Girls, how tired I am of these doctors with their non-existent diagnoses... I have no strength. I have healthy child without the slightest deviation, but even he is given all kinds of nonsense, based on nothing. It’s good that you have enough sense not to panic and not fall for this nonsense. Today we saw a neurologist and were given a PEP. For some reason I thought that there are no children without a diagnosis - this is how doctors see our children. They sent us to the NSG... Now until we do it, the pediatrician will not lag behind. I am inserting an article for everyone who believes in neurologists from the first word:

Very often after birth or during , the baby is given many incomprehensible and frightening neurological diagnoses. In addition, parents are frightened by the dire consequences of these diagnoses and are discharged a large number of quite serious drugs and various other methods of treatment, quite often not so cheap. We will try to understand the mysterious abbreviations of diagnoses and clarify the situation a little in this material.

About diagnoses...

Child neurology is one of the most complex branches of pediatrics; there is still a lot of overdiagnosis (setting up many redundant diagnoses) and unstudied processes. Research methods are constantly being improved, so every year there is a constant revision of approaches to diagnosis and treatment. Many diagnoses that were made 20 years ago are now not deviations or do not exist at all. These include the mysterious abbreviation PEP.

PEP or perinatal encephalopathy is a diagnosis that does not exist in the entire scientific world, and has long been outdated in Russia. This is not even a diagnosis, but a collective concept characterized by disturbances in the structure and/or function of the brain and nervous system that occur during the period from the 28th week of pregnancy to 7 days from the moment of birth, that is, there is no specific information at all. Moreover, in a literal translation from Latin, the term is deciphered even more simply - “encephalon” - brain, head, “pathos, pathia” - pathology, disorder, or, more simply, “something with the head.” From this we can easily conclude that it is not possible to make this diagnosis for a specific child - because even if a child has diseases of the nervous system and brain in particular, they all have their own clearly classified name according to ICD-10 (International Classification of Diseases).

Diseases of the nervous system include hemorrhages, defects, tumors, inflammatory processes, infections and injuries. AEDs are not included in this classification. Many neurologists replace the term AED with GTP of the central nervous system or “hypoxic-traumatic lesion of the central nervous system,” which is the same thing, simply expressed in different terms and does not change the situation.

Where do these diagnoses come from?

The course of pediatric neurology is very complex, pediatricians and neonatologists do not always have full knowledge in the field of child neurology, sometimes mistaking symptoms that are normal for a child for pathology, and there are few or no full-time pediatric neurologists in maternity hospitals. A neurological examination of a baby is a complex matter; its accuracy is influenced by many factors, both external and from the baby.

So, false results can be obtained if the baby is hungry, if he is sleeping and had to be woken up for examination, if he is warmly wrapped up and overheated. If the room is cold or too hot, and even if the doctor is too active in his manipulations. There is no need to talk about the correctness of the examination even in conditions when this is not the first specialist of the day, and the baby is already in a state of stress along with his mother, from walking around offices and standing in lines.

What is not a disease?

Babies in their first year of life have an immature nervous system, and the baby’s brain is formed during the process of growth and development. Therefore, many symptoms of the nervous system that are pathological for adults and older children are normal for young children.

Unexpressed and minor dilations of the ventricles of the brain and the interhemispheric fissure according to the results of neurosonography (ultrasound of the brain) are not pathological. The state of hyperactivity cannot be diagnosed; this is a diagnosis for older children. Persistent regurgitation after feeding is not a sign of damage to the nervous system; it requires observation and examination, but it cannot be unambiguously attributed to neurological problems. A marbled skin color is considered normal - this is when against the background of white skin you can see the presence of red and blue stains and blood vessels, reminiscent of the color of marble slabs. There is no need to worry about standing on tiptoes or walking on toes, especially at the very beginning of developing walking skills.

Often, children under 3-4 months experience tremor (shaking) of the chin when crying or sudden excitement, which is also not a reason for treatment; in addition, this also includes trembling of the hands during crying or fright. There is no need to worry if the child has eyes that roll upward so that a strip of white is visible, or a slight strabismus for up to six months.

The baby's feet and hands may be wet and cool, even if he is well dressed, these are features of the baby's blood circulation. In addition, a fontanel that pulsates or bulges when screaming, a large or small size of the fontanel, and the dynamics of its closure are different for everyone - this only requires observation and control. Meteorological sensitivity is also considered normal for children.

