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Rationale and Methods of Cranial Treatment for Children with Down Syndrome
During interviews with parents, I discovered that many of these children with Down syndrome had a position preference during their sleeping or lying quietly. I consistently found an oblique pattern in these children's skulls and pelvises. It should not be surprising that this produces motor difficulties when we realize that an asymmetric cerebellum develops under these circumstances, as well as an asymmetric tentorial notch with the consequent altered stresses throughout the brain. Such a mechanism would be prone to middle ear infections with the slightest incitement and to eyes with a very difficult time in both movement and appearance. Motor function throughout the body (near and far pointing, balance, motor integration, and coordination) will remain disturbed until this factor is improved. Later in life, headaches might be a frequent problem.

The condition of the baby or infant can also provide evidence of the health of its nervous system. I found the following in these children's histories:

• Vomiting or spitting up after feeding
• Gastrointestinal difficulties
• An arched back or a throwing back of the head when the baby is held on his side or suspended by his ankles
• Asymmetrical motion of arms or legs; failure of cross-crawl pattern development with resulting neurological disorganization
• Mixed dominance of ears, eyes, hands, legs, feet
• Spells of ceaseless crying
• Lack of sequence or missing stages in motor development going from rolling over, crawling flat on the floor, creeping on hands and knees, cruising around furniture, and walking
• Perceptual dysfunctions that interfere with visual and auditory skills
• Frequent ear infections and sinusitis that have previously required frequent antibiotic medical treatment

Any of these signs in the child suggest that some areas of the central nervous system have been compromised. Cerebellar and brainstem disturbances are frequently found with motor or sensory impairment problems, slow development, hypotonia, and movement asymmetries. Problems with spitting up or vomiting after birth indicate the vagus or hypoglossal nerves and entrapments at the jugular foramen. All these signs indicate problems in the occipital area.

For most of this century, manipulative physicians have emphasized the importance of the cerebellum and have sought to discover ways of diagnosing dysfunction in this critical brain area. The relationship of the tension, rhythmic movement, and symmetry of the leaves of the tentorium cerebelli has been at the top of this list for structural faults contributing to cerebellar troubles. The lack of motor development, the difficulty in gaining an upright posture, and the poor or delayed development of fine motor skills seen in children with Down syndrome may all be related to cerebellar dysfunctions.

The use of force employed during cranial treatments must be understood very clearly. Sensitivity in working with a delicate and already impaired mechanism is crucial. The forces applied during these corrections are slight, but prolonged, giving the meningeal mechanism and the sutural misplacements a chance to "rebound" and "reset" their tensions. Especially with disturbances around the foramen magnum and the condylar parts, definite precautions must be taken not to push the condylar part(s) inward or toward the midline where the neurological irritation already exists. We should also remember that cranial challenge and treatment forces should be carried away from, rarely toward, foramina or fontanels. This is crucial if we are to avoid further crowding of the neurological tissues and membranes, thus inviting iatrogenic effects.

As part of the process of getting acquainted with these children, I always speak in a friendly, gentle voice with the child. I look them "in the left eye" and interact with them as gently and reassuringly as I can. I let them hold onto my fingers or give me a hug if they wish to do this before we begin. Occasionally, a child may cry, and if he does not begin to relax with treatment, I let him "regroup" in either his parents arms or my own. Then we work with him again…he usually permits this.

I take my time while letting the child get used to the treatment rooms, the tables, and me. Still in the process of getting acquainted I run my fingers over the various joints between the bones of the head to find out whether there is overlapping of any of the bones, any hardness or irregularity, whether one is pushed up against the other, and also whether there is any asymmetry of the head, any imbalance in the structure of the bones of the head.

Often, these children will reach out to touch me, taking comfort from the feel of my fingers or hands softly working on their head and neck. Sometimes they will draw strength and comfort from me, as I do from them during the work. The children almost always look into my eyes searching for comfort and assurance there, seeing whatever distance and space and warmth and affection they can find in them. Usually, these babies are so open and impressionable that I can get them smiling and often laughing just by winking and smiling at them in the right way.

Sometimes during the examination of these babies, in order to keep "the little adult" quiet and happy, I let them nurse or suck on a bottle while being treated. Occasionally, no matter what I do, the child will throw a fit and cry during the corrections. This crying, which increases the intracranial pressures in the baby's head and spinal canal, is frequently helpful and increases the speed with which the corrections can be made.

Decompression of the sutures is a frequent part of the treatment of these children, and the sutures that were compressed were palpably released. Frequently, I was able to demonstrate an obvious sutural ridge in a compression sutural fault to the parents. The parent would touch the ridge, I would decompress the suture, and they would feel the ridge once more to find it improved, smoother, and more resilient to pressure.

