Warning Signs of Neurological Disorders in Children

What is a Neurological Disorder?

The nervous system regulates the body, such as movement, speech, thought, emotions, senses and automatic functions like breathing and digestion. It consists of the brain, spinal cord and system of nerves throughout the body.

A neurological disorder is any condition in which any component of this system doesn't function or develop as it should. In children, this may involve incomplete maturation of the brain prior to or following birth, injury or infection of part of the brain or abnormal communication among the brain's cells.

Childhood epilepsy (seizures), cerebral palsy, developmental delays, autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), speech and language disorders and intellectual disability are some of the most prevalent neurological disabilities that are diagnosed in Indian children. A study from a pediatric OPD in the North West of India revealed seizures (69%), cerebral palsy (19.5%) and developmental delay (9.7%) to be the most common conditions in a pediatric neurology clinic.

What matters is that all of these conditions are NOT the child's or parents' fault. There is no definite single cause in many. Many respond very well to treatment or therapy or both  if identified early.

Signs to Be Aware of for Every Age

Children grow in a graded manner. Six months is not eighteen months! The best way to see a neurological red flag is to know what children are expected to be able to do by the time they reach a particular age  and when they are unable, have delayed or lost a skill.

In Babies (0-12 Months)

The brain develops more during the first year of life than at any other time. During this time, warning signs are:

Not making eye contact for 2 months. This is a time when a child should be able to begin to focus on faces and to follow with the eyes. Failure to make eye contact is a warning sign for autism and/or a neurological eye disorder.

Lack of muscle tone in the trunk or stiff muscle tone. Abnormal muscle tone occurs when the movement of your baby's limbs is unusual, either very loose and floppy (like a rag doll) or very stiff and difficult to move. It can be a sign of cerebral palsy or other motor nerve disorders.

Failure to smile at 3 months. Social smiling is an important early developmental skill, which is initiated by a caregiver's face. If it is not present it may be a neurological or developmental problem.

Ability to NOT babble by 6 months. By this age babies should be starting to make sounds that vary. Specific sounds that do not change or remain silent can indicate a speech-language or hearing problem related to neurological issues.

Seizures or fits. If the baby stiffens, shakes rhythmically, stares blankly and is unresponsive or stops breathing for a short while, it is a medical emergency and should be evaluated immediately. Infants who have seizures should always have a serious symptom.

Sitting without support by 6 months or on own by 9 months. If the head and body control are below these levels, it should be assessed if it continues.

Toddlers (1 to 3 Years)

It's the time when children should be exploring, pointing, naming things and starting to put words together. Indications of this stage are:

Does not use single words for 16 months

Now it's expected that a child at this age will be able to recognize some words. However, if the child makes no sound at this stage, and no pointing or waving, then silence is a major concern.

No Two word combinations at 24 months

Words such as 'more milk' or 'daddy come' should be making their appearance. If your child is not starting to combine words by the age of two, he or she should be evaluated.

Forgetting what has been learned

Developmental regression is when a child who could talk ceases to do so, or a child who could walk begins walking poorly, and this is an emergency to see the medical professional. It may be a sign of an ongoing neurological disorder.

Walking on a ball of feet

A few times or walking on your toes is not a cause for concern in early toddlerhood. A child walking on their toes and who cannot comfortably put their heels down consistently however, may have tightness in the leg muscles which may indicate neurological causes.

Unusual and repetitive movements of the body

Some children with ASD repeatedly flap their hands, rock their bodies or spin circles and move their bodies over and over again, often along with social withdrawal or speech delay.

Not pointing or waving by 12 months  

These gestures indicate that the brain is associating actions with social communication. One of the early indicators of autism is that they are not present.

In School-Age Children (4 to 12 Years)

Older children are in the school, learning, socialising and physical. At this age, neurological warning signs can sometimes be easier to recognize due to the clear expectations:

Frequent, unexplained headaches. If your child has recurrent headaches (headaches that occur more than once) or headaches that wake your child from sleep, or are becoming more frequent with time, they should be investigated. With younger children, who are not able to describe pain, watch for sudden crying, covering the head, and unusual quiet.

Sudden changes in behaviour or personality. One of the signs of a neurological change in a child, rather than a mere ‘phase', is if they become withdrawn, aggressive, forgetful or confused.

Balance and/or coordination problems. If the child is more prone to falling or bumping into objects, has trouble climbing stairs, or has a clumsy gait that has not been present before, there is a reason to investigate.

Drop in performance at school. If a child has been doing well and then suddenly has trouble paying attention, remembering information, or reading and/or writing, they may have a learning disorder, ADHD or an attention and memory problem that hasn't been diagnosed.

Seizures or absences. There are types of epilepsy that are nothing like the convulsions that most people associate with the word. Absence seizures look like the child staring into space for a few seconds and then carrying on as normal. Repeatedly, particularly in the middle of activities, this should be assessed by a specialist.

Weakness or numbness in one part of the body. If a child complains that one arm or leg is 'weak' or 'heavy' or that one side is 'not working right' – or if he or she starts to use one side of the body differently – it is important to see the child as soon as possible.

The Most Common Neurological Conditions in Indian Children

Epilepsy (Fits or Seizures)

Epilepsy is the most prevalent neurological disorder in Indian children. A seizure is an abnormal discharge of electricity from the brain that results in a sudden change in the body or behaviour for a brief period of time. This may be manifested as shaking and jerking, stiffening, blank staring or sudden loss of consciousness. The majority of seizures stop after less than two minutes. If the child has experienced two or more unprovoked seizures, then generally the diagnosis of epilepsy is made.

