on its own without treatment." -American Academy of Pediatrics.
Here I would like to explain why chiropractors see ear infection/inflammation as a very preventable problem that can be managed without invasive intervention.

1. Progression of an infection.
  • Fluid. If the fluid does not drain out, it creates a perfect environment for the bacteria to live and multiply, leading to an ear infection over time.
  • Pain. Accumulation of fluid causes pressure in the canal. The constant presence of fluid
  • The fluid can also put pressure on the tympanic membrane, possibly rupturing it.
2. Why is the fluid there?
  • In babies the Eustachian tubes are short, narrow, and horizontal. As we grow older they tilt more vertically to allow for better drainage.
  • Your baby may be teething. Gums are red and inflamed, there is a runny nose, and an overall flushed appearance. This is the normal process of inflammation that has to happen to allow for tooth eruption.
  • Dairy consumption stimulates mucus production body-wide, and creates more fluid than the Eustachian tubes can drain out.
  • Other common allergens, such as SOY or WHEAT can also over stimulate the body to produce fluid.
  • A hyperactive immune system.
  • "A growing number of scientists believe that the increase in America, Europe, Australia and Japan in allergic and auto-immune diseases (which stimulate the humoral or Th2 branch of the immune system[Vaccinations]) is caused by the lack of stimulation of the cellular or the Th1 branch of the immune [Natural Immune Response] system from the lack of acute inflammatory responses and discharges in childhood" –PHILIP F. INCAO, M.D
  • Multiple doses and rounds of vaccinations may have a role in creating this phenomenon. Since the body is not allowed to have a natural immune cascade, it has a fast emergency response when a vaccine is given. This teaches our immune system to respond to all foreign particles with greater force than necessary do deal with them.
  • Subluxation and misalignment of Atlas (C1), cranial and facial bones. These affect the internal ear structure and the tube's ability to drain efficiently. A shift in the Atlas may also irritate the local nerve endings, causing pain and extra fluid production. These structures may be compromised after a difficult labor and delivery, after a C-Section delivery, and after falls or bumps on the head.
3. What happens with repetitive antibiotic use?
  • Antibiotics take 3-4 days to go into full affects. If your child is feeling better after 2 days of taking them, chances are it's not the antibiotic, it's their own immune system.
  • Repeat Antibiotic use has been suspected to lead to more ear "infections"! Antibiotics don't just target the bacteria in the ear canal. They can kill off the beneficial gut bacteria which we need for proper digestion and immune system function. That is why it's common to see constipation or viral infections after a course of antibiotic treatment.
  • Your body becomes a breeding ground for stronger bacterial strands. After your immune system has been exposed to the same antibiotic, killing off the weak bacteria, it allows for the stronger bacteria to stay alive and multiply. This creates a more resistant strain, and then the usual medication doesn't work anymore, so a new antibiotic needs to be prescribed.
4. What you can do
  • At the first signs of ear pulling monitor your child's temperature and mood. Have your pediatrician or chiropractor conduct an ear exam.
  • Take into account that the ear pulling may be associated with teething, fatigue, or a recent fall affecting the skull, face, or jaw.
  • Have your pediatric chiropractor evaluate the child's spinal alignment. A Subluxation of the 1st
  • Cervical vertebrae, TMJ, and other cranio-facial bones can directly affect the ear canal, sinus drainage, and the nerve input to that area.
  • If there is low-no fever, wait 3-4 days before asking for a prescription. It will take this long to see the effects of our immune system, even though it has already started working before any symptoms arose.
  • Remove all dairy, wheat, and/or soy from diet for 2 weeks. If you are a nursing mother, remove these items from your diet as well.
  • Use garlic drops in both ears as recommended.
  • Turn on humidifier with eucalyptus oil in the baby's/child's room.
  • Increase vitamin C consumption (for mother if nursing, for baby if on solids).
  • Get a chiropractic check-up to make sure that the spine and skull are properly aligned.
  • If antibiotics are taken, supplement diet with PROBIOTICS to replenish gut bacteria supply. Choose capsules that contain cultures in BILLIONS. Lactobacilus bifidus should be included in the culture.
  • For a nursing mother, sprinkle some from a capsule before at each feeding.
  • If a bottle is taken, break a capsule and put in ¼ of it in at each feeding.
  • If solid-fed, sprinkle ½ capsule at each feeding. Do not give yogurt at this time. It is dairy based and does not have enough cultures.

Monday, April 19, 2010

More Bacteria Makes You Healthier!?