Treatment of the newborn infant in its first year of life does not require more than a few minutes, as a rule, but observation during the treatment must be very alert. Be sure the touch to the head is always very light and watch closely for reactions in the face, eyes, hands, and feet.

With experience, you learn to become aware of emotional changes in these infants, and this too will aid in our evaluation of progress. In treating brain conditions in all ages, whether infants, children, or adults, as physiologic progress is made, effort and imagination must be exercised to encourage the patients to put their new capabilities to work. No progress thrives as much as the progress that is put to work.

Case Reports

Case 1: J was 20 months old on first examination. He was delivered by C-section five weeks premature with a breech presentation and was hospitalized for six months after birth. He was on oxygen for the first 14 months of his life. He had difficulty crawling and usually had his head down. His pelvis was usually up when he crawled, and he scuttled about on the floor. On examination, the neck and pelvic muscles were hypotonic. The left occipital squama was posteriorly rotated, with a ridge (sutural compression) along the left temporo-parietal suture. The left temporal bone was drawn into external rotation, with a noticeable posterior rotation of the thoracic vertebrae on the same side. Treatment to the entire cranium was given. J wanted to stand for the first time in his life after the first treatment. His energy was up, and he was moving about happily. After three visits, J was able to crawl normally and was standing. He was also making more gestures with his hands and interpreting information better. He was using both hands well. He had one eye socket that was quite narrow originally, and this eye became balanced with the one opposite. Cataplex C® (from Standard Process Labs) was effective for the irritation, redness, and chapping of J's cheeks. J has been seen seven times, at three-month intervals presently. His sister has become a patient.

Case 2: D was 18 months old. He was on oxygen for the first ten months of his life. He had no independent movement of the right and left limbs; he always moved both of them together. He had nightmares. On examination, he was found to have nasal congestion and difficulty breathing. The left occipital squama was anteriorly rotated, with a slight exaggeration of the parietal horn on the same side. The right occipitomastoid suture was prominent and posteriorly rotated. The suboccipital musculature was hypertonic on the left and right. Release of the right occipitomastoid suture was accomplished on the first visit. Upper thoracic fixations were corrected with a hand-held instrument. Sacral decompression was performed. The neurolymphatic reflexes for the lungs were active and treated. D began to use his arms and legs better unilaterally. He also began getting off his knees by pulling himself up onto the sofa for the first time. After two visits, he was using his left hand and foot independently and well. He was also more verbal, had no more nightmares, and his tongue thrusting was improved. He continues trying to stand. His father (an inspector who notices everything) has mentioned that the angulation and growth of D's teeth have improved since coming in for treatment. Cataplex C® supplementation removed the cracking of the skin on the back of D's hands and cheeks. D has been seen four times and is seen once every two months presently. His father has become a patient.

Case 3: H was 27 months old. He was put on oxygen at birth. He was born with patent ductus arteriosis. He had heart surgery shortly after birth. An atrial septal defect was still present. He had hearing aids in both ears. A diagnosis of both ears being occluded with Candida Albicans was given, and oral thrush was present. When he was five months old, H had infantile spasms for six weeks; this was a seizure-like activity that occurred two weeks after a DPT vaccine had been given. He was put on Depacote and Prednisone, which stopped the seizures, but the seizures or the medication caused the "infantile regression." He went back to a state of almost complete catatonia. He was not yet walking when he was brought in for treatment. His motor and social skills were delayed. His right eye deviated down and inward; he wore glasses. H was overactive and didn't sleep well at night. However, his energy level was relatively low. On examination, a right lateral sphenoid strain was present, as well as a right temporal bulge cranial fault. There was peaking of the mid-portion of each frontal bone, especially present on the right. The right occipital squama was posterior. Parietal external rotation was present on both sides, and these were both improved after the first treatment session. Zygomatico-facial sutural restrictions were found and mobilized. Sinus congestion was present in both nostrils. Fourth ventricle mobilization was given for some time. A slight superior inclination of the left eye was leveled by the sphenoid strain correction. The frontal and zygomatic bones on the left were also released, improving the shape of the orbital cavity and the integration of cranial nerves III, IV, and VI, which improved convergence of the eyes. An anterior atlas was found, and corrected by occipito-atlantal decompression. After the first visit, H began to push up to move and stand. After ten sessions, H was using his upper body as well as his lower and is able to climb stairs and stand. His skin breakdown problems responded well to Calcium lactate and Cataplex F® (S.P.) supplementation. His mother and father have become patients.

