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Osteopathic Manipulative Medicine Use in Pediatric Patients With Pertussis

  • Tami Hendriksz and Stacey Pierce-Talsma
Published/Copyright: February 1, 2019
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 119 Issue 2

OMT Minute: Osteopathic Manipulative Medicine Use in Pediatric Patients With Pertussis

eVideo. Tami Hendriksz, DO, demonstrates the use of osteopathic manipulative treatment—specifically balanced ligamentous tension—to help treat a child with pertussis, or whooping cough.

Pertussis, or whooping cough, is a severe, potentially life-threatening disease caused by the bacteria Bordetella pertussis and is one of the most prevalent vaccine-preventable diseases in the United States.1 The classic presentation of pertussis occurs in unvaccinated children younger than 10 years who develop paroxysms of cough followed by forced inspiratory efforts (a whoop) and posttussive emesis.2 The coughing spells may lead to gagging, apnea, and cyanosis. Older children and adults often experience mild or asymptomatic disease. Continued outbreaks of pertussis may be due to several factors, including lower vaccination rates, waning immunity in previously vaccinated adolescent and adult populations, and genetic changes in the circulating strains of pertussis.3,4

Supportive care is the mainstay of management for pertussis, although antimicrobial treatment with macrolides is recommended early in the course of the disease (within 7 days of the onset) and in high-risk individuals (such as infants and pregnant women).5 Prevention includes postexposure antimicrobial prophylaxis for all household and close contacts and age-appropriate immunization against pertussis.

Symptomatic therapies such as bronchodilators, corticosteroids, antitussive agents, and antihistamines have not proven to be effective for pertussis-related cough.5 Osteopathic manipulative treatment (OMT) offers a potentially useful adjuvant to the traditional supportive care that is provided to patients with pertussis. Understanding the anatomy and neuropathophysiologic process of the cough reflex helps identify key areas that may be evaluated and treated with OMT. The diaphragm may be assessed, as it is the main muscle of respiration and facilitates venous and lymphatic return.6 Diaphragmatic dysfunction can occur as a primary dysfunction or as the result of a dysfunction at or near the diaphragm's attachments, including ribs 6-12, lumbar vertebrae L1-3, and the xiphoid process.7 The cervical spine may also be assessed, as the diaphragm receives its innervation from the phrenic nerve (C3-C5). The occipitoatlantal region (OA) may also be assessed, as vagus nerve afferents and efferents are an integral part of the cough reflex.8 Paroxysms of coughing may lead to somatic dysfunction of any of these listed areas, among others.

The video demonstrates the balanced ligamentous tension technique of the thoracic diaphragm, which is a passive technique and may be used for an infant or child with pertussis.9

Contraindications to this type of assessment and treatment include lower rib or vertebral fractures, as well as malignant neoplasm, open wounds, incisions, or infection in the areas where the physician's hands are placed. Successful treatment should optimize respiratory biomechanics while facilitating venous and lymphatic return.6,7 This technique can be used with patients of all ages with pertussis (and other respiratory illnesses), including newborns and infants, who are the most vulnerable. Assessing and treating the diaphragm in patients with illnesses like pertussis may aid in symptomatic and physiologic improvement.6

From the Touro University College of Osteopathic Medicine-CA in Vallejo.
Financial Disclosures: None reported.
Support: This video was produced by Touro University College of Osteopathic Medicine-CA.

*Address correspondence to Tami Hendriksz, DO, Touro University College of Osteopathic Medicine-CA, 1310 Club Dr, Mare Island, Vallejo, CA 94592-1187. Email:

Acknowledgments

Special thanks to Jeff Reedy for contributions in video production and editing, Lee Ann Cuny, DO, and our model, Vivianna Nuño.

References

1. Mooi FR , Van Der MaasNA, De MelkerHE. Pertussis resurgence: waning immunity and pathogen adaptation—two sides of the same coin. Epidemiol Infect. 2014;142(4):685-694. doi:10.1017/S0950268813000071Search in Google Scholar PubMed

2. Cherry JD , TanT, Wirsingvon König CH, et al. Clinical definitions of pertussis: summary of a Global Pertussis Initiative roundtable meeting, February 2011. Clin Infect Dis. 2012;54(12):1756-1764. doi:10.1093/cid/cis302Search in Google Scholar PubMed PubMed Central

3. Phadke VK , BednarczykRA, SalmonDA, OmerSB. Association between vaccine refusal and vaccine-preventable diseases in the United States: a review of measles and pertussis [published correction appears in JAMA. 2016;315(19):2125].JAMA.2016;315(11):1149-1158. doi:10.1001/jama.2016.1353Search in Google Scholar PubMed PubMed Central

4. Centers for Disease Control and Prevention (CDC). Pertussis epidemic—Washington, 2012. MMWR Morb Mortal Wkly Rep. 2012;61(28):517-522.Search in Google Scholar

