Friday, December 12, 2008

Pediatric CranioSacral Therapy: An Initial View

By Kailas, LMT, NCTMB, CST, Cert. Ayu. CranioSacral Therapist and Certified Ayurvedic Practitioner in Los Angeles

Pediatric CranioSacral Therapy should ideally begin with a treatment immediately after birth if possible, or shortly thereafter. The protocol for infants under one year is specialized for their stage of physiological development and needs, and includes aspects which are corrective and preventive.

Periodic CranioSacral Therapy sessions can help a growing child overcome adaptive challenges, and assist them to develop an open, relaxed, confident center. Specific disabilities which are often complex, misdiagnosed and overmedicated, can be treated holistically and compassionately through CranioSacral Therapy alone or as part of an integrated program of medical care and therapy along with other modalities, such as sensory integration therapy, music and art therapy, or occupational therapy.

Newborns may be treated successfully in short sessions under ten minutes, while older, more active children are usually treated in a longer session. Children my prefer to have their parent close to them, and the therapist should support the mother and child, or father and child, and if need be, work on them together as part of the process of building trust and ensuring the family connection is integrated into the treatment.

The ability of the therapist to adapt to the child, acknowledging their unique personalities and feelings, and ensuring that one has permission from the child to proceed is fundamental to successful treatment. To a preverbal child, the therapist must bond through silence, using eye contact and gentle motions, staying alert for signs that the child has reached a limit, or wants a change in the treatment or environment. Even with babies, as well as older children, it is important to address them by their name, and inform them intelligently and compassionately who you are, what your purpose is, and what you are going to help them with.

A conducive environment for treating children is a warm and colorful child-safe room which not only gives the toddler or young child room to move and explore, has sufficient and varied toys for different ages, but also includes a support for a variety of treatment options in addition to the treatment table, such as a chair or cozy bean bag. For teen-age children, something that makes the treatment room look cool, such as video game posters, can help them feel more at ease.

Treating Children Under One Year

Newborn and Infant CranioSacral Therapy Protocol

The child can be cradled in your arms or lying on a treatment table, awake or asleep. Support and palpate the sacrum while holding the newborn’s head. Palpate the cranial bones for overlaps and check for asymmetry in the vault or face.

Invite the craniosacral motion and craniosacral fluid to come into your perception, and place a finger into the infant’s mouth. Induce or enhancing the sucking response by sending gentle rhythmic energy and touch through the hard palate in synchrony with the infant’s own craniosacral rhythm. Use your hands to gently enhance the overall craniosacral motion through the body.

If you palpate restriction of the temporals or tentorium, use a direction of energy from one side of the cranium, flowing across the tentorium, while palpating the opposite ear, which will release and unwind. If you palpate anteroposterior restriction of the falxes or compression of the sphenoid, use a direction of energy from the posterior of the cranium, flowing forward to the frontal, to release it. Or lay the child down and using a modified third vault hold, gently decompress the sphenoid using intention alone.

Move the child to a horizontal position, and move your hand from the sacrum cephalad, placing one or two fingers on the back of the neck, very gently stabilizing the vertebrae while using the other hand to decompress the atlanto-occipital joint.

Take the hand from behind the neck, and supporting the infant’s spine, move it caudally to the pelvis while evaluating the spine and tractioning it very gently, until you reach the pelvis. This can be done in an integrated, slightly rocking motion that feels good to the baby.

Lay the child on your lap or on the table and bring both hands to the pelvis. Evaluate, release, and balance the illia. Then move to the shoulders and with both hands, send energy to release and balance the clavicles, glenohumeral joints, thyroid, thymus, heart, lungs and neck.

If you palpate a sense of “directionlessness” or feel that the baby wants to clear their birth experience, gently invert the infant to allow them to experience and integrate gravity. The baby can be positioned to slide through your cradling arms in order to simulate birth, while you provide comfort and love to supporting and nurture their process. It must be clear that the baby must guide this process.

At the end of the session, the child can be cradled or placed in the parent’s arms and may go to sleep. If you have any specific concerns, re-evaluate the baby, for newborns within twenty-four hours, or within three days, if older.

Anatomical Considerations for Newborns and Infants

There are important anatomical considerations with newborns and children under eight years of age which require a therapist to modify their techniques. From birth to the end of the second year the primary osseous structures are still in formation, attaining their full features and proportions from three to eight years of age.