A copy of the letter his mother wrote for the Down Syndrome Association's newsletter, Hand in Hand, November 2001, is given below with permission:

"A parent's perspective on her son's experience with chiropractic care and cranial sacral therapy with Dr. Cuthbert…"

I am not in the medical/health care field and do not profess to be an expert on any level. What follows is strictly a parent's perspective on chiropractic care and cranial sacral therapy as my son and my husband and I have experienced…. After speaking with Dr. Cuthbert for quite awhile on the phone and determining that he did indeed have experience in treating children with Down syndrome, I decided to let him see H.

My motivation in wanting H to see a chiropractor was purely for functional reasons, but since the first visit, H's experienced a lot more than just better all-around health. H, like most people with Down syndrome, has unusually small ear canals. So small in fact, that when he was 16 months old, he had one of his ear canals surgically enlarged to allow for air flow (the primary purpose of the surgery was to determine why he was profoundly deaf but that's another story). The main reason I wanted Dr. Cuthbert to see H was to manipulate his head and facial bones in such a way that would allow for a more natural growth process of his eyes, nose, and mouth area and so he wouldn't suffer chronic upper respiratory problems throughout his life. My husband and I had also noticed H's head was, for lack of a better word "lumpy." It just didn't look very round. And so I thought Dr. Cuthbert could perhaps take a look at that and change the shape a little. A third concern of ours was H's chronically dry and chapped skin. I, of course, tried every lotion and potion available, but nothing seemed to really help.

At the initial visit, I was very impressed with the thoroughness of Dr. Cuthbert's questions. He wanted a complete and total medical history of H and asked detailed questions about his development thus far. He also wanted to know about any food preferences or allergies.

As he began working on H (who was totally relaxed and giggling most of the time by the way), Dr. Cuthbert told me that typically after he's worked with a child with Down syndrome a couple of times, they will often begin doing a lot more gross motor activities. If they have favored one side of their bodies or haven't used their arms or legs correctly, they usually will after a few visits. I really didn't think much of that comment, because I wasn't having H see a cranial sacral therapist to "fix" his Down syndrome or for any other superficial reason.

Since our first visit with Dr. Cuthbert last November (2000), H's face has totally cleared up (turns out he was missing a key vitamin involved with digestion). His chronically runny nose has cleared up, and his head is much more appropriately shaped, which for H means the blood is flowing between both sides of his brain much more efficiently. (There are probably a lot more benefits that Dr. Cuthbert could much more expertly explain!) When H first began seeing Dr. Cuthbert at the age of two years and three months, he could sit up and that was about it. He wasn't trying to crawl or bear weight on his legs without A LOT of prompting. Within four weeks of the initial visit, H began crawling up the stairs, began pulling himself to stand against the couch, and he began to bear weight on his shoulders and on his knees in the crawling position. Another big change for H was that he had been prescribed glasses when he turned two but by February of last year, after a couple of months of cranial sacral therapy and chiropractic care, he didn't need them anymore. A few weeks ago at his yearly eye exam, the ophthalmologist said his vision continues to look great and not to worry about glasses in the foreseeable future (no pun intended!!).

Our experience with cranial sacral therapy has been that H's overall health has improved, and his willingness to explore and get around the house has increased. Throughout the cold season of January-April of last year, Dr. Cuthbert was able to give H more relief than the typical "pink stuff" that seems to take up residence in most of our refrigerators!! Having H more healthy and mobile has definitely improved the overall quality of our family life, and I am most happy to encourage other families to research the information and ask Dr. Cuthbert any questions you have.

Case 4: E was 22 months old when I first saw her. E was a "blue baby," born by C-section, and was put on oxygen at birth. She caught colds frequently. She had inversion of the right eye. A left lateral strain of the sphenoid improved this on the first visit. After three visits, E was able to run. Cranial treatment improved E's ability to invert the femurs bilaterally. Her mother and father have become patients.

Case 5: R was 11 months old. He constantly spat up his food. He had middle ear pressure problems, as well as overactivity. He frequently shook his head left to right violently. He ground his eight teeth at night. He had "Mosaicism," and there were not extensive facial anomalies. There is a history of Down syndrome in his father's family. After the first visit, R was able to push up onto his hands and feet, which he was not doing previously. After four visits, he was no longer spitting up his food. His other therapists remarked to his parents that R's coordination was "definitely improving." After six visits, R began to walk. His skin problems were also improved with Cataplex C ® supplementation.

