Child Neurology focuses on the nervous system disorders of infants children and adolescents. Learn about what a child neurologist does and the conditions treated.

Overview and Definition

What Is Child Neurology?

Child neurology, also known as pediatric neurology, is a specialized branch of medicine that deals with the diagnosis and management of neurological conditions in neonates, infants, children, and adolescents. When asking what is child neurology, it is defined as the study of disorders affecting the brain, spinal cord, nerves, and muscles in developing individuals. Unlike adult neurology, which often deals with degenerative conditions, this field focuses heavily on developmental processes and congenital issues.

The nervous system of a child is constantly growing and changing, meaning that symptoms and conditions can present very differently than they do in adults. Pediatric neurologists manage a wide spectrum of diseases, ranging from relatively common issues like migraines and febrile seizures to complex rare genetic disorders, cerebral palsy, and muscular dystrophies.

Scope and Conditions

The scope of child neurology is vast and multidisciplinary. It encompasses epilepsy and seizure disorders, which are among the most common reasons for referral. It also includes neurodevelopmental disabilities such as autism spectrum disorder and global developmental delay. Movement disorders like tics or Tourette syndrome are managed here, as are neuromuscular conditions like spinal muscular atrophy (SMA) and Duchenne muscular dystrophy.

The field also covers acquired brain injuries from trauma or infections like meningitis and encephalitis. Understanding the specific developmental stage of the child is crucial, as a delay in reaching milestones like walking or talking is often the first sign of a neurological problem.

Symptoms and Risk Factors

Signs of Neurological Issues in Children

Child Neurology

Symptoms in child neurology can be subtle or dramatic depending on the age of the child. In infants, signs may include hypotonia, often described as “floppiness,” or failure to track objects with their eyes. As the child grows, missed developmental milestones are a major red flag.

Parents might notice a regression in skills the child previously had, such as a toddler who stops speaking. Seizures can present as staring spells (absence seizures) or varying degrees of convulsing. Persistent headaches, especially those that wake a child from sleep, require immediate evaluation. Abnormal movements, unsteadiness (ataxia), or muscle weakness are also key clinical indicators.

Risk Factors and Etiology

Child Neurology

The causes of pediatric neurological disorders are diverse. Genetic mutations play a significant role, with many conditions being inherited or arising from spontaneous gene changes. Complications during pregnancy or delivery, such as lack of oxygen (hypoxic-ischemic encephalopathy) or premature birth, are significant risk factors for conditions like cerebral palsy.

Infections during pregnancy (like Zika or CMV) or early childhood (meningitis) can cause lasting damage to the nervous system. Traumatic brain injuries from falls or sports are common acquired causes. However, for a significant number of children with epilepsy or developmental delays, the specific cause remains idiopathic or unknown despite extensive testing.

Diagnosis and Imaging

Clinical Assessment and Genetic Testing

Diagnosis begins with a detailed history of the pregnancy, delivery, and developmental milestones. The neurological examination in children involves assessing reflexes, muscle tone, and coordination through play and observation. Because many pediatric disorders have a genetic basis, advanced genetic testing is frequently utilized.

Chromosomal microarray analysis and Whole Exome Sequencing can identify specific gene mutations responsible for rare disorders, guiding targeted treatments. Metabolic testing is also performed to rule out errors of metabolism that can damage the brain if left untreated.

Neuroimaging and EEG

Imaging is a cornerstone of diagnosis. Magnetic Resonance Imaging (MRI) is the gold standard for visualizing the pediatric brain and spinal cord. It is radiation-free, which is critical for children, and provides detailed images of structural abnormalities like cortical dysplasia or brain tumors.

For children who cannot stay still, sedation is often used to ensure high-quality images. Electroencephalography (EEG) is the primary tool for diagnosing epilepsy. It records the brain’s electrical activity using sensors on the scalp. Video EEG monitoring, often done over several days in the hospital, captures the physical behavior during a seizure to correlate it with brain wave patterns.

Treatment and Rehabilitation

Medical and Surgical Management

Treatment in child neurology is highly personalized. For epilepsy, a wide range of antiepileptic medications is available to control seizures. In drug-resistant cases, the ketogenic diet—a high-fat, low-carbohydrate medical diet—may be prescribed. For autoimmune conditions like anti-NMDA receptor encephalitis, immunotherapy is life-saving.