  • To ease passage through the birth canal a baby’s bones, muscles, and tendons are soft and malleable. Soft fibrous membranes, called fontanelles, bridge the gaps between their cranial bones. The frontal, occipital, sphenoidal, and mastoid fontanelles begin to ossify from two months after birth, with the mastoid and frontal fontanelles remaining quite flexible, closing as late as the middle of the second year. The Interdigitated sutures do not form until second year (1), allowing the brain to double in size. Born with 330 bones, the child will eventually possess a skeleton of 206 bones when they mature to adulthood(2).

  • The frontal bone consists of two parts at birth, joined by the metopic suture, which vertically bisects the median forehead and does not close until between the fourth and eighth year as the frontal sinuses continue to develop, attaining proper proportion and maturity between eight years and puberty.

  • The ethmoid consists of the two labyrinths which are not developed fully until after birth. In the first year the perpendicular plate and crista galli ossify and eventually join the labyrinths.

  • The occiput is in four parts at birth and joins between the fourth and sixth year, when the squama and condylar parts ossify.

  • The temporal bones are in three parts at birth, with the petrous and mastoid parts, and the squama, joining during the first year.

  • The sphenoid is also in three parts at birth; the body with the lesser wings, and two lateral segments consisting of a great wing and pterygoid process. The great wings and body of the sphenoid unite with the small wings after the first year. The sphenoidal sinuses remain immature until after puberty.

  • Maxilla is also two parts at birth, with the maxillary sinuses not reaching maturity until after the second dentition. The proportions of the maxilla are subject to radical resizing as the baby grows through both dentitions.

  • The mandible at birth consists of two parts, with a symphysis that becomes a suture in the first year. The entire mandible, especially the alveolar part, changes proportions during dentitions.

  • The parietal bones are generally fully formed at birth, however their edges remain soft until the fontanelles ossify.

  • The vertebrae of a newborn are primarily the same shape, and has only the two kyphotic curves; the lordotic curve being developed during crawling.(3) The spine grows 50% during the infant’s first year.

The CranioSacral Therapist must be aware of these and other physiological and developmental aspects, and tailor their treatment protocol accordingly. It is suggested that the therapist be fully capable of performing the core CranioSacral Therapy techniques on adults, and then proceed to gain experience with children of progressively younger ages before working directly with newborns.

Indications during Pregnancy and Birthing

In addition to congenital, hereditary, and neonatal diseases and abnormalities, circumstances and events during pregnancy and birth can adversely affect the health and wellbeing of a baby. CranioSacral Therapy has been clinically shown to correct many of these adverse health conditions, and to prevent developmental, behavioral, and learning dysfunction as the child grows.

Stress, illness, and toxicity during pregnancy can contribute to craniosacral system dysfunction, such as restrictions of the dura4 and other membranes. Toxicity from cigarettes, alcohol, drugs, diet, medicines, and exposure to household chemicals and electromagnetic smog may also affect the craniosacral system.

The mother’s feelings about an unexpected or unwanted pregnancy, her unresolved birth issues, or her occupational stress can be transmitted chemically and energetically to the developing fetus, and can cause imbalances in the baby’s bioenergy and emotional disposition(5).

CranioSacral Therapy can provide a loving therapeutic release and realignment after birth to clear restrictions of the soft tissue which may have been induced in the womb, promote detoxification through fluid exchange and enhancement of the craniosacral system, and balance bioenergy.

During birth, as the baby traverses the birth canal, it receives a natural full-body massage. The pressure and curvature of the canal stretches and mobilizes its joints and muscles, awakens nocioception and proprioception, and promotes fluid exchange throughout the brain and body. Upon leaving the yoni, it receives a second natural massage as it adjusts to air pressure, light, sound, and contact with its mother.

Any abnormalities which may have been introduced during the birth process, such as the cranial bones overriding each other, or strain due to the baby’s passage, tend to autocorrect in the first ten minutes as the baby’s body adjusts itself in space. However, in many traditional cultures, shortly after delivery, a newborn is washed, oiled, and massaged by midwives, mother, or grandmother, who stretch the spine, align joints and bones, tone the skin, and stimulate the infant’s senses. While this level of natural postpartum care is rare today, a CranioSacral Therapy treatment after birth will correct any cranial bone overrides or birth-induced soft tissue tension which the baby’s body may not have autocorrected.

