What does a pediatric neurologist check? An examination by a neurologist for a baby is important. When the Problem Really Exists

Consider the most common neurological diseases of newborns, their symptoms. In fact, it is important for every mother to know the symptoms, since almost all neurological problems can be corrected and treated if they are detected in time - at an early stage!

Almost every baby has some kind of neurological problem: one child has problems with tone or sleep, another has increased intracranial pressure, the third is too inhibited or excitable, the fourth is vegetative - due to a violation of the regulation of vascular tone, a mesh appears on his skin subcutaneous capillaries, and the palms and feet are constantly wet and cold ...

Perinatal encephalopathy (PEP), which is also coded as a "syndrome of CNS disorders"

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

If you notice in time emerging problems and eliminate them with the help of medicines, herbal remedies, massage and physiotherapy, then AED can pass by 4-6 months, maximum - by a year. In mild cases, there are no consequences, and more serious or unnoticed 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 should not be upset about this. After all, the main danger - the threat of the formation of cerebral palsy (CP) - bypassed the crumbs! (For more on what to do if cerebral palsy is diagnosed, see page 62.)

In the first month and then three more times during the year, show the 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 membranes of the brain and spinal cord, the crumbs circulate cerebrospinal fluid - cerebrospinal fluid. It nourishes the nerve cells, carries away the end products of metabolism, absorbs shocks and shocks. If for some reason more cerebrospinal fluid is produced than flows out, or if external pressure is applied to the head of the crumbs, as during childbirth, intracranial pressure (ICP) increases 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 sutures and fontanelles, which allows the bones of the skull to diverge, equalizing the pressure.

Thanks to this, the baby does not feel severe pain due to intracranial hypertension, but he feels some discomfort and informs his mother about it. You just need to be able to hear his signals!

Does the baby often cry and spit up often, especially when the weather changes? It looks like he has really high ICP!

Mommy should be alert a bright pattern of saphenous veins, translucent on the temples and bridge of the baby's nose, and sometimes throughout the entire cranial vault. An additional cause for alarm is a white stripe of sclera that periodically appears above the iris of the crumbs, as if he opened his eyes wide in surprise.

• Beware if the circumference of the head of a monthly crumb exceeds the circumference of the chest 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 (normal - up to W x W cm) and small (1 x 1 cm).
• Keep the situation under control with a neurologist. Due to the compensatory capabilities of the sutures and fontanelles, it often happens that on neurosonography or ultrasound of the brain, the doctor detects intracranial hypertension in the newborn, and there are no clinical signs of trouble: the baby is satisfied, calm, develops well, sleeps soundly at night ... In this case, treatment is not required - only observation by a specialist.
• If increased ICP begins to cause concern to the child, the doctor will prescribe diuretics that remove excess fluid from under the membranes of the brain of the crumbs.
• An excellent remedy for mild hypertension is a pharmacy children's tea with horsetail, which has a diuretic effect.

Hypertonicity and hypotonicity of muscles in a newborn

Our biceps and triceps never completely relax - even in a state of sleep, they retain residual tension, which is called muscle tone. In a newborn, it is very high: what is normal for a child in the first weeks of life is a gross pathology for a six-month-old baby.

To fit in mom's tummy, the baby had to shrink into a ball due to the increased tension of the flexor muscles. It is important that it is not excessive. Muscular hypertension sometimes affects only one half of the child's body. Then the baby lying on its back bends in an arc, turns its head only in one direction, and on the tummy falls on the side where the tone is higher.

Muscular Hypertension Syndrome - one of the most common manifestations of PEP. The tone should be normalized as soon as possible: otherwise the child will lag behind in motor development, will face difficulties when walking.

This can be avoided doing massage and gymnastics with baby.

Smooth swaying movements relax the clamped muscles. The effect can be achieved by rocking the baby while bathing, as well as on the handles, in the stroller, rocking chair. These movements are great for relaxing tight muscles!