Case 6: C was 20 months old. He was very small. He had several heart defects and was on an oxygen tank on his first visit, because of fluid buildup in his lungs and low oxygen saturation in his blood. He was scheduled for heart surgery 20 days after his first visit with me, but his parents wanted to give chiropractic a try. On his first visit, a definite posterior rotation of the occiput, parietal, and temporal bones on the left side were found. The sphenoid and frontal bone were carried backward also. There was a temporal bulge and mastoid buckling on the left side. After the first treatment, there was better juxtaposition of the right and left occipital squama. The parietal bulge on the left was also much improved compared to the right, and the parietal horns were equidistant from the surface of the table now. Internal rotation of the femurs was balanced with insalivation of Cardiotrophin®, and this was given. After three visits (before his heart surgery), C was using his left hand and pushing himself off the ground with his arms -- these were new abilities for him. His parents noticed that the bridge of C's nose began to gain more prominence. He was also off the oxygen, as he had much better blood saturation with oxygen as measured by his pediatrician after two visits with us. I confirmed this finding in the office, using the TuffSatTM instrument (%SpO₂). (C went from a measurement of 86 to 95 in two weeks under care.) C's exploratory heart surgery revealed an improvement in all the holes originally diagnosed in the lower portion of the heart, but there was still a small opening at the top. The cardiologist told the family that there would be "no need for surgery again for at least five years, if then." Both sides of C's body are being used well at this time.

Case 7: J was three years old. He was on oxygen the first five weeks of his life. He was not yet walking. He crawled on his belly and was unable to stand. Tongue protrusion was very prominent. He had weak lower extremities, and was still in diapers. He was only 25 pounds and 35 inches tall. He occasionally ground his teeth and made intense facial muscle contractures, squeezing his face into a grimace. The occipital squama was posteriorly rotated. The sphenoid was in obvious extension, with a vaulting oral cavity. The masseter was treated for myofascial gelosis with a percussion instrument. Left lateral sphenoid strain was present. The metopic suture was peaked, with internal frontal rotation bilaterally. That evening, immediately after correction, J was crawling around on his hands and knees; before he could only scoot about on his stomach. After four visits, his crawling was improved, and his eyes were following objects better. His mother and brother have become patients.

Case 8: W was 42 months old. His mother has taken training at the Institutes for the Achievement of Human Potential, and she wanted cranial treatment for her son. She noticed the contour and shape of his head were not ideal. The boy's manual dexterity was poor. W had two intestinal surgeries for duodenal atresia, as well as heart surgery. W's energy level was low, and he was a restless sleeper. On initial examination, the right temporal bone was in external rotation, with a left parietal horn. The right side of the cranium was in posterior rotation, but the left occiput was in posterior rotation also. Frontal, occipital, and parietal molding was done, and compression at the bregma was treated. There was improvement in W's eye function after the first visit, and there was better juxtaposition of the squamousal and condylar portions of the occiput. After three visits, W is beginning to speak quite a bit better. He is also more energetic and is beginning to run around for the first time.

Case 9: IA was 45 months old. His mother had first taken him for cranial treatment with Dr. Magoun, an osteopath, in Denver, and this work was helpful. His mother wanted to continue this in Pueblo. IA's walking was impaired; the left side of his body moved more slowly and was not as coordinated as the right. He complained of a painful palate, and numerous allergies. IA occasionally held his neck, complaining of tension there. He also had hearing and visual troubles. He had to use both eyes one at a time to see an object. He first looked at something with his left eye, and then turned his head to see it again with the right eye. Left posterior occipital rotation and a right superior sacrum were found. His first cervical vertebra was corrected with a respiratory assist, as was the third cervical. After the first visit, IA's left arm and leg were working better. After four visits, his left arm and hand were moving very well, with the left and right sides in sync. He was able to use binocular vision properly as well. Both the condylar and squamousal parts of the occiput are now in good juxtaposition. IA has been given eight treatments and has grown over a foot during this period. His mother, father, two sisters, and brother have also become patients.

Case 10: X was 18 months old. He had heart surgery for atrial septal defect five months before I saw him. His left arm and leg were also slower than the right. The left parietal horn was molded into proper position on the first visit, as well as the occipital distortion. After two visits, X was able to pull himself up and stand for the first time.

Case 11: Y was 29 months old. He was not walking. His parents noticed that his low back and gluteal areas had low muscle tone. He was on oxygen for five months. Acid reflux had been a problem for him. There was a breakdown of the skin on his cheeks and legs. On examination, Y had a narrow extension head. Parietal horns were present bilaterally. His feet were subluxated and corrected. A glabellar cranial fault was found, with falx cerebri tension present from its anterior to posterior poles. After the first visit, Y had more confidence when going into a walking mode. His constipation was improved. After three visits, he was using his left and right sides together better and was pushing toys around with more gusto. Cataplex C® improved his cheeks and legs.

