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Does My Child Need To See A Neurologist?
The most common question I am asked when I tell someone that I am a neurologist is whether or not I do brain surgery. It is common to confuse a neurologist with a neurosurgeon, and although we work closely together, we have very different jobs. So what exactly does a neurologist do? Neurologists treat disorders of the central and peripheral nervous system which includes the brain, spinal cord, peripheral nerves and even muscle. The nervous system is wondrously complex machinery that coordinates seamless communication between the brain and body, allowing you to sing to your children while navigating your way to a new store in heavy traffic without getting into an accident. It’s pretty amazing when you stop to think about it! When this system breaks down, neurologic disorders such as headaches, seizures, developmental delay, abnormal movements and weakness can occur. Although there are many other disorders that neurologists treat, these are a few of the common things we see. So when can your pediatrician diagnose and treat such problems and when do you need to see the specialist? I am hoping to provide a guide for you as a parent.
The estimated world-wide prevalence of headache in children is a staggering 54%!1 If your child has occasional mild to moderate headaches that do not interfere with daily life and are relieved by rest or over the counter medications, then you should be able to manage them with the help of your pediatrician. Only a small percentage of children with headaches have migraines, commonly called sinus headaches or sick headaches. These are moderate to severe, debilitating headaches accompanied by other symptoms such as nausea, vomiting and sensitivity to light and sound that make the child want to hide in a dark room to sleep it off. Your pediatrician can begin treating your child’s migraines in several ways. If, however, you are unable to get the headaches under control, then you should seek out a neurologist. Other headache red flags that should prompt a visit to the neurologist include very frequent headaches, worsening or changing headaches, and headaches accompanied by signs of neurologic dysfunction such as weakness, numbness, confusion, vision loss, or early morning vomiting.
If you think seizures are rare, think again! 10% of the population will have a seizure in their lifetime, but only 1% of the population will develop recurrent seizures (also known as epilepsy). Children are prone to a specific kind of seizure called febrile seizures. These occur in children between the ages of 6 months and 5 years and are quite common. Although they can be frightening to witness, they do not tend to cause any long term issues. Studies have shown that the majority of children with febrile seizures do not develop epilepsy or any other long-term neurologic problems.2 Febrile seizures are typically managed by pediatricians and do not require daily medication. If your child has any other type of seizure, they need to see a neurologist.
Watching your baby learn and grow is one of the most fascinating aspects of being a parent. Likewise, it can be quite concerning if your baby does not achieve his or her milestones on time. Every child is different, and pediatricians are very adept at picking up developmental problems along the way. If children fall into the category of “global developmental delay,” meaning that they have problems in more than one developmental area (motor, social, language and thinking), they need further screening. A pediatrician will start this process, but it usually includes further evaluation by a neurologist or neurodevelopmental pediatrician. One developmental “red flag” is regression. Regression refers to the loss of previously attained skills, such as if your child was talking or walking and suddenly stopped.
Children often move in ways that adults do not. Babies’ nervous systems are not mature enough to smoothly control their arms and legs. So how do you know if it is normal or not? As children grow, some develop movement “habits” that they do when excited, startled or bored. These movements are called “stereotypies” and are often confused with tics or other movement disorders. Simple stereotypies such as hand flapping can occur in otherwise normal children and are not concerning by themselves. Your pediatrician should be able to help determine if your child’s movements are stereotypies. If your child is otherwise fine and has this diagnosis, you do not need to see a neurologist. Another common abnormal movement is tics. Tics are involuntary repetitive movements (eye blinking, nose twitch, grimace) or sounds. Tourette syndrome is diagnosed when a child has more than one motor and at least one vocal tic for more than one year. Some children have transient tics in childhood, but if you are concerned that your child may have Tourette syndrome, they should see a neurologist. In general, if your child has involuntary movements or problems moving that interfere with daily life, you should have him evaluated.
Did you know even children can have strokes? While often for different reasons than adults, little ones can be affected at any point in childhood or even in utero. Children can have weakness from other diseases as well, such as muscular dystrophy and myasthenia gravis. Some weakness red flags include early handedness (suggesting weakness of the opposite hand), delayed motor milestones, sudden weakness of any part of the body (signs of a stroke), or troubles performing tasks that used to be easy (climbing stairs, running). Weakness can be tricky to diagnose in children and can often be confused with general fatigue or other joint issues or illnesses. Your pediatrician should be able to screen for true weakness on exam, and if it is found, you will likely wind up in a neurologist’s office. When in doubt, your pediatrician is your best guide to help you make these determinations and should always be your first resource with any medical questions about your child. However, our team has pediatric neurologists specially trained in each of the categories of neurologic disease listed above, should they be needed.