It is recommended that all infants be evaluated for strain patterns especially in the cranium and cervical spine and intervention be undertaken to correct these strain patterns, if needed. Signs of strain, misalignment or fascial “stuckness” include: the infant often seems to want to go into extension (an indication of strain in the occiput), preference for turning or rolling over to one side and atypical head shape. Because the fascia is quite supple in infants and the cranial bones have not yet fused, it is easier and less costly to correct small misalignments before they compound over time and possibly contribute to structural problems, learning disabilities, sensory disorders, and disrupted attachment. Ideally, all babies would be evaluated and minor adjustments undertaken so that they might move through the world optimally and with ease as they grow and develop.

What causes strain patterns in infants? The birth process in combination with genetics, fetal lay (positioning within the uterus), sleeping in car seats and other aspects of daily living can lead to strain patterns in infants. While suckling and crying are two of the ways the infant body naturally remodels the cranial bones to help alleviate any residual asymmetries in the skull, stress from birth or residual strain/misalignment may overwhelm the baby’s ability to self correct. It then becomes the therapists job to assist the child back into balance/alignment.

The process of giving birth – even the most ideal birth scenario possible – puts a great deal of strain on the head and neck of the newborn. During a vaginal delivery the vault of the cranium goes through significant molding. At the time of birth, the baby’s cranium is composed primarily of fluid and membrane with the bones of the cranium like little islands that will fuse as the child develops. This helps protect the cranial joints from significant displacement during birth. During the birth process, strong compression and decompression forces may move the cranial bones and if, instead of moving back into position, they get stuck, nerves or blood vessels may be impinged upon. The most vulnerable spot is the base of the skull (the cranial base/occiput) because nerves and blood vessels go in and out of the skull from here. Infants whose births required obstetrical interventions such as C-sections, vacuum extraction or use of forceps – all of which can result in displacement of cranial bones, membranes and cranial nerves – are at particular risk for strain patterns.  C-section babies often have overly stiff crania and palates due to the process of going from a high-pressure to a low-pressure environment without the molding process, which takes place in the birth canal. Emergency C-section births, especially those that occur after a vaginal delivery is attempted, have the greatest potential for resultant misalignments because the infant goes through the early stages of compression and molding and then abruptly, in the reverse direction, experiences strong forces of extraction. Overall, I would recomend evaluating for strain patterns and intervening if needed is recommended for all infants and it is particularly recommended for infants who’ve had obstetric interventions such as C-sections.