KiSS Syndrom

KiSS syndrom affects new-born babies.  KiSS is  the abbreviation   of   Kopfgelenk   Induziert   Symetrie   Storungen  which can be  translated by induced symetry  troubles  of cervical vertebra.


This syndrome, very little known in France, leaves parents alone to cope with their child’s trouble.

KiSS syndrom affects new-born babies. KiSS is the abbreviation for Kopfgelenk Induziert Symetrie Storungen which can be translated by induced symmetry troubles of cervical vertebra.« KiSS kinder» are children who display symmetry disturbances induced by the cranio cervical junction articulations (attitude in inclination and fixed hyperextention). These children can be affected by nervous and/or digestive troubles.

This syndrom is currently little known by health practitioners, and wrongly confused with congenital torticollis ( stiff neck) plagiocephaly or congenital assymmetrical pelvis.

The existence of a precise definition of the pathologies mentioned above permits in the first stage to point out the distinctive features of KiSS syndrome.

It is while performing an osteopathic treatment of a clinical case that we came to discover this syndrome

An epistemological survey among French doctors, mid-wives, physiotherapists and osteopaths reveals that it is not an orphan case. However, the poor knowledge of its diagnosis leaves little chance for proper medical care.

This survey points out at an evidence : early intervention is essential for treatment of KiSS Kinder

A. MAGOUN (1951)

Unfortunately,things haven’t changed since 1951 when Magoun already wrote :

« A brain trouble, which is not fatal, is not really taken into consideration in the medical world. A perinatal accident, which seems to be insignificant or difficult to diagnose if we only take into account the medical check-up, can provoke a minimal injury of the brain which can lead to more severe problems later on during the growth.

There are several difficulties during evaluation of these minor brain troubles. The lack of knowledge of the neurological development, the story of childbirth so often incomplete, especially if the mother has undergone anesthesia, and in case of lack of adequate neurological examination of the baby ».

« Mother nature has done a perfect job. If one restores a body in a perfect manner by reestablishing the balance of its structures, food and rest are only necessary to help nature complete the work.»

Andrew-Taylor STILL

Our study :

For the last three years todate, we have been treating children suffering from KiSS syndrom .

It all started from a case met at Dr Serge Larcher’s clinic (a general practitioner and osteopath) in Saint-Brice Sous-Forêt 95.

I was then a student, but he found it interesting to make me share the discovery of a clinical case of one of his patients.

Thus, I had the opportunity to meet the child we shall name MARIE to preserve anonymity.

Marie was 4 months old then and had the following attitude :

  • Extension of the head, rotation to the right, inclination to the left
  • Exension in the shape of a » C » of    the rachis
  • Assymetry  of pelvis
  • Impossibility of  making hands  join

After several unconclusive results with different health practitioners, Marie’s parents eventually decided to turn to osteopethy.

KiSS KINDER MAIN SYMPTOMS :

Type I : (Lateral inclination)

  • Torticolis
  • Face and skull dissymetry
  • Rachis fixation in lateral inclination
  • Pelvis asymetry
  • Asymetric use of the upper and lower
  • Delayed maturation of joints

Type II : Opisthotonos

  • Head in fixed hyperextension
  • Flat back of head
  • Uplifted shoulders
  • Upper limbs flexion upduction (plane posture)
  • Difficult dorsal decubitus
  • Weakeness of the mouth, salivation
  • Unilateral dysfunction
  • Cold and sweaty limbs extremeties

MANAGEMENT OF KiSS SYNDROM MEDICAL CARE

Ex-ray of cervical rachis and pelvis

The first step is to obtain x-rays of these children’s cervical rachis and pelvis.

The x-rays do not lead to diagnosis of KiSS Syndrom but aim at a diagnosis differential

First and foremost, exclusion of any form of pathology contraindicating recourse to manipulation is essential before treatment

Questionnaire to be filled in by parents

The second part consists in having parents fill in a questionnaire. This questionnaire helps us plan treatment  of the child as precisely as possible and find out similarities between different cases.

Planning of three sessions close to each other (15 day)

The first session consists in getting acquainted with the child, diagnose KiSS Syndrom and start C0/C1 osteopathic treatment (with medical certificate according to decree no 2007-435,25 march 2007 on acts and exercise conditions of osteopathy) then start four-handed cranio-sacral therapy ( 2 osteopaths) and liberate diaphragm.

Then follow-up of patient (varies according to cases )

It is unfortunate to realize that the story of these children is always similar. The distress of parents is great, the response of health professionals inadequate

Marie’s parents made us discover KiSS Syndrom, which they had    themselves    discovered    through    internet   research.

This syndrom, very little known as it is often wrongly confused with congenital torticolis (stiff neck) itself generally defined as a shortness of the sterno-cleido-occipito mastoidian (SCOM) which is accompanied by rotation of opposite side and lateral inclination towards the shortened muscle. [1]

In adequation with osteopathic concept, Sutherland used the following metaphore, alluding to an English saying “as the twig is bent,so is the tree inclined”. [2]. So we understand the importance of an early osteopathic care of these children.

