On reception at the neurologist: several words about norm and pathology of
to your kid will be executed soon or 1 month was already executed!Behind remained
one of the most difficult periods of life of the newborn. The first month of life of the child becomes for it the first critical period after the birth: it is characterized by hard work of all bodies and systems of an organism “responsible“ for adaptation (adaptation) of the newborn to environment conditions, essentially new to it. By the end of this period all transition processes have to come to the end, however under the influence of adverse environmental conditions, at the burdened course of pregnancy and childbirth adaptation processes, natural to the newborn, can accept a pathological orientation and lead to a neurologic disease of the child.
also needs to visit At this particular time for the first time the neurologist - usually just to be convinced: at the kid everything is all right; but if it not so - to reveal, “take“ pathology right at the beginning, not to allow to develop to a disease. For definition of a level of development of the child and an exception of neurologic pathology value not only an assessment of the created reactions to light, a sound, physical and psychoemotional activity of the newborn, but also his appearance has (actually, and my article will be generally devoted to this last subject).
So what first of all the neurologist at survey of the monthly child will pay attention to? On a form and the size of his skull, a look, a pose, a type of integuments. Why it is so important? Why often our disorders and experiences are connected with existence of deviations from appearance of the child, especially if this change of a form and the size of a skull? It is connected first of all with the fact that such changes can be a diagnostic symptom of serious diseases - hydrocephaly and a mikrotsefaliya.
the Form and the size of a skull
the Aberration - possible pathology...
Hydrocephaly is the excessive increase in the sizes of a skull, fontanels caused by increase in amount of cerebrospinal fluid in a skull cavity. At this disease also the shape of a skull changes - its brain department considerably prevails over front, the frontal part sharply acts forward, in temples and a forehead the expressed venous network is observed.
of Mikrotsefaliya is a reduction of the sizes of a skull and early closing of fontanels. At a congenital mikrotsefaliya the sizes of a skull are small since the birth, cranial seams are narrowed, fontanels or are closed, or the small sizes. Further the slow rate of a gain of a circle of the head so sometimes at the child of 2 - 3 years honor the sizes of a skull same, as well as at the birth is noted. At a mikrotsefaliya the skull has the specific form: the brain department of a skull is less front, a forehead small, sloping, the line of a forehead and nose is slanted.
Such states as a hydra - and a mikrotsefaliya, lead further to a delay of intellectual and physical development and therefore demand correction from the earliest age!
... or reason for further inspections? whether
But any aberration unambiguously has to confirm a pathological state? Of course, no! Clinical supervision show that there is a set of factors which influence a form and the size of the head. Of course, even small increase or reduction of a circle of a skull at the newborn in comparison with age norm can be considered as risk factor concerning development of hydrocephaly or a mikrotsefaliya, however it is not necessary to panic, having hardly found out that the head of the child is a little more or less norm: this circumstance has to become first of all a signal to need of carrying out additional inspections for an exception of pathological states. What it inspections?
- by Absolutely safe and reliable method is the neyrosonografiya (ultrasonic research of a brain through a big fontanel). This research will help not only to see changes of structure of a brain and signs of increase of intra cranial pressure, but also to estimate a blood-groove on the main vessels of a brain.
- by Even more reliable method is yaderno - a magnetic resonance of a brain (nuclear magnetic resonance), however this research for kids is carried out under the general anesthesia therefore carry out it only according to rather weighty indications. In this case consultations of the oculist and the neurosurgeon are also necessary for
“Homework“ for parents
Besides, directly since the birth you can independently control a gain of a circle of the head of the child which is one of the main indicators of norm and pathology. How to make it competently? Weekly measure by
- a circle of the head of the child and fix the received figures in specially got notebook. the Centimetric tape at measurement have
- on the most acting skull points (frontal and occipital hillocks).
- in order to avoid misunderstanding the same person has to take measurement.
Besides a head circle gain, it is possible to control the breast circle gain which is one of the general anthropometrical indicators of development of the child. For this purpose: weekly measure by
- a thorax circle on the same day when you measure a head circle; a centimetric tape have
- at the level of the line of nipples of the child.
