Questions to the children's neurologist: what is important to know the parents of the child up to a year. Examination of the neurologist for the baby - important points

21.08.2018

The first trip to the neurologist with Fields stunned me, to be honest. I ask the doctor: "How serious is this all about?" He replies, laughing almost: “Yes, nobody leaves me, so that I don’t say anything.” As it turns out, many diagnoses are made just automatically. Like, if a child, for example, is kesarenok, here is such a label for you, because you are kesarenok. There are diagnoses that do not exist or do not correspond to the symptoms. Here is just the information below about it.

I found the information in one of the LJ blogs. I highly recommend reading other posts. Very useful and sobering.

FACTS AND DELUSIONS OF PERINATAL NEUROLOGY

neurologist S.V.Zaitsev

Keywords: perinatal encephalopathy (PEP) or perinatal damage to the central nervous system (PP CNS), hypertensive-hydrocephalic syndrome (HGS); dilatation of the ventricles of the brain, interhemispheric fissure and subarachnoid spaces, pseudocysts on neurosonography (NSG), muscular dystonia syndrome (SMD), hyper-excitability syndrome, perinatal convulsions.

Pediatric neurology was born relatively recently, but is already experiencing difficult times. At the moment, many doctors practicing in the field of infant neurology, as well as parents of infants who have any changes in the nervous system and mental sphere, are “between two fires.” On the one hand, the school of "Soviet children's neurology" is an overdiagnosis and incorrect assessment of the functional and physiological changes in the nervous system of a child of the first year of life, combined with the long-obsolete recommendations of intensive treatment with a wide variety of medicines. On the other hand, there is often an obvious underestimation of the existing neuropsychiatric symptoms, lack of general pediatrics and the basics of medical psychology, some therapeutic nihilism, and fear of using the potential of modern medical therapy; and as a result - lost time and lost opportunities. At the same time, unfortunately, a certain (and sometimes significant) “formality” and “automaticity” of modern medical technologies lead, at a minimum, to the development of psychological problems in a child and his family members. The concept of “norm” in the neurology of the late 20th century was sharply narrowed, it is now intensively and not always justifiably expanding. Probably the truth is somewhere in the middle ...

According to the Perinatal Neurology Clinic of the NEVRO-MED Medical Center and other leading medical centers in Moscow (and probably in other places), so far more than 80%. children of the first year of life come in the direction of a pediatrician or neuropathologist from the district clinic for a consultation regarding a non-existent diagnosis - perinatal encephalopathy (PEP):

The diagnosis of perinatal encephalopathy (PEP) in Soviet pediatric neurology very vaguely characterized almost any dysfunction (and even structure) of the brain in the perinatal period of a child’s life (from about 7 months intrauterine development child and up to 1 month of life after birth), arising from the pathology of cerebral blood flow and oxygen deficiency.

At the basis of such a diagnosis, one or several sets of any signs (syndromes) of a probable disorder of the nervous system were usually located, for example, hypertensive-hydrocephalic syndrome (HGS), muscular dystonia syndrome (MLD), and hyper-irritability syndrome.

After conducting a comprehensive examination: clinical examination in combination with data analysis of additional research methods (brain ultrasound - neurosonography) and cerebral circulation (Doppler brain vessels), fundus fundus and other methods, the percentage of reliable diagnoses of perinatal brain damage (hypoxic, traumatic, toxic metabolic, infectious) is reduced to 3-4% - it is more than 20 times!

The saddest thing in these figures is not only a certain unwillingness of individual doctors to use the knowledge of modern neurology and conscientious delusion, but also clearly visible, psychological (and not only) comfort in the pursuit of such "overdiagnosis."

Hypertension-hydrocephalic syndrome (HGS): increased intracranial pressure (ICP) and hydrocephalus

Until now, the diagnosis of “intracranial hypertension” (increase in intracranial pressure (ICP)) is one of the most commonly used and “favorite” medical terms in pediatric neurologists and pediatricians, which can explain almost everything! and at any age parents complaints.

For example, a child often cries and shudders, does not sleep well, erupts a lot, eats poorly and gains little weight, wrinkles his eyes, walks on socks, his hands and chins tremble, there are convulsions and there is a lag of psychoverbal and motor development: - increased intracranial pressure. True, convenient diagnosis?

Quite often, the “heavy artillery” - the data of instrumental diagnostic methods with mysterious scientific graphs and figures - is used as the main argument for parents. The methods can be used either completely outdated and non-informative / echoencephalography (ECHO-EG) and rheoencephalography (REG) /, or “not from that opera” (EEG) examinations, or incorrect, in isolation from clinical manifestations, subjective interpretation of the normal variants in neurosonodopplerography or tomography.

Unhappy mothers of such children unwittingly, with the filing of doctors (or voluntarily, eating their own anxiety and fears), pick up the flag of "intracranial hypertension" and for a long time get into the system of monitoring and treatment of perinatal encephalopathy.

In fact, intracranial hypertension is a very serious and rather rare neurological and neurosurgical pathology. It accompanies severe neuroinfections and brain injuries, hydrocephalus, impaired cerebral circulation, brain tumors, etc.

Hospitalization is obligatory and urgent.

Intracranial hypertension (if it really is) is not difficult to notice for attentive parents: it is characterized by persistent or paroxysmal headaches (usually in the morning), nausea and vomiting, not associated with food. The child is often sluggish and sad, constantly naughty, refuses to eat, he always wants to lie down and cuddle up to his mother.

A very serious symptom can be strabismus or pupil difference, and, of course, impaired consciousness. In infants, the bulging and stress of the fontanel, the divergence of the seams between the bones of the skull, as well as excessive growth of the head circumference are very suspicious.

Without a doubt, in such cases, the child should be shown to specialists as soon as possible. Quite often, quite a single clinical examination to exclude or pre-diagnose this pathology. Sometimes requires additional research methods (fundus, neurosonodopplerography, computed or magnetic resonance imaging of the brain)

Of course, the expansion of the hemispheric fissure, ventricles of the brain, subarachnoid and other spaces of the cerebrospinal system in the images of neurosonography (NSG) or tomograms of the brain (CT or MRI) cannot serve as evidence of intracranial hypertension. The same applies to isolated from the clinic, violations of cerebral blood flow, detected by Doppler of the vessels, and "finger pressure" on the roentgenogram of the skull.

In addition, there is no connection between intracranial hypertension and translucent blood vessels on the face and scalp, tiptoeing, shaking hands and chin, hyperexcitability, developmental disorders, poor academic performance, nasal bleeding, ticks, stuttering, bad behavior, etc. etc.

That's why, if your baby has been diagnosed with PEP, intracranial hypertension, on the basis of “staring out” the peephole (Gref's symptom, “the setting sun”) and walking on tiptoes, then you should not go crazy. In fact, these reactions may be characteristic of very excitable young children. They are very emotional about everything that surrounds them and what is happening. Attentive parents will easily notice these relationships.

Thus, when making a diagnosis of AED and an increase in intracranial pressure, it is naturally best to contact a specialized neurological clinic. This is the only way to be confident in the correctness of diagnosis and treatment.

It is absolutely unreasonable to start the treatment of this serious pathology on the recommendations of a single doctor on the basis of the above “arguments”, besides this unreasonable treatment is not safe at all. What are only diuretic drugs that are prescribed to children for a long time, which is extremely unfavorable effect on the growing body, causing metabolic disorders.

There is another, equally important aspect of the problem that must be considered in this situation. Sometimes drugs are necessary and unlawful refusal of them, on the basis of only own beliefs of the mother (and more often the father!) Of medical harm, can lead to serious unpleasantness. In addition, if there is indeed a serious progressive increase in intracranial pressure and the development of hydrocephalus, often incorrect medical therapy for intracranial hypertension entails a loss of an opportunity for surgery (bypass surgery) and the development of severe irreversible effects for the child: hydrocephalus, impaired development, blindness deafness and others.

Now a few words about the least "adored" hydrocephalus and hydrocephalic syndrome. In fact, we are talking about a progressive increase in intracranial and intracerebral spaces filled with cerebrospinal fluid (CSF) due to the existing! at that moment intracranial hypertension. At the same time, neurosonograms (NSG) or tomograms reveal changes in the course of time of the ventricles of the brain, interhemispheric fissure and other departments of the cerebrospinal fluid system. It all depends on the severity and dynamics of the symptoms, and most importantly, on the correct assessment of the relationship between the increase in intracerebral spaces and other nerve changes. This can be easily determined by a qualified neurologist. True hydrocephalus, which really requires treatment, as well as intracranial hypertension, is relatively rare. Such children must be observed by neurologists and neurosurgeons of specialized medical centers.

Unfortunately, in ordinary life, such an erroneous "diagnosis" occurs in almost every fourth to fifth infant. It turns out that quite often some doctors incorrectly call hydrocephalus (hydrocephalic syndrome) a stable (usually insignificant) increase in the ventricles and other cerebrospinal cerebrospinal fluid spaces. By external signs and complaints, this does not manifest itself, and does not require treatment. Especially if a child suspected hydrocephalus on the basis of a “big” head, translucent vessels on the face and scalp, etc. - this should not cause panic in parents. Big size head in this case plays almost no role. However, the dynamics of head circumference growth is very important. In addition, you need to know that among modern children are not uncommon so-called "tadpoles", in which the head has a relatively large size for their age (macrocephaly). In most of these cases, babies with large heads show signs of rickets, less commonly macrocephaly, due to the family constitution. For example, the father or mother, or maybe grandfather has a big head, in a word, is a family affair, does not require treatment.

Sometimes, when performing neurosonography, an ultrasound doctor finds pseudocytes in the brain — but this is not a reason for panic! Pseudocysts call single round tiny formations (cavities) containing CSF and located in typical brain regions. The reasons for their occurrence, as a rule, are not known for certain; they usually disappear by 8-12 months. of life. It is important to know that the existence of such cysts in most children is not a risk factor for further neuro- mental development and does not require treatment. Nevertheless, although rarely enough, pseudocysts are formed on the site of subependymal hemorrhages, or are associated with perinatal cerebral ischemia or with intrauterine infection. The number, size, structure and location of the cyst give specialists very important information, taking into account which, on the basis of the clinical examination, the final conclusions are formed.

Description of NSG is not a diagnosis! and not necessarily a reason for treatment.

Most often, NSG data provide indirect and uncertain results, and are taken into account only in conjunction with the results of the clinical examination.

