Author: Dominic Anaya
Dominic Anaya is an osteopathic physician and licensed massage therapist in Oregon. He has been doing craniosacral work for almost 20 years and teaches it at the National College of Naturopathic Medicine.
Most bodywork practitioners understand the seriousness of performing any work on infants. Here is a human at the beginning of his or her existence—the very beginning, if one is performing prenatal work with the mother. “Just as the twig is bent, the tree’s inclined,” wrote the poet Alexander Pope, and variations on this phrase are a favorite among bodyworkers who work with children. It represents the idea that seemingly small asymmetries in a child’s anatomy or posture can negatively influence development and become significant issues later in life if undetected. There’s no better time for a craniosacral practitioner to get in touch with the fluid motion of the cranial rhythmic impulse (CRI) than at this tender stage of development. At birth, we are a nearly pure, blank slate of a human—our bones not fully ossified, our tissues still getting used to the gravitational pull of the earth, and our bodies unfamiliar with the stresses and strains of life. An infant is a human at its most vulnerable and most influential time. Here is where you can create great change in the life of another.
The Birth Experience Birthing is a strenuous event for both mother and child. Even the most uncomplicated vaginal birth places enormous pressure on the child’s body. The bones and sutures of the infant skull are not fully formed, to allow for an easier passage through the birth canal. For the most part, babies recover quite well from this pressure, but the worry is always that some region of the head will take enough pressure to create a lasting restriction that will negatively impact the growth of the infant. Any complications during delivery will only exacerbate this risk. A prolonged labor subjects the infant to the pressure of the birth canal for longer periods of time, increasing the risk of anatomical restriction. A delivery that requires the use of forceps or vacuum extraction will not only increase the amount of pressure an infant is subjected to, but these pressures will be of a mechanical nature that infant bodies are not adapted to handle.
A birth by Cesarean section is something quite different. This is not a denouncement of C-section births, but they have very different risks involved compared to a normal delivery. In a C-section delivery, the fetus experiences an abrupt decrease in physical pressure, instead of an abrupt increase. Our bodies do not expect this type of birth and the result is an increased risk to the fetus. Much has been written about infants delivered by C-section experiencing a higher risk of neonatal death, respiratory complications and asthma, future development of allergies, and even diabetes. Some of these risks are attributed to the lack of microbial exposure from not traveling through the birth canal, or the effects of the surgery (including exposure to general anesthesia), but the pressure difference is also a factor. For instance, the pressure of the birth canal usually squeezes fluid from an infant’s lungs in order to better clear them to receive oxygen. This does not occur during a C-section. All of these risk factors highlight the importance of speaking with the mother about the birth experience. Taking a good history of the prenatal period and the delivery will help a practitioner understand what physical pressures the baby experienced during birth. Time spent communicating with the mother and infant is extremely important during an infant craniosacral session—not just to receive medical information, but also to create rapport. It’s vital to take the time to transmit our intentions of caring and well-being to both mother and child during this initial meeting.
Anatomical Concerns When I do craniosacral work, regardless of the client’s age, I am first and foremost guided by what I perceive from the client’s body and CRI. That being said, the anatomist in me does worry over some critical areas of a newborn’s body.
When we are born, our bones have not yet fully developed. Notably, the bones that form the base of the skull, the vertebrae, and the pelvis are still partially cartilage, ensuring the give and flexibility that will allow for an easier passage through the birth canal. The occiput doesn’t become a single solid bone until approximately age 6; the cervical vertebra does not solidify until age 8; and the bones of the pelvis may not fuse until the second decade of life. The foramina—little holes in the bones that the cranial and spinal nerves travel through—also have give and flexibility. If the compression of these bones during birth is transmitted to the foramina, the nerves passing through them will be compressed as well.
In most births, these compressions are transitory and any potential injury to the nerves is quickly resolved. I believe, however, that the occasional child will have a lasting compression that could impact her into adulthood, and craniosacral work is very important for these children. The following regions of the body are areas that I pay particular attention to when I am working with infants. Vagus Nerve: The vagus nerve is the 10th cranial nerve (CN X). This nerve is the source of parasympathetic innervation to the organs of the chest and the upper gut. Its innervation to the upper gut (esophagus, stomach, duodenum, pancreas, liver, and adrenal glands, to name a few) helps activate gut peristalsis, gastric emptying of contents into the small intestine, and the release of gastric acid and digestive enzymes. I consider this nerve any time an infant is described as having symptoms of colic. If a decrease of parasympathetic innervation would delay digestion or gastric emptying, it seems apparent that such a child would feel gassy and bloated.
The vagus nerve exits the skull at the jugular foramen, which is a hole between the occipital and the temporal bones. As the head of the infant travels through the birth canal, pressure from the vaginal walls can compress these two bones together, potentially deforming the jugular foramen and impinging on the vagus nerve. I like to address this area by using a mastoid hold. I let the pads of my fingers (usually my middle and ring fingers) contact the medial aspect of the mastoid processes and palpate the rhythm. If this area feels stuck—if the rhythm is not being transmitted smoothly through these bony landmarks—I may apply gentle traction laterally, in essence spreading the mastoid processes apart.
