With the development of perinatal medicine and neonatology, the success rate of neonatal resuscitation has gradually increased, and the incidence of pediatric cerebral palsy (referred to as pediatric cerebral palsy) has also been increasing.
In clinical work, it is often found that children with cerebral palsy who receive rehabilitation treatment often miss the best time for rehabilitation because they fail to detect and intervene early, resulting in poor rehabilitation results and leaving serious neurological sequelae.
I. What is pediatric cerebral palsy? What are the causes of pediatric cerebral palsy?
Pediatric cerebral palsy is a common disability in pediatrics. It is a non-progressive brain injury caused by various reasons from before birth to one month after birth, mainly manifesting as central movement disorders and postural abnormalities. Children with cerebral palsy can sometimes be associated with mental retardation, epilepsy, behavioral abnormalities, sensory perceptual impairment, and visual and auditory impairment.
The diagnosis of pediatric cerebral palsy especially emphasizes that the following 2 conditions should be met.
1. The symptoms of developmental delay or motor disorders appear in infancy;
2. Central palsy due to progressive diseases such as metabolic diseases or degenerative diseases and transient developmental delay in normal children should be excluded.
There are many causes of pediatric cerebral palsy, which can occur at birth, before birth or after birth, but not all children with these causes have cerebral palsy. The causes of perinatal brain damage include congenital intrauterine infection, intracranial hemorrhage and intracranial hemorrhage due to birth injury, congenital abnormal brain development and malformation, hyperbilirubinemia leading to nuclear jaundice, and various other causes of perinatal brain damage.
Therefore, it is important for parents to understand the causes of the disease early and to take measures such as physical examination during pregnancy and perinatal care to reduce the occurrence of pediatric cerebral palsy. In particular, parents should be reminded that some children with underlying pathologies or congenital genetic metabolic diseases may be misdiagnosed with ischemic-hypoxic encephalopathy due to similar hypoxic manifestations during delivery, or even misdiagnosed with pediatric cerebral palsy later. For some children with unknown causes, detailed screening for genetic and metabolic diseases and chromosomal and genetic tests are needed to exclude these diseases from delaying treatment.
What are the early symptoms of pediatric cerebral palsy? How to differentiate and diagnose from other diseases?
The typical symptoms of pediatric cerebral palsy are motor developmental delay, abnormal muscle tone, abnormal posture and abnormal reflexes.
Some of the early manifestations of pediatric cerebral palsy tend to be as follows.
1.Sometimes excessive agitation, excitement, crying, difficulty in sleeping, reduced sleep time, paroxysmal crying during sleep that cannot be comforted by breastfeeding, sometimes too quiet, and little physical activity;
2. feeding difficulties, uncoordinated sucking and swallowing, much drooling, no weight gain;
3, easily frightened, sensitive to sound stimulation, easily frightened, difficult to comfort;
4, like to jerk up, nursing difficulties, feel tight limbs, difficult to insert the arms into the sleeves when dressing, difficult to extend the thighs when changing diapers, difficult to break the fist when bathing, stiff back in an arch shape, head like to tilt back, etc.
Some of the above conditions may also occur in normal children, so the diagnosis of cerebral palsy should not be made solely on the basis of one or two of these abnormalities. If there are multiple abnormalities and children with high risk factors for cerebral palsy, special attention should be paid to the possibility of cerebral palsy. Parents often think that cranial MRI, EEG or cranial CT can diagnose pediatric cerebral palsy, but this is actually a misconception. The cranial MRI and cranial CT can understand whether there is any abnormality in the cranial structure, which may be helpful to explore the cause of cerebral palsy and judge the prognosis. The EEG can understand whether there is a combination of epilepsy and has a reference value to guide the treatment.
Pediatric cerebral palsy needs to be differentiated from some diseases in infancy, especially some progressive diseases such as metabolic and hereditary diseases, such as congenital hypothyroidism, phenylketonuria, trisomy 21, other chromosomal diseases, congenital hereditary organic acid, amino acid, lipid metabolic diseases, adrenal cerebral leukodystrophy, congenital myasthenic syndrome, spinal muscular dystrophy and other progressive diseases .
These diseases can be manifested as developmental delay, epilepsy, motor backwardness, abnormal posture, abnormal muscle tone, abnormal reflexes and the early symptoms mentioned above. The main point of differentiation is that pediatric cerebral palsy is a non-progressive disease and the condition will gradually improve with developmental symptoms, while the disease that needs to be differentiated has a progressive course or developmental regression, and relevant laboratory tests can show positive evidence when parents find that their child has motor When parents find that their children have motor regression and intellectual regression, they should go to a specialist hospital in time, and do not blindly think that it is pediatric cerebral palsy and carry out simple rehabilitation treatment while neglecting the treatment of the primary disease.
How can parents detect pediatric cerebral palsy at an early stage?
As the motor system and nervous system of infants and young children are in the developmental stage, early detection and treatment of pediatric cerebral palsy will be more effective, but if the best rehabilitation time is missed, the disability rate will be significantly increased and the symptoms of serious neurological damage will be left behind, which will seriously affect the quality of life for a lifetime. Therefore, parents should pay attention to it. First of all, if parents have high risk factors for pediatric cerebral palsy, they must understand the knowledge about pediatric cerebral palsy and recognize the early symptoms of pediatric cerebral palsy, and go to a professional physician in a specialized hospital for timely and regular examination. The doctor will ask detailed questions about the child’s birth history and mother’s pregnancy, and carefully examine the child’s neurological functions to evaluate the child’s neurological functions and intervene early in children with early onset of cerebral palsy.
Secondly, parents should not be accustomed to thinking that rickets or hypocalcemia or hypomagnesemia is the cause of irritability, irritability, crying and feeding difficulties in children aged 2 months or younger.
The hospital should choose a children’s hospital or a related specialized hospital, where the specialist can master the knowledge of pediatric developmental neurology and Vojta postural reflexes. Parents should not be satisfied with normal cranial imaging and EEG, which are not necessary for the diagnosis of cerebral palsy.
Early detection of pediatric cerebral palsy will lead to better treatment results, so parents should be alert to the early symptoms of pediatric cerebral palsy. If this optimal period is missed, permanent neurological damage such as backward motor development and abnormal gait is often left behind and requires surgical orthopedic consultation, which is difficult and inevitable. However, parents should also be aware that if a child presents with only 1-2 symptoms during the neonatal period and is generally well, this may not necessarily mean that the child has cerebral palsy, but may also be a transient manifestation of a normal child, which requires observation and regular follow-up.