Once again I remind about the other extreme: in difficult cases, sometimes there is a clear underestimation on the part of parents (less often - and doctors), problems that a child has, which leads to a complete rejection of the necessary dynamic observation and examination, with the result that the correct diagnosis is made late, and treatment does not lead to the desired result.

Undoubtedly, therefore, in case of suspected increased intracranial pressure and hydrocephalus, the diagnosis should be carried out at the highest professional level.

What is muscle tone and why is it so "loved"?

Look at your child's medical record: is there no such diagnosis as “muscular dystonia”, “hypertension” and “hypotension”? - probably, you just did not go with your baby up to the year to the clinic to a neurologist. This, of course, is a joke. However, the diagnosis of "muscular dystonia" is not at least (or even more often) than hydrocephalic syndrome and increased intracranial pressure.

Changes in muscle tone can be, depending on the severity, as a variant of the norm (most often), and serious neurological problem (this is much less common).

Shortly about external signs changes in muscle tone.

Muscular dystonia is characterized by a state where muscle hypotonia alternates with hypertension, as well as a variant of disharmony and asymmetry of muscle tension in individual muscle groups (for example, more in the hands than in the legs, more to the right than to the left, etc.)

At rest, these children with passive movements may experience some muscular hypotension. When trying to actively perform any movement, with emotional reactions, when the body changes in space, muscle tone increases sharply, pathological tonic reflexes become pronounced. Often, such violations further lead to incorrect formation of motor skills and orthopedic problems (for example, torticollis, scoliosis).

Muscle hypertension is characterized by an increase in resistance to passive movements and a restriction of spontaneous and voluntary motor activity. Severe muscle hypertension can also significantly affect the rate of motor development.

Disturbance of muscle tone (muscle tension at rest) can be limited to one limb or one muscle group (obstetric paresis of the arm, traumatic paresis of the leg) - and this is the most visible and very disturbing symptom, forcing parents to immediately contact a neurologist.

To notice the difference between physiological changes and pathological symptoms in one consultation is sometimes quite difficult even for a competent doctor. The fact is that the change in muscle tone is not only associated with neurological disorders, but also strongly depends on the specific age period and other features of the child’s condition (agitated, crying, hungry, drowsy, froze, etc.). Thus, the presence of individual deviations in the characteristics of muscle tone, does not always cause worry and requires some treatment.

But even if functional disorders of muscle tone are confirmed, there is nothing to worry about. A good neurologist, most likely, will prescribe a massage and physical therapy classes (exercises on large balls are very effective). Medications are prescribed extremely rarely.

Hyperactivity syndrome

(syndrome of increased neuro-reflex excitability)

Frequent crying and whims about and without, emotional instability and hypersensitivity to external stimuli, disturbed sleep and appetite, abundant frequent regurgitation, restlessness and flinching, trembling of the chin and handles (etc.), often in combination with poor gain weight and violation of the chair - will you recognize such a child?

All motor, sensitive and emotional reactions to external stimuli in a hyper-excitable child occur intensely and abruptly, and can also fade away just as quickly. Having mastered these or other motor skills, children continuously move, change poses, constantly stretch to some objects and capture them. Usually, children show a keen interest in their surroundings, but increased emotional lability often makes it difficult for them to contact others. They are very impressionable, sensitive and vulnerable! They fall asleep extremely badly, only with their mother, they constantly wake up, cry in their sleep. Many of them have a prolonged fear reaction to communication with unfamiliar adults with active protest reactions. Usually, hyper-excitability syndrome is combined with increased mental exhaustion.

The presence of such manifestations in a child is only a reason for referring to a neurologist, but in no case is there any reason for parental panic, and even more so, medical treatment.

Much less often, hyper-irritability can be associated and explained by the perinatal pathology of the central nervous system. In addition, if a child’s behavior suddenly suddenly and for a long time was disturbed with little to no apparent reason, he developed hyper-excitability, the likelihood of an adaptation disorder (adaptation to external environmental conditions) due to stress cannot be ruled out. And the sooner the specialists look at the child, the easier and faster it is to cope with the problem.

And, finally, most often, transient hyper-excitability is associated with pediatric problems (rickets, digestive disorders and intestinal colic, hernia, teething, etc.).

There are two extremes in the tactics of monitoring such children. Or “explanation” of hyper-excitability with the help of “intracranial hypertension” and intense drug treatment with often using drugs with serious side effects (diacarb, phenobarbital, etc.). Or the complete disregard of the problem, which can later lead to the formation of persistent neurotic disorders (fears, tics, stuttering, anxiety disorders, obsessions, sleep disorders) in the child and his family members, and will require a long-term psychological correction.

Of course, it is logical to assume that an adequate approach is somewhere between them ...

Separately, I wanted to draw the attention of parents to convulsions - one of the few disorders of the nervous system that really deserves close attention and serious treatment. Epileptic seizures occur in infancy not often, but sometimes it is difficult, cunning, and disguised, and almost immediately, immediate medical therapy is needed.

Such attacks can be hidden behind any stereotyped and repetitive episodes in the child’s behavior. Incomprehensible startles, nods of the head, involuntary eye movements, “fading”, “pinching”, “limping”, especially with the sight stopped and the lack of response to external stimuli, should alert the parents and force them to turn to specialists. Otherwise, a late diagnosis and untimely prescribed drug therapy significantly reduce the chances of treatment success.

All the circumstances of the episode of convulsions must be accurately and fully memorized and, if possible, recorded on video, for further detailed narration in a consultation. If convulsions last for a long time or recur - call “03” and urgent consultation with a doctor.

AT early age The child’s condition is extremely changeable, therefore developmental deviations and other disorders of the nervous system can sometimes be detected only during long-term dynamic monitoring of the baby, with repeated consultations. To this end, specific dates for scheduled consultations of a pediatric neurologist in the first year of life are determined: usually at 1, 3, 6 and 12 months. It is during these periods that most severe diseases of the nervous system of children in the first year of life (hydrocephalus, epilepsy, cerebral palsy, metabolic disorders, etc.) can be detected. Thus, the identification of a specific neurological pathology in the early stages of development allows you to start complex therapy on time and achieve the maximum possible result.

And in conclusion, I would like to remind parents: be sensitive and attentive to your kids! First of all, it is your meaningful participation in the life of children - this is the basis of their future well-being. Do not heal them from “suspected diseases”, but if you are worried and worried about something, find an opportunity to get independent advice from a qualified specialist.

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Affective respiratory attacks:

Affective respiratory attacks - is an acute breath hold. May occur when a child screams or cries. For anger, resentment or pain (for example, when falling), the child begins to cry so bitterly that his breath lingers, there is no air in the lungs, the child reddens first, then turns blue and immediately begins to breathe. At the time of lack of air, short-term oxygen deprivation of the brain is possible and the child loses consciousness. At this time there may be seizures.

All this lasts for several tens of seconds, after which children become lethargic, sometimes drowsy. Such attacks can occur in 2% of children under 2 years, rarely up to 4 years. Usually this happens in very stubborn, wayward children who, at all costs, try to achieve their goals.

Such states, as a rule, disappear without a trace and serve as one of the manifestations of early childhood nervousness. During an attack, you should take the child to fresh air, turn it face down so that the sunken tongue does not block the airway. You can sprinkle your face with cold water, but do not give to drink, because the child at this moment does not swallow.

In order to avoid a seizure, it is necessary to “shift” the child’s attention to some other object, to distract him and try to avoid conflict situations. The unity of the views of the whole family on the attitude towards this problem is necessary, since the child very quickly learns to take advantage of the current situation. In many cases, you need a consultation with a psychologist. Such attacks are not particularly dangerous, but in all cases consultation with a doctor is necessary to exclude epilepsy and cardiac arrhythmias. It should also be remembered that frequent attacks due to oxygen starvation brain can lead to neurological diseases.

Speech disorders:

If it seems to you that the child speaks little, find out from the speech therapist how he should speak at this age.

The development of the child's speech depends on how much they talk to him from the first days of life. At first, the newborn does not seem to respond to appeals to him. But it takes several weeks, and the child listens to the sounds of speech, as if freezes. Some time later, in response to your speech, it begins to make sounds: “gu,” “u.” By 1.5-2 months, it is good, and by 3 months, it is long, long, melodiously, it quiets down when you start talking, then it is walking again, smiling. By 6-8 months, chains of sounds appear: “ba-ba-ba”, “ma-ma-ma”, by 9-12 months - words. By the year the child usually knows 6-10 words.

By 15 months, he begins to consciously turn to parents and other family members: “mom”, “dad”, “woman”. By 18 months, it is good at copying intonations, following instructions (“take and bring, put”, etc.). By 2 years can speak short two-word sentences ("mother, am"). After 2 years, sentences are formed, and a 3-year-old child already speaks phrases, sings songs, reads short rhymes. True, the speech is still fuzzy, not always clear to others. However, this is not always the case.

If the child speaks little, it is necessary to find out if he has a hearing loss or lesions of the nervous system. If the child hears well, it is necessary to constantly talk to him, to teach him not to use gestures, but words.

Surrounded by the “wall of silence”, the kid lacks incentives to develop speech. If the child’s speech is not clear, you should consult a speech therapist to check if he has a short bridle of the tongue. Pathology of the hard palate (cleft) also leads to a violation of sound pronunciation, even after surgical correction. If there is no abnormality on the part of the organ of hearing, oral cavity, it is necessary to consult a neuropathologist in order to rule out the delay in the psycho-speech development as a consequence of the damage to the nervous system.

It should also be remembered about the hereditary features of speech development. There is a natural difference in the development of the speech of children: someone starts talking earlier, someone later. The more talk with the child, the earlier he will learn to talk. Most speech disorders are a consequence of the pathology of hearing.

Sleep disorders in a child:

Like adults, children have a different need for sleep. Newborns sleep from 12 to 20 hours a day, older children - all night. However, some can sleep only 4-5 hours and do not sleep during the day. In most cases, these are hereditary characteristics, but also the mode of life of the child makes its own changes. Children who are little active during the day, sleep badly at night, as, incidentally, are overly active, unable to calm down in the evening.

Children with asthma, eczema, allergies, food intolerance also sleep poorly at night. Much depends on how to stack the child. In some families, it is customary to rock the baby in your arms, in others - to lay in the crib. The advantage of the latter method is that parents can spend some time together.

About half of children under 5 wake up at night, which is the norm. Another thing is that in this case the parents are not getting enough sleep. Therefore, they can get up to the child alternately or sleep a little longer in the morning.