Recently the buzz word on the street is "Probiotics" and their utilization is on the rise amongst the pediatric population. More research is surfacing proving that the environment in our gut is directly linked to our ability to have healthy digestion, elimination, and as a result, a well functioning immune system. Here is a user-friendly guide to creating a healthier intestinal lining.

WHEN DO I NEED TO TAKE OR GIVE PROBIOTICS?

If you were taking antibiotics during pregnancy.
If you were given an antibiotic IV during labor per hospital protocol.
If your baby was delivered via C-Section, no exposure to microflora as with vaginal birth.
If you are a nursing mother and are taking antibiotics.
If you are a nursing mother and are feeling sick.
If your child has had any antibiotic intake.
If your child is constipated or has diarrhea.
If your child has a viral or bacterial infection.
If your child shows signs of allergies or food sensitivities.

HOW DO I PICK AN AGE-APPROPRIATE PROBIOTIC?
  • 4 MONTHS OR YOUNGER: Choose the BIFIDOBACTERIUM species including bifidum, longum, infantis, brevis. This is the first species to colonize our gut after birth. They are found throughout the entire intestine, but primarily in the Large Intestine.
  • 4MONTHS OR OLDER: Add LACTOBACILLUS species, including rhamnosus, casi, salivarius, paracasei. This species appears later, and is primarily in the small intestine.

HOW MANY COLONIES SHOULD I TAKE OR GIVE?


Our digestive tract normally contains TRILLIONS of these bacterial strains.
  • FOR PREVENTION: Adult 15-25 Billion CFU Daily.....Child 10-15 Billion Daily
  • DIARRHEA or DETOX: 200-300 Billion Daily for 7-10 days
  • FIGHTING A COLD: 50-100 Billion Daily for duration of cold + 7 days
HOW DO I ADMINISTER THE PROBIOTICS?
While Yogurt contains live cultures, it is still not the best way to go as it is a dairy-based product. You also have no way of knowing how many cultures are still living at date of purchase.
  • Nursing Mothers: Open a capsule or use powder and sprinkle some around the areola prior to latch-on.
  • Bottle-Feeding: Add specific amount to bottle from a capsule, powder, or liquid drops.
  • Pipette: Dissolve specified amount with breast milk or formula.
WHERE DO I FIND THEM?
  • The best quality will be in the refrigerated section of a health-food store. When kept at lower temperatures the life of the bacteria is prolonged and you can be more confidant that you are getting what the label states.
  • The other option is getting them from a trusted distributor such as your pediatrician, or a holistic practitioner.
WHAT SHOULD I LOOK FOR ON THE LABEL?
  • Look for a clear statement of the number of colonies on manufacture date, or even better, that the certain number will still be present at expiration date.
  • Be aware of probiotics that contain color, flavor, or sugar.
  • Avoid ones with false commercial claims, as these are most likely not third party tested for purity.
  • The contents should be a combination of different colonies, all using their Latin names.
References:
Donald Gerken, DC, DACCP, CST from PATHWAYS journal

Monday, April 5, 2010

Tips For a New Mother's Spine.

1. Feeding
A lot of time is spent getting to know your little one while feeding them. It is very important to pay close attention to your posture while you are seated and cradling your baby. While feeding, shoulders have a tendency to roll forward, the chest caves in, and the neck curves forward, and the head droops down. Repetitive stress such as this will lead to breathing changes, headaches, sense of fogginess, muscle soreness and weakness, and possible tingling in hands and arms.

  • Nursing / Bottle-feeding:
  1. It is extremely important for you to switch arms while feeding. This ensures that you strengthen both of your arms equally and one side does not fatigue more than the other. For your baby this plays a major role in the development of their neck muscles and eye movements.
  2. Recline slightly or use a support beneath your baby, such as a Boppy Pillow or My Breast Friend. This takes the load off of you arms and shoulders and decreases the stress placed on your Thoracic spine. Remember that the Thoracic spine provides nervous stimulus to your lungs, heart, and breast tissue.
  3. Check where your head is when feeding the baby. We all like to gaze at them as they eagerly slurp and drift off to sleep, but most of the time your head will end up tilted in the same direction, even if you change arms.
    Try this: If your baby is cradled with their head on your left arm, rotate your head to the LEFT and tilt to the RIGHT. Then switch your baby to the right arm and make sure to rotate you head to the RIGHT and tilt it to the LEFT. It may seem uncomfortable at first, which is simply and indication of a motion restriction or muscle shortening in your neck.
  4. After each feeding session stretch your arms. Do some shoulder rolls, link your hands behind your back, hold a broom stick on each end and bring it behind your back.
  • Solids
    1. If you are sitting to the side of your child, switch sides from left to right and try to minimize spinal rotation.
    2. It is best if you sit directly in front of your baby and on the same level, rather than leaning down or having to reach up.
2. Sleeping
    Whether you choose to stay close to your baby at night, or wish to place them in a different room, there are a number of habits to keep in check. After all, a well rested and pain-free parent is much more adapt to meet the needs of their developing child than one who is suffering on top of sleep deprivation.