All described conditions require dynamic monitoring by a local police officer. together with a neurologist and nothing more.

What to look for

All babies are individuals from birth, and their development follows their own specific programs, influenced by health, heredity, and even gender. When assessing psychomotor skills and general development You need to pay attention only to the deadlines for the formation of certain skills. Here is an express questionnaire that can serve as a guide when assessing certain symptoms. And what should you pay attention to when in doubt? Serious deviations are periods exceeding one and a half to two months.

When did your baby start holding his head up? – period 1-1.5 months.
- when did the baby start to roll over? – beginning at 3-4 months, active revolutions by six months.
- did the baby play with his legs – grabbing, putting them in his mouth? – for some, starting from 3-4 months, and the general age is 6-7 months.
- when did you start sitting down? They usually sit down from a supine position earlier, and later from a position on all fours; both options are normal - the average time is 6-8 months.
- when did you start crawling, how did you do it? First, the babies sway, standing on all fours, crawl back, then in front. The norm is to crawl on your belly, on all fours and even sideways - the average period is approximately 7-8 months.
- when did you start standing up without support? – usually 9-11 months.
Walking without support usually begins at 9-18 months.
Focusing on average terms, you can immediately notice deviations that require consultation with a specialist.

Consequences…

There are many negative consequences from such diagnoses; overdiagnosis is not in vain for the family. Of course, making such diagnoses related to the nervous system to parents who are far from medicine causes a state of anxiety, if not fear. Parents begin to consider the child inferior, deeply sick, this leads to intra-family instability, parents begin to look for reasons, blaming themselves and their partner. Parents' concepts of the norm change, and when an independent study or consultation with another specialist does not reveal pathology, parents begin to have doubts. Overdiagnosis leads to unreasonable expenses for treatment, doctors and rehabilitation, which are not required.

For a child negative consequences maybe even more. The first thing that has a negative impact is that overdiagnosis leads to more frequent visits to doctors, which undoubtedly increases the risk of contact with sick children and contracting infections, causing stress and fear of the “white coat”.
Secondly, all these diagnoses lead to the prescription of unnecessary treatment, which sometimes has not been fully monitored during this period. age group and has side effects, leading to disastrous results.
Third, often actually existing disorders in the nervous system tend to be attributed to PEDs, although the problems are sometimes of a completely different nature, and therefore they are not corrected or treated correctly, which sometimes deepens the disorders even more.

How to monitor your baby?

Almost all pathologies of the nervous system are identified during active monitoring of the baby, and sometimes it takes more than one month to make a final decision about the problem. Therefore, all examinations by a neurologist are carried out within strictly prescribed periods - when the baby reaches key stages in neurological terms - usually the first, third, sixth months and year. However, in case of doubt or the appearance of alarming symptoms, a visit to a neurologist is possible from the very first day of life. If you have doubts about the diagnosis and treatment, you should consult several specialists, fortunately, modern conditions they allow it.

Are we treating? Or do we not treat?

In fact, only very real, serious and clearly defined diagnoses require serious drug therapy. These are always drugs aimed at a specific problem - decreased muscle tone during spastic paralysis, anticonvulsant drugs for seizures. But for PEP, broad-spectrum drugs are usually prescribed and are not always tested and have proven effectiveness in children. Many of these drugs are generally prohibited from being prescribed in a clinic setting. They are prescribed only under the constant supervision of a neurologist in a hospital setting and only according to strict indications, as they have a large list of side effects.

So, which drugs should be questioned from their prescriptions? This is a group of vascular drugs - cinnarizine, sermion, cavinton. Then a group of hydrolysates of neuropeptides or amino acids - actovegin, solcoseryl, cortexin, cerebrolysin. Nootropic drugs are unacceptable - piracetam, aminalon, phenibut, picamilon, pantogam. It is also worth questioning the prescription of homeopathy and herbal preparations - valerian, motherwort, lingonberry leaf, bear's ears, etc.

All statements about improving the nutrition of brain tissue are myths; all these drugs are prescribed to most children, but they have not undergone proper research and it is impossible to judge their effectiveness and safety. The use of such drugs will be useless at best. And in some diseases it can cause harm - allergies can occur, including anaphylactic shock, cardiac dysfunction, kidney function, or the nervous system itself, which is being treated.

