The skull develops from life
All over the forehead - from temple to temple. . .
O. Mandelstam

Your baby will soon be or has already turned 1 month old!

One of the most difficult periods in a newborn’s life is behind us. After all, the first month of a child’s life becomes for him the first critical period after birth: it is characterized by the intense work of all organs and systems of the body “responsible” for the adaptation of the newborn to environmental conditions that are fundamentally new for him. By the end of this period, all transition processes should be completed, however, under the influence of unfavorable environmental conditions, with aggravated pregnancy and childbirth, natural for the newborn adaptation processes can take a pathological direction and lead to a neurological disease in the child.

It is at this time that it is necessary to visit a neurologist for the first time - usually just to make sure that everything is fine with the baby; but if this is not the case, in order to identify and “capture” the pathology at the very beginning, to prevent the disease from developing. To determine the level of development of the child and exclude neurological pathology, it is important not only to assess the formed reactions to light, sound, motor and psycho-emotional activity of the newborn, but also his appearance (in fact, it is this last topic that my article will mainly be devoted to).

So, what will the neurologist first of all pay attention to during the examination? one month old baby? On the shape and size of his skull, facial expression, posture, appearance of the skin. Why is this so important? Why are our worries and experiences often associated with the presence of deviations from the outside? appearance child, especially if it is a change in the shape and size of the skull? This is primarily due to the fact that such changes can be a diagnostic sign of serious diseases - and microcephaly.

Skull shape and size

Deviation from the norm is a possible pathology. . .

Hydrocephalus- this is an excessive increase in the size of the skull and fontanelles, caused by an increase in the amount of cerebrospinal fluid in the cranial cavity. With this disease, the shape of the skull also changes - its cerebral part significantly predominates over the facial part, the frontal part protrudes sharply forward, and a pronounced venous network is observed in the area of ​​the temples and forehead.

Microcephaly is a reduction in the size of the skull and early closing fontanelles. With congenital microcephaly, the size of the skull is small from birth, the cranial sutures are narrowed, or closed, or small in size. Subsequently, a slow rate of growth in head circumference is noted, so that sometimes a 2-3 year old child’s skull size is almost the same as at birth. With microcephaly, the skull has a specific shape: the cerebral part of the skull is smaller than the facial part, the forehead is small, sloping, the line of the forehead and nose is sloping.

Conditions such as hydro- and microcephaly subsequently lead to delayed mental and physical development and therefore require correction from the very beginning. early age!

. . .or a reason for further examinations?

But should every deviation from the norm clearly indicate a pathological condition? Of course not! Clinical observations show that there are many factors that influence the shape and size of the head. Of course, even a slight increase or decrease in the circumference of the skull in a newborn compared to the age norm can be considered a risk factor for the development of hydrocephalus or microcephaly, but you should not panic when you discover that the baby’s head is slightly larger or smaller than normal: this circumstance should first of all, become a signal for the need for additional examinations to exclude pathological conditions. What kind of examinations are these?

• An absolutely safe and reliable method is neurosonography ( ultrasonography brain through the large fontanelle). This study will help not only to see changes in the structure of the brain and signs of increased intracranial pressure, but also to evaluate blood flow through the main vessels of the brain.
• An even more reliable method is nuclear magnetic resonance of the brain (NMR), however, this study for children is carried out under general anesthesia, so it is carried out only for sufficiently compelling indications.
• In this case, consultations with an ophthalmologist and a neurosurgeon are also necessary.

"Homework" for parents

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 circumference weekly chest 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.

What determines the shape of the skull?

Normally, as a child passes through the birth canal, the bones of the skull overlap each other. Features of the flow birth process influence 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. (hemorrhage 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 full-term 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, it should always be borne in mind that even if normal, 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.

At pathological processes, accompanied by an increase in 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 characteristics do not limit the diversity possible options abnormalities 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.

When and how should a neurologist examine a child?

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 complex 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
"Guta-Clinic", Moscow

Discussion

Hello! My daughter is 2 months old, the pediatrician recommended that she undergo neurosonography and contact a neurologist. Based on the results of neurosnography, a diagnosis of 6 slight widening of the interhemispheric fissure was made (3.7 compared to the norm of 2.1). The neurologist examined her and revealed: active, smiling, humming, Graefe's symptom periodically, relying on curled fingers. My daughter shudders, her sleep is disturbed, and she spits up periodically. The doctor diagnosed: s/m PNRV, hypertype SDN, s/m LDN.
The diagnoses, why they are dangerous, and how to decipher these symptoms are not entirely clear. Help, I'm very afraid of losing time.

