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ATNR Cerebral Palsy or Laryngomalacia


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ATNR Reflex and Cerebral Palsy or Laryngomalacia

A missed or over-looked diagnosis of compromised breathing.
I get at least two inquires / Zooms a week looking to help 'head control' 'over-active ATNR' 'dystonia'.
This is because of structural airway positioning; quite possibly laryngomalacia.

Laryngomalacia Symptoms Infants and Children include:

  • Noisy breathing (stridor) — An audible wheeze when your baby inhales (breathes in). It is often worse when the baby is agitated, feeding, crying or sleeping on his back.
  • High pitched sound
  • Difficulty feeding
  • Poor weight gain
  • Choking while feeding
  • Apnea (breathing stoppage)
  • Pulling in neck and chest with each breath
  • Cyanosis (turning blue)
  • Gastroesophageal reflux (spitting, vomiting and regurgitation)
  • Aspiration (inhalation of food into the lungs)
This is why the frustrations of working with reflex therapies are not necessarily beneficial.
You need to work very closely with a specialist, ENT, who performs a non-sedated nasopharyngolaryngoscopy (NPL).
They will also be looking for paralysis due to intubation, and other possible structural issues.
When the structural issues have been identified - you then need to work very closely with a movement specialist because it affects all aspects of development.
"My daughter had Laryngomalacia. It is often overlooked and I had to push very hard to get a scope to diagnose mild/moderate Laryngomalacia. It affected her head control and core strength which affected all of her gross motor milestones and caused feeding problems. The first sign was “stridor” at 6 weeks." - Helen I. 

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Video Transcript

ATNR Cerebral Palsy or Laryngomalacia?

Just because you see a child that looks like they’re in “ATNR”; if they have cerebral palsy, most likely they have some kind of paralysis around the vocal cords, larynx, or a Laryngomalacia, which is the flaps that are too thick or too overgrown. 

So what happens is when a child has compromised windpipes larynx, whatever it is, what they will do, we will see the elbow cross midline, and the head is here.  

So I'm going to do it in both positions.   

The elbow, if you do it yourself, cross your midline on your elbow in wrench your neck. 

That is the most room you're going to get out of an esophagus. 

OK, it is not dystonic CP. 

This is not ATNR. 

This is “I can't breathe” and this is the only position that I have. 

But really, for the most part, when you're seeing that elbow here; this is [gasping] also too. 

You should not hear a child breathe.  

This kind of child is a snarphaly. 


And you’ll have a lot of respiratory issues going on and that's what's going on. 

It is not an ATNR.  

So the first thing that needs to be done is, I prefer, an ear, nose and throat scope, an ENT. 

They go in. 

Again, is there a paralysis? 

That's a different story than Laryngomalacia.  

But there's something going on with the cords, and it has to be identified, because again too if you put the child vertical with the head brace and everything, you're fighting against the breathing.  

So what you were doing is when you're fighting against the breathing (breathing, balance, and heart function come first [for functional movement]), so when you're trying to [address the problem with ATNR exercises], you're messing with their language, which is, “I can't breathe.” 

So when [ATNR Cerebral Palsy has been misdiagnosed, again], your trying to put them in a position where they're going to say, “I can't breathe, I'm going to breathe.”  

And so again, you'll start saying, “That ATNR it’s horrible,” and keep working with it.  

It's not ATNR.  

So second of all, we need to identify where the structural issues are.   

Can it be fixed by surgery?  

In a lot of cases, if it's Laryngomalacia, yes, they can go in and trim the flap and so forth, but again, for the older children it's a little bit harder. 

What you need to start doing is very specific lessons.  

'Cause I can guarantee you, 5 bucks, you put that head midline and [immediately your child goes into what you call “ATNR” when it’s not. Your child is panicking and wants to breathe]. 

And also, it’s not that they, can’t breathe, they might have grown out of the Laryngomalacia, or the paralysis is not as bad now that they're older, but their brain is saying, “If I go midline or I go to the other side, I can't breathe.” 

And they will protect the breathing first, and when they're protecting the breathing the brain can't learn. 

So in other words, like if I'm dunking you out of water, I can't say, “Let's learn Russian while we're doing this.” 

I also wouldn't do a pillow because you're going to restrict the airway. 

[On average], I literally identify three kids a week that just can't breathe, and they've been just diagnosed as dystonic CP. 

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