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, there is no developmental delay important indicator 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, nerve damage brachial plexus(the baby’s arm is “sluggish”, straightened in all joints, brought towards 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 methods diagnostics – ultrasound cervical region 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 bent too much at the hip and knee joints whether there is strong resistance when changing clothes, swaddling, or vice versa - there is lethargy, weakness, “hyperextension”.
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 reaction “readiness to jump” looks very vivid (or the reaction “parachutist reaction” - I read it in one German training manual). This is also the support reaction of the upper limbs.
An 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, which 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).
Further healthy baby Examinations by a neurologist and orthopedist will be required more than once a year.
He now has to master complex motor skills, in many ways consciously learning the beauty and dexterity of movements.
Algorithm for examining a child:
The program of a complete neurological examination includes:
1. Conversation with a doctor, general examination (collecting anamnesis, conducting differential diagnosis, formation of a survey program).
2. Electroencephalography (EEG). (EEG is the main method for diagnosing overt and hidden predisposition to seizures and epilepsy to monitor the progress of treatment of epilepsy. EEG is a recording of the bioelectrical activity of the cortex cerebral hemispheres 3. Check for hyperventilation).
4. Ultrasound examination of the cerebral arteries.
5. Ultrasound examination of the arteries of the neck.
6. Doppler sonography (ultrasound echography). Dopplerography is a method for studying the vessels of the neck (extracranial Dopplerography) and great vessels brain (transcranial Doppler sonography 7. Color Doppler sonography.
Neurosonography (or ultrasound of the brain) is a harmless, safe, reliable and cheap ultrasound examination of the “picture” of the brain.
It is carried out using sectoral sensors of various frequencies both through the fontanelle and through the temporal fenestra in children over one year of age.
The technique allows on an outpatient basis, without the use of anesthesia, which is necessary when performing computed tomography and nuclear magnetic resonance imaging, obtain data on the state of the child’s brain. 8. Transcranial Doppler sonography
MRI/CT head
Angio-CT Using a computer tomogram, it is possible to examine the entire arterial system - from the base of the skull to the knees. The examination is carried out on an outpatient basis and lasts no more than 10 minutes. The blood circulating in the vessels does not block x-rays, and for the vessel to become visible on x-rays, an iodine-containing contrast agent must be injected into the blood. also possible:
1. Screening myography in just 10-15 minutes makes it possible to look at the condition of the brain stem and spinal cord on the right and left. Computer podometry - 2. (computer barometry, podometry)
Computer podometry allows you to evaluate not only the relief of the foot, but also the distribution of loads in statics and dynamics.-3Neuroenrgometry
Neuroenergometry is used to assess brain metabolism.
Neurological examination reveals possible deviations from the outside nervous system organic or functional in nature. Organic disorders are the result of perinatal lesions, previous neuroinfections, traumatic brain injuries or hereditary causes(paresis, paralysis, dysfunction of cranial nerves, cerebellar or extrapyramidal disorders, dysfunction of sensory systems).
A neurological examination of a newborn begins with observing the child’s behavior during feeding, wakefulness and sleep, the position of the head, torso, limbs, and spontaneous movements. As a result of physiological hypertension of the flexor group muscles, which predominates in a child in the first months of life, the newborn’s limbs are bent in all joints.
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The purpose of an examination by a pediatric neurologist is to confirm (or exclude) the neurological basis of the existing symptoms.
An age-appropriate examination should assess all major neurological functions in an adequate, comprehensive and reliable manner. How younger child, the more difficult it is to decide which components of the study are appropriate to apply. As the child gets older, it may be decided to test only certain functions and aspects.
There are symptoms that are only examined in young children and are not relevant to older children. The interpretation of symptoms is specific in each age group
Possibilities for a neurological examination of a child
- Detection of local pathology.
- Detection of neurological disorders (paresis, ataxia, hyperkinesis).
- Determination of the degree of general immaturity of the central nervous system without signs of damage.
- Determination of pathological or abnormal neurological functions in combination with symptoms of behavioral and neuropsychological disorders.