Case 12: Z was ten and a half years old. He was not very verbal. There was evident tongue confusion, mixed dominance of the limbs, and poor fine motor skills. Z liked to lie on the floor with his head turned to the same side all the time. He was born with esophageal atresia. He had had four strabismus-related surgeries. The ocular muscles had been cut and resected. Tubes were placed in both ears. I informed his mother that because Z was ten years of age, cranial changes would be more challenging and slower to achieve. Fourth ventricle compression equalized the leg length inequality and leveled the shoulders and head. Myofascial gelosis to the masseter muscle was treated with a percussion instrument. A frontal cranial fault was also found. After three visits, there was improvement in Z's fine motor skills. He was also writing and drawing a little better. There was also improvement in his wandering eye.

All but three of the cases profiled here are still under care. Pelvic and spinal adjustments were always given when indicated in all these cases. The primary focus in the cases described has been upon the cranial aspect, because the improvement of the occipital distortion has proven to be the most important correction in most of these cases. When that was properly corrected, the child began to dramatically improve.

Conclusion
There are encounters in a doctor's life that grant you an intimate vision of your life and calling and offer you a more direct route to the soul of your work. After these encounters, the doctor's soul is not the same as it was before. The child with Down syndrome will reveal a dimension of spiritual and emotional tenderness that are all too often hidden for most of us under the pressures of modern life in our space-age-a-go-go-society. These patients with Down syndrome and their families reconnected me to my calling as a physician. Working with these children made me realize, once again, how much we have to offer other human beings and how much of a difference we can make. The gratitude the physically and mentally challenged can feel for even a little improvement in their state will enrich your practice. What to your normal patients seems of little consequence and is often taken for granted become, to these who wish with all their being to feel and think and move more normally, the greatest gifts of all.

A comprehensive applied kinesiology chiropractic approach with precise, gentle, restorative manipulative treatment has helped these children immeasurably. Their general level of well-being, as well as their neurological integration and functional development, have been significantly improved.

Children who have struggled with distorted functions due to impairments of structure may need training to teach them how to correctly use their reformed mechanism. The tongue thrusting frequently found in children with Down syndrome may need myofunctional therapy. Adjunct therapies, such as vision and auditory training, tutoring, and a well-balanced diet of whole, natural foods with carefully selected supplements will then be far more effective. These essential therapies were not discussed in this paper, because my concern here was not with the chemical environment that surrounds the child's nervous system or the nutrition from which the child builds his nervous system, but with the performance and structure of the neuro-musculo-skeletal system in which and with which the child lives and expresses himself.

Many of the families I have treated this year are able to afford these complementary therapies. The local school districts also have programs with trained personnel to facilitate this kind of training. The various therapists frequently remarked to the parents how much improvement the children began to make after their first few sessions with an applied kinesiology/craniopath chiropractor.

The ability we possess to repair the neurological disorganization in these children – clumsiness, the "floppy baby" phenomenon, sensory and motor disorganization – and then to bring them from labored crawling to normal creeping to standing and walking can be affected rapidly with the proper treatment to the cranial-sacral mechanism. Parents are frequently amazed at the speed with which this happens. Once the cranial mechanism is repaired and begins to move freely, the child becomes a new creature with his or her potentialities greatly improved for normal function. This is why the cranial mechanism must be included in the physically and mentally challenged, because it is in fact the headquarters for all the functions that operate within the child. Parents who we can make understand the importance of this work to the development of their children will refer other children as well as adults to you for care. Fathers, mothers, brothers, and sisters of these children with Down syndrome have become patients and received the benefit of whole body manipulative evaluation and treatment.

Scott C. Cuthbert, BA, BCAO, DC
A native of California, Dr. Scott Cuthbert first attended St. John's College, where he received his BA in the liberal arts. Dr. Scott (as his patients call him) then graduated from the Palmer College of Chiropractic in Davenport, Iowa. He migrated to Ireland and practiced chiropractic on Finn MacCool's gorgeous island for two years. He now practices in Pueblo, Colorado. He came to study the applied kinesiology chiropractic of Dr. George Goodheart in 2000 and found within that study a lifetime's work. Dr. Scott is on the board of directors of the International College of Applied Kinesiology (ICAK-USA) and is chairman of its research committee. He practices at the Chiropractic Health Center in Pueblo, Colorado and can be reached at (719) 544-1468 or via email at cranialdc@hotmail.com. His research can be reviewed at http://www.icakusa.com/.

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