Subluxation C0/C1, a hypothesis to explain adaptative mechanism of KiSS.

The ligaments and muscles of sub-occipital region are under stress, which generates a muscular spasm.

The cranio-cervical junction is impacted.

When the skull is in dysfunction, centre of gravity is modified. There will be negative effects on the neurological and vascular structures at the base of skull and neck. More particularly, structures next to  muscles are under stress.

Vertebral arteries and cervical nerves stick up from the posterior part of the occipito-atlantoidian ligament. It is likely that this ligament and others account for irritation of the neuro-muscular system in the case of KiSS Syndrom.

Likewise, sub-occipital ligaments, erector muscles of rachis, small and long obliques,sterno-cleido-mastoidian, scapula elevation, trapezius muscles, scalene (in particular fore-scalenes) are involved.

Due to inclination of skull, and tension s of cervical rachis muscles, pelvis will position itself on one side to compensate body structure.

By pulling on one side of the spine, pelvis will incline it, generating contraction of muscles on one side and creating opisthotonos.

The so-called subluxation of the hip may be the result of it.

The corrective technique of KiSS entrails normalization of subluxation of C0/C1, which equally harmonizes the adaptation phenomena quoted above.

The reharmonization process after correction of atlas subluxation must include stabilization of all the muscles.

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Benefit of 4- handed osteopathic treatment

Pierre TRICOT in his article entitled “Osteopathy in the service of children with disabilities” written with a view to informing new parents at the EHEO (13) association, explains why  it  is  interesting  to  have  several  practitioners    apply treatment. [15]:

“Treatment by several practitioners is of great interest because each part of the body is a communication channel with the outside (if only through the skin). Thus, each part of the body is a potential entry route for osteopathic treatment. And, as all parts communicate with each other, a change obtained in one part of the body brings about changes in the whole body.

Treatment by several practitioners permits not only to detect anomalies in the tissue-life of several parts of the body, but also to simultaneously liberate them. This method also permits to perceive changes taking place in different parts of the patient’s body when a problem area is liberated. In this way the body can be helped to adapt to the change.

For all these reasons, treatment by several practitioners enables to go much farther and often much faster in the work of in-depth liberation an adaptation. This is particularly important for patients with big tissue problems which is the case of children with disabilities”.

Epistemological survey among health professionals

First of all, it is important to investigate Marie’s case and see if it is isolated, or if it is regularly met in doctors’  offices. To do so, we have carried out an epidemiological investigation with different health practitioners likely  to have met this type of problem, namely: mid-wives, medical doctors (gynecologists, obstetricians, pediatricians, general practitioners), osteopaths and physiotherapists. This means, in France, 198.913 professionals likely to have been faced with KiSS Syndrom cases.

So, more than 2.800 mails (chosen among random sample of health practitioners) were sent between September 28, 2011, to october  28, 2011.

The aim of this survey was a better insight into a health problem within a population, but also an evaluation of an adequate health care.

TESTIMONY FROM A MOTHER

Today our child is 2 years old and had KiSS Syndrom

As young parents, we did not panic early enough for lack of orientation and information by doctors. And yet we had told them there was a problem.

Induced delivery was very long and difficult (foetal distress, septicaemia, abnormal intrauterine position), caesarian delivery should have been applied.

When about 18 months old, my daughter started saying “mummy it hurts…back”. This has really been the trigger.

She started walking when she was 13 months old, and nevertheless, fell dow n regularly. She always walked, her arms and elbows stuck to her body and inclined to the rear, she felt the ground before walking to avoid falling and had balance problems and head-aches, which she started telling when about 20 months old.

She uttered cries at night while sleeping whenever she changed position and every time we sat her on her child car-seat.

As for food, it was hell, she could not swallow a single morel, she turned red and could not keep the food.

All attemps at allopathic, physiotherapic or osteopathic treatment proved unsuccessful.

We were told that our child was hyperactive (she could not sit still, could not focus her attention on anything). I understood later that it was not a question of hyperactivity, but the effect of her body aches and discomfort which she was desperately trying to minimize.

After noting all these problems and getting no answer in spite of all my attempts at pointing them out to my daughter’s pediatrician, physiotherapist and osteopath, I happened to come upon the dissertation written by Soizic Carron de la Carrière. I sent her a message and she responded immediately.

At last we had fallen on the right people, Soizic Carron de la Carrière and Doctor Larcher. My husband and I went up to Paris in spite of some questioning. Today, I regret nothing and if I had to do it again, I would run.

To day, our daughter no longer falls down, she does not complain of pains, has no longer any digestive problem. She is now sociable. It is a radical change.

I am sorry to realize that this syndrome is so little known, and leaves us, parents, in great anguish. I hope that the works of Soizic Carron de la Carrière will help make this syndrom better known. Thus, the children concerned and up until now badly directed, will receive early proper care.

Photography of treatment

This survey enabled us to find out that :

Only 10% of the people interviewed have already heard of KiSS Syndrom. Among them : 55% osteopaths, 35% mid- wives and 10% physiotherapists. Osteopaths are the more numerous health practitioners to have heard about KiSS Syndrom. Most of them have come to know it through personal research or post-graduate training.