Exercise in the fetal position will be beneficial. Lay the baby on your back, cross your arms on your chest, pull your knees up to your tummy and hold with your left hand, and tilt your baby’s head with your right hand, then gently and rhythmically rock towards you and away from you and from side to side (5-10 times).

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

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

Controlling a child's development in the first year of life is critical to their well-being later on. If the baby is healthy, develops “according to plan”, then visits to the neurologist will be preventive. If pathological changes are found in the baby, then timely correction will prevent serious deviations in physical, cognitive and mental development.

On examination by a neurologist, the main indicators of the neuropsychic development of the baby are evaluated by checking his congenital reflexes. The need for early diagnosis is due to the special flexibility of the formation of brain structures and the sensitivity of the central nervous system of the baby to external influences (and negative ones).

A neurologist's appointment has several goals:

• baby development control
• informing parents about the child's condition, potential health hazards, methods of treating or preventing deviations from the norm, about the principles and techniques of developmental activities for a healthy baby
• treatment of identified pathologies

Diagnosis of indicators of developmental delay before the age of 3 months is especially important. With great accuracy, it helps to predict future problems in the formation of certain skills in a child up to a year, and sometimes for the entire preschool period of his life.

Note!

At the appointment with a neurologist, you can and should ask all the questions that interest you. Any. In order not to forget important moments, think them over at home beforehand and write them down. The activity of the parent is an effective help to the work of the doctor!

It is the family that has on the baby of the first year of life the influence that becomes the basis of his health or pathology in the future. The role of the mother is invaluable - the constant interaction between her and the child is the main condition for stimulating development.

Examination of a newborn by a neurologist takes place even in the maternity hospital. There, the baby is given an ultrasonography of the brain through the fontanel. Later, when the fontanel is overgrown, it will be impossible to do an ultrasound of the brain - the bones of the skull do not transmit ultrasonic rays. The survey is carried out in order to detect anomalies. Brain cysts are often detected, but today there is no explanation for their appearance. Small, up to 5 mm formations pass on their own. If the cyst is larger, it is monitored in dynamics.

The second visit to the neurologist should take place after a month of the baby's life. You should prepare for it in advance. What needs to be emphasized by the mother in the daily care of the baby? What does a neurologist look at in 1 appointment?

The following things should be of concern:

• Too short periods of sleep. If the baby is fed, then he usually sleeps. The reason for waking up for him: hunger, cold, loud noise, pain in the abdomen. Stomach colic causes the baby to cry "through sleep" without waking up. A healthy baby sleeps most of the day.
• Impaired mental function. By the end of the first month of his life, the baby learns: to focus on the face of the mother, a bright toy. Turn your head towards the sound. If he remains indifferent to external stimuli, then this is a serious cause for alarm.
• Trembling (tremor) of the chin and hands, blue nasolabial triangle, convulsions.
• Frequent regurgitation, vomiting after feeding. All babies spit up often. The reason for this is the air that enters the stomach with milk. Formula-fed babies are especially susceptible to this. The baby burps air in the first minutes after feeding, a little food comes out with the air - this is normal. Anxiety should be caused by profuse regurgitation, which is not associated in time with feeding.
• Fixing the child in a certain position. A healthy baby constantly moves his legs and arms randomly, without taking a certain position. When laid out on the stomach, he cannot hold his head for a long time. Be sure to tell the doctor if your baby has "learned" to hold his head well or prefers a certain position - this indicates hypertonicity of his muscles.

What mom doesn't need to do is try to check reflexes on her own. This should only be done by a specialist. Mom should feed the child at least half an hour before taking it and tell the doctor about him as many details as possible.

An examination by a neurologist at 1 month begins with a visual assessment of the baby, his posture, movements.

Then the doctor sequentially checks:

1. Development of the nervous system. Tests all innate (unconditioned) reflexes, evaluates their safety and strength.
2. Physical development. Conducts by assessing the shape and size of the skull, compliance with the growth of the head of the normative parameters.

