Consultation with a GOOD NEUROLOGIST. What is checked at 3 months.

In the maternity hospital

When the mother and baby are discharged from the maternity hospital, the baby undergoes ultrasonography of the brain. Brain cysts are a common diagnosis in newborns. Why this pathology occurs is not completely known to medicine. If the tumor size is no more than 5 mm, then there is no reason to worry, and the tumor will resolve by three months. If a cyst has been detected, then it is necessary to monitor the dynamics of its development every month.

The causes of central nervous system disease are:

1. Pathological pregnancy;
2. Complications during childbirth;
3. Congenital infections;
4. Injuries, prematurity.
5. You should not postpone examination by a neurologist if you notice:
6. Restless sleep;
7. Regurgitation and vomiting syndrome;
8. ZPR;
9. Tremor of the arms, legs and chin;
10. Paroxysms of varying duration.

Let's take a closer look at what a neurological examination is like at each stage of life.

What is the difference between a pediatric neurologist and a neurologist?

Very often, many parents ask a common question - is there a difference between a pediatric neurologist and a pediatric neurologist? In fact, these two definitions are absolutely identical, and their definitions are equivalent to each other. Why are both terms still used?

The fact is that the term pediatric neurologist is a rather outdated name for a specialist doctor, used in medicine until 1980, which has now taken on a different name - pediatric neurologist.

As for medical workers abroad, there is still a difference in terms:

A neurologist is a specialist who deals with diseases of the nervous system.

A neurologist is a specialist who carefully studies pathomorphology.

Upon reaching one month

At one month, during an examination, the neurologist pays attention to the child’s reflexes and posture. At one month of age, innate reflexes are most obvious.

The neurologist pays attention to the condition of the muscles, since newborns are characterized by hypertonicity, the position of their body is similar to what it was in the womb: the baby draws in his legs, clenches his fists.

The muscles should be symmetrical on both sides. Different muscle tone indicates the presence of pathologies. A newborn is able to stretch after sleep when he is one month old.

The body movements of a small person are chaotic and disorderly. In the first month of life, the baby begins to focus on an object, examines it carefully, and is even able to follow its movements.

If the baby can hold his head up at two weeks, this indicates intracranial hypertension, which is treated by a doctor. During this period, the child begins to express emotions, for example, smiling when hearing his mother’s voice. It is absolutely impossible to ignore visiting a neurologist at this age.

At this stage, the baby learns to use his hands. The baby begins to study them, putting his fingers in his mouth. By three months, the newborn’s reflexes practically disappear, as the cerebral cortex begins to be responsible for regulation. The grasping reflex is replaced by conscious grasping of objects.

A three-month-old baby should be able to hold his head upright. If this does not happen, then the child is likely to have delayed physical development or hypotonia. This will be revealed during the examination.

At this age, an emotional-motor reaction directed towards an adult appears. It occurs during communication or when a new object comes into view. Children's laughter is heard more and more often in the house. The tone and tension of the flexors decreases, postures become more relaxed.

What is neurology in children?

Neurology in children is a complex, multifaceted medical discipline that deals with diseases of the nervous system of a small patient. If a qualified doctor still detects neurology in a child, this can be explained by the following most common reasons:

• Receiving a birth mechanical injury;
• fetal hypoxia, as well as insufficient oxygen supply due to possible repeated entanglement in utero;
• complex process of childbirth and labor;
• acute toxicosis of pregnant women throughout the entire period;
• genetic inheritance.

What is neurology in eight-year-old children?

The child’s psyche is like plasticine; it is very susceptible to stress and any circumstances; parents, in turn, are advised to ensure that it is not damaged. In what cases does neurology occur in school-age children, namely 8 years old?

1. Excessively heavy loads on the child’s body.
2. A feeling of constant fear caused by the behavior of parents, as well as their pressure.
3. Adaptation period at school.

Such neurosis is accompanied by anxiety, sometimes stuttering, tics, and fainting. At the slightest manifestation of these symptoms, you should immediately consult a doctor.

At six months of age

During this period, the neurologist looks at the child’s skills during the examination. At six months, the baby should be able to roll over onto his back and stomach, raise his head, and lean on his elbows.

The child begins to recognize his parents and distinguish them from other people. The reaction to strangers is completely unpredictable: from a smile to strong crying.

At six months, the baby is able to perform simple manipulations with toys, for example, transferring an object from one hand to another. Body movements gain precision and confidence. Emotional reactions become less monotonous, the child begins to try to repeat simple combinations of sounds.

After six months, the head circumference increases by one cm. There are attempts to assume a sitting position, even with the help of adults.

Older children

During the examination, the neurologist pays attention to the baby’s ability to sit without support and evaluates physical development. Children at this age begin to crawl and stand up.