Hypoglossal Nerve: The hypoglossal nerve is the 12th cranial nerve (CN XII). This nerve provides motor innervation to the tongue, directing its movements for eating and speech. I consider this nerve any time an infant is described as having difficulty sucking or latching onto the nipple during breast-feeding, or even a general failure to gain weight normally. The muscular coordination that is required for swallowing is more complex than most people realize, and it doesn’t help if the newborn’s tongue is not properly innervated because of an impingement of the hypoglossal nerve. The hypoglossal nerve exits the skull through the hypoglossal canal, which runs right through the occipital condyles, anterior to the foramen magnum. During a vaginal birth, the occipital condyles are pressed into the articular facets of the atlas (vertebra C1) inferior to them. This compressive force risks compromising the hypoglossal canal and the nerve running through it. To address this region, I use the cranial base release hold, placing the tips of my fingers just inferior to the occiput and applying gentle traction superiorly. With this technique, I hope to decompress the atlanto-occipital joint, lifting the occipital condyles off the atlas (vertebra C1).
Diaphragm: Given that the diaphragm is the muscle responsible for generating pressure gradients within the body, I like to check in with this region to see how it reacted to the birth process. Did it fight the increase in pressure that was experienced in the birth canal? Was it “shocked” by the sudden pressure drop experienced in a C-section birth? The diaphragm is actually an uncommon place to find dysfunction in the newborn (at least in my experience), but these are things to consider. The diaphragm, in addition to being the prime force behind respiration and venous return, has some very important anatomical relations. The vagus nerve, the greater and lesser splanchnic nerves, and other structures involved in the digestive process pass through the diaphragm. The esophagus also passes through the diaphragm, with the diaphragm acting as part of the lower esophageal sphincter. If the diaphragm is held too rigid or too lax after birth, it will interfere with these structures. I use two separate holds for this area. My standard diaphragm hold is one hand resting underneath the infant’s back, with the palm at about the level of the T12 vertebra, and the other hand lightly resting on the anterior of the infant, with the palm at the level of the subcostal margin. With my hands in this position, I simply tune into the rhythm and listen. After this, I bring my hands to either side of the infant’s lower thorax. Using the pads of my fingers, I gently hook onto the medial side of the angle of the 12th rib. Once my fingers have a hold on each side of the 12th rib, I apply a slight lateral traction, attempting to spread and open the diaphragm up.
Sacrum/Pelvis: In my experience, this area is also an uncommon site of restriction, but given its importance, I always check it. The newborn pelvis is not fully ossified yet, and there is quite a bit of cartilage and flexibility in this region. While this usually means resilience, it can also mean vulnerability to compression. The spinal nerves that exit through the anterior sacral foramina carry all the parasympathetic innervation to the hindgut, the end of the digestive system. Just as an impinged vagus nerve can disrupt parasympathetic innervation and potentially affect gut motility and gastric emptying, so can a disruption of the sacral nerves translate to decreased gut motility and delayed defecation. Also of concern is a compression of the pelvis that restricts sacral motion. The sacral motion will remain restricted when the child begins learning to walk, adding difficulty to what is already a complex task. If left unaddressed into adulthood, there is the potential for lifelong dysfunction and suboptimal development.
I address this region much like I do the thoracic diaphragm. The first hold I apply is my standard sacral hold, with one hand underneath the sacrum, the sacral crest lying along the midline of my hand, and the fingers pointing inferiorly in the same direction as the apex of the sacrum. The other hand is on the anterior surface of the pelvis, with the palm on top of the abdomen and the hypothenar eminence of that hand on the superior aspect of the pubic crest. After I have tuned into the rhythm here for a bit, I then move my hands to either side of the pelvis. I hold one innominate with each hand, the pads of my fingers hooked into the medial aspect of the posterior superior iliac spine (PSIS) and my thumbs resting on the medial aspect of the anterior superior iliac spine (ASIS). With my hands in this position, I apply a slight lateral traction, attempting to decompress the sacroiliac joints on either side.
A Great Start in Life Doing craniosacral work on babies is a beautiful thing. A human will never again be as fluid and unrestricted as when he or she is first born. Most babies will never need a craniosacral treatment, but caring, intelligent touch is a great way to welcome the baby to our world and provide an additional source of tactile input. On the rare occasion that an infant does have a restriction, the sooner it is addressed, the better. If caught early, these restrictions are usually easily released and allow for a fuller development of the child at its most formative time. If not addressed, these restrictions can potentially follow the child into adulthood, creating issues that may be minor, but can take their toll over the years.
The areas I outlined above are by no means the only areas I address on an infant, but they are the areas that I take particular care to check because of the negative effects that dysfunction at these regions can have on the development of the newborn. One of the most memorable infants I worked on was a 2-month-old who had stopped gaining weight, was below 10 percent on the growth charts, and had chronic colicky symptoms. I saw the child once, addressing all the regions that I discussed in this article. I received a follow-up call from the mother a month later, reporting that her child had shot up in the growth charts (past the 70th percentile), was feeding well, and had a remarkable decrease in colic.
This work isn’t magic; it’s simply well-applied bodywork based on anatomical knowledge. Tuning into the rhythm of a newborn is a wonderful experience, presenting a full, fluid motion one will rarely feel in adults. If done right, one may be giving a brand-new human a great start in life, and save him or her from unknown dysfunctions that might have made life so much harder.