01/16/2008 21:33:04, Natalia

Hello.
My daughter is 3 weeks old. I recently noticed the asymmetry of her skull, i.e. her right temporal cavity is larger/deeper than the left. Tell me, is this dangerous? Is this a pathology or will symmetry be restored over time? And how to contribute to the restoration/formation of the normal shape of the skull?
PS: we alternate the sides of the child’s sleep.

12/21/2007 11:03:55, Stas

zdrastvuyte. u menye docinka 8 let i ona mikrocefaliya .a kak mojna uznat kakie budeshe jdyot emu.u neqo kajdiy nideli spazmi bivayet.ona ne ustayot v meste.pomaqite pojalusta kokoy lekorstva mojet uspokoyet eqo?ya jdu iz vas otveti.

12/07/2007 21:53:24, Ramil

The child is 7.5 months old, boy. Born on time, naturally (without caesarean section). At birth, she was diagnosed with hypoxia. The child is on breastfeeding.
The child has problems sleeping. The child sleeps only in a stroller or with a nipple in the chest (uses a nipple instead of a pacifier). He has not taken and does not take any medications.
Over the past month, a procedure to expand the eye canal has been performed 4 times.
The procedure is painful. The first 3 times the child reacted quite calmly and calmed down within 10 minutes after the end of the procedure. The fourth time he began to cry immediately after he was brought to the clinic, and after the end of the procedure he could not calm down for an hour.
According to the ophthalmologist (head of the department of the eye clinic at the Morozov Hospital), the procedure will be repeated until the eye canal can be expanded. Maybe 20 times.
Question:
Can the procedures affect the child’s psyche or will he forget everything and have no mental problems?

08.11.2007 15:00:20, Vadim

Hello, Doctor
I'm worried about the size of my head
I'm 21 years old, height 180, weight 75
and the diameter of the head is 54 cm.
my chin is almost GONE!
it feels like the head is the neck
only her hair and face grew
please help me tell me why

Hello, Doctor!

Rebenku 5 mesyacev, pri podderjanii rebenka on derjit noqi na noskax, normalno lı eto?
Mi ocen bespokoimsya cto on ne smojet xodit. After osmotra doktor skazal cto u neqo porez na noqax i cerepnoe davleniee i naznacıl etı lekarstva:
Mojno li eti lekarstva prinimat pri takom diaqnoze.
Doktor cto bi vi posovetovali cto nam delat?
Zaranee blaqodaryu.
1 Flexital N10

2 Diacarb N6

3 Eufillin N10

4 Gluferal N

5 Mydocalm N10

6 Calcium is a magician

7 Asparkam N10

03.05.2005 10:02:06, S

Tell me, if the child is only a month old and the neurologist said that the fontanelle is 0.5 and whatever that is good! Is this very bad? And how will this affect the baby's development?
[email protected]

04/05/2005 14:11:35, Roman

I'm 16 years old, I have
enlarged frontal and parietal
skull bones maybe
it was passed down by inheritance,
How to solve this problem,

other therapy. Is it possible
make changes to
genetic level.
Write the answer

03/17/2005 06:48:03, Anton

I'm 16 years old, I have
enlarged frontal and parietal
skull bones maybe
it was passed down by inheritance,
How to solve this problem,
maybe you can use laser or some other
other therapy. Is it possible
make changes to
genetic level.
Write the answer

03/17/2005 06:46:26, Anton

My son was about 4 months old when his psychomotor development was delayed. During the examination, the neurologist at the children's clinic said that the child was completely healthy and had no abnormalities. But (thanks to the advice of a medical friend) we turned to a chiropractor. The chiropractor identified at first glance the non-disjunction of the sutures of the skull bones (the reason was due to postmaturity at 3 weeks and rapid labor). After the first massage session, the bones separated and the child began to catch up in development. Therefore, there is no hope for medical examinations. Just my own observations...