Oral unconditioned reflexes

• Sucking. The baby is put on a nipple, which he begins to actively suck. Automatism fades by the year. At this time, it is necessary to wean the child from the pacifier and bottle, so as not to transfer the sucking reflex to the category of conditional (specially formed).
• Search. This reflex is well known to attentive parents - any touch on the child's mouth or cheeks makes him turn his head in this direction and look for the chest with his open mouth. This is especially pronounced in a hungry baby.
• Proboscis. Automatism is associated with an involuntary contraction of the circular muscle of the mouth with a light cotton on the lips - the baby immediately stretches his lips with a tube.
• Palmar-oral - a complex automatism related to the spinal-oral. When pressing on the palm of the baby in the area of ​​​​the thumb, he “groups” forward in the thoracic region, tilts his head and opens his mouth.

• Neck tonic asymmetric. If you turn the child's head to the side without his participation, then his arm and leg automatically unbend on this side, and on the opposite side of the body, the limbs bend. The flexors-extensors work, the baby "gets up" in the pose of a swordsman.
• Labyrinth tonic. When laying the baby on his stomach, he automatically first picks up everything for himself (flexors), then makes, as it were, swimming movements. The cycle ends with elements of spontaneous crawling.
• Neck tonic symmetrical. When the child's head is passively tilted forward, he unbends his legs and bends both arms. When tilting the head in the opposite direction, the limbs act in the opposite direction - the legs are bent, the arms are unbent.

Note!

Only a specialist knows where and how to press to check the operation of automatisms. Self-checking of the baby's reflex reactions will cause him at least discomfort, at most involuntary urination, defecation (Perez, Talant reflexes).

• Lower and upper grasping reflexes - involuntary bending of the palms and feet when pressing on certain points. The upper sign to parents is how tightly the child grabs when putting an adult's finger into his palm.
• Upper defensive reflex. Since all innate reflexes are “given” to the baby for survival, when laid out on the stomach, the baby turns his head to the side. Its purpose is not to suffocate. Automatism passes by one and a half months.
• Reflexes of Perez, Talent and Embrace are tested with the help of manipulations on the back, blows on the changing table.
• Support reflex, extension, walking pattern. When the support is touched in the “standing” position, the baby’s legs involuntarily straighten, the tilt of his body forward provokes automatic stepping. By 3 months, these “skills” fade away and reappear by the year when the child learns to stand and walk on his own. In a child with developmental disabilities, the walking pattern persists for a long time.

Violation or inhibition of spinal reflexes is an alarming symptom that may indicate a violation of the spinal cord. It should be understood that the condition of the baby, how long he ate and slept, has a significant impact on the severity of reflexes. The mother should inform the doctor about this.

What the pediatric neurologist checks at the appointment is the growth of the baby's head. Normally, during the first month of life, the head increases in circumference by 1.5 cm. Size variability takes place (a girl is smaller than a boy), but too fast head growth, as well as too slow, indicates possible pathologies - hydrocephalus or microcephaly. Both pathologies are fraught with mental retardation, delayed physical development.

Examines the neurologist and the condition of the fontanelles. In a healthy baby, fontanels close: large (parietal) by 8-10 months, small (occipital) by 2-3. A faster closing of the fontanelles does not allow the head to grow normally, a slower one indicates a possible intracranial pressure. Not only the size, but also the shape of the head is evaluated.

The neurologist evaluates the general condition of the child, his mood, emotional reactions, typical facial expression. The results of the examination are reported to the parents.

The next examination by a neurologist is at 3 months and at 6. These examinations differ from what the neurologist looks at 1 time.

Visit to a neurologist at 3 months

If no deviations were detected at the first appointment, then an examination by a neurologist at 3 months is more prophylactic.

The doctor evaluates the skills of the baby that he has formed:

• ability to hold one's head
• the ability to roll onto your back from your stomach
• recovery complex in relation to a loved one
• responses to speech, gentle voice

At three months, the child is more relaxed, quickly focuses on moving objects, passing people. Turns his head to his mother's voice, responds to speech with a smile, laughter, quick movements of arms and legs. Starts humming.