Timing is an important element: more than one examination is necessary to monitor the dynamics of symptoms.
The neurological examination of a child is largely age dependent and focuses on changes in the nervous system, i.e. immaturity and/or pathological processes. Therefore, with the exception of acute conditions, it is necessary to conduct several examinations at certain time intervals, including comparison with age norms.
Careful preparation of consultation and involvement of parents in diagnostic work make assessment more effective. It is better to take anamnesis without the child, so the presence of a third party is desirable. It is advisable to bring existing examination reports, previous examinations, school notebooks, diaries, and tests to the examination.
The room where the inspection is carried out is important. It should be warm, spacious, with children's furniture and toys. It is very good when the inspection is carried out at home. Here the child is in a natural, safe and comfortable environment, he behaves at ease. Therefore, the value of such inspections is always higher. This applies primarily to the diagnosis of autism spectrum disorders.
Currently, consultation examinations are very important, when two or three specialists are present at once. This provides more information about the patient’s condition and provides a more accurate verification of the diagnosis. Consultative examinations should be carried out in a comfortable, cozy environment and take longer. Both parents and child usually prepare in advance for this examination.
We invite you to undergo an examination by a pediatric neurologist in Odintsovo, in our Doctor Kvant Center, professional psychoneurologists with extensive clinical experience will diagnose the disease and conduct complex therapy aimed at improving the condition and recovery of your child.
Even in children of the first year of life, pathology of the nervous system can be detected, the causes of which are disturbances in the period intrauterine development fetus (infection, fetal hypoxia) or severe 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 for individual schedule. Special attention is given .
In some cases, in addition to examination by a neurologist, additional hardware examination. 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, pupil size, movements eyeballs(identification). At each examination, the child’s reflexes, muscle tone, range of motion in joints, sensitivity, skills and communication skills are checked.
Even in the 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 intrauterine), checks the presence and symmetry unconditioned reflexes in a baby, muscle tone (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 and 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 also evaluates 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 foot, 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 skin, sensitivity, speech, mental development, the 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.
Study of the nervous system in children early age has specific features associated with age physiology this period of development. The intensive formation of the nervous system in the first years of life leads to a significant complication of the child’s behavior, therefore, a neurological examination of children in this group should be dynamic and take into account the evolution of basic functions. Neurological examination of a newborn begins with an examination. The child is examined in a calm environment, eliminating distractions if possible. The examination is carried out 1.5–2 hours after feeding at a temperature of 25–27 °C. A neurological examination begins with observing the child’s behavior during feeding, wakefulness and sleep.The position of his head, torso and limbs, as well as spontaneous movements, are observed. In a child in the first months of life, physiological hypertension of the flexor group muscles predominates; the newborn’s limbs are bent in all joints, the arms are pressed to the body, and the legs are slightly abducted at the hips. Muscle tone is symmetrical, the head is in the midline or slightly thrown back due to increased tone in the extensors of the head and neck. The newborn also makes extension movements, but the flexion posture predominates, especially in upper limbs, i.e. the child is in his usual embryonic position. It is necessary to describe the position of the head, the shape of the skull, its size, the condition of the cranial sutures and fontanelles (retractions, pulsation, bulging), displacement, and defects of the cranial bones. Determining the size of the skull at birth and monitoring the further dynamics of its growth are important for diagnosing hydrocephalus and microcephaly in the first weeks of a child’s life.
Normally at birth it is 35.5 cm, in the 1st month – 37.2 cm, in the 2nd month – 39.2 cm, in the 3rd month – 40.4 cm, in the 6th month – 43.4 cm, 9 th - 45.3 cm, and by the 12th month it is 46.6 cm. These head circumferences have average, since weight and other parameters at birth vary. So, normal weight at birth can range from 2500 g to 4000 g. With slow growth of the skull, rapid closure of cranial sutures and premature closure of the fontanel, one should think about severe damage to the nervous system. In some cases, the child's facial expression matters.