07.12.2004 03:12:23, MammothOK

Hello. My daughter is 1.5 months old. Sometimes she looks "surprised." The neurologist directed us to a neurosonogram. On the direction it is written: "s-m LDN?" What does this “surprised” look and LDN mean? Thanks in advance for your answer

11/13/2004 01:02:21, Julia

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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 eye slits, 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.

Also in 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, 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 evaluates and 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 feet, walks on his toes or curls them up;
• developmental delay.

Checkups after a year

A child at any age may need examination and assistance from a neurologist.

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

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, a child may have a neurological pathology even at a very 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.

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 sorts 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 this diagnosis should be made specific child is not possible - 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, one should pay attention only to deadlines 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 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 brings with it more frequent hikes according to doctors, which undoubtedly increases the risk of contact with sick babies 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 controlled in this 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 for spastic paralysis, anticonvulsants 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 may 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.

The very first acquaintance of a newborn with a doctor occurs immediately after birth, during an examination by a neonatologist. Meetings with other specialists in white coats, in the absence of other indications, take place according to the examination calendar. And one of the first names on it is a neurologist (neuropathologist).

A pediatric neurologist (or neuropathologist) is a specialist who carefully monitors the development and maturation of the baby’s nervous system. The state of the human nervous system is one of the main indicators of the state of the whole organism. And if you do not pay due attention to the nervous system and its pathological manifestations from an early age, this can lead to a delay in the baby’s psychomotor development, disturbances in his behavior and many other “diseases from the nerves.”

Doctor's examination: when, why and why?

Every child, even a completely healthy one, should be observed by a neurologist. The doctor, together with the parents, will monitor the compliance of the baby’s psychomotor development with the age norm, celebrate his new successes and achievements, and give moms and dads individual recommendations on raising and caring for the child. The baby's neurological status changes during the first year of life (approximately every three months), so a preventive examination (routine medical examination) is usually carried out at 1 month, 3 months, 6 months and 1 year. In the second year of life, it is necessary to bring the child to a neurologist twice - at 1.5 and 2 years, and then the examination must be carried out annually. Based on certain symptoms, the specialist determines during each examination whether there is a delay in the child’s development, and, if necessary, prescribes additional examinations or consultations with other specialists.

Visit to the doctor

An examination of a baby by a specialist usually consists of several stages. First of all, each mother will share her complaints with the doctor, talk about the general well-being of the child and the diseases he has suffered. Based on the complaints, the neurologist will draw up a detailed examination plan and begin examining the baby.

Study of cranial nerve functions
The position of the eyes at rest, determining the size of the pupils, the asymmetry of the face, observing the reaction to sound, the volume of the voice, the position of the tongue in the mouth - all this allows the specialist to assess the condition of each pair of cranial nerves.

Research of the motor sphere
The presence and severity of reflexes is an important indicator of psychomotor development. The study of the motor sphere includes assessment of:

• muscle tone (dystonia - hypertonicity or hypotension);
• tendon reflexes;
• identification of pathological and postural (their meaning is the creation of a static posture, while the muscles are “trained” to hold the pose actively), as well as unconditioned reflexes.

Sensitivity study
These studies are extremely difficult to conduct in infants. Here the doctor turns to parents for help and their observations of the baby. For example, periodic complaints from parents about the child’s anxiety when putting on a hat are considered by neurologists to be hyperesthesia - increased sensitivity of the skin to irritation.

Cognitive assessment
This is an integral part of the neurological examination. In children under 6 months of age, pathological manifestations may include communication disorders, which are determined by the ability to focus their gaze, follow an object, and identify familiar faces with their gaze. Various manifestations of the emotional sphere (a variety of facial expressions, smiling, laughter, babbling) are also a strong indicator of the maturity and state of the child’s nervous system.

Note to moms
During a visit to a specialist, the baby should be in a state of maximum comfort. For this purpose, all the necessary conditions have been created in the doctor’s office - there is optimal lighting and air temperature and a comfortable changing table. However, mothers must also ensure that the baby is comfortable and calm. To do this, the child must be allowed to rest a couple of hours before the visit to the neurologist, and do not forget to feed him an hour before the doctor’s visit.