Sleep disorders include:
   nightmares;
   night terrors;
   sleepwalking (sleepwalking).

Nightmares very unpleasant for a child. They occur due to respiratory disorders: with asthma, allergies, enlarged tonsils, nasal congestion, due to psychic causes (scary films, etc.), pain or sensations suffered, and also in hot and stuffy rooms. Usually between 8 and 9 years. The child dreams that someone is being crushed, persecuted, and so on. In the morning he remembers that he was dreaming. These disorders are in the phase of fast sleep.

Night terrors.The child wakes up at night and screams for a few minutes, not recognizing others. It is not easy to calm him down, he is frightened, he has a rapid heartbeat, wide pupils, rapid breathing, distorted facial features. Most often nightly fears occur between 4 and 7 years. After a few minutes, the child calms down and falls asleep; in the morning, he does not remember anything. Night fears arise in a phase of less deep sleep.

Sleepwalking (sleepwalking, somnambulism) appears in a shallow sleep phase or a shallow sleep exit phase: Children get out of bed, walk around the room, talk, go to the toilet or urinate in the room, then return to their bed or the other and go to bed. In the morning they do not remember this. Sometimes the dreaming is combined with night fears. It should be remembered that tired children sleep soundly. Therefore, the physical and mental activity of the child during the day: outdoor games, singing, reading poetry, reading glasses - promotes sound sleep.

By the age of 3, children are much less sleep during the day or refuse from it altogether. daytime sleep. Laying the baby in the evening after a bath, a bedtime story helps to fix the regime, and the child quietly goes to bed. You can leave the dim light of a night lamp or the light in the corridor, if the kid is afraid of the dark. In the crib the child can take a favorite toy or book. Sometimes quiet music or “white noise” helps (the work of any household appliances, quiet conversations of adults among themselves). You should not rock the baby in your arms as it wakes up as soon as it is placed in the crib. It is better to sit next to and sing a lullaby. The bedroom should be cozy, warm.

If a child cries, afraid to stay alone, teach him to this gradually. Putting the child, go out for a few minutes and come back. Gradually increase the time of absence. The child will know that you are somewhere nearby and will return to him.

For nightmares and night terrors, you must reassure the child, put him down. If necessary, on the advice of a doctor, you can give light sedatives. It is important that the child does not watch movies in the evening, fairy tales that may scare him. When snowing, you must safely lay the child, do not wake him. It is necessary to examine him at the doctor and, if necessary, to carry out treatment. Remember about the safety of the child: close the windows and doors so that he does not get on the stairs and does not fall through the window.

Sleep disturbances are common in infants and younger children. However, regular laying at the same time allows you to work out a certain mode. In case of sleep disorders, consultation with a doctor and the use of appropriate medications is necessary

Awkwardness:

All small children are a little awkward, as their nervous system does not keep up with the development of muscles and bones. Starting on his own, the child soils clothes, scatters food, learning to dress - he fights with buttons, clasps, and latches. Often falls, bruises, bruises and bumps appear on the head, arms and legs. At the age of 3, it is still difficult for a child to build a tower of cubes, preschoolers do not draw well, they write, they often break dishes, they don’t know how to estimate distances, so they embarrassly throw and catch the ball.

Many children do not distinguish the right side from the left. More often, they are overly excitable, impulsive, can not concentrate for a long time. Some begin to walk late (after one and a half years). It should take some time to make up this gap. In some children, coordination of movements suffers "by inheritance." Other children have emotional disturbances.

Children with any disabilities: coordinating, emotional, manipulative - they feel different from everyone. Sometimes awkwardness results from injuries, especially of the head. Premature babies are also slightly different from their peers. In many cases, as the child grows, imperceptible, disturbances of the type of minimal cerebral insufficiency manifest themselves. The embarrassment of the child complicates the problems of education. Failure to perform any task can cause the child anger, resentment, a tendency to solitude, shyness, self-doubt, especially if peers begin to laugh at him.

Not rough neurological disorders they often do not notice, and the child is assessed as “normal but unbearable”, which leads to punishment, reprimands, even greater violations of behavior and pathological formation of character. The child begins to avoid school, finds any reason not to go to classes, where he is scolded, ridiculed. Parents must first understand that the child is not all normal. If you notice that your child is particularly embarrassing, contact a neurologist, a psychologist, to identify and clarify the nature of the violations as soon as possible.

Every tenth child has minor violations, so it is important to show maximum patience and attention in order to make the appropriate correction. Mutual understanding, patience, not punishment, ridicule and reprimand are necessary for success. If there is minimal brain damage, do not worry, there are many ways to treat and correct these disorders.

Bouts of anger:

Anger attacks are often in children between the ages of one and a half to 4 years. The most difficult time is from 2 to 3 years. This is a critical age of self-affirmation. By age 4, seizures become significantly more rare. At the age of 2-3 years, about 20% of children get angry every day for one reason or another.

The main reason for anger is dissatisfaction with the fact that a child cannot express his desires in the way he wants. Children at this age very well understand everything that is happening around them, and they long for everything to be as they like. If this does not happen, anger is poured into attacks of anger, which cause much concern to parents, especially in public places. Sometimes you have to even slap the baby.

To avoid this unpleasant situation, always analyze your actions before you go somewhere with your child. Children usually begin to be naughty if they want to eat. Always have some fruit or cookies with you. If the child wants to sleep, try to return home at bedtime or go after the child wakes up and has a good mood. Sometimes it is possible to “shift” the child’s attention to something unusual and interesting in the environment.

Attacks of envy of a sister or brother can be prevented by giving the child maximum attention and tenderness, and not scolding him. Try to stay calm and not respond to the antics of the child. Do not think about what others say. Many of them also have children and know how difficult it is with them. Sometimes in anger, a child cries and can cause affective-respiratory attack, but, fortunately, this is rare. Always stay calm and be consistent.

Take the crying baby in your arms and hold tight so that it cannot break free. All nearby objects that he can grab and throw, move aside. If the child does not want to move from his seat, leave him and go, but do not let go of sight. Usually, children always run after their parents. Despite the difficulties, do not let the child win, otherwise it will be even harder each time. In case of anger attacks in a child after 5 years, it is necessary to consult him with a psychologist.

Problems of parenting in children:

Problems of education are very diverse. Causes of problems can be attacks of anger, refusal to eat, sleep disturbance, excessive excitability, and sometimes aggression when the child can cause damage to himself and others, biting and fighting. The behavior of parents in such situations depends on their culture, upbringing, and social status. Especially a great influence on the behavior of parents have their own childhood experiences.

Some parents are very strict with the child and do not allow any indulgences, others relate more gently and loyally. From a medical point of view, there are no uniform approaches to education. The main thing is that parents do not humiliate and insult the child. Children who are accustomed to the regime of the day and constantly know what they will do next, as a rule, do not cause troubles in education, even if they are excessively excitable.

Parents are looking for help when they do not cope with the child and their methods of education do not produce results. There are no ideal children, but the parents' behavior in matters of upbringing largely predetermines the fate of the child. Sometimes education (or, better to say, its absence) contradicts all norms of behavior in society. In education it is necessary to take into account the peculiarities of the child. Some babies are calm, timid from birth, others, on the contrary, are mobile and energetic.

Restless children sleep poorly, prone to nightmares, get tired quickly. If they are constantly under fear of punishment, they see strained relations between their parents, then they try in any way to draw attention to themselves, including bad behavior. In many ways, parenting is the result of parental behavior. A child who has not been given sweets begins to act up, but if he does not achieve his goal, he will draw conclusions for himself.

Sometimes a child’s bad behavior manifests itself in certain situations: if he is hungry, wants to drink, or is tired. Then it is very easy to establish the cause and normalize the situation. If a child misbehaves, it is necessary to patiently and easily explain his mistakes and repeat it in appropriate situations. Children react to a sensitive, attentive attitude, especially to praise, even if they do not always deserve it. An excited child can be allowed to "throw out energy" in the game, in sports, so that he calms down.

You can not let the child all. If it says “No!” - this should be sure “no”, by law for all family members. It is very bad when one of the parents prohibits, and the other, on the contrary, permits. Always respond intelligently to the antics of the child. It is better to praise for good behavior than to punish disobedience. You can even promise a reward for something good and you should definitely keep your promise. However, the reward should not be a daily stimulus for the behavior of the child.

The daily regimen and the consistent attitude towards the child can prevent many difficulties. If you cannot cope with the problems of raising your child, contact a neurologist or psychiatrist to identify possible (hidden) abnormalities from the nervous system.

Increased excitability:

This term is not always used correctly. Often, an energetic, active child is called excitable. However, children suffering from increased excitability are not only mobile, but also restless, they cannot concentrate, make many unnecessary movements in doing any work, study poorly, cannot complete the work begun, their mood quickly changes.

Such children often have bouts of anger, when they throw objects on the floor, they often suffer from a lack of coordination, awkwardness. Such phenomena occur in 1-2% of children, 5 times more often in boys than in girls. Correction similar behavior need to be done as early as possible: as they grow up, overly excitable children can commit antisocial actions. The reasons for increased excitability are not fully understood. Great importance is attached to hereditary factors and the impact of the social environment. The influence of allergies (eczema, asthma) and other diseases, as well as deviations during pregnancy and childbirth, is not excluded.

If the child is very excitable, you must carefully consider the mode of his day. Find out what interests the child, and use these interests to teach him attention concentration, perseverance, and better coordination and physical activity of the hands. This may be drawing, coloring, designing, certain games, sports activities, etc. Do not give the child to himself, but give freedom at certain hours.

The main role in the correction of the behavior of an excitable child belongs to the parents. The child trusts you, and with you he feels protected. If necessary, you can ask for help from a neurologist, psychologist, allergist.

Consider the most frequent neurological diseases of newborns, their symptoms. In fact, it is important for every mother to know the symptoms, since almost all neurological problems are amenable to correction and are treated, if they are detected in time - in the early period!

Almost every baby has some kind of problem in the neurological part: one child has problems with tone or sleep, another has increased intracranial pressure, the third one is too slowed or excited, the fourth vegetatic - because of a dysregulation of the vascular tone on his skin, a mesh appears on the skin subcutaneous capillaries, and palms and feet are constantly wet and cold ...

Perinatal encephalopathy (PEP), which is also encoded as the “syndrome of CNS disorders”

Her signs found in 8-9 out of 10 newborns. They occur with adverse effects on the nervous system during pregnancy, childbirth and the first week after the birth of the baby.