  • Co-Sleeping
If your baby sleeps in the center of the bed, and you nurse at night, make sure to switch sides. Constantly rotating to your left (or right) will compress the same shoulder and may start to create a scoliosis-type curve in your spine.
    1. Use a pillow that supports your neck, not your head.
    2. Use a pillow between your legs when on your side to prevent lumbar and pelvic rotation.
  • Crib/Bassinet
If possible place the crib in a room so that it is approachable from both sides.
    1. When laying your baby down try to prevent any twisting. Either position yourself so that you only have to bend forward at your waist, or separate the process into 2 movement, first bend, pause, then twist. This allows your muscles to lengthen appropriately and prevent spasm.
    2. If your crib is co-sleeper (we used the Arms Reach Mini Co-Sleeper to conserve space) and is against the bed, alternate what side it's on weekly.

    3. On the go
    Whether you are taking a road trip, running to the store, going for a walk, or a run, the state of your body needs to be as important as the placement and comfort of your little one.
    • Driving
    1. Change the location of your car seat. I know that it is more convenient for the car seat to be stationary on the right side, but this forces you to always twist to the right if it's an infant one (or left if it's for a toddler). TWISTING places the greatest stress on the tiny ligaments that support our discs. So, either switch the seat placement from side to side, or put it in the middle and come from different sides to take the baby out. Remember that the baby may also be turning his/her neck toward the closest window, and switching sides will benefit their muscle and visual development.
    2. Shortly after delivery and for the year ahead use a lumbar support in your vehicle, even if it's just a quick trip to the store.
    • Baby-Wearing
    1. Whichever sling, wrap, or carrier you choose, keep in mind that as soon as the weight you carry exceeds 10-15% of your own body weight, your spine is greatly affected.
    2. If you wear a sling, change sides each time you wear it from shoulder to shoulder. If you don't, you will feel discomfort in your neck and shoulders, and may get more frequent headaches. If your sling is resting close to your neck, rather than out by the shoulder, you are interfering with the brachial plexus that may lead to numbness and tingling in your hands.
    3. If you use a front carrier, or a backpack, make sure that there is some type of upper and lower back latch to keep your shoulders from sotating forward and distribute the weight throughout your entire spine, rather than front-load.
    4. Please realize that when your baby is straddled facing you or facing out, there is a certain unnatural degree of leg and pelvic external rotation. This plays a role later on when they are beginning to crawl, stand and walk. So limit the time of continuous wearing to 30-45 minutes. If you will be out longer, just take them out, stretch their legs for 5-10 minutes and continue. more on this topic in upcoming blog....
    • Baby/Toddler Carrying
    1. We have a tendency to naturally put more weight on one leg vs. the other. Try standing in a relaxed pose and see which way your body shifts. You will generally buckle one knee slightly and turn the other leg out. This becomes a problem when you are trying to cook, vacuum, write, or talk on the phone with your right hand and your baby is hanging out on your left hip supported by your left arm. Try to switch hips from time to time to recreate balance in your pelvis and spine.
    2. If you have a gassy/colicky baby who will only be calm in a football carry (my little Sasha was like that for the first 3 months of her life due to some post-delivery intervention), switch arms. If you always carry on your left arm, their head will be turned to the right. So, hook your hands together and cradle their belly, and switch arms.
    3. Racking your little one to sleep either in a cradle hold or over the shoulder hold may be more comfortable for you on one side. Switch to the other shoulder to even out the load and also change your head tilt.
    • Stroller
    1. Choose a stroller with an adjustable handle heaight, or one more appropriate for the person who will be the primary "stroller-pusher". I just got a great little umbrella stroller perfect for me (I am 5'4''), but I would not recommend it for anyone even 1/2'' taller.
    2. Check to see where your wrists are on the stroller handle. Are they twisted, flexed, or laterally bent? Are your elbows straight or bent while pushing? Pick one where your wrists are in a neutral position and your elbows are slightly bend.
    3. Choose a stroller that matches your activity level. If you want to get back into running, pick one that is lite and easy to maneuver. If you like slow sedentary walks on forest trails, pick one with sturdy wheels.




