When it comes to children’s healthcare, pediatricians are often considered the frontline for recognizing, diagnosing, and treating problems. With this in mind, the question must be asked – what is the role of pediatricians for children with neurologic injuries? Are they still the frontline, or are they just one cog in the wheel of healthcare?
What are Neurologic Injuries?
Neurologic injuries or disorders affect the nervous system, as well as the electrical or biochemical functions in the brain, spinal cord, or nerves. Some of the more common neurologic injuries affecting infants include:
- Brachial Plexus Injury
- Neural Tube Defects
- Periventricular Leukomalacia (PVL)
This list is not exhaustive. There are many neurologic injuries and disorders that can affect infants and young children, especially those who experienced a difficult birth or were born prematurely.
The Role of the Pediatrician in Assessing or Diagnosing Neurologic Injuries
According to a recent session at the American Academy of Pediatrics National Conference and Exhibition, pediatricians absolutely should be a frontline for addressing neurologic injuries or disorders. Pediatricians should incorporate routine screening for neurologic problems and ensure that referrals to a pediatric neurologist is timely. Dr. Susy S. Jeng, MD, FAAP, recommends pediatricians consider the following screening options to identify neurologic injuries in infants and neonates:
- Routine measurement of the baby’s head circumference.
- Checking for asymmetric Moro reflex, with follow up on whether both hands are being used equally. Unequal use is one sign that a brachial plexus injury may have occurred.
- Evaluating birthmarks for any signs of neurocutaneous disorders. Pigment and vascular skin lesions may not be present at birth, but may indicate a problem.
- Children who appear “floppy” should be evaluated for peripheral and central nervous system problems.
- Evaluating children with delays in two or more developmental domains may indicate a need for further evaluation.
- Hypotonic infants may need assessment of deep tendon reflexes at their annual well-checks.
Pediatricians also have a role as educator and mentor for the families they serve. They should be aware of the signs and symptoms, differential diagnosis, and support options to help families understand neurologic diagnosis and treatment options.
The Role of the Pediatrician in Treating Neurologic Injuries
Not only are pediatricians central to assessing and diagnosing your child, they are also a critical component to any treatment plan. Your pediatrician will be right by your side as you determine what treatment options are most suitable, consult with other healthcare providers, and continue to monitor the health and progress of your child.
Of course, the type of treatment your child needs will often determine the level of direct involvement your pediatrician will have. Among some of the most common neurological injuries or disorders, you may find treatment options such as:
- Hemorrhage: The treatment of a hemorrhage depends on the nature and severity of the injury. In some cases, no treatment at all is necessary. In others, the focus is on preventing other illness or injury that could make the hemorrhage (and effects) worse. In more severe cases, surgery may be required to reduce swelling and stabilize the child.
- PVL: Because PVL results in damage or death to white matter (tissue) in the brain, there is no known treatment. Your doctor(s) will create a management plan based on several factors, such as:
- Gestational age
- Overall health and medical history
- Nature and extent of the condition
- Your child’s tolerance to medications or therapies
- Expectations for the course of your child’s condition
- Brachial Plexus Injury: Treating a brachial plexus injury also depends on the severity of the injury and damage done. Minor injuries may resolve and heal on their own. More severe injuries often require physical therapy, non-invasive procedures, and ongoing monitoring. The most severe cases sometimes require surgery to repair damage and restore function.
- Hypotonia: Hypotonia involves weakened or “loose” muscle tone, so one of the best treatment options is physical therapy. To most effectively treat hypotonia, physical therapy and related plans should set clear goals or milestones, such as walking, sitting upright, or participating in activities. Therapy plans also often include support for developing fine motor and coordination skills.
As this list example shows, there are many ways that your pediatrician may be involved in the treatment of neurologic injuries or disorders. He or she likely will work alongside a team of healthcare providers to ensure the proper treatment plan is created and followed through. Your pediatrician will also continue to act as your child’s primary care doctor addressing and treating normal illnesses and concerns you may have.
One Cog in the Wheel of Healthcare
In many ways, your pediatrician is the frontline of care for your child. When it comes to neurologic injuries, however, your pediatrician may be more easily recognized as one cog in the wheel of healthcare. With most of the injuries or disorders discussed in this article, your best chance of maximizing your child’s health and quality of life is assembling a support team that will ensure your family is equipped for success.
Many families find it helpful to include a legal professional in their support team to help address any legal issues and ensure their legal rights are protected. Because some neurologic injuries are caused by negligence of a healthcare provider, a legal professional can also provide options for legal support and recovery.