Note! An important point of this visit is obtaining a permit for vaccination. The doctor either gives permission for this, or the baby receives a medical exemption - a temporary exemption from vaccinations for medical reasons.

Visit to the neurologist in six months

What does a neurologist check in six months? These are skills that are already very numerous if parents were engaged in their development.

What should a child be able to do at 6 months:

• sit, roll over from stomach to back and back, try to get up with support, play with legs, arms
• take toys independently, shift them from hand to hand
• eat from a spoon complementary foods in the form of a semi-liquid substance
• hold a bottle of water, drink on your own
• pronounce some syllables, express emotions with facial expressions, gestures, sounds
• distinguish “us” from “strangers”, single out a mother or one significant person who provides constant care

This visit for the first time can bring difficulties in examining the child, as he has learned to respond to the situation and strangers. It is important for mom to choose the time to visit the doctor so that the child is not sleepy, tired or hungry. Strive to build a trusting relationship with the doctor, do not ignore even preventive visits to the doctor - this will help to avoid many difficulties in the upbringing and development of the child.

A very important specialist is a pediatric neurologist who deals with problems of the central and peripheral nervous system in patients from birth to 18 years of age. According to statistics, every fifth child has functional or organic problems with the central nervous system, which require a consultation with a neurologist. Preventing the progression of nerve pathologies in children avoids irreversible damage that will significantly reduce the quality of life.

A pediatric neurologist must be a good and competent specialist in his field in order to effectively diagnose and treat relevant pathologies. In children, the nervous system is not perfect for a long time and continues to develop until adulthood, requiring careful accompaniment. Missed pathology can cause disability, but rarely leads to death.

When to contact a pediatric neurologist?

Parents should know what a pediatric neurologist treats and when to seek help. In childhood, when the socialization of the child is in a state of active development, and this process occurs individually, it is difficult to notice any problems in the neurological area. Parents should be alert to the following symptoms, which are the reason to go to the neurology clinic:

• increased excitability of the child, which is manifested by poor falling asleep, superficial sleep, constant awakenings and moodiness;
• for newborns, the neurologist notes a special symptom: trembling of the limbs and head during crying or anxiety;
• frequent, unmotivated regurgitation;
• apathy of the baby, lack of interest in the surrounding reality;
• convulsive syndrome during fever of any origin;
• frequent headaches in older children (in babies, the subjective symptom cannot be determined in any way, so you should pay attention to the general condition and mood of the child);
• fainting (two or more times in a certain period of time);
• involuntary twitching of muscles of different groups;
• excessive motor activity (it is difficult to assess it on your own, so a pediatric neurologist checks for deviations from the norm using various tests);
• developmental delay in the first year of life, which the pediatrician must report;
• enuresis after the age of 5-6 years;
• stuttering and other speech defects.

Do children need preventive check-ups?

In babies under 12 months old, the pediatrician looks for various abnormalities every 4 weeks.

The need for such an approach is due to the fact that parents will not be able to independently assess the physiology of the development of the baby and notice pathological changes in time.

The same situation is with a pediatric neurologist, who is recommended to visit during the following periods:

• one month after birth;
• at 3 months;
• in six months;
• after reaching one year of age;
• at 4-5 years old (pre-school period);
• at 7 years old (junior school);
• at 13-14 (teenage).

A neurologist for children observes the formation of the nervous system up to adolescence, where serious hormonal changes take place. Preventive examinations by this doctor allow you to notice violations in the initial period and not bring them to a severe course. Besides, a neurologist can detect psychomotor underdevelopment in time or mental retardation.

How is an appointment with a specialist?

At the appointment with a pediatric neurologist, the following things are checked:

• visual reflexes;
• muscle tone and strength;
• coordination;
• superficial and deep reflexes;
• sensitivity disorders;
• development of cognitive functions (speech, memory, and so on).

Additionally, general laboratory tests and specific instrumental techniques, for example, EEG, MRI, ultrasound with dopplerography of cerebral vessels, and others, may be prescribed.

