Assessing And Treating Congenital Diastasis Recti In Children

As a pediatric therapist, you understand the importance of addressing even the most subtle conditions that can impact a child’s development.

Congenital diastasis recti poses unique challenges in children. Unlike adult cases, pediatric cases manifest early, demanding specialized attention and intervention.

In this blog, you’ll understand what exactly diastasis recti is and how it functionally affects children. You’ll also learn techniques that you can use to help manage and treat this condition.

Diastasis recti is the separation of the rectus abdominis at the linea alba. This causes a widening of the gap between the two rectus abdominals and results in weakness of the anterior abdominal wall and protrusion of the abdomen.

The rectus abdominis sheath is an aponeurosis of the three anterolateral abdominal muscles (internal and external obliques and transverse abdominis). These muscles converge into the rectus sheath and linea alba, distributing multiple forces of directional pulls during movement. The linea alba serves as one of the most important lines of fusion within the body’s fascial matrix.

Diastasis recti is commonly recognized in pregnant and post-partum women or obese adults. This is known as an acquired diastasis recti, and in many cases is considered cosmetic.

When looking at diastasis recti in children, there are greater considerations than simply cosmetic. Newborns with this condition have congenital diastasis recti. This is measured to be an inter-rectus distance greater than 3 centimeters.

The causes are unknown, but it’s more prevalent in children with:

• Generalized low tone
• Developmental delays
• Down syndrome
• Hypermobility syndromes

The greater prevalence in children with these conditions lends support to the hypothesis of collagen deficiency and fascial weakness as predisposing factors. However, congenital diastasis recti can be seen in typically developing kids as well.

Physicians tell parents that the congenital diastasis recti in their babies are expected to resolve with time. Even though it’s not pathological, this separation can cause functional impairments in babies and children throughout development.

When the linea alba is torn and separated, the abdominal wall becomes weakened, which causes a decreased capacity to generate pressure and transmit forces. This affects trunk strength and stability, respiratory function, and intestinal function. These impairments very profoundly affect a developing infant or child.

As a pediatric therapist, you may not have kids referred to you specifically for diastasis recti. You may actually be seeing a child for something entirely different. However, being able to identify a diastasis recti on physical exam and determine the extent to which it’s impacting the child’s function could be life-changing for that child.

If the gap doesn’t naturally close, it may be necessary to repair it surgically. Let’s look more closely at how diastasis recti affects the development and function of young kids.

When intact, the rectus and linea alba should ideally serve as an anchor for all the abdominal muscles. When a baby or child lifts their head, the first muscle to activate is the rectus abdominis, which is part of the superficial front line fascia.

When the gap widens with a diastasis, the entire myofascial chain is affected. Children with congenital diastasis recti experience difficulty activating their rectus abdominis muscles, and you will notice their core flexion strength is limited.

A diastasis recti becomes visible or palpable with a head lift in supine, during gross motor activities, or when voicing. There are 5 subtypes based on the location of the gap, and most commonly you will identify gaps above the navels.

You may notice several observable characteristics, including:

• the shape of thorax and flared rib cage
• wide infrasternal rib angle
• protruding or wide belly button

Children with hypermobility or low tone might also exhibit:

• hyperextended knees
• anterior pelvic tilt
• increased lumbar lordosis
• bulging stomach

Because these kids have core weakness, this can lead to gross motor strength delays, coordination issues, and frequent falls. Some children may exhibit extreme laxity of the deep front fascial line and stiffness of the deep back line, leading to early onset scoliosis.

Because these children struggle to effectively activate their rectus abdominis for gross motor skills, they compensate using “motor tricks”. For example, when transitioning from supine to sitting, they may compensate for lack of flexion strength by rolling to one side, rolling to prone, or using their arms to pull up.

Or they may compensate by using accessory neck extensors or flexors. When attempting to sit up, this could be demonstrated through mouth opening or an over-activation of the platysma or sternocleidomastoid.

A child’s diastasis may worsen as intra-abdominal pressure increases. This is important to keep in mind when treating bowel and bladder issues, especially because these cases can present with difficulties in pressure regulation.

Observing a child’s thoracic and abdominal skin movement during respiration can provide valuable insight. The direction of skin movement indicates thoracic and abdominal movement during respiration.

You may note restrictions in skin mobility when a child breathes, which reflect restrictions in the thoracic and abdominal fascia. Let’s take a look at how you can incorporate skin mobility into your treatment.

With the skin as a large sensory organ, you can take advantage of this sensory input system to stimulate motor output. Gentle touch and stretching of the skin stimulate mechanoreceptors, which influence muscular activation and joint positioning.

The treatment goals for pediatric diastasis recti focus on assisting in normalizing pressure and activating the core muscles. Manual techniques such as connective tissue massage and skin rolling on the thorax and abdomen can help improve fascial mobility and muscle activation.

Kinesiotape is very effective in facilitating a functional closure of the diastasis. The tape is applied across the diastasis to provide sensory stimulus via the stretch of skin. With the abdominal muscles in a shortened length-tension position, sensory input from the tape cues abdominal recruitment.

Once you have taped your kid’s belly, you can incorporate functional training, such as gross motor skills or PNF patterns, to develop improved core strength and stability.

Keep in mind that pediatric skin is different from adult skin, so use brands that are specifically developed for sensitive and young skin!

You can also use pressure garments or abdominal binders to optimize the posture of the ribcage and trunk and promote good breathing mechanics.

These techniques for treating pediatric diastasis recti are just scratching the surface! You can learn in much greater depth about this topic by enrolling in my online Pediatric Pelvic Health Summit course. Our guest lecturer brings her many years of diastasis expertise to this discussion, where she discusses cutting-edge research and novel treatment techniques.

Look forward to seeing you there!