Are We Getting Ahead of Ourselves?

With a new baby comes a tsunami of excitement and curiosity. After that comes a wave of worries and concerns, and perhaps a bit of comparison. As new moms get together in their circles and share stories of their growing miracles, it is often difficult not to wonder if your baby is Normal, Ahead of the Class, or Trailing Behind. If at any time we feel as though ours is just not quite reaching the milestones on time, some of us try to speed things up a bit.

A FEW WORDS OF CAUTION FOR SOME PARENTS WHO JUST CAN'T WAIT.


 

MY BABY IS NOT STTING

In Utero we all start out with one curve, a big thoracic C curve. So, in the first few months of life it may help to prop up your infant slightly after meals, or carry her around in a sling. But if this continues on after she is able to hold her head up strong, even 10 degrees can this little of bend can impact her developing spinal curvature. At this point it may help to lay her on her back, but prop up the surface she is on. The road to unsupported sitting is paved by gradual muscle building and all of the stages prior to it are responsible for targeting muscle groups in their proper order. If a stage is skipped, some deep core muscles will be weaker which will interfere with the milestones ahead. Don't force your baby to sit upright, near the 90 degree angle. Why?

  1. Sitting places the greatest load on our spine and discs. Unnatural early sitting will put greater stress on vertebrae and discs, dehydrating them, slowing growth, and decreasing the quality of bone deposition.


     

  2. A baby left sitting in a BUMBO chair (even for 15minutes daily) before they are able to sit on their own does not allow for paraspinal muscles to strengthen and support the column, creating future instability in the spine and pelvis.


     

  3. The load of a slouching baby pulls the head forward and places extra pressure on the middle thoracic curve. This begins to affect neck muscles, cranial structures, and their digestive system.

MY BABY IS NOT EATING SOLIDS

    At the grocery store, baby food is mashed up and ready to be served at 3 months of age. So, you pick your brand, make sure there is an assortment of flavors and colors and bring it home for your hungry little monster to try. Whether you are introducing this shift after breastmilk or formula, don't be discouraged if your baby turns his head and starts to fuss. New research has indicated that it is beneficial to breastfeed exclusively until a minimum of 6 months. Why?

  1. The digestive system is just learning and growing. The gut needs to develop a sufficient enough amount of flora and good bacteria to help your baby handle the new larger food protein particles that will be coming his way. A great indicator of this is the eruption of teeth, which nature would not allow to happen until the body was able to accept what the teeth have ground up.


     

  2. Physically, the baby needs to know how to sit on his own, unsupported, which is another indicator that the abdominal muscles have developed enough to support the digestive system.


     

  3. The immune system is also affected directly via the gut. If a food is taken in that cannot be properly digested, the nutrients don't get absorbed, and the body launches an immune attack on this food particle thinking that it is a foreign bacteria or virus. If this food continues to be presented time and time again, the baby may develop an allergy to it as well as other foods similar in composition. The allergy does not always have to present as hives and difficulty breathing, it may come in the form of vomiting, spit up, stool change, or a new skin rash.

So, as a rule, don't force the food in until your baby is sitting up, accepts it, and has some teeth that have come through.

MY BABY IS NOT WALKING

    There is not enough stress placed on the importance of the crawling stage. Many parents are happy when their baby goes directly from sitting to standing, and then walking. It is important to remember that this stage is there for a reason, and skipping it will have some major negative implications. Why?

  1. The cross-crawl pattern stimulates brain centers responsible for reading comprehension. While your baby can't really do either right now, these centers need to be prepped for when they start to learn letters and numbers.


     

  2. Crawling allows for opposite muscles to strengthen and coordinate. This prevents overdevelopment of one side of the body and allows for greater muscular support when the baby is ready to start walking.


     

  3. Proprioceptors in the brain are also being stimulated as your baby starts to discover where they are in space and they begin to learn how to control the objects around them.


     

  4. Putting babied in walkers before their knee and hip joints are strong enough to support their weight can create ligamentous laxity and alter their gate, foot arches, and place undue stress on developing disks and bones of the spinal column.


     

    If your baby is between 16 and 18 months and is unable to walk on their own it is advisable to contact your pediatrician, chiropractor, or other development specialist.


     


 


 


 

Thursday, February 25, 2010

When should my new baby see a chiropractor?

After speaking at a recent pregnancy workshop, the following question was raised by 3 expectant moms.

When and how often should we get our babies checked and adjusted?