It is necessary to determine whether there are congenital craniofacial asymmetries and other specific features that occur with Down's disease, glycogenosis, mucopolysaccharidosis and mucolipedosis.
The general physique of the child, the proportionality of the torso and limbs are also important, as they may indicate a chromosomal pathology. The most difficult and important task in newborns is the study of functions cranial nerves. It is necessary to take into account the evolution of functions and the immaturity of brain structures.
I pair of cranial nerves- olfactory nerve. Newborns react with displeasure to strong odors. They become restless, scream, and wrinkle their faces.
II pair – optic nerve. All parts of the eyeball in children are sufficiently formed. A special feature is the incomplete development of the fovea centralis and imperfect accommodation, which reduce the possibility of clearly seeing objects. Thus, physiological farsightedness is observed. When irritated by an artificial light source, the newborn reflexively closes his eyelids and slightly throws his head back. Visual impairment may occur due to retinal hemorrhage during difficult childbirth.
III, IV and VI pairs of cranial nerves: oculomotor, trochlear and abducens nerves. A newborn has pupils of the same size, with lively, direct and friendly reactions to light. Movements of the eyeballs are carried out separately, since there is no binocular vision. The eyeballs often spontaneously convert toward the midline, which can result in convergent strabismus. With constant convergence, damage to the central nervous system occurs. The movements of the eyeballs in a newborn are jerky, later the gaze becomes fixed and the child begins to follow objects. It is important to consider the size of the palpebral fissures. Gaze paresis is most often congenital, as it is caused by underdevelopment of the brain stem.
V pair- trigeminal nerve. The motor reflex is checked during the act of sucking. In case of defeat trigeminal nerve lower jaw sags, shifts to the affected side, the sucking process becomes difficult, the chewing muscles atrophy on the damaged side.
VII pair– facial nerve. When it is damaged, facial muscles are disrupted. Peripheral paresis facial nerve manifested by pulling the corner of the mouth to the healthy side. With a central lesion, asymmetry of the nasolabial folds is noted.
VIII pair– auditory and vestibular nerves. In response to a sharp sound, the newborn closes his eyelids, becomes frightened, and motor restlessness, breathing rhythm changes, etc. As the child grows and develops, he first responds to the mother’s voice, and by the 3rd month he begins to respond to other sounds. The vestibular analyzer begins to function in the prenatal period. Promotion of the fetus birth canal causes excitation of the vestibular apparatus, therefore, at birth, short-term spontaneous small-scale horizontal nystagmus can be observed. If the nystagmus is constant, then this indicates damage to the nervous system.
IX, X pairs– glossopharyngeal and vagus nerves. The functioning of these nerves during sucking, swallowing and breathing is examined, assessing their synchrony. When affected, the child holds milk in his mouth, does not swallow it for a long time, has difficulty taking the breast, screams during feeding, and chokes.
XI pair- accessory nerve. When it is affected, the newborn does not turn the head in the opposite direction; there is a tilting of the head back, twitching of the head and spastic torticollis. In a large percentage of cases, damage to the accessory nerve is combined with damage to the brachial plexus during childbirth. With hemiatrophy, underdevelopment of the sternocleidomastoid muscle is observed.
In severe central palsy, the head is constantly tilted to the side, leading to spasmodic torticollis.
XII pair – hypoglossal nerve. The position of the tongue in the mouth, its mobility, and participation in the act of sucking are assessed.
With central paralysis, bilateral damage to the corticonuclear pathways, the functions of the tongue are impaired ( pseudobulbar syndrome). Atrophy of the tongue muscles is not detected.
With developmental defects, there may be macroglossia (an increase in the size of the tongue) or congenital underdevelopment of the tongue (Coffin syndrome).
With intrauterine, intranatal and postnatal lesions of the nervous system, the development of motor skills is primarily affected, therefore it is necessary to carefully analyze motor activity, the volume of active and passive movements in various positions - on the back, stomach, in an upright position. On at this stage it is necessary to check all reflexes and, most importantly, pay attention to their reduction.