If time notice emerging problems and eliminating them with the help of drugs, herbal remedies, massage and physiotherapy, the AED can take as long as 4–6 months, maximum to a year. In mild cases - without consequences, and more serious or unnoticed in time neurological problems after a year often result in the so-called minimal brain dysfunction (MMD). This diagnosis indicates some weakness and vulnerability of the baby’s nervous system, but you shouldn’t be upset about it. After all, the main danger - the threat of the formation of cerebral palsy (CP) - bypassed the crumb! (More about what to do if cerebral palsy is diagnosed, see p. 62.)

In the first month and then three more times during the year, show your baby to a neurologist. If there is no such specialist in the children's clinic, ask the pediatrician for a referral to the district consultative and diagnostic center.

Intracranial pressure

Under the shells of the brain and spinal cord crumbs spinal fluid circulates - CSF. It nourishes the nerve cells, carries away the end products of metabolism, absorbs shocks and tremors. If for some reason the liquor is produced more than it is flowing, or there is pressure from the outside on the head of the crumbs, as during labor, the intracranial pressure (ICP) rises to a critical level. And since there are many pain receptors in the meninges, the child would suffer from an unbearable headache if it were not for the system of stitches and fountains, allowing the bones of the skull to disperse, equalizing the pressure. Thanks to this kid severe pain because of intracranial hypertension, she does not feel, but she feels some discomfort and reports this to her mother. You only need to be able to hear his signals!

Does a crumb often cry and often regurgitate, especially when the weather changes? It seems that ICP has really increased!

Mom should be alerted a bright pattern of saphenous veins, translucent at the temples and nose of the baby, and sometimes throughout the arch of the skull. An additional reason for alarm - white strip sclera, periodically appearing over the iris of the crumbs, as if he was surprised to open his eyes wide.

Be wary if the head circumference of a one-month crumb exceeds the chest circumference by more than 2 cm. Check the seam between the parietal bones in the middle of the head (its width should not exceed 0.5 cm), as well as the distance between the opposite edges of the fontanelles — large (normally W x W cm) and small (1 x 1 cm).
Keep the situation under control with a neurologist. Due to the compensatory possibilities of sutures and fontanels, it often happens that a doctor finds intracranial hypertension in a newborn in neurosonography or ultrasound of the brain, and there is no clinical sign of trouble: the crumb is satisfied, calm, develops well, sleeps well at night ... In this case, treatment is not required - only observation by a specialist.
If the increased ICP starts to give the child anxiety, the doctor will prescribe diuretics that remove excess fluid from the crumbs of the brain.
A great remedy for mild hypertension is a children's pharmacy tea with horsetail, which has a diuretic effect.

Hypertenus and hypotonia of the muscles in the newborn

Our biceps and triceps never relax to the end - even in a state of sleep, they remain residual tension, it is called muscle tone. It is very high in a newborn: the fact that for a child in the first weeks of life is normal, for a six-month-old infant it is a gross pathology. To fit in mom's tummy, the baby had to shrink into a lump due to the increased tension of the flexor muscles. It is important that it is not excessive. Muscle hypertension sometimes affects only one half of the baby's body. Then the baby lying on its back bends in an arc, turns its head only in one direction, and on the tummy it collapses on that side, where the tone is higher.

Muscle Hypertension Syndrome - one of the frequent manifestations of the probe. The tone should rather be normalized: otherwise the child will fall behind in motor development, will encounter difficulties when walking.

This can be avoided , doing massage and gymnastics with the baby.

Smooth swinging movements relax the clamped muscles. The effect can be achieved by shaking the baby while swimming, as well as on the arms, in a wheelchair, rocking chair. Such movements perfectly relax the clamped muscles!
Benefit exercise in fetal position. Lay the baby on your back, cross the arms on your chest, pull your knees up to the tummy and hold with your left hand, tilt the baby's head with your right hand, and then gently and rhythmically swing it towards you and away from you and from side to side (5-10 times).

Muscle hypotonia - the exact opposite of hypertonus: the arms and legs of the newborn are not pressed to the body, as expected, but half-open, resistance to passive extension is insufficient. But in order for the child to actively develop physically and master the motor skills, his tone should be normal.

Follow the changes in muscle tone with a neurologist! If you do not fight muscle hypotonia, the baby will learn to roll over, crawl, sit and walk, his feet will remain flat, legs and spine will twist, sprains will occur in loose joints. You and your doctor should do everything to prevent this.

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"Perinatal" comes from the words regga - around, natus - childbirth. Pediatric neurology is a complex pediatric science, and perinatal neurology is considered one of its very important sections, as it studies the functions of the central nervous system in health and in pathology in the neonatal period ™.

From the first minutes of a child’s life, the pediatrician is faced with the task of correctly assessing the state of the functions of the brain and spinal cord of a newborn, recognizing even minor deviations in their activities, and if pathology is detected, if necessary, prescribe the correct treatment.

Prevention of diseases of the nervous system of the child during pregnancy

Ideally, of course, to prevent the occurrence of diseases of the nervous system. But how to achieve this? First of all - to do everything possible for the normal course of pregnancy throughout its length. During pregnancy, there are so-called critical periods when the impact of a factor leads to damage to the fetal nervous system during fetal development.

The most important for the formation of the central nervous system are the first three months of intrauterine life, when all the elements of the child’s nervous system are laid. By the end of the third month, Willi-Zie's arterial circle of the brain is already being formed, providing a trouble-free blood supply to the brain. Therefore, in the first weeks of pregnancy, pathogens of infectious diseases such as acute viral infections, influenza, rubella, toxoplasmosis, mycoplasmosis, chlamydia, cytomegaly, listeriosis, syphilis, serum hepatitis, can penetrate through the mother’s immature placenta and cause deep damage to the internal organs and brain of the child . Damage to the fetus in the early stages of its development is often multiple, but the nervous system is the first to suffer.

After the final formation of the child’s brain, the sufficiently effective placental barrier is activated (after 12 weeks), and the influence of adverse factors no longer leads to the formation of fetal malformations, but they can cause premature birth, functional immaturity of the fetus, and intrauterine hypotrophy.
At the same time, there are factors that can adversely affect not only the development of the nervous system of the fetus during any period of pregnancy, but also the reproductive organs and tissues of parents: penetrating radiation, alcohol consumption, and severe drug poisoning.

The use of alcohol by parents often leads to the fact that children are born weak, often ill, they have skeletal deformities and congenital malformations of internal organs - the heart, kidneys, lungs. It is known that the mental health of a child conceived while intoxicated is under serious threat.

Smoking can also have a serious effect on the fetus. Nicotine causes a narrowing of the blood vessels in the placenta, which causes less oxygen to reach the baby, with particularly serious damage to the brain of the fetus, which grows and develops rapidly in the last weeks of pregnancy and requires an increased supply of oxygen and nutrients. Level mental development children, born by womenthose who smoke during pregnancy are significantly lower than the level of intelligence of their healthy peers.
The developing fetus has a special need for oxygen. If there is not enough oxygen, undesirable deviations in the development of the central nervous system and other organs of the fetus are possible. Oxygen is a “vitamin of the air,” and future mothers should remember this, especially those suffering from heart defects, anemia, hypertension and in general such diseases that entail oxygen deficiency.

Unfortunately, drug use during pregnancy is one of the new phenomena in the life of our society. The probability of congenital malformations in children born to women who use drugs is 3 percent, which represents a fairly high level of probability of pathology. Drug use leads to the birth of weak children with reduced vitality. Drugs cause deformities of the limbs, changes in the chromosomes and various types of disorders of the brain.

Substances harmful to the fetus are medications, soothing the nervous system - tranquilizers, as well as anticonvulsants. Any medication a pregnant woman should take only as prescribed by a doctor, in exactly the specified therapeutic doses. It is necessary to inform the doctor about pregnancy.

An important role in the development of the fetus is played by the mother's nutrition. Malnutrition or lack of vitamins can affect the normal course of pregnancy, especially in the early period of fetal development. Specific nutritional recommendations, which vary with the gestation period, can be obtained from the obstetrician at the antenatal clinic.

A pregnant woman should be outdoors for 3-4 hours daily, enjoy nature. In addition to walking, it is desirable to perform a special gymnastics complex. During this period, it is very useful to listen to calm, better classical music, to receive only positive emotions. In the seventh month of intrauterine development, the child already hears, has a visual perception, he develops a sense of taste, and if he is touched (mother strokes his stomach), he feels it. Also, the child already recognizes the voices of the father and mother. A woman should enjoy her pregnancy and remember that she is not a future, but a real mother, and her baby is God's highest gift.

Following these recommendations will help a woman carry out the desired child. The child will be strong before birth, it will better endure the process of childbirth, more confidently adapt to the new conditions of existence. The mother should regularly visit the clinic for female consultation and be tuned to a successful outcome of natural childbirth.

Childbirth - one of the crucial stages of the completion of pregnancy. The health of the newborn greatly depends on the correct passage of labor. It is very important to completely overcome the barrier of fear of childbirth. Fear of birth pain and doubts about a happy outcome are fraught with weakening generic activity. Any help with the most good intentions, including anesthesia and genital stimulation, can cause birth injuries. It is very important to understand and comprehend it well. The average duration of pregnancy is 280 days. Most newborns appear between 266 and 294 in the afternoon. By this time, the child weighs 3-4 kg.

Identification of developmental pathologies in the newborn

Evaluation of the newborn on the Angar scale

Every newborn in the delivery room assesses his condition on a scale that was developed by the pediatrician Virginia Apgar. This scale provides an assessment of the viability of the newborn according to five main features - heartbeat, respiration, skin color, muscle tone, and reflex excitability. Each feature is evaluated on a three-point system (0, 1, 2). Assessment of the condition of the newborn is the sum of the five signs and is carried out in the first minute after birth, and then after 5 minutes, after which the results are compared. Healthy children are rated on the Apgar scale at 8-10 points.

What does a healthy newborn look like? His heartbeat is 100-140 beats per minute. Immediately after birth, the baby screams loudly, the color of his skin is pink, and the baby reacts with active movements in response to a touch.

General examination of the newborn

For judging the neurological status of the child, a general examination of the newborn is very important. The child normally makes a chaotic movement of the limbs in full. Look at the newborn through the eyes of a neurologist. For newborns, physiological hypertonia is characteristic (a mild increase in muscle tone in the group of flexors of the upper and lower extremities), therefore its arms and legs are in a bent state, the hands are compressed into cams, and the hips are slightly divorced. This hypertonus is easily overcome, and the doctor can freely make flexor and extensor movements in the arms and legs. Muscle tone in the muscles that unbend the head is somewhat increased, so that newborns normally have a slight tilting of the head backwards. In position on the back of a newborn independently turns his head equally in both directions. Lying on his stomach, he occasionally raises his head for 1-2 seconds, turning his head to the side. Much can tell the doctor posture of the newborn, his movement.