Novel gene therapies are revolutionizing the field, offering potential cures for previously fatal conditions like Spinal Muscular Atrophy (SMA). Neurosurgery is an option for structural issues, such as removing a brain tumor, placing a shunt for hydrocephalus, or disconnecting seizure-causing areas of the brain.

Habilitation and Therapy

Unlike rehabilitation which restores lost skills, habilitation focuses on helping children learn skills they never acquired. This multidisciplinary approach involves physical therapy to improve gross motor skills like walking, occupational therapy to help with fine motor tasks and daily activities, and speech therapy for communication and swallowing issues. Early intervention programs are critical because the young brain has a high degree of neuroplasticity, meaning it can often rewire itself to compensate for injury more effectively than an adult brain.

Long-Term Care

Transition to Adulthood

Many pediatric neurological conditions are chronic and require lifelong management. Long-term care involves monitoring the child’s growth, bone health, and cognitive development. As medical advances allow more children with complex needs to survive into adulthood, the transition from pediatric to adult neurology care becomes a critical phase. This process involves educating the adolescent about their condition, fostering independence where possible, and transferring medical records to adult specialists who understand the long-term sequelae of childhood disorders.

Education and Quality of Life

Neurological disorders often impact learning and behavior. Child neurologists work closely with schools to establish Individualized Education Programs (IEPs) that provide necessary accommodations, such as extra time for tests or specialized classroom aides. Support extends to the family, as caring for a child with special needs can be demanding. Social workers and support groups help families navigate the emotional and financial challenges. The ultimate goal is to maximize the child’s potential and quality of life, focusing on what the child can do rather than their limitations.

Symptoms and Risk Factors

Common Neurological Symptoms In Infants

Detecting neurological issues in infants relies heavily on observation of movement and interaction. Since babies cannot speak or follow complex commands, parents and doctors look for physical signs. One of the most common concerns is hypotonia, often called “floppy baby syndrome.” This is where the baby feels like a rag doll and lacks normal muscle tension. Conversely, hypertonia involves muscles that are too stiff.

Other infant symptoms include:

  • Failure to meet milestones like rolling over or sitting
  • Lack of visual tracking or eye contact
  • Abnormal head growth either too fast or too slow
  • Persistent crying or irritability that cannot be soothed
  • Jitteriness or rhythmic movements that might be seizures

Symptoms In Toddlers And Children

Child Neurology

As children grow, symptoms may become more apparent as they attempt more complex tasks. In toddlers, delays in walking or an unusual gait, such as toe walking, can be a sign. Speech delay is a frequent reason for neurology referral. This includes not talking at all or losing words they used to say.

Key signs in this age group:

  • Frequent stumbling or clumsiness
  • Staring spells where the child seems to “zone out”
  • Repetitive behaviors or loss of social engagement
  • Severe headaches or complaints of head pain
  • Regression in toilet training or motor skills

Seizures And Epilepsy Signs

Seizures are the most common serious neurological condition in children. They occur when there is an abnormal burst of electrical activity in the brain. Not all seizures involve convulsions or shaking. Some are subtle and easily missed. A generalized tonic clonic seizure involves stiffening and jerking of the whole body.

Subtle seizure signs:

  • Absence seizures characterized by brief staring and unresponsiveness
  • Sudden falls or “drop attacks” without tripping
  • Repetitive blinking or lip smacking
  • Sensations of fear or strange smells before an event
  • Jerking of just one arm or leg

Headaches And Migraines In Kids

Headaches are surprisingly common in children. While often due to dehydration or viral illness, chronic or severe headaches fall under child neurology. Migraines in children can look different than in adults. A child might not complain of head pain but instead have recurrent stomach aches, known as abdominal migraines.

Migraine features in children:

  • Pain on both sides of the head rather than just one
  • Nausea and vomiting
  • Sensitivity to light and sound
  • Desire to lie down in a dark room
  • Visual auras like seeing spots or zigzag lines

Developmental Delays And Regression

Developmental delay refers to a child not reaching developmental milestones at the expected times. This can affect motor skills, speech, cognitive skills, or social skills. Global developmental delay means the child is behind in two or more of these areas. Regression is even more concerning. This is when a child loses skills they had previously mastered. For example, a child who could walk stops walking, or a child who spoke in sentences goes back to babbling. Regression is a red flag for specific neurological or metabolic disorders.