The extinction of reflexes indicates the inclusion of complex motor acts. A delay in the extinction of reflexes indicates a delay in the child’s development. But you need to take into account that the child is quickly exhausted and the result may be false.
Therefore, it is necessary to determine the group of reflexes that are most important for diagnosis.
These include: sucking, Robinson, Moreau, Babinsky, Bauer reflex, support and automatic gait reflex, Perez, search, proboscis, palmar-oral, plantar flexion of the fingers, leg withdrawal reflex, Arshavsky's heel reflex, spontaneous crawling, Galant reflex, superior and inferior Landau reflex, asymmetric cervical tonic reflex of Magnus Klein. When studying suprasegmental postural automatisms, the child’s motor development is assessed - the ability to raise his head, sit, stand, and walk.
The medulla oblongata (myelencephalic) centers take part in the regulation of muscle tone, and later the midbrain (mesencephalic) centers take part. Untimely development of one or another part of the nervous system leads to the formation of pathological tonic activity and impaired motor function. Myelencephalic posotonic automatisms include:
1) asymmetric cervical tonic reflex - the head of a child lying on his back is turned to the side so that the chin touches the shoulder. In this case, there is an extension of the limbs to which the face is turned, and flexion of the opposite ones;
2) symmetrical tonic neck reflex - flexion of the head causes an increase in flexor tone in the arms and extensor tone in the legs;
3) tonic labyrinthine reflex - in the supine position there is a maximum increase in tone in the extensor muscle groups, and in the prone position - in the flexor groups.
All these myelencephalic postural reflexes are physiological for up to 2 months, and in premature infants the reflexes persist for a longer period - up to 3-4 months. When the nervous system is damaged and occurs with spastic phenomena, the tonic and cervical reflexes do not fade away. In parallel, mesencephalic righting reflexes are gradually formed, which ensure straightening of the torso.
At the 2nd month of life they manifest themselves in the form of straightening of the head - a labyrinthine straightening reflex to the head. This reflex develops chain symmetrical reflexes, which are aimed at adapting the body to a vertical position. They provide positioning for the baby's neck, torso, arms, pelvis and legs. These reflexes include the following:
1) cervical straightening reaction - turning the head to the side is followed by rotation of the torso in the same direction. This reflex is expressed at birth. Its absence or suppression may be a consequence protracted labor or fetal hypoxia;
2) trunk straightening reaction. When the child’s feet touch the support, the head straightens. Clearly expressed from the end of the first month of life;
3) straightening reflex of the trunk. This reflex begins to form from birth and becomes pronounced by the 6th–8th month of life with further improvement and complication. Starts with turning your head, then shoulder girdle and finally the pelvis. All of the above reflexes are aimed at adapting the head and torso to a vertical position.
But there are true righting reflexes, they contribute to the development of motor reactions. These include: defensive reaction hands– pulling them apart, pulling them forward, pulling them back in response to a sudden movement of the body; Landau reflex(righting reflex) - if the child is held freely in the air face down, then first he will raise his head so that his face is in a vertical position, then tonic extension of the back and legs occurs. The work and development of the cerebellum, basal ganglia and cerebral cortex can be assessed by the balance reaction. Due to a group of reflex reactions, the child maintains balance when sitting, standing and walking. These reactions appear and develop only after the final installation of rectification reactions, and complete their formation in the period from 18 months to 2 years. The straightening and equilibrium reactions are the basis for performing motor functions. When studying the motor functions of an infant, muscle development, volume and strength of active and passive movements, the state of muscle tone and coordination are assessed. Muscular development is determined by inspection, palpation, and measuring symmetrical areas with a centimeter tape. Muscle atrophy in children indicates their underdevelopment or disruption of their innervation (paresis and paralysis due to injuries or infectious lesions). Muscle hypertrophy in newborns is rare with Thomsen's myotonia. The muscle tone of the newborn is examined in a calm state of the child, and the stimuli should not be strong, otherwise the assessment may be incorrect. If the nervous system is damaged (hemorrhage, birth trauma, asphyxia), muscle hypotension or hypertension is observed. But with a number congenital diseases hypotension occurs (phenylketonuria, Down's disease). When assessing spontaneous movements, their volume and symmetry are taken into account. If muscle tone is impaired, the newborn's movements may be slow or strong, like throwing movements. Muscle tone in newborns depends on the position of the head in space or in relation to the body. Normally they are symmetrical. Their asymmetry indicates hemiparesis. Of the tendon reflexes, the knee, reflexes from the tendons of the biceps and triceps muscles are the most developed. With intracranial trauma and congenital neuromuscular diseases, inhibition of tendon reflexes is observed, and with increased intracranial pressure and in excitable children, hyperreflexia is observed. Using special diagnostic techniques, movement disorders are identified.