Even in children of the first year of life, a pathology of the nervous system can be detected, the causes of which are disturbances in the period of intrauterine development of the fetus (infections, fetal hypoxia) or a difficult course of childbirth. The consequences of damage to the nervous system can be a delay in the mental and physical development of the child, speech impairment, etc. Observation of a neurologist, therefore, is shown to each child with a certain frequency. In this article, we will answer possible questions from parents and eliminate their concerns about what a neurologist looks at in children.

Damage to the nervous system in infants is quite common. But these diseases can have a latent form, so in the first year of life, babies are repeatedly examined by a neurologist: at birth, at 1 month, at 3, 6, 9 months. and upon reaching the year. Sometimes doctors prescribe more frequent monitoring of the baby according to an individual schedule. Particular attention is paid to .

In some cases, in addition to an examination by a neurologist, an additional hardware examination is prescribed. Early detection and timely treatment can significantly reduce or even eliminate the consequences of neurological pathology in older children.

Examinations of a neurologist for infants should be carried out without fail even in the absence of complaints from parents. It is in the first year of life that the baby develops intensively, and it is easier for the doctor to identify deviations.

When examining a baby, a neurologist examines the head, determines its size, condition and size of the fontanel. Draws attention to the symmetry of the face and palpebral fissures, the size of the pupils, the movement of the eyeballs (identification). At each examination, reflexes, muscle tone, range of motion in the joints, sensitivity, skills and sociability of the child are checked.

Even in the maternity hospital, the baby is given an ultrasound of the brain to exclude cysts, which often appear during fetal hypoxia. If cysts are found, then such an examination is carried out in dynamics. Cysts up to 3-4 mm in size should disappear without a trace.

Checkup at 1 month

The doctor pays attention to the posture of the child (it still resembles the intrauterine one), checks the presence and symmetry of unconditioned reflexes in the baby, muscle tone (the predominance of flexor tone - the arms and legs are bent, the fists are clenched) - it must be symmetrical.

The movements of the baby are still chaotic, their coordination is absent. A child at the age of one month can for some time hold his gaze on an object and follow its movement. The baby is already smiling, having heard an affectionate speech.

The neurologist measures the circumference of the baby's head and checks the size and condition of the large fontanel. In the first half of the year, the size of the head increases by 1.5 cm every month (the average circumference at birth is 34-35 cm), and in the second half of the year - by 1 cm.

Checkup at 3 months

The baby's posture is more relaxed, as the flexor tone has already decreased. The child can take fists in his mouth, grab objects with handles. He holds his head well. If the baby does not hold his head, this may indicate a developmental delay. The baby can already laugh, shows animation at contact and showing the toy.

Checkup at 6 months

The baby should independently roll over on his stomach and back, raise his head, leaning on the handles. In the supine position, the child can raise his feet and play with them. By 6 months, the child is sitting, can not only hold the toy, but also shift from handle to handle. A six-month-old child recognizes loved ones, especially his mother. May react to strangers by crying. Sometimes a baby at 6 months pronounces syllables.

Checkup at 9 months

Some babies are already crawling, with support they stand on their legs. The child can step over the legs, holding on to the support. The doctor also evaluates fine motor skills: the ability to take an object with two fingers and hold it. The kid imitates the movements of an adult: he knows how to wave his hand when saying goodbye, claps his hands, etc.

The baby knows his parents well, understands the meaning of many words and the word “no”, finds (at the request) an object familiar to him from among others. If the fontanel of the child remains open, then an additional examination is prescribed (ultrasound of the brain, MRI).

Inspection per year

The doctor evaluates the development of the baby, his skills and abilities. The child should be able to rise to his feet, stand, walk by the handle. The circumference of the head increases by 12 cm per year. The baby drinks well from a cup, must properly hold a spoon and eat from it. The kid recognizes all family members, knows the names and shows body parts (ear, nose, eyes, etc.), pronounces some words.

Unscheduled visit to a neurologist

Parents should be wary and visit a doctor unscheduled for such symptoms:

• frequent or profuse regurgitation;
• increased excitability, frequent shuddering;
• or limbs (at rest or when crying);
• at elevated temperature;
• bulging and pulsation of the fontanel;
• gait disturbances: the baby does not stand on the foot completely, walks on toes or presses them;
• developmental delay.