Muscle Weakness And Hypotonia

Muscle disorders can present as weakness or fatigue. A child with neuromuscular disease might have trouble keeping up with peers on the playground. They might use their hands to “climb” up their legs to stand up from the floor, a sign known as Gowers’ sign. Hypotonia, or low muscle tone, makes a child feel limp. It can affect feeding in babies and posture in older children. These symptoms prompt an investigation into the nerves and muscles to rule out conditions like muscular dystrophy or spinal muscular atrophy.

Movement Disorders Symptoms

Movement disorders involve abnormal voluntary or involuntary movements. Tics are sudden, repetitive movements or sounds and are the hallmark of Tourette syndrome. Tremors are rhythmic shaking of a limb. Dystonia involves sustained muscle contractions that cause twisting and repetitive movements or abnormal postures. Chorea is characterized by brief, irregular, unpredictable movements that appear to flow from one body part to another. These symptoms can impact a child’s ability to write, eat, or walk and can also have social consequences.

Child Neurology

Genetic Risk Factors

Genetics play a massive role in child neurology. Many conditions are hereditary, passed down from parents to children. A strong family history of epilepsy, migraines, or developmental disorders increases a child’s risk. Some conditions are caused by spontaneous genetic mutations that occur for the first time in the child. Advances in genetic testing have allowed doctors to identify the specific gene defects responsible for many complex neurological syndromes. Understanding the genetic risk helps in diagnosis and family planning.

Prenatal And Birth Risk Factors

The health of the mother during pregnancy and the events surrounding birth are critical risk factors. Prematurity is a significant risk; babies born very early have fragile blood vessels in the brain that can bleed, leading to long term issues like cerebral palsy. Lack of oxygen during a difficult delivery, known as hypoxic ischemic encephalopathy, can cause brain injury. Infections during pregnancy, such as Zika or cytomegalovirus, can affect brain development. Exposure to toxins, alcohol, or drugs in utero also poses severe risks to the developing nervous system.

Acquired Risk Factors

Not all neurological issues are present at birth. Healthy children can acquire neurological conditions through external factors. Traumatic brain injury from falls, sports accidents, or car crashes is a major cause of disability. Infections of the nervous system, such as meningitis or encephalitis, can leave lasting damage. Exposure to environmental toxins like lead can affect cognitive development. Autoimmune reactions, where the body attacks its own brain tissue after a viral illness, are another acquired risk factor. Understanding these risks highlights the importance of safety gear like helmets and vaccinations.

Diagnosis and Imaging

Diagnosis and Imaging

The Clinical Interview

The diagnostic journey begins with a conversation. The clinical interview is perhaps the most important tool a child neurologist has. The doctor will ask detailed questions about the child’s medical history, starting from the mother’s pregnancy and the birth process. They will ask about developmental milestones: when did the child smile, sit, walk, and talk?

Family history is reviewed to check for genetic links. For episodic conditions like seizures or headaches, the doctor will ask for a detailed description of the events. Parents are often asked to provide videos of behaviors if possible, as this can be incredibly helpful.

The Physical And Neurological Exam

Child Neurology

After the interview, the doctor performs a physical exam. This is tailored to the child’s age. For an infant, it involves observing spontaneous movements, checking head shape and size, and assessing muscle tone by moving the baby’s limbs. For older children, it includes more formal testing.

The doctor checks reflexes using a rubber hammer. They assess muscle strength by asking the child to push and pull. Coordination is tested by having the child walk, hop, or touch their finger to their nose. Cranial nerves, which control vision, hearing, and facial movements, are also evaluated.

Developmental Assessment

Assessing development is a key part of the exam. The neurologist observes how the child interacts with their environment and with their parents. They look at play skills, which are a window into cognitive development. Can the child stack blocks?

Do they engage in pretend play? Communication skills are assessed by listening to the child speak or observing non verbal cues. The doctor compares the child’s skills to what is expected for their age group to identify any delays or deviations.

Electroencephalogram EEG

An Electroencephalogram, or EEG, is a test used to detect abnormalities in the brain’s electrical activity. It is the gold standard for diagnosing epilepsy. Small metal discs called electrodes are pasted onto the child’s scalp. These sensors detect brain waves, which are recorded by a computer. The test is painless. It can be done while the child is awake or asleep. Sometimes, a prolonged video EEG is required, where the child stays in the hospital for a day or more to capture a seizure on video while recording brain waves simultaneously.