Traction test. The child lies on his back, his hands take his wrists and slowly pull him towards a sitting position. Normally, moderate resistance to extension of the arms at the elbows is felt. With hypotension, resistance is weakened or absent. In hypertension there is excessive resistance. There may also be asymmetry in muscle tone.
Withdrawal reflex. The newborn lies on his back, and a needle prick is applied to the relaxed lower limbs on each sole in turn, while the hips, legs and feet are flexed at the same time. Strength and symmetry are assessed. A weakening of the reflex is observed with spinal cord injury, with congenital and hereditary neuromuscular diseases, myelodysplasia.
Cross extensor reflex. The child lies on his back, his leg is passively extended and an injection is made into its sole. The other leg is extended and slightly adducted. Physiologically, this reflex is weakened in the first days of a child’s life. Pathological weakening or absence is observed with lesions of the spinal cord and peripheral nerves.
Lower limb abduction test. With the newborn lying on his back, the straightened lower limbs are quickly moved to the sides. Normally, there is moderate resistance, which is weakened or absent in muscle hypotonia. With increased muscle tone, resistance is sharply expressed. Hip extension may be difficult when congenital dislocations and hip dysplasia.
Sensitivity testing is of lesser importance. In a newborn, only superficial sensitivity is developed, and deep sensitivity develops by 2 years, since by this age the afferent system in the spinal cord and brain matures. The child has well-developed tactile, temperature and pain sensitivity. The child accurately localizes the stimulus and reacts quickly, but of significant diagnostic significance this study does not carry. With meningitis and hypertensive hydrocephalic syndrome, there may be an increase in the sensitivity of the skin (hypersthesia).
With malformations and spinal cord injuries, there is no reaction to pain and temperature stimuli. The autonomic function of a newborn is imperfect due to its morphological and functional incompleteness. Autonomic disorders may be manifested by attacks of cyanosis, pallor, redness, marbling of the skin, disorders of the rhythm and frequency of breathing and cardiac activity, hiccups, yawning, regurgitation, vomiting, unstable stools, and sleep disturbances. There may be trophic disorders of the skin, subcutaneous tissue and bones.
Level assessment mental development difficult for a newborn. The degree of mental development is determined by observing the child’s visual and auditory reactions, his play activities, the ability to distinguish between loved ones and strangers, ways of communicating with adults, etc. Mental development disorders are caused by limited communication between a child and adults and delayed motor development. Significant damage to the nervous system is observed when identifying pathological signs again.