If the child is sick, he may be lethargic, inactive, and sometimes literally spread. In other cases, on the contrary, the tone of the muscles in the limbs is elevated: when swaddling, the peculiar stiffness of the limbs immediately attracts attention.

A generic tumor, edema of the soft tissues of the presenting part of the fetus that occurred during childbirth, is characteristic of most newborns. Most often it is located on the head in the parietal and occipital regions. In the case of the presentation of other parts of the body, the generic tumor is localized in the region of the face, buttocks, perineum, limbs.

In most cases, a generic tumor disappears within two to three days after birth and does not require treatment. By the time of discharge from the hospital, the birth tumor is already disappearing. The larger the size of the generic tumor, the more difficult was the birth of the child, and such a child should be especially carefully examined by a neurologist.

Some children may have bruises on the face, neck, and body as a result of severe childbirth.

Sometimes during birth, another tumor forms on the head - cefalomatoma. This “blood tumor” or “subperiosteal hematoma” is a tumor-like mass filled with blood of a soft consistency with a dense cushion along the edges.

Cefalohematoma is localized within one bone, usually parietal. When the breech presentation cephalhematoma can be located in the occipital region.
Cefalohematoma - a sign of mechanical birth trauma.

Self resorption of cephalhematoma occurs within 6-8 weeks. Treatment is usually not required. For large sizes cefalohematoma, doctors sometimes resort to puncture, remove blood and apply a pressure bandage. One of the indicators of the fact that delivery was difficult, is such a sign as finding the bones of the skull on each other. This small dislocation of the parietal bones usually does not damage the underlying brain tissue, but it certainly indicates that the head of the child passed through the birth canal, experiencing great resistance, and in these cases signs of damage to the nervous system are often detected.

The bones of the skull in premature babies are soft and malleable, so the skull deformation easily occurs during childbirth. The parietal bones easily find each other, so there is a special risk of brain damage to a premature baby.

A large role in assessing the condition of a child is played by the state of the springs

Springs are membranous, not ossified areas of the arch of the child's skull. In total, the fetus has 6 springs, but by the time of birth all of them are closed, except for one of the front, the largest fontanel. It has the shape of a rhombus and is well felt on the temechke. It comes in different sizes. Sometimes you can see how the spring is pulsing. Closes a large spring by the end of the first or second year of life.

Tension, protrusion of fontanelles in a newborn is a serious sign of increased intracranial pressure. When a large amount of CSF (hydrocephalus) accumulates in the cranial cavity, the fontanelles increase in size, become strained and close much later.

Hydrocephalus - dropsy of the brain - occurs due to excessive accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain or subarachnoid space, which is accompanied by their expansion.

Depending on the time of occurrence of hydrocephalus is divided into congenital and acquired. Causes of hydrocephalus may be excessive fluid formation in the ventricles of the brain; violation of the process of re-suction or outflow of fluid through the cerebrospinal fluid paths due to some kind of obstacles and mixed forms. They all require different approaches to treatment.

According to localization, internal hydrocephalus with the expansion of the ventricles of the brain, external with the expansion of the subarachnoid spaces, and the general one are distinguished.

In most cases, internal hydrocephalus is associated with a violation of the outflow of cerebrospinal fluid from the ventricles (occlusive), external hydrocephalus occurs due to atrophy of the brain substance.

Hydrocephalus can occur with an increase in intracranial pressure and normal intracranial pressure.

The cause of congenital hydrocephalus that develops in utero is, as a rule, various intrauterine infections - cytomegaly, syphilis, toxoplasmosis, acute viral infections, rubella, etc., as well as a malformation of the brain. Intraventricular hemorrhage can occur during childbirth, which can also cause hydrocephalus.
The cause of acquired hydrocephalus, developing after birth, most often are transferred inflammatory infections and diseases of the brain.

In some newborns, the head has a size smaller than normal, then talking about microcephaly.

Most often, even with small sizes the head of the child develops normally, but there is microcephaly as a malformation, which is characterized by a decrease in the skull due to underdevelopment of the brain.

There are primary hereditary microcephaly, including true familial, and secondary microcephaly. The latter happens in case of chromosomal and hereditary metabolic diseases, as well as due to infectious diseases and mother intoxication during pregnancy (influenza, rubella, cytomegaly, toxoplasmosis, alcoholism, drugs, etc.), intracranial birth injury, oxygen starvation of the fetus and newborn.

The appearance of a child with microcephaly is typical: there is a disproportion between the facial and brain parts of the skull with the underdevelopment of the latter, a decrease in head circumference by more than 2-3 standard deviations from the average norm, the narrow and sloping forehead, prominent brows, large ears, high and a narrow palate, the so-called "Gothic". The large spring is closed, becomes hard in the first months of life, or even in utero. In children with microcephaly, mental retardation, and sometimes mental retardation of varying degrees, is often detected.

It is very important to know the growth rates of the head circumference in the first months of life. A healthy child is born with a head circumference of 35-36 cm. The maximum increase in head circumference for the first month is 3 cm, for the second month - 2 cm, from the third to the sixth month the head grows by 1 cm per month, and from the sixth to the twelfth month - by 0.5 cm per month.

Thus, by the year the boys have a head circumference of 46–48 cm, girls –– 42–47 cm; the head circumference in the first year of life is 11–12 cm. If the increase in head circumference goes faster or, on the contrary, slower, it is necessary to determine the reason.

When examining a newborn, you must pay attention to the neck and the position of the head. Normally, in a newborn in a supine position, the head should be in the midline. The child equally often turns the head to the left and to the right.

Often in infants, torticollis is detected. The main sign of torticollis is not correct position heads - tilt sideways and face rotation. There are several reasons that cause torticollis. There are muscular, neurogenic, bone and skin forms. All of them can occur intrauterinely (before birth), in which case they are called congenital, or primary. Such forms of torticollis are assessed as an anomaly, or malformation. Torticollis may occur during or after giving birth. In such cases, they are called acquired, or secondary.

Consider all the forms in order.

Muscular torticollis. Inborn muscular torticollis arises even in utero due to congenital malformations of the sternocleidomascula (civatella) muscles. Squat muscle is underdeveloped or shortened. On examination of a newborn, the inclination of the head to the shoulder in the direction of the affected muscle and the turn of the face in the opposite direction are determined; however, the head cannot be brought to the middle position, the asymmetry of the location of the auricles is visible. If the child is not treated, then with age, the severity of the deformity with congenital muscle shank increases. This is mainly due to the lag in the growth of the sternum muscle with the correct growth of the cervical spine.

Acquired muscular torticollis occurs due to injury to the nodule muscle during labor. Immediately after birth, the child usually has no signs of torticollis, by the end of the second week you can feel the thickening and compaction of the nodulary muscles on the one hand, and by the end of the second month of life, the torticollis reaches the maximum degree, which manifests itself by tilting the head toward the affected muscle and turning the face in the opposite, with the asymmetry of skin folds on the neck: on the lesion side, the folds are deeper, often there is diaper rash. Muscle compacting gradually decreases, and the muscle becomes normal. But sometimes the muscle loses its elasticity, becomes thinner and lags behind in growth, then signs of torticollis increase and become especially pronounced by 3-6 years, just as in the case of congenital muscular torticollis.

Neurogenic forms. The overwhelming number of cases of torticollis in newborns indicates a generic injury of the cervical spine. It should be said that in the process of even normal labor, when passing through the birth canal, the baby’s head bends so tightly that it sometimes causes injury to the cervical spine and the spinal cord canal located inside the spinal cord and also very important for the blood supply to the spinal cord and brain, which also pass inside the cervical vertebrae in the special canals of the vertebral arteries - right and left. In such cases, they talk about neurogenic muscular wriggle, which is among the acquired.

Unlike myogenic, neurogenic forms of torticollis are visible from the first days of a newborn's life. As a result of trauma to the cervical spine, the blood supply in the vertebral arteries system decreases, which leads to malnutrition of the spinal cord at the cervical level, where the centers responsible for the muscle tone of the neck are located. As a result, there is a difference in the tone of the neck muscles: on the one hand it is higher, on the other it is lower. This leads to a lateral tilt of the head towards the higher tonus of the neck muscles. A lying child constantly turns his head to one side. Unlike the myogenic torticollis, this hypertonus is quite easily overcome, you can easily bring the head to the middle position and turn it to the other side. The neurogenic character of muscular torticollis is convincingly confirmed by electromyographic study data (EMG).
As mentioned above, cervical vertebrae may be injured during labor. Sometimes such a trauma leads to nadvizhima, dislocations and even vertebral fractures, especially the 1st and 2nd.

An example of the congenital bone form of torticollis can be Clippe-la-Feil disease - short neck syndrome. This is a developmental anomaly that includes three main symptoms: a short neck, short hair growth and cervical vertebral defects - fusion of the vertebrae and non-concoction of the arches.
Skin form torticollis. The pterygoid neck belongs to the skin form of torticollis. For it, the side folds of the skin on the neck are especially typical.

Congenital short pterygoid neck is often combined with Klippe-la-Feil syndrome, may be one of the symptoms of Shereshevsky syndrome, which has a chromosomal nature and is accompanied by a lack of function of the pituitary gland and sex glands. Post-burn scars on the neck lead to the development.

When examining a newborn, one can detect a set of symptoms, which we call cervical, or “cervical,” from the Latin word cervix - neck. They are very important in the diagnosis of neurological diseases of the neonatal period ™.

One of the very persuasive, eye-catching symptoms is the “short neck” symptom. It seems that the child’s neck is very short, the head seems to be inserted directly into the shoulders. Because of this, an abundance of transverse folds on the neck is formed. The symptom of "short neck" occurs as a result of the load on the cervical region and overstretching of the neck during labor, followed by a reflex contraction of the neck muscles according to the "harmonica phenomenon". Retracting the neck, the child kinda spares it. Later, it is in these children that another very important symptom can appear - pronounced tension of the cervico-occipital muscles.

