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Briefing: infant orofacial conditions

Infant orofacial conditions such as tongue tie are complex and require interdisciplinary care. Osteopaths working with infants and their caregivers manage the neuromusculoskeletal implications of orofacial conditions for the neck, head, back and posture. This practice briefing for health stakeholders describes good practice in osteopathic management of orofacial conditions, other health professional groups osteopaths work with for management, and practice advice Osteopathy Australia offers its members working in the field to promote infant health and development.

Why do we need a briefing on infant orofacial conditions?

An orofacial condition is a clinical presentation affecting use of muscle groups in the face, head, upper neck, or throat essential for feeding and speech development, including the tongue (e.g. tongue tie or ankyloglossia). Some osteopaths offer neuromusculoskeletal interventions for jaw gape, jaw muscle use, range of motion, and muscle conditioning in babies and infants with orofacial conditions.

Osteopathy Australia is committed to creating practice briefings to help the profession and external health stakeholders - other health organisations, practitioners, or case managers, to understand the parameters of good practice in osteopathy.

Osteopathy Australia acknowledges the complexity of care in orofacial paediatric practice, as well as differing levels of practice skill in this area within osteopathy. It aims to promote high quality care for this patient group given their vulnerability, and the strong overlap between orofacial structures, feeding ability and nutrition intake, as well as to promote healthy outcomes during this crucial stage of human development.

Osteopathy Australia's position

Osteopathy is a government regulated, university trained, allied health profession in Australia; osteopaths have a neuromusculoskeletal scope of practice and are also trained in general primary care management.

A neuromusculoskeletal scope of practice focuses upon how muscles, ligaments, tendons, bones, joints and nerves, the circulatory system, and all biomechanical components of the body work together to influence physical function, movement, and capacity for daily activities. In addition, primary care management requires osteopaths to have knowledge of indicators of physiological risk beyond the neuromusculoskeletal system for onward referral.

Osteopaths applying biomechanical reasoning in supporting babies and infants with an orofacial condition and their caregivers perform important roles. These osteopaths manage the neuromusculoskeletal contributors to, and impacts of, such conditions for the jaw muscles, neck, head and back; these osteopaths manage the interconnected regional neuromusculoskeletal impacts. They may assess for issues needing further investigation specific to the temporomandibular joint, gape opening, tongue range of motion, neck movement and broader muscle recruitment groups supporting the neck, face and jaw. The osteopath may where indicated, apply manual therapy techniques for baby or infant orofacial muscle function and jaw motion, or to support the diaphragm, larynx, nerve function, and blood supply.

Some clinical evidence suggests manual therapy may assist in strengthening jaw muscles and jaw muscle coordination in some babies and infants with orofacial conditions or dysfunctions, although more scientific studies are needed to confirm the level of treatment effect and its significance.i

For a caregiver, an osteopath may provide education on the interface between orofacial conditions, muscle recruitment groups and muscle strength. An osteopath may also offer clinical ergonomic or postural advice, and/or prescribe equipment and clinical exercises. Clinical interventions aim to aid neuromusculoskeletal health, prevent injuries and compensatory movement patterns that can be sustained in feeding or caring for babies and infants with an orofacial condition or dysfunction.

Osteopathy Australia encourages its members to consider their individual training, practice experience, clinical focus, clinical scope and level of professional skill whenever offering neuromusculoskeletal assessments and interventions to babies and infants with an orofacial condition or their caregivers. Sound, risk managed quality practice is underpinned by:

  • Up to date knowledge of orofacial conditions in the early years, general clinical indicators, and health professions involved in further first-line investigation, differential diagnosis, and management in keeping with sound interdisciplinary practice

  • Up to date knowledge of normal development milestones and indicators of clinical risk in babies and infants, including indicators of broader physiological or system risk requiring immediate outbound referral

  • Sound awareness of evidence informed and age-appropriate manual therapy techniques, movement and exercise-based approaches, as well as their relative and absolute contraindicators for babies and infants with orofacial conditions

  • Ongoing reflective practice experience, and the integration of practice-based reflective learning into care approaches

  • Sound awareness of clinical issues in orofacial management beyond the neuromusculoskeletal scope of osteopathic practice, for which referral for input or advice is most appropriately sought from another health or care professional.

Quality clinical management involves osteopaths working seamlessly in communication with other health and care professionals acting within their scopes of practice. Other health professionals include, but are not limited to: medical practitioners (general and paediatrics), maternal, child and family health nurses, International Board-Certified Lactation Consultants (IBCLC), Australian Breast Feeding Association breast-feeding counsellors, speech pathologists and paediatric dental practitioners.

Osteopathy Australia acknowledges that surgical interventions for orofacial conditions are complex and should be determined by professionals appropriately trained or specialised in this area.ii

Osteopathy Australia strongly encourages its members to coordinate with other health professionals for clinical issues including:

In the baby/infant:

  • Latching or sucking difficulties

  • Inadequate milk transfers (not enough wet or soiled nappies)

  • Inadequate weight gains within the first two weeks and beyond

  • Weight loss

  • Differential diagnosis and first-line management of suspected tongue ties (ankyloglossia)

  • Complex/serious health concerns (red flags)

In the caregiver:

  • Breast feeding quality or technique

  • Biopsychosocial factors impacting breast feeding quality

  • Nipple damage or shape variation concerns

  • Breast pain

  • Milk flow issues

Note: some osteopaths hold a second qualification specific to orofacial or feeding dysfunctions in the early years and are dual qualified or registered. The clinical roles of these osteopaths may expand upon or beyond themes in this practice briefing.

Authorisation

This practice briefing was informed by a peer consultative process involving Osteopathy Australia’s titled Advanced Paediatric Osteopaths.

Acknowledgements

Osteopathy Australia acknowledges a range of organisations for offering feedback for this position, including the Australian Breast Feeding Association (ABA), Lactation Consultants of Australia and New Zealand (LCANZ) and Speech Pathology Australia (SPA). These organisations were consulted for their knowledge of orofacial conditions and their management for infants and their caregivers. Please note that the consultation of and acknowledgement of these organisations is not intended to imply any organisational “endorsement” of this practice briefing.

Review

This practice briefing was developed in 2022. It is to be reviewed in 2026, or as often as required to reflect emerging clinical evidence, practice issues or regulatory requirements.

Related positions

Australian Dental Association, ‘Ankyloglossia and Oral Frena Consensus Statement’, Version 1, 2020

Osteopathy Australia, ‘Osteopathic clinical management for babies, infants, and children’

Osteopathy Australia, ‘Osteopaths, children and the wider healthcare system’

References

i Herzhaft-Le Roy & Xhignesse, ‘Efficacy of an Osteopathic Treatment Coupled With Lactation Consultations for Infants’ Biomechanical Sucking Difficulties: A Randomized Controlled Trial’, Journal of Human Lactation, 2017 Feb;33(1):165-172

ii Australian Dental Association (2020), Ankyloglossia and Oral Frena Consensus Statement, Version 1

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