For what needs such “amateur performance“? Taking these simple measurements, you will help the doctor to make an objective picture of development of the child and will be able to be quiet, having excluded a possibility of development of serious diseases (normal the monthly gain of a circle of the head at the full-term child should not exceed the first three months 2 cm a month; about one year the circle of a thorax is more than circle of the head of the child approximately on 1 cm).
Well, and now several words about what can and have to be normal and that is pathology. On this subject I tried to give conversation a shape of answers to the questions most often concerning young parents.
On what the shape of a skull depends?of
Is normal when passing the child on patrimonial ways there is an imposing of bones of a skull at each other. Features of a course of patrimonial process influence change of a shape of a skull. At the complicated patrimonial act there can be a sharp finding of bones of a skull at each other, and it will lead to its deformation which will remain rather long time.Change of a shape of a skull can be expressed to
in preservation of a swelling of soft tissues of the head in that place which the child moved ahead on patrimonial ways. The swelling disappears within the first 2 - 3 days. Kefalogematoma (hemorrhage under a periosteum) also changes a shape of a skull. It resolves more slowly, than the swelling, and this process demands supervision of experts (the neurologist, the surgeon).Change of a shape of a skull is connected by
also with age features. At the newborn the skull is extended in the perednezadny direction, and in several months the cross size of a skull will increase, and its form will change.
Some change of a form and the size of a skull maybe at normal development in premature children, or at frequent laying of the child on the same side, or at long lying of the child on a back.at
As the head grows?to
At the newborn on average the circle of the head is equal to 35,5 cm (the range of 33,0 - 37,5 cm is considered normal). The most intensive gain of a circle of the head of the full-term children is noted in the first 3 months - on average it is 1,5 cm for every month. Then the gain decreases a little, and by a year the circle of the head of the child is on average equal to 46,6 cm (borders of norm 44,9 - 48,9sm).
the Circle of the head of the premature child increases quicker, than at full-term, and the gain is most expressed in the period of an active increase of body weight, and by the end 1 - go year of life reaches normal amounts. The exception is made by deeply premature children.
However, it is always necessary to mean that even at normal development of the child there can be physiological deviations from average sizes which are often connected with constitutional features or influence of environment.
What is fontanels?Fontanels are located
in the field of a convergence of bones of a skull. Forward, big, the fontanel is located between frontal and parietal bones. At the birth it has the sizes from 2,5 to 3,5 cm, then gradually decreases by 6 months and in 8 - 16 months is closed. Back, small, the fontanel is located between parietal and occipital bones. It has the small sizes and is closed to 2 - 3 month of life.
At the pathological processes which are followed by increase of intra cranial pressure, fontanels are closed later, and happens, as open again. The small sizes of a forward fontanel can be norm option if they are not followed by reduction of a circle of a skull, rates of its gain and a delay of psychomotor development.
Above-mentioned signs do not limit all variety of possible options of deviations at the child of early age. However it must be kept in mind that any unusual option of appearance of the child demands careful inspection and supervision over its growth and development.
When and how the neurologist has to examine the child?
Development of the child of early age - very sensitive sign of a condition of an organism. It depends both on hereditary features, and on a difficult complex of social conditions and demands dynamic supervision of doctors. Do not forget to show the kid to experts in established periods - 1, 3, 6, 12 months!
If you invite the expert to the house, then it is necessary to consider the following:
- inspection of the child has to be performed on a pelenalny little table or other soft, but not caving in surface;
- the situation has to be quiet, whenever possible exclude the distracting factors; >
- it is desirable for li to perform inspection in 1,5 - 2 hours after feeding;
- air temperature indoors has to be about 25 ° With, lighting - bright, but not irritating.
in conclusion of article once again: do not postpone visit to the neurologist, remember - timeliness of carrying out all improving, preventive and medical actions aimed at providing its normal development depends on the correct assessment of a state of health of the newborn, and only the expert is capable to give the correct assessment!