What can our baby do?
Before you go to see a neurologist, you yourself can try to assess the psychomotor development of your child. The following tips will help you with this:

• At 1 month, the baby maintains the uterine position while sleeping, but from the 3rd week he stretches when waking up. Can't hold his head upright. Briefly fixes his gaze on a bright object and follows its movement in the horizontal direction. From 3.5–5 weeks the first smile appears in response to a gentle voice addressed to him, and throat sounds appear. Movements are unfocused and chaotic.
• At 2 months, the child can turn from back to side, repeats the mother’s smile and reacts with inept imitative facial expressions to her facial expression. The first manifestations of the revitalization complex are noted.
• From 3 months, lying on his stomach, the baby rests on his forearms and lifts and holds his head well. Fixes his gaze on an object brought to his face and hums. The baby has a clearly expressed complex of revival, both in response to an adult and to any optical stimulus. The baby plays with his hands, feels his fingers, pulls them into his mouth. Laughter appears for the first time.
• At the age of 4 months, the child confidently rolls over from his back to his stomach and sits down when pulled up by his arms, assisted by movements of his head and shoulders. Holds a rattle in his hand and waves it. The smile turns into a loud, ringing laugh. Holds mother's breast or bottle during feeding with both hands.
• At 5 months, the child lies on his stomach for a long time, raising his head and shoulder girdle, leaning on the palms of his straightened arms, crawling on his stomach sideways and backwards, less often forwards. He smiles at his image in the mirror, recognizes his mother and reacts differently to strangers.
• At 6 months, he actively turns over from his stomach to his back and moves on his belly. Transfers the toy from one hand to the other. Prefers some toys over others. Babbling appears.
• From 7 months the baby gets on all fours and tries to crawl. When strangers appear, signs of fear and crying appear. He looks for and finds with his gaze the object that the adult is asking about, and extends his hand to his reflection in the mirror.
• At 8 months, the baby sits up and lies down on his own, sits confidently without support. Crawls on all fours. Holding on with his hand, he gets up, stands, and lowers himself. At the request of an adult, performs learned movements (“okay”, “goodbye”, “give me a pen”). Knows his name.
• At 9 months he walks with support from his arms or holding onto a support with his hands. While sitting, he bends and turns. Drinks from a cup. Looks for a hidden toy or one that has fallen on the floor.
• At 10 months, he takes steps forward, holding onto a movable support with his hands. Performs various actions with objects. Imitating an adult, he repeats various sounds and syllables after him. Tears paper, newspaper, follows the movements of thrown objects.
• At 11 months, a child can stand for a short time without support. Walks holding the hand of an adult. With support, squatting and bending over, bends over to pick up a toy. Places one object on top of another, removes and places the rings of the pyramid on the rod. Can drop a small object into a mug. The first meaningful simplified words appear.
• By 12 months, the baby gets up, stands and walks independently. Says up to 10 words. Begins to help when he is dressed. Sometimes he uses the pot for its intended purpose. Knows the meaning of the word “impossible.” The beginnings of manipulative games appear.

During the first year of life, a neurologist examines the baby several times. And even if during the examination the doctor discovers any “deficiencies” in the formation of the nervous system, do not be alarmed: most of them are early diagnosis amenable to correction. This is why you should never postpone a visit to a neurologist.

L.A. Kozlovskaya, neurologist, Clinic “9+”
(Mother and Child Group of Companies)

The development of a child in the first year of life occurs within a certain time frame. By the second month of life, your baby holds his head well, follows the object, walks, smiles; at 3-3.5 months – rolls over onto its side; at 4.5-5 – turns from back to stomach, takes toys; at 7 months - sits, crawls from 8, at 10-11 - stands on a support and begins to walk independently until one and a half years.

In general, according to generally accepted ideas, the absence of developmental delay is an important indicator of health. But it also happens that with relatively good psychomotor development, some disturbances in the overall harmony of movements arise, “discomfort”, which alarms attentive parents. The range of complaints is very wide - from a persistent tilt of the head to one side from 1.5-2 months to significant asymmetry in movements, gait disturbances after a year. Of course, gross anomalies are detected already in the maternity hospital. For example, congenital muscular torticollis, damage to the nerves of the brachial plexus (the baby’s arm is “flaccid”, straightened in all joints, brought to the body), congenital deformation of the feet, etc.