The symptom of "doll handle" also refers to the "neck" symptoms. It is also important in that it is detected even in case of light lesions of the upper extremities - flaccid paresis of the arm. The essence of the symptom is that a sick, weak, paretic arm seems to be attached to the body and is separated from it by a deep fold. This crease-slit resembles the doll’s attached hand, hence the name of the symptom. This symptom occurs in all newborns with obstetric paralysis of the hand.

Similarly, the symptom of a “doll's head” looks like: a head in children with injuries of the cervical spine and spinal cord appears to be pressed against the body, when viewed from the back, on the border of the head and body, there is a deep groove.

Birth trauma can lead to the so-called obstetric paralysis of the arm - flaccid paresis of the arm. In severe cases, the straightened arm lies motionless next to the body, unbent at the elbow joint, and the shoulder is turned inward. Passive movements of the hand, which the doctor checks, are free. Very typical of most cases of the disease is a distinct decrease in muscle tone in the affected (paretic) arm, up to re-extension, recurvation of the arm in the elbow joint.

If you put the newborn on the palm face down, the "sick" paretic sluggish arm hangs, which immediately attracts attention.

Active movements of the handle can be reduced as due to the weakness of the muscles of the shoulder girdle and shoulder (paresis of Erb-Dushen), they can bleed movements in the lower parts of the arm and hand (paresis of Degerin-Klumpke). The most severe damage to the motor neurons of the cervical spinal cord leads to the development of total muscle paralysis of the entire handle of the newborn.

Evaluation of cranial nerve function in newborns

After a general examination, the neurologist proceeds to assess the functions of the so-called cranial nerves. The nuclei of these nerves are located in the brain stem. Assessing the function of the cranial nerves, the doctor concludes that the brain is damaged or not. In the case of deviations from the norm speak of cerebral pathology, that is, due to brain damage.

There are twelve pairs of cranial nerves.

So, let us try to evaluate the function of the cranial nerves in the newborn.

I nerve - olfactory. In a newborn, it is impossible to examine this nerve, since the patient’s participation is necessary to assess the sense of smell: it must answer whether it smells and from which side.

II nerve - optic. With the normal function of this nerve, the newborn squints at the bright light and turns its head and eyes toward the source of light, with a sudden bright flash the child flashes and throws back the head. By two months, a blink reflex appears as the light approaches the eyes. A great deal of information is given to the neurologist by examining the fundus: it allows you to identify hemorrhages, congestion, atrophy of the optic nerve nipple, neuritis, and helps the neurologist to properly assess the degree of damage to the nervous system.

III, IV, VI pairs - oculomotor, blocky, abducent nerves. Thanks to these nerves, synchronous movement of the eyeballs occurs. The doctor pays attention to the shape and size of the pupils: the pupils should be correct form and equal in magnitude, respond well to light. The pathology of the oculomotor nerves, which means the brain, manifests anisocariep - different pupils in size, strabismus, which may be convergent, with affection of the abducent nerve (VI), or diverging - with lesions of the oculomotor nerve (III).

The symptom of the “setting sun” is defined as follows: when a child is transferred from a horizontal position to a vertical, the eyeballs go down, and a sclera strip appears above the iris; after a few seconds, the eyes return to their original position. This symptom often indicates an increase in intracranial pressure.

V pair - trigeminal nerve. This mixed nerve contains sensory and motor fibers. It is impossible to assess the sensitive function of the trigeminal nerve in a newborn (he cannot say anything), but a violation of the motor function of the V nerve in such a child can be determined. With the defeat of the motor portion of the nerve, the lower jaw on the side of the lesion drops slightly, there is an asymmetry of standing between the upper and lower jaws, the child doesn’t grab the nipple, and therefore sucking is difficult.

Many newborns refuse to breast or suck very badly. Various explanations are given for this, including a reference to the mother’s poorly formed nipple. Of course, the pathology of the upper respiratory tract can also be the cause of impaired sucking. Such sucking may be one of the earliest symptoms in congenital heart defects, but the most common cause is neurological pathology - a lesion of the cranial nerves that provide the act of sucking: weakness of the muscle muscle (V nerve), circular muscle of the mouth (VII nerve) and tongue (VII, IX, XII nerves). Therefore, in the case of suckling disruption in the newborn,
consult a neurologist to rule out organic damage to the nervous system.

VII pair - facial nerve. It is best to evaluate the function of the facial nerve in a newborn when it cries, as it is immediately apparent how symmetrical the face is. In normal conditions, both at rest and crying, the face of a newborn is symmetrical. The defeat of the VII nerve is manifested in the asymmetry of the face.

If the nucleus of the facial nerve in the brainstem is affected, then only the lower part of the facial muscles suffers: when weeping on the side of the lesion, there is a drop in the angle of the mouth. Mouth looks skewed.

With the defeat of the facial nerve itself, weakness of the muscles of the entire half of the face develops, while the child has a poor mouth angle on the affected side and the eyelids (lagophthalmos) do not fully close on the same side. This is especially noticeable when crying. The cause of the defeat of the facial nerve in a newborn in the first case is most often a birth injury of the brain, and in the second - a trauma of the skull - the crack of the base of the skull.

VIII pair - auditory and vestibular nerves. It is possible to check hearing as follows: to a sound stimulus, for example, clap with hands, the newborn responds by closing the eyelids (hearing aid), motor restlessness, and fright.

In the first days of life, healthy newborns may experience short-term, small-scale horizontal nystagmus. Nystagmus is a pendulum-shaped twitching of the eyeballs. Roughly pronounced nystagmus is a sign that the brain stem is involved in the pathological process, and, as a rule, accompanies a severe pathology of the brain. The floating movements of the eyeballs in a circle, the so-called coarse rotator nystagmus, always indicate a particularly severe pathology of the brain stem.

The defeat of the auditory nerve leads to hearing loss. Causes of hearing loss may be different. There are cases of both a congenital hearing defect in children and the toxic effects of antibiotics and other drugs (gentamicin, monomitsin, kanamycin, streptomycin, biseptol, furosemide) on the auditory nerve. Deaf children should always look for signs of a generic cerebrospinal injury (brain injury and spinal cord and spinal cord injury at the cervical level), in which pathology develops in the pool of vertebral arteries, as these blood vessels feed the inner ear. It is very difficult to assess the nature of hearing impairment in children, and only after the child grows up does it become possible to record an audiogram and thus determine the location of the hearing loss. But it is necessary to remember about a possible vascular catastrophe, since the necessary treatment carried out in time can be very effective.

IX, X, XI, XII pairs of cranial nerves - glossopharyngeal, vagus, accessory, hypoglossal nerves form a special company called the caudal, bulbar group of nerves. They are damaged in newborns more often than any other brain formations, since during birth a very large load falls not only on the cervical spine and spinal cord, but also on the brain stem directly adjacent to it, its final division.

The symptoms of damage to this group of nerves are called bulbar symptom complex, or bulbar paralysis. Such newborns are choked, milk flows out through the nose, crying becomes not only quiet, but also has a nasal hue.

Due to the weakness of the circular muscles of the mouth and the muscles of the tongue, the child cannot take the breast well, grab the nipple, he does not have enough strength to suck. Sometimes this simp-tomocomplex is first noticed when a child starts to be fed with cereals, mashed potatoes, and minced meat. The child can not eat solid food, chokes.

Thus, the study of brain functions, namely cranial nerves in newborns, is very important, provides a large amount of information, allows the doctor to correctly diagnose the disease, start timely treatment and prevent the development of serious complications.

Evaluation of the motor activity of the newborn

It is very important to correctly assess the motor activity of the newborn. It is especially necessary to pay attention to the symmetry of movements in the limbs: the pace and range of movements in the left arm and left leg should be the same with the movements in the right arm and right leg. Even small restrictions in the arms and legs should be noticed by the parents and the doctor, as they may indicate paresis or paralysis of the limbs.

What are paresis and paralysis?

Paresis is the weakening of voluntary movements in the limbs and the reduction of their volume (partial, incomplete paralysis).

Among paresis emit:

Monoparesis - the defeat of only one limb;
hemiparesis - the defeat of the arms and legs on one side;
upper paraparesis - the defeat of both hands;
lower paraparesis - the defeat of both legs;
tetraparesis is a lesion of both arms and both legs.

Paralysis (plegia) is the complete absence of voluntary movements in the limbs. In the complete absence of movements in the limbs, doctors use the terms - monoplegia, hemiplegia, upper and lower paraplegia, tetraplegia.

If there is paresis or paralysis, it is necessary to determine where the damage occurred - in the cerebral cortex or in the nerve cells of the spinal cord.

Movement disorders occur with damage to the motor nerve path (it is also called pyramidal), which consists of two neurons - the central and the peripheral.
The central motor neuron is located in the cerebral cortex in the motor zone of the anterior central gyrus. Its long appendix passes through the main deep structures of the brain, including through the brainstem, delivering fibers to the nuclei of the cranial nerves. At the border of the medulla and the spinal cord, the fibers of the central motor neuron pass to the opposite side, fall into the lateral cords of the spinal cord and descend in their composition to the lowest parts. In the course of the spinal cord from the motor path the fibers to each segment, ending at the cells of the anterior horns of the spinal cord.

Damage to the central motor neuron in any of its segments leads to the immediate development of central “spastic” paresis, which has very typical signs: increased muscle tone (hypertonia), high tendon reflexes (hyperreflexia), pathological foot signs.

The second neuron of the motor path, the peripheral, is the motor cells of the anterior horns, which are located all the way down the spinal cord. Fibers from peripheral neurons emerge as part of the anterior roots of the spinal cord and participate in the formation of plexuses, which form mixed peripheral nerves containing sensory and motor threads. The motor second neuron in the muscles ends. Damage to the second neuron of the motor path on any of its segments leads to the development of peripheral "sluggish" paresis or paralysis of the limb, which is characterized by a decrease in muscle tone (hypotonia), a decrease in tendon reflexes (hypore-flexion), followed by "weight loss", muscle atrophy.

Damage to the neurons of the anterior horns of the spinal cord is detected on the electromyogram by characteristic changes. That is why the electromyographic study helps to find out the cause and localization of the nervous system damage in movement disorders. Of course, to identify paresis in newborns is much more difficult than in older children.
In older children, the method of determining the reduction of muscle strength is simple: the patient has a resistance, resistance to the doctor when he tries, for example, to bend or unbend a child’s arm or leg forcibly. If the child does not offer resistance or it is very little - the doctor concludes that the muscle strength decreases.

Naturally, it is impossible to appeal to the newborn. In these cases, one has to use the mediated method. One of the indirect signs of paresis may be posture limb. So, with sluggish paresis of the arm baby the hand is sluggishly lying next to the body, the palm is usually straightened, the forearm is turned inward, as if twisted (pierced).