As for fine motor skills, the child is already able to hold an object with two fingers. The child parodies the movements of adults: waves his hand, claps his hands. The baby knows well who his mom and dad are and is wary of strangers. The baby understands that this is impossible, can find the desired object among others, and understands the meaning of the spoken words.

An examination at one year of age cannot be ignored, because the baby begins to become a full-fledged person. At the age of one year, many children are already able to move independently, some take their first steps holding a parent’s hand.

In the year and third month, every healthy child should be able to walk. The ability to sit at the table becomes better: the baby holds cutlery, eats with them, and knows how to drink from a mug.

The development of the cognitive sphere occurs by leaps and bounds: the child knows the names of objects, parts of the human body, and the sounds that animals make. By this time, the head circumference increases by ten cm.

The most common questions parents ask a neurologist

Hypertonicity is a normal phenomenon inherent in all newborns up to a certain age. Babies bend their arms, press them to their chest, clench their fingers tightly into a fist, and the thumb lies under the others. The lower limbs are also bent, but less than in the arms.

Dads and moms may notice that the tone changes; if you turn your head to the left or right, the muscle tone will become higher on one side. This feature of the child's body is called muscular dystonia. But don’t be afraid of medical terminology; this condition is considered absolutely normal.

By four months, muscle tone becomes less and less, and many muscle groups are used when moving. Hypertonicity cannot be treated in any way, but it is permissible to do a massage that promotes the harmonious development of the body. Advice on how to do a massage should only be given by a qualified specialist. During the examination, the doctor will tell you if there is cause for concern.

Trembling in the body, or scientifically called tremor, occurs in the first stages of life. The reason for this is the incompletely formed central nervous system. Tremor occurs due to emotional shock, physical stress, but sometimes the attack begins suddenly. Trembling can occur on both sides or on one.

The sucking reflex is one of the main ones in children under one year old; it is innate. Any irritation of the mouth causes sucking movements in the newborn. The reflex ceases to manifest itself when the child reaches four years of age. In infants, there is a search reflex, as well as a proboscis reflex. While eating, these reflexes intensify, but this does not mean that the child wants to eat.

This behavior of the child is explained by the Mohr reflex. It persists for up to six months and often occurs when changing body position or loud sounds. If you pick up a baby from the crib and then put it back, the baby will involuntarily raise his arms up. Sometimes the Mohr reflex occurs involuntarily or as a response to knocking, screaming or clapping.

Regurgitation up to five times a day is the norm, not a neurological disorder. This is especially common in the first month of life. Regurgitation is associated with the structural features of the gastrointestinal tract and its functioning: the ventricle is located horizontally, has the shape of a circle and a very small volume, no more than ten mm.

Regurgitation is also promoted by:

• Excessive amount of food;
• Prematurity;
• Underweight;
• The breathing process is still imperfect;
• Lack of digestive enzymes;
• Swallowing air while eating;
• Short intervals between feedings.

This phenomenon is called Graefe syndrome. The presence of a stripe between the iris and the eyelid does not indicate the presence of any pathologies; it occurs quite often in newborns.

It occurs due to changes in body position, changes in lighting, and also simply due to the individual characteristics of the body. The immaturity of the nervous system also contributes to its formation.

Graefe's symptom goes away on its own within six months. But if the symptom is accompanied by strabismus, high excitability, mental retardation, then you should immediately visit a neurologist for an examination.

Small children sometimes start banging their heads against objects around them. Scientists do not fully know what causes head shaking in children under 3 years of age. It is believed that in this way babies train the vestibular apparatus and calm down. You've probably noticed that shaking your head ends up falling asleep.

Sometimes children bang their heads to attract attention and express protest. In psychology, this syndrome is called “self-punishment.” A child hits his head so that mom and dad will feel sorry for him. Such behavior can be avoided if direct prohibitions are not made. To prevent head banging from causing serious physical harm, you should remove dangerous objects away from the baby.

In addition, right from birth, you can independently monitor the growth of the child’s head circumference, which is one of the main indicators of normality and pathology. How to do this correctly?

• Measure the child's head circumference weekly and record the resulting numbers in a specially kept notebook.
• When measuring, place the measuring tape at the most protruding points of the skull (frontal and occipital protuberances).
• To avoid misunderstandings, the measurement must be carried out by the same person.

In addition to the increase in head circumference, you can monitor the increase in chest circumference, which is one of the general anthropometric indicators of child development. For this:

• Measure your chest circumference weekly on the same day you measure your head circumference;
• Place the measuring tape at the level of the baby's nipple line.

