👩⚕️ Pediatric neurology is a service offered by a physician who is sub-specialized in disorders of the central and peripheral nervous system. This translates to conditions that affect a child’s development, sleep, learning, or school performance.
Among the services offered are the management and treatment, particularly in the office, of headaches, developmental delay, behavior problems, seizures or epilepsy, intellectual disability, cerebral palsy, autism spectrum disorder, micro and macrocephaly, attention deficit and hyperactivity disorder, movement disorders, tics or tourette syndrome.
🏥 Also, pediatric neurologists evaluate hospitalized patients. Those most common conditions in the hospital include head bleeds, seizures, motor weakness, and central nervous system infections such as meningitis and encephalitis.
🩺 Professional help must be sought when there is a concern, for example, in the child’s development (delay in speaking, walking, crawling, turning around, poor social communication, eye contact, among others). Also, if there are neurological crises such as seizures. It is very common to see migraine or tension headaches in children, especially if there is a family history of migraine. There are many patients who come to the office referred by the school, teachers, or psychologists due to poor school performance to evaluate if there is attention deficit and hyperactivity or indeed seizures. For example, there are patients referred by teachers as they notice that they become spaced or their grades begin to drop for no apparent reason.
📚 Neurological evaluation often involves studies such as head images, either CT or MRI. In many cases, another head study called electroencephalogram (EEG) is recommended. EEG is an office-based study to assess for abnormal discharges that predispose the patient to seizures. There are cases needing referral to a psychologist for psychometric and psychoeducational tests to rule out intellectual disability, specific learning problems or multiple behavioral problems such as oppositional defiant disorder.
📱 If you understand that your child should be evaluated by a pediatric neurologist, you just have to call for an immediate appointment.
Healthy habits at bedtime.
Febrile seizures are the most common neurological disorder in infants from 6 months of age to children before 5 years of age. These seizures are divided into 2 types: simple and complex.
Simple febrile seizures are defined as seizures generated by fever for less than 15 minutes, without focal findings, and that do not recur within 24 hours. Most febrile seizures fall under this classification, and they can recur in about 1/3 of children during early life. It is important to remember that they are a benign phenomenon, and their association with future epilepsy risk is only slightly higher than the general population
Complex febrile seizures are those that last longer than 15 minutes, seizures involving multiple events in a 24-hour period, or when they involve a focal event such as movement of a single hand or foot. They have a higher risk of recurrence during the young age of the child.
It should be mentioned that there are various types of seizures including generalized, myoclonic, absence seizures, among others. For example, if a teenager drops things in the morning, or has difficulties while brushing his or her teeth, this could be a type of seizure. In contrast, a child who stares into the distance, and does not respond to name or touch could be another type of seizure.
Regardless of the type of seizure, it is necessary to help the patient. If a child is seen having a seizure with vigorous movements of all limbs, the most important thing is to place the patient on the side while holding the head either on the assistant’s lap or by placing a towel under the patient. You have to be aware of the clock as if the seizure reaches 5 minutes you have to prepare to get to the nearest emergency room or call 911 because the patient will probably require intravenous medications to stop the seizure.
If you understand that your child should be evaluated by a pediatric neurologist, you just have to call for an immediate appointment.
A concussion is a mild brain injury that commonly causes confusion, memory loss, and a headache. A concussion can happen as a result of a fall or other type of accident directly or indirectly impacting our brain. It can also commonly happen during participation in sports. Among adolescents who play sports, concussion is one of the most common injuries.
If your child gets a concussion (either on or off the field), it’s very important that they stop playing sports until a doctor says it’s safe to start again. Be aware that kids sometimes lie about their symptoms or simply do not recognize them. Moreso, if they are afraid that they will not be allowed to play if keep having symptoms.
Among boys, the sports most often linked to concussions are soccer, and football. Among girls, the sports most often linked to concussions are soccer, lacrosse, and field hockey.
The symptoms that can happen minutes to hours after a concussion include:
● Memory loss – children sometimes forget what caused their injury, as well as what happened right before and after the injury
Symptoms that can happen hours to days after a concussion include:
Depending on your child’s mechanism of injury and symptoms they need to be worked up. To check if your child has a concussion, the doctor will ask about their symptoms and behavior, and do an exam. The doctor will also ask your child questions to check that they are thinking clearly.
If the doctor suspects a serious injury, they might order an imaging test of the brain, such as a CT or MRI scan. These tests create pictures of the skull and inside of the brain. But these tests are not usually needed for a routine concussion. In fact, a CT scan can be risky, because it involves radiation. Studies show that doing unnecessary CT scans in children and adolescents increases the risk of cancer later.
Your child should see a doctor who has experience treating concussions. This might be your child’s regular doctor, or they might refer you to a Child Neurologist.