Epilepsy is not a mental disorder and children with epilepsy can have a full and active life. For many children, medication is very effective and they will no longer have the condition. Diagnosis is crucial, and should be done at an early stage by a pediatric neurologist in Jaipur, to determine the type of epilepsy and thereby decide on the treatment.

Cerebral Palsy

Cerebral palsy is a disorder in the brain that causes movement, muscle tone and posture problems. It can result from damage to the developing brain, typically before or during birth. Is not a progressive disease. Children with cerebral palsy have a wide range of abilities, some being mild in nature, affecting one arm or leg, and others being more severe with their mobility being affected. The sooner after the injury physiotherapy and rehab starts, the better the outcome will be.

Abnormal muscle tone since infancy, unusual movement patterns, delayed sitting and walking and ongoing toe-walking can all be signs that may indicate cerebral palsy. Lurie Children's Hospital research shows that early intervention has a profound impact on children with neuromotor conditions in their motor, communication and independence skills.

Autism Spectrum Disorder (ASD)

Autism is a developmental disorder that impacts a child's communication, social interaction and information processing. It's called a 'spectrum' because it looks very different in each child. Autistic children may be non-verbal or may be able to communicate freely but have difficulties mastering social rules. Early indicators include not looking into the person's eyes, not talking, repetitive behaviors and problems with change.

While there is no 'cure' for autism, children whose communication and interaction with the world around them is significantly improved by the early provision of structured support, intervention and therapy in speech therapy, behaviour therapy and occupational therapy, make a very big difference. It is best if children can be identified early, before the age of three.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is a condition which is the most common and under diagnosed in school going children in India. An ADHD child struggles to focus, sit still and to regulate his or her impulses – not because he or she is being uncooperative or lazy – but because ADHD affects the mechanisms of attention and self-control that reside in the brain. These children may often be classified as disruptive in a classroom setting where they need evaluation and support.

ADHD is manageable. Children with ADHD can thrive in school and socially, with the appropriate support, such as behavioural strategies, school modifications, and in the case of medication.

When to see a specialist, rather than wait?

Western villages of Jaipur such as Bagru, Dudu, Phagi, etc. parents wait for a long time to get a specialist evaluation for their children's neurological symptoms. This is because sometimes they think that the child will outgrow the behaviour. It was often hard to get to a pediatric hospital in Jaipur or too costly. At times, people around them didn't even know what was going on was more than a 'phase' of development.

VISIT HOSPITAL IMMEDIATELY

If your child has a seizure or fit for the first time or if the seizure lasts longer than 5 minutes, it is not just a 'fever fit' in a young child that needs to be assessed, but one that lasts longer than 5 minutes or a first seizure.

VISIT HOSPITAL WITHIN A WEEK

If your child has lost a skill that they once could do, they no longer talk, walk or behave as they used to. Developmental regression is always significant.

BOOK AN APPOINTMENT AS SOON AS YOU CAN

If your child has not achieved clear milestones: was not speaking by 16 months, was not beginning to use phrases by 24 months, was not walking by 15 months, is not making eye contact, making repeated unusual movements or balance problems.

A child specialist hospital in Jaipur that has a dedicated pediatrics department, can offer a child a best pediatric neurologist in Jaipur or best pediatric surgeon in Jaipur and has access to diagnostic imaging that enables the children to have a cleaner diagnostic pathway than through GP's and referral that can take months.

What To Expect When Meeting A Pediatric Specialist In Jaipur.

Many parents are concerned that their child may be overwhelmed and/or frightened by a specialist visit. In real terms a pediatric consultation involves observing the child, asking questions of the parent and responding to age-appropriate questions from the child. Depending on the symptoms, the doctor may:

• Notice how the child moves, sits, walks and interacts
• Discuss the mother's pregnancy and birth history, developmental milestones, and neurological history in the family.
• Evaluate hearing and sight
• Have blood tests to screen for nutrient deficiencies, thyroid gland or metabolic issues that may impact brain development.
• If seizures are suspected, recommend an EEG (electroencephalogram), which is a test that measures the brain's electrical activity.
• If a structural brain problem is being considered, suggest that an MRI or CT scan is performed  a good radiologist will do everything to minimise pain.

These tests don't hurt. A lot can be accomplished at the best child hospital in Jaipur which offers diagnostics even within its premises, without having to travel to multiple locations. The results will help the specialist to make a diagnosis, the first and most important step in the direction of proper treatment.

Conclusion

More than the common perception in Indian families, neurological conditions are more prevalent than what is thought in children. Most of them can be identified by regular parents' attention to developmental milestones and behavioral shifts, behaviors that parents are already noticing. It's not necessarily the condition which makes the difference between a child receiving the help they need and one who does not. It's a question of whether they were aware of the symptoms early enough to take action.

If you notice anything from this guide, the best next step is to have a consultation with a pediatric specialist rather than a wait and see strategy. The pediatrics and Neonatology Department at Jaipur Vatika Hospital on the Jaipur-Ajmer Expressway at Thikariya offers the most convenient developmental screening, investigation and coordinated specialist referral to a best pediatric neurologist in Jaipur or best pediatric surgeon in Jaipur and the surrounding belt. The pediatric hospital in Jaipur has an on-site lab, which is accredited by the NABL and 24/7 emergency pediatric care.

Consultation can be made through JVH E-Consultation App or can call the helpline (+91-8209809753) which is open 24/7. Emergencies: Walk-in OK.