Visual Diagnosis of Babies
a guide for caregivers
Introduction
Are you wondering if your baby’s colic/reflux/constipation/gas/sleep challenges/excessive fussiness/latch issues/feeding problems/etc might be structural and therefore treatable with osteopathy or other kinds of bodywork? Here’s a list of common restrictive patterns in newborns and infants that caregivers can diagnose just by looking, but that you might not realize are impacting the child’s functioning. Because many fascial (connective tissue) restrictions are not evident on a visual exam (which is why my exam is primarily with my hands), this isn’t a comprehensive list.
So if your little one is dealing with challenges in any of the Newborn Big 3 (eating, sleeping, and pooping,) I recommend getting them evaluated even if there’re no visually apparent restrictions. But if they’re having those issues and they DO have one of these patterns, find yourself an osteopath stat.
With the help of my only-slightly-creepy teaching doll
The Linebacker
Linebacker baby, compressed from top to bottom
These neck-free babies are adorable, but there are some benefits to having a functional cervical spine. A straightforward example is nursing. Try this: relax your shoulders, open your mouth as wide as you can, and then close it. Now shrug your shoulders up to your ears and try opening your mouth again. If your body works like mine (and the Linebacker babies I see in my office), you can’t open your mouth as wide. If you can, it’s likely from tipping your head back to create more space between your chin and chest, something that these babies either
1. can’t do because the same fascial restriction pulling their head down is keeping their chin tucked or
2. can do but this extended head and neck causes its own issues.
When a baby can’t open their mouth wide, they struggle to get the whole nipple in their mouth and end up with a shallow, pinchy latch. It also can impact digestion because the tension usually goes all the way down to the gut, if not lower. You would probably also struggle to eat if your necktie got zipped into the fly of your pants, which is the equivalent of what’s happening with these babies’ fascia.
The Tiny Spy
Every time you lay the baby down (or put them in the carrier or the car seat), they turn their head to the same side. You turn their head forward and next time you look at them, they’re back checking over their shoulder to see if they're being followed by any suspicious characters or unmarked cars. This is really common and is actually a torticollis, typically thought of as head tilted to one side (which if i was including in this list, I would call “The Inquisitive Parakeet.”) The same forces that are turning the head are also tilting it, but I find that the turn is much easier for caregivers to pick up on than the tilt. In fact, this might be the most easily noticeable of these patterns.
Even when the head turn is not as dramatic or visually apparent, it’ll show up in nursing as a side preference. I can’t tell you the number of parents whose explanation for their babies’ chest side preference (too much supply on that side, too little supply, more challenging nipple shape, too forceful letdown, etc) turns out to be much less relevant to the child’s nursing success than the direction their head is pointing. Comfort with different nursing holds is influenced by a lot of factors, so this is not true of all these babies, but if your baby can only nurse in cradle position on one side and football hold on the other, you’ve got a Tiny Spy on your hands. This head position is a particularly important one to catch and treat early because, like the world’s cutest pumpkin, they’ll start to develop a flat spot (aka plagiocephaly) on whichever side is in contact with the ground. Fortunately, baby heads are soft and malleable, so when we release the restrictions that are holding them in this twist (which, by the way, almost always go all the way down to the pelvis) the normal symmetric motion will round the head back out like rolling a ball of clay between your hands.
The Frogger
Oh those cute little froggy legs! And oh, how much poop they get on those tiny heels as they valiantly fight to dip their feet back into the blowout diaper you’re attempting to change! It’s totally normal and expected for newborns to have scrunched up little legs. After all, there wasn’t enough room to practice stretching them out, especially in those last weeks of pregnancy. But by 5-6 weeks, we expect their resting leg position to be in a more relaxed infant “M” shape. And even before then, they should be softening up, stretching their legs out, and not requiring wrestling pins to keep their feet poop-free at changing times. And it’s not a foregone conclusion that they should need 5 weeks to get there. When we brought my baby in for our one week checkup, the nurse was shocked by how easily the tiny legs extended when she did the height/length measurement. (But of course my mom and I had been doing basically non-stop baby fascia treatments for the preceding 7 days.)