Treatment of a concussion involves:
Image: Starke Kopfschmerzen – Migräne – Medizinische Illustration – 3D Rendering
A parasomnia is a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt your sleep. A parasomnia can occur before or during sleep or during arousal from sleep. If your child have a parasomnia, he or she might have abnormal movements, talk, express emotions or do unusual things. Your child is really asleep, although you might think he or she is awake. Here are the most common ones.
Night terrors (also called “sleep terrors”) are episodes in which children wake up suddenly at night and act very upset. They might scream and jump out of bed, as if running away from something scary. They might be sweating, breathing fast, or have a racing heart. During a night terror, you won’t be able to calm your child down, even if you try. It usually lasts about 10 to 20 minutes, and they might have it twice or 3 episodes a week.
Confusional arousals are episodes in which children behave in a confused way because they are in between sleeping and waking up. They sit up in bed, moan, or cry. During this episode, you won’t be able to calm your child down, even if you try. These episodes usually last 10 to 30 minutes.
Although it can be scary to see your child having a night terror or confusional arousal, it’s important to know that these conditions aren’t dangerous. Also, your child won’t remember them the next day.
Nightmares are very scary, sad, or upsetting dreams that wake a person up. After a nightmare, children often have trouble going back to bed. Nightmares usually happen in the second half of the night.
Another common condition is sleepwalking, which is when a child walks or talks while asleep. It happens more often in children than adults. Most children outgrow their sleepwalking as they get older. It usually happens in the first part of the night. Sleepwalking children can crawl, walk, run, or talk while asleep. They might try to do something, like start to get dressed or walk out of the house. When children sleepwalk, they can have their eyes open and a blank look on their face. They will not respond to you when you talk to them. An episode of sleepwalking can last a few seconds to minutes, but usually lasts 10 to 20 minutes. After the episode is over, the child will fall back asleep. This might be in their own bed or in another place in the house.
When your child sleepwalks, there are things you should and should not do. You should not try to hold your child down or wake them up. Instead, you should gently guide your child back to their bed.
You can help your child by making sure they don’t get hurt when sleepwalking. To help keep your child safe, you can:
Night terrors, confusional arousals, and sleepwalking sometimes run in families. Children can have 1 or more of these conditions. If these conditions don’t happen very often and don’t lead to other problems, your child will probably not need further tests. Most children outgrow their night terrors and confusional arousals over time, but it can take up to a few years.
Some children might need tests to make sure another medical problem isn’t causing their night-time behavior. Your Child Neurologist might order tests if your children have frequent night terrors or confusional arousals, or any of the following symptoms:
If your child has a night terror or confusional arousal, you should stay with them until the episode stops. You should not try to wake them up. Once the episode stops, your child will go back to sleep.
If your child has a nightmare, there are things you can try that might help. You can:
You might be able to prevent night terrors and confusional arousals by making sure your child gets enough sleep. To do this, try to stick to a regular sleep schedule. In general, children 3 to 5 years old should get 10 to 13 hours of sleep (including naps). Older children should get 9 to 11 hours each night, and teens should get 8 to 10 hours.
If your child has trouble falling asleep or getting a good night’s sleep, here are some things you can try:
Headaches are common in children. Two of the most common types of headaches in children are:
Children also tend to get headaches if they have a cold, the flu, a sore throat, or a sinus infection. In rare cases, headaches in children are caused by a serious infection (such as meningitis), severe high blood pressure, or brain tumors.
Take your child to the doctor right away (without giving any medicine) if they have a headache that:
Tremor is a medical term for trembling or shaking. A person with tremor has a body part that rhytmically shakes, and cant be controlled. It most commonly involves the hands, but can also affect the arms, head, vocal cords, trunk, or legs. It may be a single condition or the result of another or even a medication side effect.
There are many different types of tremors, and there are several possible trigers such as:
In most cases, tremors in children have no serious, progressive, underlying condition but when they occur a diagnostic evaluation should be made.
Bell’s palsy also is known as acute peripheral facial palsy of unknown cause. It can affect people of any age. Males and females are equally affected. It is thought to be due to swelling (inflammation), and irritation of the facial nerve in the area where it travels through the bones of the skull, but the exact cause is not known. The facial nerve controls movement of the muscles of the face.
Even though the cause is often not clear, a type of herpes infection called herpes simplex or herpes zoster might be involved. This is the most common cause. The possible causes of facial nerve palsy are many and may be congenital, infectious, traumatic, neoplastic or idiopathic.
Symptoms of acute peripheral palsy come on suddenly and may include:
Often, acute peripheral facial palsy can be diagnosed just by taking a health history and doing a complete physical exam. Symptoms often begin to improve right away, but it may take weeks or even months for the muscles to get stronger. Sometimes, corticosteroids are used.
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