Indicators of neuropsychic development of a young child:
10–20 days: the newborn keeps an object in the field of view (step tracking);
1st month: The child fixes his gaze on a stationary object. Begins to smoothly follow a moving object. Listen to the sounds and voice of an adult. Starts to smile. Lying on his stomach, he tries to raise and hold his head;
2 months: Fixes gaze on an adult's face or a stationary object for a long time. The skill of long-term tracking of a moving toy or adult appears. Makes searching turns of the head towards the sound. He rises and briefly holds his head while lying on his stomach. Begins to pronounce individual sounds;
3 months: is in an upright position, able to keep his gaze on an adult’s face or a toy for a long time. Reacts animatedly to attempts to communicate with him. Able to lie on his stomach for several minutes, leaning on his forearm and raising his head high. With support from the armpits, firmly rests on the legs with maximum load on hip joints. Keeps head upright;
4 months: begins to recognize close relatives, responding with positive emotions. Searches with his eyes for an invisible source of sound. Positive emotions are expressed by laughter. Able to grab a hanging toy and look at it for a long time. Starts to “walk”. Holds mother's breast or bottle with hands during feeding;
5 months: reacts differently to attempts at contact between close and strangers. Able to recognize the mother’s voice, distinguish between strict and affectionate intonations when addressing him. Quickly takes the toy from the adult’s hands and holds it. He begins to lie on his stomach for a long time, leans on the palms of his straightened arms, and rolls over from his back to his stomach. Stands straight and stable on his feet with support from the armpits. Able to eat thick foods from a spoon;
6 months: the child is able to distinguish between his own and someone else’s name, takes a toy from different positions and plays with it for a long time, transfers it from one hand to another, can roll over from his stomach to his back and move around, moving his hands and crawling a little. Begins to pronounce individual syllables (beginning of babbling). Eats food well from a spoon, removing it with his lips;
7 months: actively engages with toys (knocking, waving, throwing), crawls well. In response to the question “where?” able to look for an object that is constantly in one place. Drinks from a cup;
8 months: spends a long time playing with toys, imitating the actions of an adult (rolling, knocking, taking out, etc.). Sits and lies down independently, stands up and steps around, holding on to the barrier. To the question “where?” finds several objects in their places, at the command of an adult performs previously learned actions (for example, “give me a pen,” “kiss,” etc.);
9 months: the child is able to perform dance movements to the sound of music. Performs various manipulations with objects depending on their properties and qualities (rolls, rattles, opens). Moves from object to object, lightly holding onto them with his hands. To the question “where?” finds multiple objects regardless of their location. Knows his name. Imitates an adult, repeats syllables after him;
10 months: at the request of an adult, performs various actions (opens, closes, brings). Makes his first independent attempts to climb the stairs. At the request of “give”, finds and gives familiar objects;
11 months: masters new movements and begins to perform them according to the word of an adult (applies, removes, puts on, etc.).
Able to stand independently and take the first independent steps. First attempts at generalization (“give”);
12 months: the child is able to recognize friends in photographs, perform independently learned movements with toys (rolls, feeds, drives, etc.). Sits independently without support. Understands (without showing) the names of objects, actions, names of adults, carries out instructions (bring, give, find, etc.). Distinguishes the meaning of the words “can” and “cannot”. Easily imitates new syllables, pronounces up to 10 words;
1 year 3 months: walks, squats and bends independently. Knows how to command adults in games (feed a doll, assemble a pyramid). Begins to use “lightweight” words (car – “bi bi”, dog – “av av”);
1 year 6 months: the child is able to select objects of a similar type from objects of different shapes according to the proposed pattern or word. Movements are more coordinated, he steps over obstacles at a walking pace. Capable of reproducing frequently observed actions. At a moment of strong interest or surprise, he names objects. Says 30–40 words.
On command, selects among several externally similar objects two that are identical in value, but different in color and size;
1 year 9 months: able to distinguish between three objects of different sizes. Begins to assemble primitive structures (builds gates, benches, houses). Uses for communication simple sentences. Answers questions during examination story pictures. Makes independent attempts to dress or undress;
2 years: The child is able to step over obstacles by alternating steps. Reproduces a series of logically related play actions (bathes, wipes the doll). Lexicon 300–400 words. On command, talks about events;
2 years 6 months: the child is able to match a variety of objects in four colors (red, blue, yellow and green). With a “sidestep” step he steps over several obstacles lying on the floor. Performs interconnected or sequential two- or five-stage play actions (feeds the doll, puts it to bed, goes for a walk). Dresses independently, but does not yet know how to fasten buttons or tie shoelaces. Actively uses the questions “who?” and where?";
3 years: The child is able to perform a specific role in the game. Use complex sentences, questions “when?” and why?". Vocabulary is 1200–1500 words. Dresses independently, without or with little help from an adult, fastens buttons, ties shoelaces.