When sluggish paresis of the upper extremities affects the lower parts - the brush. The posture of the “seal paws” is very characteristic, when both hands are straightened and sluggishly hanging down. In the hands with flaccid paresis, over-bending in the elbow joints is always revealed, in the legs with sluggish paresis - over-bending in the knee joints. The legs of such a child can easily get to his face.

The manifestation of a reduced muscle tone in case of sluggish paresis in the legs is the characteristic “frog posture” - the legs unfold, fall off to the sides. For the same reason, with paresis in one leg, a symptom of a “falling foot” can be identified, which indicates the weakness of the muscles of this leg. With flaccid paresis, predominantly in the lower sections of both legs (in the feet), a symptom of “heel feet” may occur, when the doctor can easily touch the back of the foot of the newborn with the front surface of his leg.

On the contrary, with spastic paresis of the hands, the brushes are tightly clenched into the cam, and the handles are bent at the elbow joint, and sometimes diaper rash appears in the folds of the palms. Attention is drawn to the peculiar "stiffness" in the limbs.

Great importance doctor attaches to the sample for breeding legs: healthy baby You can passively spread your legs about 90 degrees - 45 degrees on each side. If the legs are divorced more, then the hypothesis about the sluggish paresis of the legs is great; if it is less, the doctor ascertains the increase in the tone in the legs, their spasticity.

In the rougher cases of spastic paresis, the legs are not divorced at all, they are tightly attached to each other and even “fit” one on another - a typical symptom of “overlap” arises.
A very important sign of increased muscle tone in the legs is the “chick” symptom. When trying to put a baby on his feet, such a child, firstly, stands on tiptoe and, secondly, often crosses his legs. The rougher “chicks”, the higher the muscle tone in the legs, indicating a central, spastic paresis.

This symptom of chicks can persist for a very long time, and with gross paralysis it remains almost forever, which makes it impossible for the child to move around easily, and in severe cases it does not even allow him to walk. The phenomenon of “chicks” is very often found in premature babies, since spastic paresis in their legs is especially common. A rough sign of a birth trauma of the cervical spinal cord is a symptom of a falling head: when trying to lift a child by the arms from a prone position, he cannot “pull out” and hold his head.

There is another symptom of cervical injury. It manifests itself in the following way: newborns lie on their backs in an unusual posture - the head is turned to the side almost 90 degrees in relation to the body, and in some children this symptom is minimally expressed, in others it is very rough. This is a sign of a kind of “loosening”, instability of the cervical vertebrae due to the trauma of the vertebral joints in this area, which can be confirmed radiologically, including in older children.

When the child’s sluggish paresis of one leg, asymmetry of the femoral folds may be noted, which is sometimes mistakenly regarded as a sign of hip dysplasia. The reason for this asymmetry of the femoral folds is that a newborn with flaccid paresis of the leg, due to muscle pathology, again has a loosening in the hip joint, the muscles of the diseased leg “lose weight”, and the excess skin is gathered into folds.

With flaccid paresis in the feet of the sole of a newborn, you can easily fold it together. The child himself prefers to lie with divorced hips in a “frog pose”. In children with flaccid paresis of the legs, a deep fold sometimes forms between the leg and the body. This so-called symptom of the attached “doll leg” is one of the most important symptoms characteristic of the lumbar level of lesion in spinal birth injury.

In severe pathology of the lowest parts of the spinal cord due to circulatory disorders in the pool feeding the arteries of the newborn immediately after birth, true incontinence of urine and feces can occur: the child is constantly wet, and from the anus all the time feces, and with a slight pressure on the abdominal the wall of the newborn urine and feces increased. Characteristic of intermittent diaper rash, even with good care. In boys, urinary incontinence is easier to notice: droplets of urine are constantly visible at the tip of the penis.

However, the cause of incontinence of urine and feces can be not only the birth injury of the spinal cord, but also the congenital underdevelopment of the spinal cord (congenital myelodysplasia), spinal cord hernia, but these diseases are rare.

Disorders of urination and bowel movements, the so-called pelvic disorders - a very severe symptom complex that requires intensive, targeted therapy. The treatment is most effective in case of vascular origin of pelvic disorders, that is, in case of circulatory disorders in the final section of the spinal cord.

Continuing the conversation about movement disorders in newborns, I especially want to draw the attention of parents to the symptom of a uniform decrease in muscle tone in the arms, legs, muscles of the back and abdomen, called the myatonic syndrome. It is also called the "sluggish child" syndrome.

One of the most common causes reducing muscle tone - diffuse muscular hypotonia in newborns and older children - impaired function of the “brain stem energy substation”, the so-called reticular formation. The reticular formation is responsible for maintaining and regulating the tone of the muscles of the whole organism, the blood supply to the reticular formation is provided by all the same vertebral arteries, so often damaged during childbirth.

The myatonic syndrome is one of the most frequent neurological symptom complexes in the neurology of newborns. Over time, it may disappear completely, but for some children, the effects remain for life. The result of a pronounced decrease in muscle tone in growing children is excessive mobility in all joints of the extremities until an audible crunch, over-bending (recurrence) in the elbow and knee joints, when the arm or leg is in the shape of an arch when stretched. For these patients, the typical symptom of "thumb", when the child can safely bend thumb hand to forearm. And here is another manifestation of diffuse muscular hypotension (no other patients have such an unusual opportunity to “fold in half” - to freely reach with their toes of their own forehead or vice versa) - while sitting, the child easily bends forward so that his head can lie down between the feet. All this is reminiscent of folding penknife. Often children take this position during sleep. Miatonic syndrome in school-age children often causes delight in parents and teachers - children are striking in their flexibility, they easily perform the gymnastic “bridge”, “splits”, “fish”. As a rule, most of the newborns with myatonic syndrome are born with allowances, with extrusion, with stuck shoulders. They usually experience motor development delays: such children begin to hold their heads, sit, walk a little later. They prefer to sit, and starting to walk, often fall down, get tired quickly.

The main distinguishing feature of the myatonic syndrome from other conditions in which muscle tone may decrease is the combination of a uniform decrease in muscle tone with high tendon reflexes identified by a neurologist. The reason for this is the defeat of the motor pyramidal path at the same level of the brain stem, where the reticular formation is located.

The combination of low muscle tone with high tendon reflexes, as well as the phenomenon of “chicks”, is characteristic only of the myatonic syndrome due to the birth trauma of the cervical spine with the spinal cord in its canal.
Disorders of muscle tone in newborns already at birth can manifest clubfoot. In this case, the bones are developed normally, and the abnormal position of the feet is caused by a violation of the innervation of the muscles. This condition is called secondary neurogenic clubfoot.

A very simple, but very demonstrative technique, which allows you to immediately diagnose neurogenic clubfoot, is this: if during the first days of life, when you did not have time to develop secondary contracture (stiffness) in the ankle joint, a normal position can easily be given to the curved foot, - This is a neurogenic clubfoot that can be clearly confirmed electromyographically.

With a bone form of congenital clubfoot, foot deformity is also evident from the first day of life, but no manual attempts to lift the foot and give it the correct position do not give effect.

Hence it is clear that the treatment of congenital clubfoot and neurogenic clubfoot differ in many ways. Orthopedists deal with the treatment of bone forms of clubfoot.

In conclusion, I want to emphasize that motor disorders in newborns are very common.

Unconditioned reflexes of newborns

The doctor examining the newborn pays attention to his unconditioned reflexes. By examining them, the doctor receives important information about the activity of the central nervous system and can evaluate whether it is the norm or a deviation from the norm.

The golden rule of neuroscience can be considered that a healthy baby should have a complete set at birth. physiological reflexesthat disappear by 3-4 months. Pathology is the absence of them in the period of the newborn ™, as well as a delay in their reverse development.
It is unacceptable to stimulate the reflexes of the newborn, especially the reflex of the automatic walking.

DIAGNOSTICS

Objectively, the state of ICP can be assessed only during surgery with an opening of the skull or (less reliably) during lumbar puncture (this is when a needle is inserted into the space near the spinal cord and pressure is judged by the rate of fluid flow). All other studies provide indirect information that can develop into a certain picture only with proper interpretation by a doctor. An increase in the ventricles of the brain, subarachnoid spaces, and the interhemispheric fissure is often detected in healthy people and says nothing about the clinical picture.

For NSG (CT, MRI) diagnosis is not made and treatment is not prescribed.

The most accessible initial diagnostic method for suspected ICP elevation is fundus examination. Additional methods of examination are intended to clarify the nature of the brain damage.

Visualization methods (neurosonography, computed or magnetic resonance imaging) are not directly related to the determination of pressure, although they can help to clarify the cause of the disease, assess the prognosis and suggest the direction of action.

The use of echoencephaloscopy (Echo, or Echo - echoencephalography) "to determine ICP" - a common misconception in the post-Soviet space. It is fundamentally impossible to estimate pressure with the help of echoes. This ancient method is used only for a quick and very approximate search for large intracranial volume lesions (tumors, hematomas, etc.). These echoes can be useful in the car 03 or in the emergency department when determining the methods of first aid and choosing the place of hospitalization.

You can not assess ICP using electroencephalography (EEG), rheoencephalography (REG).

Just in case, it is worth mentioning the notorious “computer diagnostics” of the whole organism in 2 hours, about which all the lampposts of any city are full of announcements. Remember, dear parents, similar methods of charlatan - these procedures are not at all related to the diagnosis of something and serve only to take money.

TREATMENT.

The treatment of conditions associated with an increase in ICP depends on the causes of their occurrence. Thus, in hydrocephalus, operations are performed in which an excess of CSF is removed from the cranial cavity, in the presence of a tumor, its removal is performed, and in case of neuroinfections, antibiotics are administered. Symptomatic drug treatment aimed at reducing ICP is also used, but this is usually a temporary measure for an acute situation.

Incorrect common practice of “treating” any diuretic drugs (diacarb, triampur). In most cases, this treatment is aimed at a non-existent diagnosis. If there is real evidence, treatment should be carried out in the hospital under strict control. The desire for "medical treatment of intracranial hypertension" can lead to a loss of time and development for this reason of irreversible changes in the body (hydrocephalus, blindness, impaired intelligence). On the other hand, the treatment of a healthy patient threatens "only" with the side effects of the drugs used.

No condition with elevated ICP is treated:

- “vascular preparations” (cavinton, cinnarizine, sermion, nicotinic acid, etc.)