Magnetic Resonance Imaging MRI

Magnetic Resonance Imaging, or MRI, uses strong magnets and radio waves to create detailed images of the brain and spinal cord. It does not use radiation. MRI is excellent for showing the structure of the brain. It can reveal tumors, structural malformations, strokes, or areas of inflammation. For young children who cannot stay still, sedation or general anesthesia is often required to ensure high quality images. The MRI machine is noisy, so hearing protection is provided.

Genetic Testing And Counseling

With the advancement of science, genetic testing has become a routine part of diagnosis for many developmental and neurological conditions. A blood sample is usually all that is needed. Tests can range from checking specific chromosomes (chromosomal microarray) to sequencing the entire coding region of the genome (whole exome sequencing). These tests can identify the root cause of a disorder, which helps in understanding the prognosis and potential risks for future children. Genetic counseling is provided to help families understand the complex results.

Child Neurology

Metabolic Screening

Some neurological problems are caused by the body’s inability to break down or use food properly. These are called metabolic disorders. Screening involves blood and urine tests to look for abnormal levels of chemicals like amino acids, organic acids, or ammonia. Identifying these disorders early is crucial because some can be treated with special diets or medications to prevent brain damage. This is different from the standard newborn screening and looks for more specific or rare conditions.

Lumbar Puncture Spinal Tap

A lumbar puncture is a procedure used to collect cerebrospinal fluid, which is the fluid that surrounds the brain and spinal cord. A needle is inserted into the lower back to draw out a small amount of fluid. This fluid is tested for signs of infection (like meningitis), inflammation, or specific chemical markers. While it sounds scary, it is a common and safe procedure. Local anesthetic is used to numb the skin, and sometimes sedation is used to keep the child calm and still.

Electromyography EMG

Electromyography, or EMG, assesses the health of muscles and the nerve cells that control them. It is used when a child has muscle weakness. The test involves inserting a tiny needle electrode into a muscle to record its electrical activity. A related test, the nerve conduction study, uses small shocks to measure how fast and strong the electrical signals travel down a nerve. These tests help differentiate between problems in the muscle itself versus problems in the nerves.

Neuropsychological Testing

When a child has learning difficulties, memory problems, or attention issues, neuropsychological testing provides a deep dive into brain function. This is not a scan but a series of paper and pencil or computer based tests administered by a neuropsychologist. They assess IQ, memory, attention, language, and executive functioning. The results provide a detailed profile of the child’s cognitive strengths and weaknesses, which is essential for educational planning and obtaining support services at school.

Treatment and Rehabilitation

Medication Management

Medication is a primary treatment modality for many neurological conditions. For epilepsy, antiepileptic drugs are prescribed to control seizures. The choice of drug depends on the type of seizure and the child’s age. For headaches, preventative medications or acute pain relievers are used. For ADHD, stimulants or non stimulants help improve focus. The goal is always to maximize benefit while minimizing side effects. Dosage is carefully calculated based on the child’s weight and is adjusted as the child grows. Regular monitoring is required to ensure safety.

Dietary Therapies

Child Neurology

Diet can be a powerful medical treatment. The most well known is the ketogenic diet for difficult to treat epilepsy. This is a high fat, low carbohydrate, and adequate protein diet that forces the body to burn fat instead of sugar for energy.

This metabolic change can significantly reduce seizures in some children. Other diets include the Modified Atkins Diet. These are strict medical diets that must be supervised by a neurologist and a dietitian to ensure the child gets adequate nutrition for growth.

Physical Therapy PT

Child Neurology

Physical therapy focuses on gross motor skills, which involve the large muscles of the body. For children with cerebral palsy, muscular dystrophy, or developmental delays, PT is essential. Therapists use play and exercises to improve strength, balance, coordination, and range of motion.

They work on skills like rolling, sitting, crawling, and walking. They also help with the selection and use of adaptive equipment like walkers, orthotics (braces), and wheelchairs to maximize mobility and independence.