Although each little bundle is unique in their own way, here is a guide to chiropractic adjustment check points. I will be using the word SUBLUXATION which means any misalignment in the skull, spine, pelvis and extremities that interferes with proper communication between the brain and body. Also, keep in mind that the timeline is not set in stone, and each milestone may not exactly coincide with the listed age.

1. AFTER BIRTH:
the sooner the better

Even a natural, uncomplicated birth can have some negative implications on the baby's health. The position in-utero, the time spent in the birth canal, the body rotation when emerging, the degree of head tilt and force of pull by the delivering practitioner, the delivery of shoulders, use of instruments, and mother's medication, will all have an impact on their Nervous System. Watch Closely for:

  • Difficulty Turning Head to one side vs. the other
  • Facial Asymmetry
  • Moving one side of the body more than the other
  • Difficulty Latching On
  • Extreme Lethargy
  • Inability to lay flat on their back, or hyper extending back and head
  • Constant Crying (even when fed and dry)
  • Skin color changes
  • Shallow breathing
  • No muscle tone or grip strength

2. HOLDING HEAD UP: 0-3 months

This is the time when the baby begins to develop her Cervical Curve. Subluxations can lead to muscle imbalance and affect the nerve communication to:

  • Eyes
  • Ears
  • Nose
  • Mouth
  • Throat
  • Caroted and Vertebral Arteries
  • Chemoreceptors for O2, CO2, and pH, BP level regulation
  • Immune System

3. ROLLING OVER: 3-4 months

Baby begins to strengthen neck rotators and continues to build neck extensors and flexors. Also, strengthening occurs in the upper body and lower lumbar rotators. Subluxations in this area can affect:

  • Same as for 0-3 months
  • Digestive System
  • Detoxification System
  • Elimination


4. SITTING UP: 4-6 months
Here the little one is activating and developing Proprioceptors for balance and coordination, strengthening paraspinal muscles, especially lower, and strengthening abdominals. Areas affected by these changes are:

  • Eyes
  • Ears
  • Chest
  • Digestive System
  • Elimination


5. CRAWLING: 6-8 months

The cross-crawl pattern is essential to developing brain centers responsible for reading comprehension and writing. It also ensures that both sides of the body are being equally strengthened and the brain is receiving balanced information. This is a crucial stage that must not be missed. If the baby goes directly to walking, it is advisable to incorporate cross-crawl activities on a daily basis. Areas affected:

  • Neck
  • Shoulders and Arms
  • Hips and Legs
  • Proprioception
  • Brain Development
  • Coordination

6.
STANDING UP:7-10 months

This is the developing point of the Lumbar Curve. Also loading begins on hips, knees, and ankles. Upper body strength is increasing as the baby uses his arms to pull up and support himself on furniture. Watch for:

  • Leg dominance
  • Arm dominance
  • Foot and Hip rotation
  • Any body tilt while standing

Once again it is important not to get ahead of ourselves, or the developing baby. I strongly advise against baby walkers or bouncy swings that prop the growing body up before the muscles and joints are ready to handle that kind of stress. Speeding up the process in this case may actually hinder proper spinal and pelvic development.


7. WALKING: 9-16 months

If your baby has not been checked by this stage, it would be a very good time to do so. This is when we can still catch and correct any subluxations that may have begun over the last few months. Once the child is upright and weight-bearing, they will continue to strengthen all muscles according to what the structural pattern dictates. At this stage key factors to note are:

  • Head Position while standing
  • Foot and Leg rotation while walking
  • Leg bowing or knock-knees
  • Any limping or knee buckling
  • Direction of falls

8. FOLLOWING FALLS:
any age

Some falls may look worse than others. Some may not look like anything, but are actually more damaging. The falls that don't result in nose bleeds or visible scratches still impact your baby's spine due to their compressive forces. Also, with every fall there is some muscle splinting and straining, which always results in some subluxation. Examples are:

  • Falls on shoulders
  • Falls straight on the head
  • Falls with head getting caught on objects
  • Falls landing straight onto the butt
  • Trip and falls landing on the face

MY CHIROPRACTIC APPROACH: Birth History. Dietary Review. Family Emotional Background. Full Ears Eyes Nose Throat screening. Spinal and Pelvic Physical Exam. Neurological Exam. Cranial Exam. Orthopoedic Exam. Adjustments may be light manual, with the instrument, or in the form of ligament holds and stretches. CranioSacral therapy also incorporated. On the first 2-3 visits only some adjustments may be applied in order to prevent overwhelming the immature nervous system.