Why is such “amateur activity” needed? By taking these simple measurements, you will help the doctor draw up an objective picture of the child’s development, and you yourself can have peace of mind, excluding the possibility of developing serious diseases (normally, the monthly increase in head circumference in the first three months of a full-term baby should not exceed 2 cm per month; up to a year, the circumference The chest is approximately 1 cm larger than the child’s head circumference).

Well, now a few words about what can and should be normal and what is pathological. I tried to frame the conversation on this topic in the form of answers to questions that most often concern young parents.

Normally, as a child passes through the birth canal, the bones of the skull overlap each other. Features of the course of the birth process affect changes in the shape of the skull. In the event of a complicated birth, a sharp juxtaposition of the skull bones may occur on top of each other, and this will lead to its deformation, which will persist for quite a long time.

A change in the shape of the skull can be expressed in the persistence of swelling of the soft tissues of the head in the place where the child moved forward along the birth canal. The swelling disappears within the first 2-3 days. Cephalohematoma (bleeding under the periosteum) also changes the shape of the skull. It resolves more slowly than swelling, and this process requires the supervision of specialists (neurologist, surgeon).

Changes in the shape of the skull are also associated with age-related characteristics. In a newborn, the skull is elongated in the anteroposterior direction, and after a few months the transverse size of the skull will increase and its shape will change.

Some change in the shape and size of the skull can also occur during normal development in premature babies, or when the child is often placed on the same side, or when the child lies on his back for a long time.

How does the head grow?

The average head circumference of a newborn is 35.5 cm (the range of 33.0-37.5 cm is considered normal). The most intensive increase in head circumference in full-term babies is observed in the first 3 months - on average, 1.5 cm for each month. Then the growth decreases slightly, and by the age of one year the child’s head circumference is on average 46.6 cm (normal limits are 44.9-48.9 cm).

The head circumference of a premature baby increases faster than that of a full-term baby, and the increase is most pronounced during the period of active weight gain, and by the end of the 1st year of life it reaches normal values. The exception is very premature babies.

However, one should always keep in mind that even with normal development of a child, there may be physiological deviations from average values, which are often associated with constitutional characteristics or environmental influences.

What are fontanelles?

The fontanelles are located in the area where the bones of the skull meet. The anterior, large, fontanel is located between the frontal and parietal bones. At birth, it measures from 2.5 to 3.5 cm, then gradually decreases by 6 months and closes at 8-16 months. The posterior, small, fontanel is located between the parietal and occipital bones. It is small in size and closes by 2-3 months of life.

In pathological processes accompanied by increased intracranial pressure, the fontanelles close later, and sometimes they open again. Small sizes of the anterior fontanel may be a variant of the norm if they are not accompanied by a decrease in the circumference of the skull, the rate of its growth and a delay in psychomotor development.

The above signs do not limit the variety of possible deviations in a young child. However, it should be borne in mind that any unusual appearance of a child requires a thorough examination and monitoring of his growth and development.

The development of a young child is a very sensitive sign of the state of the body. It depends both on hereditary characteristics and on a complex set of social conditions and requires dynamic monitoring by doctors. Don’t forget to show your baby to specialists within the prescribed time frame - 1, 3, 6, 12 months!

If you invite a specialist to your home, you must consider the following:

• the examination of the child should be carried out on a changing table or other soft, but not sagging surface;
• the environment should be calm, eliminate distractions if possible;
• It is advisable to carry out the examination 1.5-2 hours after feeding;
• the air temperature in the room should be about 25°C, the lighting should be bright, but not irritating.

In conclusion of the article, I would like to remind you once again: do not delay your visit to a neurologist, remember - the timeliness of all health-improving, preventive and therapeutic measures aimed at ensuring its normal development depends on the correct assessment of the newborn’s health, and only a specialist can give a correct assessment!

Inna Sharkova, pediatric neurologist at Guta Clinic, Moscow

Diagnosis and treatment

Diagnosis usually does not cause difficulties; it is much more difficult to identify mild pathology of the nervous system. When examining the baby, the doctor collects an anamnesis of past illnesses from the moment of birth, finds out how pregnancy and childbirth proceeded, and what illnesses the mother had during pregnancy.

If even the slightest signs of deviation from the norm are detected, the specialist conducts an additional set of examinations, which includes:

• fundus examination;
• Ultrasound of brain structures (USB);
• EEG with Dopplerography of cerebral vessels;
• method of acoustic brainstem evoked potentials, etc.

Based on the data obtained, an accurate diagnosis is made and the most effective comprehensive treatment is selected. Modern medicine has a large arsenal of rehabilitation methods:

• physiotherapeutic methods (massage, physical therapy, physiotherapeutic procedures);
• drug treatment with the latest generation drugs (rare);
• progressive methods of neurological rehabilitation.