Occupational Therapy OT

Occupational therapy helps children achieve independence in their daily lives. For a child, their “occupation” is playing and learning. OT focuses on fine motor skills (using small muscles of the hands) and sensory processing. They help children learn to hold a pencil, button a shirt, or use utensils. For children with sensory issues, such as those with autism, OTs work on helping them regulate their response to sensory input like sound or touch. This therapy is vital for school readiness and self care.

Speech And Language Therapy

Speech therapy addresses difficulties with communication and swallowing. Neurological conditions can affect the muscles of the mouth and throat or the brain’s language centers. Therapists help children learn to articulate sounds, build vocabulary, and understand language. For non verbal children, they introduce augmentative and alternative communication (AAC) methods, such as picture boards or speech generating devices. They also treat dysphagia (swallowing difficulties) to ensure safe eating and drinking.

Behavioral Therapy

For conditions like autism, ADHD, or tic disorders, behavioral therapy is a key component of treatment. Applied Behavior Analysis (ABA) is widely used for autism to encourage positive behaviors and reduce challenging ones. Cognitive Behavioral Therapy (CBT) helps older children manage anxiety, depression, or tics by changing thought patterns. Parental training is often included to help families manage behaviors at home effectively.

Surgical Interventions

While child neurologists do not perform surgery, they work closely with neurosurgeons when intervention is needed. Surgery might be required to remove a brain tumor that is causing symptoms. For hydrocephalus (fluid buildup in the brain), a shunt may be implanted. For severe epilepsy that does not respond to medication, epilepsy surgery to remove the seizure focus or disconnect pathways can be curative. Vagus Nerve Stimulation (VNS) involves implanting a device to send pulses to the brain to reduce seizures.

Botox Injections

Botulinum toxin (Botox) injections are used to treat spasticity, which is tight, stiff muscles often seen in cerebral palsy. The injection relaxes the specific muscle, allowing for better range of motion and easier movement. This can improve gait, make it easier to wear braces, or simply make caregiving tasks like dressing easier. The effect is temporary, so injections are typically repeated every few months as part of a long term management plan.

Assistive Technology

Technology plays a huge role in rehabilitation. Assistive technology includes any device that helps a child function better. This ranges from simple pencil grips to high tech eye gaze computers that allow paralyzed children to speak. Mobility aids like power wheelchairs give children freedom. Orthotics like ankle foot orthoses (AFOs) provide stability for walking. The neurology team assesses the child’s needs and prescribes appropriate devices to enhance participation in life.

Multidisciplinary Care Clinics

Because complex neurological conditions affect so many aspects of life, many hospitals offer multidisciplinary clinics. In a single visit, a child might see a neurologist, a physical therapist, a dietitian, and a social worker. This coordinated care model ensures that everyone is on the same page. It reduces the burden on families who otherwise would have to travel to multiple appointments. These clinics are common for conditions like muscular dystrophy, spina bifida, and cerebral palsy.

Long-Term Care

Managing Chronic Conditions

Many childhood neurological disorders are chronic, meaning they last a lifetime or for many years. Long term care involves establishing a daily routine that accommodates the child’s needs. This includes strict adherence to medication schedules to prevent breakthrough seizures or symptoms. It involves regular therapy sessions and medical check ups. Parents become experts in their child’s condition, managing everything from symptom tracking to equipment maintenance. The goal of long term management is to optimize health and minimize the impact of the condition on daily life.

School And Educational Support

Child Neurology

Children with neurological conditions are entitled to support in school to help them learn. In many countries, this is formalized through an Individualized Education Program (IEP) or a 504 plan. These legal documents outline the specific accommodations a child needs, such as extra time on tests, a quiet room for exams, speech therapy during school hours, or an aide to help with physical needs. The neurologist often provides documentation and recommendations to help the school understand the child’s medical needs and learning profile.

Transitioning To Adult Care

Child Neurology

One of the biggest challenges in child neurology is the transition to adult healthcare. This process usually begins in the teenage years, around age 14 to 16. It involves preparing the young person to take charge of their own health. They need to learn about their condition, their medications, and how to make appointments. Eventually, care is transferred from the pediatric neurologist to an adult neurologist. This handoff must be carefully managed to prevent gaps in care, especially for complex conditions that adult providers may be less familiar with.

Family Support And Respite

Caring for a child with a complex neurological disability is physically and emotionally demanding. Caregiver burnout is a real risk. Family support services are essential. This includes respite care, which provides temporary relief for primary caregivers, allowing them time to rest or attend to other needs. Support for siblings is also important, as they often face unique challenges growing up with a brother or sister who has special needs. Connecting with other families facing similar challenges through support groups can provide invaluable emotional backing.