Yet 28% of them have encountered the case and 16% of them more than five times.

But, if nothing enables us to assert by 100% that the cases quoted above are actually KiSS Syndroms and not congenital stiff necks, these figures enable us to confirm that KiSS Syndrom is a rare but not orphan syndrome.

Yet, the constant increase of calls to our clinic from parents of children suffering from KiSS Syndrom, confirms the idea that it is necessary and urgent to set up a treatment protocol in France.

Consequently, what sort of treatment can be established for this type of patients?

The survey shows that 3 independent possibilities and/or complementary answer the question.

Osteopathy, physiotherapy and orthopedics.

It is also significant to realize that osteopathy gets the highest rate of favourable response as 100% of midwives efer these children to osteopathy.

Etiologic hypothesis of KiSS syndrom

The study of the 50 cases treated reveals similarities in the mothers’ pregnancy and labour.

Indeed, in 100% of the cases, we have met women with great problems of stress during pregnancy.

We could think of intra-uterine pressure linked to the mothers’ stress, causing pressure on the baby and consequently loss of mobility in-utero of the latter.

Besides, we have also noted that for these children, birth has always been very quick or very long.

Moreover, as we all know that during delivery the baby  moves in spiral in his mother’s womb, most frequently, it is during the rotations or expulsion, or on passage under pubic symphisys that he may have undergone pressure, which may cause a difference in the quality of cervical rotations.

We may also think that quickness or length of child birth may have an influence on cranio-cervical junction.

However, these are hypotheses, as we don’t have the benefit of hindsight yet.

Results

The first results of this study are rather encouraging. Osteospathy seems to bring about a significant improvement of the various troubles (posture, skull, intestine) these KiSS children suffer from. We do hope that the follow up of this work confirms the results, and opens the way to randomized study.

As for legislation and regulatory laws, it is necessary to take into account the law in force (Decree N° 2007-435 of March 25, 2007) on Acts and Conditions of exercise of Osteopath.

Meanwhile, till an evolution in the exercise of our profession, I can see no alternative but a recourse to the medical doctor in charge to obtain certificate

For the syndroms pointed out in this study, we must keep in mind that treatment given at the earliest stage is a must.

Viola Frydman D.O. in the article “ The trauma of birth” published in Osteopaths Annals in May 1976 and translated from American by P. TRICOT, pointed out the importance of early diagnosis and immediate treatment of these troubles in the post- birth period, as the most important part of preventive medicine.

This concept is particularly valid for KiSS Syndrom.

Legislation

As the object of this study concerns treatment of children under 6 months it is important to keep in mind the current legislation on ostheopatic treatment of the latter.

In decree no 2007_135 of 25 march 2007 on acts and profession practice conditions of osteopathy it is stipulated in Ch 1 : Authorised acts , article 3 par II that :

After diagnosis established by a doctor stating that there is no medical contraindication to treatment by osteopathy, the practitioner holding a degree and registered as an osteopath Is authorised to perform the following acts :

  • Manipulation of skull, face and rachis of a baby less than 6 months old
  • Manipulation of cervical rachis

In the treatment by osteopathy of cases quoted in this study, Dr Serge Larcher has systematically and beforehand established a certificate of non medical contraindication to osteopathic treatment to be in strict adequation with the legislation in force.

To that ends it seems to me essential to make sure that the symptoms mentioned above be better known by the medical community and osteopaths

The sensibilization of health professionals would permit early identification of these children and orientation towards adapted therapy.

Today, after encounter with about 1000 “KiSS Kinder” I am alarmed at the almost inexistant therapeutic care and the vast number of professionnals involved (doctors, physiotherapists osteopaths) with no answer to the problem.

The distress of parents is great, the loss of confidence in therapists a problem.

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BIBLIOGRAPHY

[1] Roselyne Lalause-Pol, Le Crane Du Nouveau- Né, Sauramps, 02/2009 (2ème Édition)

[2] Sutherland, William Garner. Contributions of Thaught, Rudra Press, Portland, 1971-1998

[3]   Heiner   Biedermann,   Kiss-Kinder, Thienne,

Stuttgart 2001

[4] Legifrance, Décret n°2007-435 du 25 mars 2007 relatif aux actes et aux conditions d’exercice de l’ostéopathie, http://www.legifrance.gouv.fr/affichTexte.do?ci dTexte=LEGITEXT000006055745&dateTexte=20110926#LEGISCTA000006105558,

consulté le 26/09/2011

[8] Harold Ives Magoun Et William Garner Sutherland, Ostéopathie Dans Le Champ Crânien Édition Originale, Sully, 11/2004

[15] Tricot, “L’ostéopathie au service de l’enfant handicapé”, http://www.eheo.org/ osteopathie.html, consulté le 12/10/2011

Photography before/after traitement

© Texte extrait du mémoire de fin d’études n°13 – Institut Dauphine d’Ostéopathie – Présenté et soutenu publiquement lors de la session d’octobre 2012 à Paris.
Le syndrome de KiSS et Traitement des enfants dits « KiSS Kinder »
S.CARRON de la CARRIERE