Extra tight froggy legs can impact nursing (especially if you try to nurse in positions that stretch the legs out) but they more commonly show up as constipation and gas pain. This is because the scrunched up hips and pelvis are also scrunching the internal space of the pelvis where the end of the large intestine (sigmoid colon and rectum) are. These are organs of motion (that’s why it’s called a bowel movement) and they don’t function as well when they don’t have space to move.
Headsup!
“She’s so strong! Look how she holds her head up already.” If you’re hearing or saying this about a newborn, cue a gif of me waving a tiny red flag. People delight in early physical achievements, but before newborns are one month old, they should not be able to hold their head upright on their own. The muscles are simply not developed enough. And even after that, they should slowly build capacity for neck control over a few months, starting with a couple seconds and gradually increasing as those little muscles gain strength. Before that time, it’s not strong muscles holding that head up, it’s tight fascia. That tension can impact the head mobility needed for a good latch. This pattern can also run down the whole back line of the body, making babies want to bend backward to put that tension on slack. Car seats can be challenging for these newborns because the seats require them to curl forward which is the opposite of their comfortable position. If your newborn is getting compliments on their strong neck, headsup! They could probably benefit from some bodywork.
The Windswept Look
Can be more subtle (except when it’s really not), and it can sometimes be easier to see if you lift the baby up by their armpits and look to see if the feet are swinging off to one side or the other. Some Windswept babies will roll themselves into a side-lying position (well before 3 months when infants start being capable of intentional rolling) to lie on whichever side they bend toward (usually the left). Try it yourself! Lying on your back with your knees bent, curve your body into a C shape bending to the left. Keeping that curve, drop your knees to one side and the other. Knees to the right, you really need to make an effort to roll onto your side, but knees to the left and flop, you just tip over.
One interesting pattern I see is that newborns and infants that bend to the right more often have jaundice because the scrunching of the right lower ribs decreases the amount of motion available for the liver (which is where bilirubin gets processed). Whereas babies who bend to the left more often have constipation and reflux issues because the scrunched organs on that side are the stomach and descending colon. This is just my clinical experience and anecdotes from other clinicians, so it would be amazing if someone with more time and the necessarily large sample size of babies could generate statistical data on this because I’m extremely curious if these anecdotal findings are borne out in the wider population. If you had a Windswept baby, I’d love to hear your comments about which side they bent to and whether or not they had jaundice or reflux. Windswept babies almost always also have a twist (shoulders going to the right or left relative to the pelvis) which brings us to:
The Combo
Any and all of these postural patterns can show up in combinations, and in fact, that’s the most common pattern of all. Windswept Spies and Froggy Linebackers are particularly likely combos because each pair is really just the same restriction showing itself in both the top and bottom of a single line of fascia. (I had one particularly sweet patient who could either extend his legs when Linebacking or extend his neck while Frogging but not both at the same time, like a little marionette with a cord between his chin and knees.) I’ve separated the patterns out here as a tool for caregivers because one element is often more visually apparent. By that same token, I’ve connected symptoms and postural patterns here as food for thought, but your mileage may vary in terms of presence and severity of those issues. Like I said in the intro, some babies have structural issues that aren’t apparent on visual exam but are palpable (and treatable!) with hands. By that token, a Froggy baby could be pooping fine but struggling with latch because of other less visible restrictions.
On the other side of the coin, a baby can have very visually-evident postural asymmetry but their super resilient body is accommodating and compensating enough that they have no eating/sleeping/pooping functional issues. In those cases, I still recommend getting treated because the earlier we treat something, the easier and faster it resolves (which means fewer appointments in the long term.) But if you want to take a wait-and-see approach, the early signs to seek out osteopathic care are if there’s asymmetry or delay in any motor milestones. Early on, that means if the newborn is reaching farther with one arm than the other, or using one hand more than the other for grabbing (handedness doesn’t appear until much later in brain development,) or tipping always to the same side when they lift their head in tummy time. Later, if they’re only rolling in one direction (see: Windswept babies and the challenge of rolling away from the bend.) And once they get to crawling, if they’re butt-scooting or crawling with one leg up. As the motor cortex in the brain is making connections (these are HANDS!... these are MY hands!... I can MOVE my hands!... I can move THINGS with my hands!) we want that development to be happening symmetrically to set our kids up for success in the thrilling lifetime adventure that is Having a Body.