Many other diseases of the neuromotor system are typically diagnosed during the first year of life, usually with close collaboration between a neurologist and an orthopedic surgeon. Therefore, now they are even trying to distinguish neuroorthopedics as an independent field in medicine.

Early recognition of neuro-orthopedic problems, disorders in the development of bones and joint functions is very important, since as the child grows and develops, the manifestation of these conditions may intensify and, accordingly, more therapeutic measures will be required to cope with the disease.

The first examination takes place, on average, from 1.5 to 3 months. This inspection is “fundamental.” Information about the course of pregnancy and childbirth is carefully collected, complaints are assessed, the child is examined (don’t be surprised that the examination itself does not take much time - here the duration can tire the child and depress his responses). If there are suspicions of disturbances in the motor sphere, then during a subsequent examination (for example, after 1 month) the most important thing is to understand whether these signs are worsening. In addition, additional instrumental diagnostic methods often help us - ultrasound of the cervical spine and brain, ultrasound of the hip joints, radiography (according to strict indications), electroneuromyographic study (analysis of the activity of muscle and nerve fibers). But I repeat once again that many anomalies of body shape and movement functions in a small child are diagnosed clearly and definitively by comparison in dynamics.

Let's focus on the main points: “what to pay attention to?” ( frequently asked question parents). It is very difficult to give an answer in a simple form, but to make it clear, let it sound like this:

• body position
• range of motion
• the presence of asymmetry in the motor sphere.

I will give examples.

When the baby lies on his back, his head is preferably turned to one side (forced position?) Normally, the head changes alternately in relation to the midline of the body, and may be slightly bent towards the chest.

The baby's shoulders are symmetrical on both sides. In a child under 3 months of age, the forearms may be slightly bent and the hands clenched into fists; this is normal. But if, when pulling yourself up by the handles, you can feel a weakening of flexion on both sides or a decrease in muscle strength on one side, this is no longer the norm.

We also pay attention to the child’s legs - are they strongly bent at the hip and knee joints, is there strong resistance when changing clothes, swaddling, or vice versa - lethargy, weakness, “hyperextension” are noted.

Now the baby begins to roll over and constantly on one side (as if he is sparing the other half of the body). Takes toys more boldly and clearly with one hand (the other “lags behind”). This is especially noticeable after 5.5 – 6 months.

Many people know the “fencing pose” (the dependence of muscle tone on turning the head) - one arm is extended and raised closer to the face, while the other is bent; the difference in the legs is weaker, but still there. Normally, this reflex disappears between 4 and 6 months of life. Its long-term preservation is beyond the norm.

When the baby lies on his stomach - at 4 months, the upper part of the body rests on the forearms and open palms, the legs are extended at the hip joints and bent at the knee joints. By 6 months, the legs are already fully extended. In pathology, these time frames are significantly disrupted.

If infant placed vertically, supporting the “armpits”, then at 4-5-6 months the legs can be straightened, and the child “stands” on his toes. But by the end of the 6-7th month the child is already resting on his entire foot. If there is hyperextension of the lower extremities with significant adduction, the ability to “stand” on the tips of the fingers remains after 8 months - these are symptoms of the disease.

The child is sitting, but we see that this requires a lot of tension in the extensor muscles - we are alarmed by this position.

The “readiness to jump” reaction looks very vivid (or the “parachutist reaction” - I read it in one German training manual). It is also the support reaction of the upper limbs.

The adult holds the child by the hips and allows the upper body to “fall” forward. The child “falls” onto outstretched arms, in most cases with open palms. Normal, checking this by 10-11 months.

You can list a lot in detail, but the main thing you need to understand is the reactions of holding the body, balance reactions, clear, purposeful movements, must be formed in a certain sequence.

And now comes the child’s main achievement - he went! Not only did his skeleton and muscles become stronger, but his mind also matured, and there was a need to expand the boundaries of his “horizon.” When he walks 20-30 meters on his own, without support, we evaluate the gait and if everything is fine, we do not limit the need to walk, run, climb, not forgetting about constant sensitive control (injury prevention).

In the future, a healthy baby will need examinations by a neurologist and an orthopedist more than once a year.

He now has to master complex motor skills, in many ways consciously learning the beauty and dexterity of movements.