- “nootropic drugs” (nootropil, piracetam, pantogam, encephabol, picamilon, etc.)

Homeopathy

Herbs

Vitamins

Massage

Acupuncture

What is muscle tone and why is it so "loved"?

Look at your child's medical record: is there no such diagnosis as “muscular dystonia”, “hypertension” and “hypotension”? - probably, you just did not go with your baby up to the year to the clinic to a neurologist. This, of course, is a joke. However, the diagnosis of "muscular dystonia" is not at all more rare (and maybe more often) than AED, hypertensive-hydrocephalic syndrome (HGS) and an increase in intracranial pressure.

Changes in muscle tone can be, depending on the severity, as a variant of the norm (most often), as well as a serious neurological problem (this is much less common).

Short external signs of muscle tone changes.

Muscular hypotonia is characterized by a decrease in resistance to passive movements and an increase in their volume. Spontaneous and voluntary motor activity may be limited, muscle probing is somewhat reminiscent of "jelly or very soft dough." Pronounced hypotension can significantly affect the rate of motor development. Muscular dystonia is characterized by a state where muscle hypotonia alternates with hypertension, as well as a variant of disharmony and asymmetry of muscle tension in individual muscle groups (for example, in the arms more than in the legs, more to the right than on the left, etc.).

Hyper-irritability syndrome or a syndrome of increased neuro-reflex excitability.

The presence of such manifestations in a child is only a reason for referring to a neurologist, but in no case is there any reason for parental panic, and even more so, medical treatment.

Constant hyper-excitability in the causal relation is not very specific and most often can be observed in children with temperament peculiarities (for example, the so-called choleric type of response). Much less often, hyper-irritability can be associated and explained by the perinatal pathology of the central nervous system. In addition, if a child’s behavior suddenly suddenly and for a long time was disturbed for almost no apparent reason, he developed hyper-excitability, it is impossible to rule out the likelihood of an adaptation disorder reaction (adaptation to external environmental conditions) due to stress (change of residence, registration in the garden, divorce of parents and others ). And the sooner the specialists look at the child, the easier and faster it is to cope with the problem.

And, finally, most often, transient hyper-excitability is associated with pediatric problems (rickets, digestive disorders and intestinal colic, hernia, teething, etc.).

There are two extremes in the tactics of monitoring such children. Or “explanation” of hyper-excitability with the help of “intracranial hypertension” and intense medical treatment using often drugs with serious side effects (diacarb, phenobarbital, etc.). Or the complete disregard of the problem, which can later lead to the formation of persistent neurotic disorders (fears, tics, stuttering, anxiety disorders, obsessions, sleep disorders) in the child and his family members, and will require a long-term psychological correction.

Of course, it is logical to assume that an adequate approach is somewhere between them ...

ATTENTION. Separately, I wanted to draw the attention of parents to convulsions - one of the few disorders of the nervous system that really deserves close attention and serious treatment. Epileptic seizures are not common in infancy, but sometimes they are difficult, insidious, and disguised, and immediate medical therapy is almost always necessary. Such attacks can be hidden behind any stereotyped and repetitive episodes in the child’s behavior. Incomprehensible startles, nods of the head, involuntary eye movements, “fading”, “pinching”, “limping”, especially with the sight stopped and the lack of response to external stimuli, should alert the parents and force them to turn to specialists. Otherwise, a late diagnosis and untimely prescribed drug therapy significantly reduce the chances of treatment success.

All the circumstances of the episode of convulsions must be accurately and fully memorized and, if possible, recorded on video, for further detailed narration in a consultation. If convulsions last for a long time or repeat - call “03” and urgent consultation with a doctor.

At an early age, the child’s condition is extremely changeable, therefore developmental abnormalities and other disorders of the nervous system can sometimes be detected only during long-term dynamic monitoring of the baby, with repeated consultations. To this end, specific dates for scheduled consultations of a pediatric neurologist in the first year of life are determined: usually at 1, 3, 6 and 12 months. It is during these periods that most severe diseases of the nervous system of children in the first year of life (hydrocephalus, epilepsy, cerebral palsy, metabolic disorders, etc.) can be detected. Thus, the identification of a specific neurological pathology in the early stages of development makes it possible to start a complex therapy on time and at the same time achieve the maximum possible result.

And lastly. What can be hidden under the record in the card - PERINATAL ENCEPHALOPATHY (PEP).

The term “perinatal encephalopathy” (PEP) in Russian pediatric neurology implies a collective diagnosis characterizing various violations of the structure and function of the brain that occurs in the perinatal period of a child’s life. The perinatal period starts at the 28th week of the intrauterine life of the child, and ends by 7 days after birth (in full-term babies) or by 28 days (in preterm). I think you can see that this term does not imply any particular pathology. It is understood that the child has “something with the brain” due to some kind of damage. At present, a world-class classification has been adopted in Russia, which describes in detail the brain lesions (hypoxic, traumatic, toxico-metabolic, infectious) and, when properly used, transmit information about the condition of the child and its causes in the formulation of the diagnosis. Only now, many neuroscientists at the present stage have replaced AEDs with "hypoxic-ischemic damage of the central nervous system" (GP CNS) in the absence of specific data does not change anything and everything that has been said is valid also for such "modern" formulations.

DIAGNOSTICS AND HYPER DIAGNOSTICS

Many doctors still consider pathology to be the signs that are the norm for this age period (for example, startle, increased muscle tone in newborns, “crossing” the legs when supported in children under 3 months, Graefe's symptom, etc.). Hyperdiagnosis possible in violation of the principles neurological examination. The most frequent of them are:

diagnostics of increased excitability or muscular hypertonia in a shivering and fettered child in a cold room, as well as in case of an agitated state or excessive manipulations of a doctor; diagnosis of depression of the central nervous system in a sluggish child with overheating or drowsiness.

Psychological causes. They consist in the fact that due to the current situation in the domestic healthcare system, “overdiagnosis” has no administrative, legal, ethical consequences for the doctor. The statement of the diagnosis leads to the prescription of treatment and in the case of the correctness or incorrectness of the diagnosis the outcome (more often, recovery or minimal disorders due to the course most characteristic of hypoxic brain lesions) is favorable.

4. Financial reasons. Excessive diagnostics lead to an overload of doctors, diagnostic rooms and support services, which, in the case of a public health institution, maintains an overestimated staffing table and prevents staff redundancy or retraining of staff, and in a commercial medical institution, it directly increases the income of medical workers.

Negative consequences for parents and loved ones of a child. Excessive diagnosis is not harmless to the family of the child.

1. First, the total diagnosis of "PEP" leads to the fact that parents consider the child sick even when he is healthy, which leads, in turn, to intrafamily psychological problems.

2. Secondly, “overdiagnosis” leads to perverse ideas of parents about “norm” and “pathology”. During the time of the research work, we were faced with two cases in which the parents, when concluding that the child was neurologically healthy, asked the question: “Is my child abnormal? Why do all children have encephalopathy but he doesn’t?”

3. Thirdly, overdiagnosis leads to unjustified treatment, which is detrimental to the budget of the child’s family.

Negative consequences for the child. "Hyperdiagnostics" has the following negative effects on the child herself, whom she allegedly must protect from the pathological state of the nervous system.

1. First, overdiagnosis leads to excessive prescription of diagnostic procedures, which most often increase the child's stay in the conditions of medical institutions and promote contact of the child with patients with infectious diseases.

2. Secondly, “overdiagnosis” leads to over-treatment, often by means and manipulations that are not adequately controlled, which sometimes leads to disastrous consequences.

3. Thirdly, the “overdiagnosis” of perinatal lesions of the nervous system, in general, leads to the fact that most neurological and not only neurological disorders that subsequently arise in a child, doctors associate with perinatal damage of the nervous system, although in fact they have arisen not at all on this.

In addition to the concept of AEDs, “increased neuro-reflex excitability syndrome”, “muscular dystonia syndrome”, “autonomic-visceral disorder syndrome”, etc. are added, which frightens parents even more. These terms are extremely vague and to some extent can be used in the description of healthy children.

TREATMENT AND HYPROXIDE

Only real, objectively identified and clearly marked consequences of perinatal lesions of the nervous system may require the use of drugs, but this is always symptomatic treatment, i.e. aimed at specific problems: in case of hypertonus - preparations for muscle relaxation, in convulsions - anticonvulsants, etc. However, most children with a formal "PEP" are prescribed a variety of drugs and their combinations with unproven efficacy. Here is a list of the most frequent irrational appointments in children's practice.

1. The so-called vascular drugs. These include drugs of various groups (cinnarizine, cavinton, sermion, etc.)

2. Preparations containing amino acid hydrolysates, neuropeptides, etc. - Cerebrolysin, Actovegin, Solcoseryl, Cortexin, etc.

3. The so-called "nootropic" drugs that "improve the nutrition of the brain": piracetam, Aminalon, Phenibut, Pantogam, Picamilon, etc.

4. Homeopathic remedies.

5. A variety of herbal preparations, including well-known to the population of valerian, motherwort, as well as lingonberry leaves, bear ears, etc.

Many common in the CIS drugs should be used very limited, according to strict indications. So, for example, the use of diacarb can be justified with hydrocephalus (not with “hydrocephalic cider” - it does not exist!), And a child with such a diagnosis must be under the supervision of a neurosurgeon. The use of phenobarbital in children with "hyper-excitability", "sleep disorders" is unacceptable. The use of this drug is possible only with convulsions (although there are more modern and usually more effective drugs), since it is proven to cause a delay in the development of cognitive functions in a child.

MONITORING AND TERMS OF THE BEGINNING OF TREATMENT

Pathology of the nervous system at an early age can sometimes be detected only during repeated examinations or during long-term monitoring of the development of a child. For this purpose, examinations by a neurologist at 1, 3, 6 and 12 months are provided. In these terms, many serious diseases will debut or become apparent. And if a child has a specific neurological diagnosis - epilepsy, cerebral palsy, etc. - delay with treatment is unacceptable! This is especially true for epileptic seizures - timely treatment can prevent the development of serious pathology in the future.

And in conclusion, I would like to remind parents: be sensitive and attentive to your kids! No one knows your child better than you, his features, character, habits. First of all, it is your meaningful participation in the life of children - this is the basis of their future well-being. Do not heal them from “suspected diseases”, but if you are worried and worried about something, find an opportunity to get independent advice from a qualified specialist.

Paretskaya A.M.

Used materials for writing the article.