If the diagnosis or prescribed treatment seems unfounded to you, if you are in doubt, you should always consult with another specialist and in another clinic.

Even in children of the first year of life, a pathology of the nervous system can be detected, the causes of which are disturbances during the period of intrauterine development of the fetus (infections, fetal hypoxia) or a severe course of labor. 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 by a neurologist is therefore indicated for each child at a certain frequency. In this article we will answer possible questions from parents and eliminate their concerns about what a neurologist looks for in children.

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

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

Infants should be examined by a neurologist even if the parents have no complaints. It is in the first year of life that the baby develops intensively, and it is easier for the doctor to identify abnormalities.

When examining the baby, the neurologist examines the head, determines its size, the condition and size of the fontanel. Pays attention to the symmetry of the face and palpebral fissures, the size of the pupils, and the movements of the eyeballs (detection). At each examination, the child’s reflexes, muscle tone, range of motion in joints, sensitivity, skills and communication skills are checked.

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

Check-up at 1 month

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

The baby's movements are still chaotic and there is no coordination. A child at the age of one month can hold his gaze on an object for some time and follow its movement. The baby is already smiling after hearing the affectionate speech.

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

Check-up at 3 months

The baby's posture is more relaxed, since the tone of the flexors has already decreased. The child can put his fists in his mouth and grasp objects with his hands. It holds the head well. If the baby does not hold his head, this may indicate a developmental delay. The baby can already laugh and shows animation when contacting and showing a toy.

Check-up at 6 months

The baby should independently roll over onto his stomach and back, raise his head, leaning on his arms. In the supine position, the child can lift his feet and play with them. By 6 months, the child is sitting and can not only hold a toy, but also transfer it from hand to hand. 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.

Check-up at 9 months

Some children are already crawling and stand on their feet with support. The child can step with his legs while holding onto the support. The doctor also evaluates fine motor skills: the ability to grasp an object with two fingers and hold it. The baby imitates the movements of an adult: he can wave his hand when saying goodbye, clap his hands, etc.

The baby knows his parents well, understands the meaning of many words, including the word “impossible,” and finds (upon request) an object familiar to him from among others. If the child’s fontanel remains open, then an additional examination (ultrasound of the brain, MRI) is prescribed.

Inspection per year

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

Unscheduled visit to a neurologist

Parents should be wary and visit a doctor unscheduled if they have the following symptoms:

• frequent or excessive regurgitation;
• increased excitability, frequent shudders;
• or limbs (at rest or when crying);
• at elevated temperatures;
• bulging and pulsation of the fontanel;
• disturbances in gait: the baby does not fully stand on his foot, walks on his toes or curls them up;
• developmental delay.

Checkups after a year

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

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, and the presence or absence of focal neurological symptoms are assessed.

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

Parents should contact a neurologist unscheduled if they have the following symptoms:

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

Summary for parents

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

An examination by a neurologist for an infant is mandatory at 1, 3, 6, 9, and 12 months of life. What does a pediatric neurologist look for at an appointment? This question interests every mother. Neurologist examinations for infants mandatory even if they are absolutely healthy. Such frequent monitoring is not at all unreasonable; the baby’s neurological status changes every three months. It is during these periods that the baby’s intensive growth occurs and certain skills are formed, so any deviations will be visible.

Before being discharged from the maternity hospital, babies undergo neurosonography(or ultrasound of the brain). Sometimes during this examination, brain cysts are found in children. The causes of cysts in children have not yet been sufficiently studied. Presumably they appear due to hypoxia (oxygen starvation). If the size of the cyst is no more than 3-4 mm, then by 3 months they will resolve without a trace. If a brain cyst is detected in an infant, dynamic neurosonography is indicated.

Diseases of the nervous system in children of the first year of life are not uncommon, and are usually associated with pregnancy pathology, difficult labor, intrauterine infectious diseases of the baby, injuries and other reasons. Special monitoring by a neurologist should be exercised over babies who were born premature.

Parents should be alert to the following symptoms:

• Anxious sleep of a child;
• Frequent;
• Twitching of the limbs, trembling (tremor) of the chin and limbs;
• Febrile seizures;
• Delayed development of the baby.

Check-up at 1 month

Examination by a neurologist at 1 month includes assessment of the child’s posture, presence and severity. At 1 month, all the unconditioned reflexes of the newborn should be clearly expressed and symmetrical. Only the automatic support and walking reflex fades away by 1-1.5 months.