Social And Emotional Development

Children with neurological conditions face social hurdles. They may look different, move differently, or struggle with social cues. Building self esteem and fostering peer relationships is a critical part of long term care. Encouraging participation in inclusive activities, adaptive sports, or clubs helps children feel a sense of belonging. Addressing mental health needs, such as anxiety or depression related to their condition, is vital for their overall well being.

Monitoring Growth And Puberty

Neurological conditions and their treatments can impact physical growth and puberty. Some medications can affect appetite, leading to weight gain or loss. Mobility limitations can impact bone density. Puberty can also change the course of neurological conditions; for example, hormonal changes can affect seizure frequency in girls. The neurologist monitors these physical changes closely, often working with an endocrinologist to ensure the child is growing and developing as healthily as possible.

Safety In The Home And Community

Safety is a top priority. For children with epilepsy, this means precautions around water (showers instead of baths) and heights. For children with mobility issues, the home may need modifications like ramps, wider doorways, or accessible bathrooms. Safety in the community involves carrying emergency medical information and medication. It also means educating teachers, coaches, and friends about what to do in an emergency, such as a seizure.

Future Planning And Independence

Long term care includes planning for the future. For some children, the goal is total independence, college, and a career. For others with more severe disabilities, it involves planning for supported living, vocational training, or guardianship. Legal and financial planning, such as setting up special needs trusts, ensures that the child will be cared for even after the parents can no longer provide care. Starting these discussions early allows for a thoughtful and secure plan.

The Role Of Advocacy

Parents often find themselves in the role of advocate. They must fight for their child’s rights in the healthcare system, the school system, and the community. This involves ensuring access to necessary therapies, medications, and educational opportunities. Advocacy organizations for specific conditions (like the Epilepsy Foundation or Cerebral Palsy Alliance) provide resources and a collective voice to push for better policies and research funding.

Why Choose Liv Hospital?

We offer a level of pediatric care that general hospitals cannot match. At Liv Hospital, we provide a child friendly environment designed to reduce anxiety. Our equipment is sized for children. Our staff, from nurses to technicians, are trained specifically in pediatrics. We have the full range of subspecialists under one roof, facilitating complex multidisciplinary care. By choosing Liv Hospital, you ensure that your child receives the most advanced and age appropriate treatment available.

FREQUENTLY ASKED QUESTIONS

What is child neurology?


It is the medical field focused on neurological conditions in infants, children, and adolescents.

It emphasizes brain development and age-specific neurological presentation.

No, it also addresses mild and developmental neurological concerns.

Yes, symptoms and needs often evolve with development.

Yes, early assessment supports better understanding and planning.

Are febrile seizures dangerous?


They are usually harmless and do not cause brain damage but they are frightening and a doctor should check the child.

No extensive research has repeatedly shown there is no link between vaccines and the development of autism.

It is usually developmental but if it happens suddenly in an older child it could signal a spinal cord issue.

Yes growing pains are real but they should not cause a limp or persistent pain during the day.

Yes stress from school or family issues is a very common trigger for tension headaches and migraines in children.

How is a neurological diagnosis made in children?


Through clinical examination combined with targeted testing.

No, imaging is used only when clinically indicated.

Yes, evaluation is adapted to developmental stage.

Yes, neurological understanding may evolve over time.

It allows reassessment as development progresses.

Is rehabilitation always needed in child neurology?


Not always, but it is common when function or development is affected.

Yes, early supportive therapy is often beneficial.

Yes, goals and strategies evolve with development.

Yes, it is essential for consistency and progress.

No, plans are individualized based on needs and development.

Why is long-term care important in child neurology?


Neurological needs often change as children develop.

Frequency depends on the condition and developmental stage.

No, it also supports development, learning, and well-being.

Yes, many develop greater independence with appropriate support.

Yes, preparing for future stages is an important component.

It is the medical field focused on neurological conditions in infants, children, and adolescents.

It emphasizes brain development and age-specific neurological presentation.

No, it also addresses mild and developmental neurological concerns.

Yes, symptoms and needs often evolve with development.

Yes, early assessment supports better understanding and planning.