Osteopaths and Breastfeeding: Intraoral Gestures in Pediatrics A Critical, Regulatory, and Ethical Clarification

Osteopaths and Breastfeeding

Commenintraoral approach in childrents on the article: Recommendations for the intraoral approach in children in osteopathy: legal prerequisites, benefits/risks assessment, and hygiene standards. L'Hermite PL, Tavernier P, Wagner A, Marangelli G, Herzhaft-le Roy J. *Mains Libres*. 2023;2:187‑195.

France has the highest number of osteopaths per capita in the world (1), and this practice (along with other manual therapies like chiropractic) is increasingly used routinely in infants to relieve various issues such as difficult feeding, gastroesophageal reflux, night crying, constipation, colic, bloating, snoring, anxiety, or ear infections. In the context of breastfeeding, practices involving intraoral manipulation are notably used to resolve sucking disorders or loosen the tongue tie.

The multiplication of training and discourse around intraoral gestures in pediatrics, particularly in the field of osteopathy, reveals a worrying trend: the normalization of unvalidated practices presented as essential for evaluating orality and sucking. This evolution illustrates a set of shifts—theoretical, methodological, and regulatory—that weaken scientific rigor and endanger the bodily integrity of infants.

We present a commentary on the article "Recommendations for the intraoral approach in children in osteopathy."

Presentation of the Article

This article proposes recommendations for the use of intraoral techniques in children in osteopathy, relying primarily on the French legal framework, which the authors consider transferable to other Francophone countries where the profession is recognized. It shows that introducing a finger into the oral cavity is legally possible for diagnostic and therapeutic purposes, provided the osteopath respects their scope of competence, obtains informed consent from parents and, as far as possible, the child, and adheres to strict hygiene standards. The authors detail the need to specifically train osteopaths in oral anatomy and physiology, child development, and the recognition of signs of pain, discomfort, or disengagement to individualize the gesture. They emphasize the assessment of the benefits/risks balance; possible benefits concern the diagnosis and treatment of oro-facial disorders, while risks, poorly documented, mainly involve trauma and infection, hence the importance of aseptic rules. The article concludes that these acts are relevant and indicated when the extraoral approach is insufficient, and announces a series of complementary works by age group to refine these recommendations.

Legal Framework: A Manifest Transgression

Reading this article, it seems appropriate to restate the legal context: osteopaths are not healthcare professionals (2), and their intervention in children under 6 months is subject to a medical certificate stating no contraindication (Article 3 of Decree 2007-435 of March 25, 2007).

Decree No. 2007-435 of March 25, 2007 (3) stipulates that osteopathic acts must be manual, non-instrumental, and external. The oral cavity is not included in this scope. The absence of an explicit mention cannot be interpreted as an implicit authorization.

Obtaining parental consent does not legitimize an act outside the regulatory framework: this is a manifest transgression of the law. The Civil Code (Article 16-3) reminds us that any infringement on the human body must respond to a medical necessity, which excludes non-healthcare professional osteopaths.

Absence of Scientific Validation: An Exploited Void

No evidence-based data (4-7) demonstrates the efficacy of osteopathy (and intraoral osteopathic gestures) in infants. The claimed benefits (tongue mobility, sucking, swallowing) rely on unsubstantiated hypotheses. The risks—trauma, infection, oral aversion—are known but minimized in the article. This gap illustrates a methodological shift: the construction of a pseudo-scientific discourse that exploits the lack of evidence to legitimize intrusive practices.

The Académie de Médecine, the Order of Physiotherapists, and the French Society of Pediatrics have recently warned about these deviations (5-7).

Internationally, it is worth noting that in Australia, chiropractors are forbidden from practicing on children under 2 years of age due to the lack of proof of the efficacy of their interventions (8-9).

Theoretical Shifts and Abusive Extrapolations

The use of the synactive theory (10), designed for neonatal observation in intensive care, is emblematic of these deviations. Its hijacking in pediatric osteopathy constitutes a major theoretical shift: an abusive extrapolation that transforms an observation tool into an implicit justification for invasive gestures. The development of orality in infants is a neuro-determined and spontaneous process. The postulate that manual manipulation could optimize it belongs to an ideological construction, not a scientific demonstration.

Misleading Regulatory References

The hygiene recommendations from the Haute Autorité de Santé (HAS), designed for regulated healthcare professionals, are inappropriately invoked in this article to validate exclusive osteopathic practices. This regulatory shift maintains a dangerous confusion: it suggests official recognition where none exists. Respecting the best practices of a profession is not sufficient, on its own, to be recognized as fully belonging to its scope of competence.

Ethical and Psychosensory Risks: An Attack on Integrity

The oral sphere is a highly sensory and emotional zone in infants. Any intrusive intervention, whether well or poorly conducted, can cause sensory disorganization, lasting oral aversion, and a rupture in parent-child trust. The absence of an official framework validating the training of osteopaths exclusive to these gestures accentuates the risk of harm to bodily and psychosensory integrity.

International Variability: A Fallacious Argument

Regulatory differences between Francophone countries (Belgium, Quebec, Switzerland) are sometimes invoked to justify practices in France. This argument is fallacious: the recognition of osteopathy as a healthcare profession in some countries cannot legitimize regulatory transgressions in another legal context.

Conclusion

The practice of intraoral gestures in pediatric osteopathy illustrates a series of deviations: theoretical shifts, abusive extrapolations, regulatory misuse, and minimization of risks. In the absence of scientific validation and an explicit legal framework, these gestures constitute an infringement on the bodily and sensory integrity of the infant. They must be considered not as an innovation, but as a transgression. Scientific and ethical vigilance requires denouncing these practices and recalling that the best interest of the child takes precedence over any attempt at professional legitimation.

**REFERENCES**

1. The demographics of osteopaths in France. Osteopath Syndicate. Consulted on 08/12/25

2. Public Health Code (L.4001-1 to L.4444-3 of the Public Health Code) defining Healthcare Professionals

3. Decree No. 2007-435 of March 25, 2007 relating to the acts and conditions of exercise of osteopathy. Sante.gouv. Consulted on 08/12/25

4. Evaluation of the efficacy of osteopathy practice – 2012 Inserm. Consulted on 08/12/25

5. "Visceral and Cranial Osteopathy" in the Newborn: A Practice That Raises Questions. Académie de Médecine 2024. Consulted on 08/12/25

6. The Order of Massage Therapists and Physiotherapists welcomes the stance of the National Academy of Medicine on visceral and cranial osteopathy in the newborn 2024. Consulted on 08/12/25

7. French Society of Pediatrics: Neonatal Osteopathy: From Non-Indication to Contraindication? 2025. Consulted on 08/12/25

8. Chiropractors have been banned again from manipulating babies' spines. Here's what the evidence actually says. *The Conversation*. 2024. Consulted on 08/12/25

9. Safer Care Victoria. Chiropractic spinal manipulation of children under 12 Independent review.

10. UNDERSTANDING THE BEHAVIOR OF THE FULL-TERM OR PREMATURE NEWBORN FROM THE SYNACTIVE THEORY. Conaitre 2011. Consulted on 08/12/25