Muscle tone is assessed, since the flexor muscles are still in hypertonicity, the baby’s position still retains the intrauterine position - the legs and arms are bent, the fists are tightly clenched. Muscle tone on both sides should be the same; if hypertonicity is more pronounced on one side and weaker on the other, this may indicate pathology. But when waking up from sleep by the end of 1 month, the baby can already stretch.

All the baby’s movements are still uncoordinated and chaotic. can already briefly focus his gaze on an object and follow its movement in the horizontal plane. Also, by 3-4 weeks of life, the baby should begin to smile in response to affectionate treatment. If a baby at the age of 2-4 weeks is able to hold his head, then this alarming symptom, which may indicate increased intracranial pressure. An examination by a neurologist at 1 month is one of the key ones, so the qualifications of a specialist are important.

Check-up at 3 months

Examination by a neurologist at 3 months one of the most important. The main achievement of life is finding your own hands. The baby can look at them or simply put his fists in his mouth. By 3 months, most of the reflexes of newborns begin to fade away, as the cerebral cortex increasingly takes over regulation. Most reflexes weaken or disappear. The grasping reflex should normally fade away by the end of 3-4 months, and voluntary grasping of an object develops instead. Another achievement is the ability to stand upright. If by this time the baby is not yet able to hold his head up on his own, then this may be a manifestation of hypotonia or retardation in growth and development.

By 3 months the baby has a revitalization complex in response to communication or any optical stimulus. Also, usually by this time the mother can already hear the baby’s laughter. The flexor tone should weaken by this time, and the baby’s posture becomes more relaxed.

Check-up at 6 months

carried out with an assessment of the baby’s skills. A child at 6 months should be able to roll over from back to stomach and back, in a position on his stomach, raise his head high and lean on his outstretched forearms. The baby recognizes his mother, but he may react differently to a stranger (for example, by crying). By six months, a child can already confidently hold a toy in his hands and even transfer it from one hand to another. Usually, by 6 months, babies can already sit (at least with support). Lying on his back, the baby can play with his feet. His movements become more and more coordinated and purposeful. Emotional manifestations become more and more diverse, the baby repeats syllables.

After 6 months, the rate of increase in head circumference is already 1 cm per month.

Check-up at 9 months

On examination by a neurologist at 9 months The data on the baby’s physical development are assessed - he should already be sitting up on his own, many children are already standing on their feet and crawling. Development is assessed fine motor skills baby - he is able to take an object with 2 fingers and hold it. The baby imitates the movements of adults more and more, he can already clap his hands and wave his hand goodbye. He knows his parents well and is suspicious of strangers. The child already knows the meaning of spoken words and finds familiar objects among others. At this age, the baby should already understand the prohibitions.

Check-up at 12 months

By the age of one year, the baby becomes an increasingly meaningful person. There are more and more skills and abilities. By 12 months, the baby can already stand on his feet, stand and walk by the hand. If your child is not walking on his own yet, don't be discouraged. You should worry if by the age of 1.5 the baby does not walk independently. The baby already knows how to drink from a cup, hold a spoon independently and eat from it, knows the names of many objects, points out parts of the body, knows all family members, and pronounces individual words. Head circumference should increase by 12 cm per year.

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 consultation with a neurologist. Preventing the progression of nerve pathologies in children allows us to avoid irreversible disorders 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 attentive support. A 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 child’s socialization 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 a reason to contact a neurology clinic:

• increased excitability of the child, which is manifested by poor falling asleep, shallow 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 children 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 within a certain period of time);
• involuntary twitching of muscles of different groups;
• excessive motor activity (it is difficult to assess it independently, so a pediatric neurologist checks for deviations from the norm using various tests);
• developmental delay in the first year of life, which should be reported to the pediatrician;
• enuresis after the age of 5-6 years;
• stuttering and other speech defects.

Do children need preventive examinations?

In babies under 12 months of age, the pediatrician looks for various deviations from the norm 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 baby’s development 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 pediatric neurologist monitors the formation of the nervous system until adolescence, where serious hormonal changes occur. Preventive examinations with this doctor allow you to notice violations early and not lead them to a severe course. Besides, a neurologist can detect psychomotor underdevelopment in time or intellectual retardation.

How does an appointment with a specialist take place?

At the reception 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, etc.).

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