5. Kilgore PE , SalimAM, ZervosMJ, SchmittHJ. Pertussis: microbiology, disease, treatment, and prevention. Clin Microbiol Rev.2016;29(3):449-486. doi:10.1128/CMR.00083-15Search in Google Scholar PubMed PubMed Central

6. Bordoni B , MarelliF, MorabitoB, SacconiB. Manual evaluation of the diaphragm muscle. Int J Chron Obstruct Pulmon Dis. 2016;11:1949-1956. doi:10.2147/COPD.S111634Search in Google Scholar PubMed PubMed Central

7. Sergueef N. Cranial Osteopathy for Infants, Children and Adolescents: A Practical Handbook. Churchill Livingston; 2007.Search in Google Scholar

8. Polverino M , PolverinoF, FasolinoM, AndòF, AlfieriA, De BlasioF. Anatomy and neuro-pathophysiology of the cough reflex arc. Multidiscip Respir Med. 2012;7(1):5. doi:10.1186/2049-6958-7-5Search in Google Scholar PubMed PubMed Central

9. Carreiro JE . The spine, rib cage, and sacrum. In: CarreiroJE. Pediatric Manual Medicine: An Osteopathic Approach.Churchill Livingston; 2009:99-154. doi:10.1016/B978-0-443-10308-7.00003-XSearch in Google Scholar
Accepted: 2019-01-08
Published Online: 2019-02-01
Published in Print: 2019-02-01

© 2019 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Articles in the same Issue

  1. SURF
  2. Medical Degree Disparity Among Authors in Obstetrics and Gynecology Journals
  3. OMT MINUTE
  4. Osteopathic Manipulative Medicine Use in Pediatric Patients With Pertussis
  5. HEALTH POLICY
  6. PROSPER or Not? Potential Medical Education Financing Reforms and Impacts
  7. AOA COMMUNICATION
  8. JAOA Peer Reviewers, 2018
  9. ORIGINAL CONTRIBUTION
  10. Assessing Competency in Family Medicine Residents Using the Osteopathic Manipulative Medicine Mini-Clinical Evaluation Exercise
  11. Detemir vs Glargine: Comparison of Inpatient Glycemic Control
  12. BRIEF REPORT
  13. Instrumental Activities of Daily Living, Neuropsychiatric Symptoms, and Neuropsychological Impairment in Mild Cognitive Impairment
  14. REVIEW
  15. Selective Serotonin Reuptake Inhibitor Use and Risk of Gastrointestinal and Intracranial Bleeding
  16. JAOA/AACOM MEDICAL EDUCATION
  17. Incorporating a Standardized Online Professionalism Curriculum in Osteopathic Medical School
  18. SPECIAL COMMUNICATION
  19. Osteopathic Manipulative Treatment for Pertussis in the 19th and 20th Centuries: A Structured Historical Literature Review
  20. CASE REPORT
  21. Rapid Maxillary Expansion and Adenotonsillectomy in 9-Year-Old Twins With Pediatric Obstructive Sleep Apnea Syndrome: An Interdisciplinary Effort
  22. CLINICAL IMAGES
  23. Aortoenteric Fistula
https://doi.org/10.7556/jaoa.2019.021
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. SURF
  2. Medical Degree Disparity Among Authors in Obstetrics and Gynecology Journals
  3. OMT MINUTE
  4. Osteopathic Manipulative Medicine Use in Pediatric Patients With Pertussis
  5. HEALTH POLICY
  6. PROSPER or Not? Potential Medical Education Financing Reforms and Impacts
  7. AOA COMMUNICATION
  8. JAOA Peer Reviewers, 2018
  9. ORIGINAL CONTRIBUTION
  10. Assessing Competency in Family Medicine Residents Using the Osteopathic Manipulative Medicine Mini-Clinical Evaluation Exercise
  11. Detemir vs Glargine: Comparison of Inpatient Glycemic Control
  12. BRIEF REPORT
  13. Instrumental Activities of Daily Living, Neuropsychiatric Symptoms, and Neuropsychological Impairment in Mild Cognitive Impairment
  14. REVIEW
  15. Selective Serotonin Reuptake Inhibitor Use and Risk of Gastrointestinal and Intracranial Bleeding
  16. JAOA/AACOM MEDICAL EDUCATION
  17. Incorporating a Standardized Online Professionalism Curriculum in Osteopathic Medical School
  18. SPECIAL COMMUNICATION
  19. Osteopathic Manipulative Treatment for Pertussis in the 19th and 20th Centuries: A Structured Historical Literature Review
  20. CASE REPORT
  21. Rapid Maxillary Expansion and Adenotonsillectomy in 9-Year-Old Twins With Pediatric Obstructive Sleep Apnea Syndrome: An Interdisciplinary Effort
  22. CLINICAL IMAGES
  23. Aortoenteric Fistula
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