Reviews after a year

The schedule of examinations is as follows: a neurologist should routinely examine children at 3, 6, 7, 10, 14, 15, 16, 17 years.

During examinations, physical development, muscle tone, the presence and symmetry of reflexes, coordination of movements, color and turgor of the skin, sensitivity, speech, mental development, the presence or absence of focal neurological symptoms are assessed.

If necessary, the doctor may prescribe an additional examination: examination by an ophthalmologist with an examination of the fundus, ultrasound of the brain, Doppler ultrasound, X-ray of the skull, MRI of the brain, electroencephalography.

Parents should turn unscheduled to a neurologist with such symptoms:

• speech disorder (, delayed speech development);
• urinary incontinence ();
• sleep disorders;
• tics (repeated, often involuntary, movements or statements, twitching of mimic muscles, grimacing, blinking, sniffing, feeling things, throwing back hair, repeating words or phrases, etc.);
• fainting;
• motion sickness in transport;
• increased activity, restlessness, distracted attention;
• traumatic brain injury.

Summary for parents

Depending on the course of pregnancy and childbirth, hereditary factors, a child may have a neurological pathology even at a very early age. Examinations by a neurologist make it possible to detect changes in the nervous system in the early stages, which will allow for timely treatment.

In children, the formation of the nervous system occurs continuously, so it is important not to skip the stages of its formation. A pediatric neuropathologist (neurologist) is a doctor who observes a child from birth to 18 years of age and checks the level of his development.

Pediatric neurologist - preventive visit

• after the baby is discharged from the hospital or when he reaches the age of one month. Since at 1 month the child begins to see and hear.
• in the interval from 3 months to 1 year, you should visit the doctor several times. Important changes are taking place: activity, contact with the external environment is increasing, the ability to pick up objects appears, crawling and sitting skills are acquired.
• from 1.5 to 3 years - a pediatric neurologist will wait for you 2 times a year. During this period, the baby learns to speak, the first life experience and impressions appear, memory is formed, a line of behavior is built with parents and friends.
• from 3 to 6 years old - an important stage in the life of a preschooler: the development of light motor skills, character traits are born.
• from 7 to 11 years old - the child takes a place in society, learns to think abstractly, masters program teachings.
• from 11 to 13 years old - a pediatric neuropathologist is needed in a given period of time. During this period, puberty occurs, the appearance, emotional background and behavior of a teenager change.
• from 13 to 18 years old visit the doctor once a year.

This examination is carried out in order to check the correct development of the child at a certain age.

Symptoms that refer to a pediatric neurologist

When observing the following signs in a child, it is necessary to pay a visit to a neurologist:

• cramps during sleep or fever.
• complaints of frequent headaches.
• or urine.
• restless sleep.
• loss of consciousness.
• frequent spitting up in babies.
• twitching arms, legs and chin at the baby.
• distraction and lack of contact with peers.
• violation of motor, speech, mental development.

A good pediatric neurologist will be able to choose an individual course of treatment for a child, taking into account his characteristics.

For what diseases do you see a neurologist?

A pediatric neurologist can not only check the development of a child, but also treat the following diseases:

• perinatal damage to the nervous system.
• birth trauma.
• hydrocephalus.
• cerebral palsy.
• traumatic brain injury.
• epilepsy.
• brain.
• nervous system inherited.
• neuroses.
• neuromuscular system.
• neurocutaneous.
• systemic disorders (eg, stuttering, enuresis).

Pediatric neuropathologist - treatment

When examining a baby, a specialist may prescribe additional studies:

• UZDG.
• eye examination.

After collecting the necessary information, the pediatric neuropathologist prescribes treatment, which includes both medications and physical actions (therapeutic massage, swimming, physical education, physiotherapy).

You should not delay the visit to the doctor, as a timely detected pathology is treated, and the recovery process proceeds faster.