Overreliance on cesarean section and the use of forceps or vacuum extraction represent other departures from traditional and natural methods of delivery, and may induce dysfunction into the baby’s craniosacral system. The rapid decompression accompanying the puncture of the uterus, and the force of physical pressure induced by instruments or even excessive traction, can produce a variety of abnormalities, including micro-tears and strain patterns in the intracranial meninges, bleeding capillaries, asymmetrical distortions and development, and abnormal flow of fluids in the cranium(6). To correct these imbalances, CranioSacral Therapy is recommended for newborns.

Postpartum CranioSacral Therapy

CranioSacral Therapy can support and reenergize new mothers by improving craniosacral system function, lumbosacral and pelvic mobility, and provide deep relaxation through stillpoint. It can also improve meridian energy flow and decrease trauma where a cesarean or episiotomy was performed, release soft tissues, and through SomatoEmotional Release, help a new mother release issues that came up during the birth. A postpartum CranioSacral Therapy session with the baby can help a mother learn to witness, trust, and enjoy the baby’s own process, improve bonding, and enhance craniosacral system function.

Common Indications for Treatment of Newborns and Infants

  • Acid reflux
  • Colic and irritability
  • Constipation
  • Fetal Alcohol Syndrome
  • Infant feeding or sucking difficulties
  • Infant Sleeping Disorder
  • Irregular head shape, flat spots or bulges, and other asymmetries
  • Maternal drug or cigarette use
  • Strabismus
  • Traumatic delivery, cesarean section, or the use of forceps or vacuum extraction

Treating Children from One to Nine Years

CranioSacral Therapy can be integrated with general pediatric care, and has proven an exceptional method for treating specific childhood illnesses and dysfunctions, including disorders of the brain, nervous system, respiratory system, emotions, and learning development. Injury and stress from athletics, homework, commercialism, and diet can be addressed therapeutically through the craniosacral system.

Modifying the Ten Step Protocol for Children

Children, ages one to nine, can be treated using a modified Ten Step Protocol which takes into account the development of their craniosacral system, bones, and tissues. The general rule is that compression techniques which are often used to exaggerate lesion patterns and induce self-correction should not be used. Instead, the techniques should be focused on decompression, and indirect methods. This is because inducing compression in the softer, malleable craniosacral system of a child has a greater effect than on adults, and can do more damage.

An example of a technique used for adults that should be modified for children is the sphenoidal compression/decompression method. Another type of compression, this time generated by the weight of the client’s own head, is utilized in the decompression of the atlanto-occipital joint. It should be modified so that one or two fingers are used, instead of the “platform” technique of raising the head, which applies too much concentrated force.

Traction techniques should be treated similarly as compression. While a child’s knee joint may be able to withstand hours of bike riding and climbing trees, not all bones, joints, and membranes are that rugged. An example would be the case of temporal bone and tentorial membrane release. In this case, the child’s temporal bones should never be taken out of synchrony, and the “earpull” technique should be directed only laterally, and any posterior compression should be avoided.

Stillpoint is another useful technique for children, but the CV-4 technique should not be used as it compresses the fourth ventricle and occiput. Instead, stillpoints should be gently induced from other locations on the body such as the feet or sacrum.

With children, less is more. Even the subtlest techniques, performed on smaller bodies, have great impact.

Common Indications for Treatment of Children

  • Acid Reflux
  • Asperger’s syndrome
  • Autism
  • Cerebral palsy
  • Chronic middle ear Infections
  • Chronic pain
  • Constipation
  • Developmental delays and learning disabilities
  • Difficult mobility
  • Eczema
  • Emotional problems such as depression and trauma
  • Genetic disorders
  • Headaches
  • Neurological conditions
  • Pickiness and hyper or hyposensitivity
  • Reactivity, touchiness or unpredictability
  • Sensory integration problems

Treating Children from Nine to Sixteen Years

Older children and teenagers may be treated using the adult version of the Ten Step Protocol.


1 Heart of Listening: A Visionary Approach to Craniosacral Work. Milne, Hugh. North Atlantic Books. 1998. Pg. 7.

2 Pediatric Massage Therapy. Sinclair, Marybetts. Lippincott Williams & Wilkins, 2004. Page 34.

3 Infant Carriers and Spinal Stress. Rochelle L. Casses, D.C. at

4 Massage Today. Applications of CranioSacral Therapy in Newborns and Infants, Part I and II. Upledger, John, DO OMM.

5 Craniosacral Therapy for Babies and Children. Piersman, Etienne and Neeto. North Atlantic Books, 2006. Page 80.

6 Massage Today. Applications of CranioSacral Therapy in Newborns and Infants, Part I and II. Upledger, John, DO OMM.