Neurology diagnoses and treats disorders of the nervous system, including the brain, spinal cord, and nerves, as well as thought and memory.
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The clinical presentation of neurological disorders in children is heavily influenced by age. A symptom that implies a specific diagnosis in a teenager may mean something entirely different in a neonate. Recognizing the patterns of dysfunction requires careful observation of the child’s spontaneous movements, interactions, and developmental trajectory.
In the neonatal period, neurological dysfunction often presents subtly. “Floppy baby syndrome,” or hypotonia, is a common red flag. The infant may feel like a rag doll when held, slipping through the hands due to a lack of muscle tone. This can stem from central brain issues or peripheral muscle diseases.
Conversely, some infants present with hypertonia or stiffness. They may keep their hands fisted tightly or arch their back excessively (opisthotonos). Persistent asymmetry, where a baby uses one hand significantly more than the other before 12 months of age, is a strong warning sign for hemiparesis or early cerebral palsy.
Developmental delay is one of the most common reasons for referral to a pediatric neurologist. This refers to the failure to meet expected milestones in motor, speech, or social domains. Global developmental delay indicates a lag in two or more of these areas, suggesting a widespread problem with brain function.
Regression is a far more ominous sign than delay. Regression occurs 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 silent. This warrants an immediate, urgent workup for neurodegenerative or metabolic conditions.
Paroxysmal events are sudden, recurrent episodes of dysfunction. Seizures are the most well known, but they can look very different in children than adults. They may manifest as staring spells, subtle eye fluttering, rhythmic lip smacking, or sudden drops to the ground.
Non epileptic paroxysmal events are also common mimics. Breath holding spells, where a child cries, turns blue, and passes out, can look terrifyingly like a seizure but are benign. Night terrors, tics, and benign sleep myoclonus are other examples that must be distinguished from epilepsy.
Headaches are a frequent complaint in older children and adolescents. Migraine is the most common cause of recurrent severe headache in pediatrics. Symptoms often include throbbing pain, nausea, vomiting, and sensitivity to light and sound. In young children, migraines may present as “abdominal migraines” with stomach pain rather than head pain.
Red flags for headaches include pain that wakes the child from sleep, headaches that are worst in the morning with vomiting, or headaches aggravated by coughing or straining. These signs raise concern for increased intracranial pressure due to a tumor or hydrocephalus.
Abnormalities in how a child walks or moves can indicate pathology in the cerebellum, basal ganglia, or peripheral nerves. Ataxia presents as a wide based, unsteady gait, often worsening when the child tries to run. Toe walking is common but can be a sign of tight heel cords associated with spasticity or autism.
Involuntary movements like tics (repetitive blinking, shrugging) are common in school aged children. Chorea involves flowing, dance like movements that the child cannot control. Tremors may occur when the child is reaching for an object (intention tremor) or when holding a posture.
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Regression is when a child loses skills they used to have, such as a toddler who stops talking or a child who could walk starting to crawl again; this is a serious red flag.
Usually no; growing pains typically occur in the legs at night and respond to massage, whereas neurological pain is often persistent, associated with weakness, or present during the day.
This could be torticollis (tight neck muscle), but it could also be a visual problem or a neurological issue causing a preference; if they ignore one side of the body, it needs checking.
Toe walking can be normal in toddlers learning to walk, but if it persists past age 2 or 3, or if the child cannot stand flat when asked, it should be evaluated.
Signs can include morning headaches with vomiting, unsteadiness when walking, changes in vision (double vision), or new seizures.
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