Pediatric neurology: diseases — симптомы, диагностика и лечение

Dyslexia is a persistent selective reading disorder with intact intelligence, normal vision and hearing, and normal learning. It is difficult for a child to associate a letter with a sound and merge sounds into a word, so he reads slowly, syllable by syllable, rearranges and skips letters, guesses endings and does not understand what he read well. At the same time, in oral conversation he argues no worse than his peers. The reason is not laziness or lack of effort, but the peculiarities of the functioning of the speech areas of the brain. Dyslexia cannot be “outgrown” without help, but regular sessions with a speech therapist significantly improve reading technique and understanding.

Psychomotor development delay (PDD) is a lag of a young child in mastering motor, speech, cognitive and social skills compared to age norms. Such a baby later begins to hold his head up, sit, walk, babble, speak his first words, and interacts worse with others. ZPR is not a final diagnosis, but a description of a condition that may have various causes: prematurity, damage to the nervous system during pregnancy and childbirth, genetic syndromes, hearing and vision impairment, hypothyroidism, lack of communication and stimulation. The sooner the delay is noticed and help is started, the better the child develops. Parents should not expect that the baby will “outgrow”: if in doubt, they should be examined by a pediatrician and a pediatric neurologist.

Macrocephaly is a child’s head circumference that is noticeably higher than average for his age and gender. In itself, such a conclusion is not a diagnosis and often does not mean a disease: the most common cause of a large head in a healthy baby is a hereditary trait when the father or mother has large heads. The second common and benign situation is a temporary expansion of the spaces around the brain in children of the first year, which goes away on its own. However, behind head enlargement there are sometimes hydrocephalus, accumulation of fluid under the membranes, mass formation or metabolic diseases. The dynamics of head growth, neurological examination and ultrasound through the fontanel help to differentiate between these conditions.

Migraines in children are repeated attacks of severe headaches, which are accompanied by nausea, intolerance to light and sounds. In children, the attack is often shorter than in adults, and the pain often affects both sides of the head or the forehead, so parents mistake it for fatigue or vision problems. The cause of migraine is the congenital increased excitability of the nervous system and the functioning of the brain vessels, and not a tumor or injury. Attacks are triggered by lack of sleep, skipping meals, dehydration, stuffiness, stress before tests and screens. Migraine is not life-threatening, but it steals a child’s school days, so it is important to recognize it and learn to control it together with a neurologist.

Microcephaly is not an independent disease, but a sign: the child’s head circumference is significantly less than the average for his age and gender. The skull grows with the brain, so a reduced head size almost always reflects underdevelopment or damage to brain tissue. Microcephaly can be congenital, when it is noticed at birth, and acquired, when the head grows too slowly in the first months and years. There are many reasons: genetic characteristics, previous intrauterine infections, oxygen starvation during childbirth, metabolic disorders. One measurement in itself does not prove anything: the dynamics of head growth, the size of the parents and how the child develops are important.

Muscular hypertonicity in infants is increased muscle tension, in which the baby’s arms and legs are bent and pressed to the body, the fists are clenched, and it is difficult to straighten the limbs. In the first 3–4 months of life, this flexor tone is physiological: it persists from the time of intrauterine development and gradually weakens. Therefore, “hypertonicity” in a healthy baby often turns out to be a variant of the norm, and not a disease. Asymmetry of movements, tilting of the head, persistent tension after six months, crossing of the legs, resting on the toes, developmental delay should be alarming. Such signs occur with perinatal damage to the nervous system and cerebral palsy and require observation by a pediatric neurologist. Treatment is prescribed only if the disorder is confirmed; The basis is exercise and massage.

Muscular hypotonicity is a decrease in muscle tone, in which the baby seems lethargic, holds a pose worse, and seems to “spread” in the arms of an adult. The tone is assessed by a doctor, not a parent: in newborns it is normally high, by 3–4 months it physiologically decreases, and some of the worries turn out to be in vain. True hypotension is a consequence of prematurity, previous hypoxia, infection, metabolic and genetic diseases, diseases of muscles and nerves, as well as hypothyroidism. The main guideline is not in the “softness” of the child, but in the development of skills: whether he holds his head, whether he leans on his forearms, whether he turns over on time. Persistent lag, along with weak sucking and lethargy, is a reason to be examined by a pediatric neurologist.

Tics are sudden, rapid, repetitive movements or sounds that a person makes involuntarily: blinking, shoulder twitching, grimacing, coughing, grunting. Before a tic, there is often an unpleasant sensation that goes away after movement, and the tic can be controlled for a short time. Tics are very common in school-age children, especially boys, and in most cases go away on their own within a few months. If motor and at least one vocal tic persist for more than a year, they speak of Tourette's syndrome. Tics are not associated with poor parenting and are not a sign of declining intelligence. They intensify with excitement and fatigue. Treatment is needed if tics interfere with learning, socializing, or cause pain.

Night terrors are episodes in which a child, an hour or two after falling asleep, suddenly sits up or jumps up, screams, cries, looks very scared, has dilated pupils, rapid heartbeat and sweating. At the same time, he does not truly wake up: he does not recognize his parents, does not respond to consolation, and may push away. The episode lasts from a few minutes to half an hour and ends with the child falling asleep again and not remembering anything in the morning. This is not a mental disorder or a sign of trauma, but a feature of immature sleep in the deep slow-wave sleep phase. For most children, fears go away on their own with age.

Perinatal damage to the central nervous system is damage to the baby's brain that occurs between the 22nd week of pregnancy and the first week after birth. The most common cause is a lack of oxygen and impaired blood flow during pregnancy or childbirth, less often it is infections, hemorrhages, severe jaundice, metabolic disorders and birth trauma. The severity varies greatly: from mild transient changes that resolve completely, to conditions leading to cerebral palsy and epilepsy. It is important to understand: such a diagnosis in the chart itself does not predict the future of the child. What matters are actual symptoms, examination data and how the baby develops over time.