Classification of early childhood nervousness. In accordance with the results of research by domestic and foreign authors, the following three clinical and etiological types of neuropathy syndromes (early childhood nervousness) are distinguished: true or constitutional neuropathy syndrome, organic neuropathy syndrome and mixed neuropathy syndrome (constitutional encephalopathic ). G. E. Sukhareva (1955), depending on the prevalence of inhibitory or affective excitability in children’s behavior, distinguishes between two clinical neuropathy options: asthenic, characterized by shyness, shyness of children, increased susceptibility, and excitable, in which affective excitability, irritability, and motor disinhibition dominate.
Clinical manifestations of early childhood nervousness. Severe autonomic dysfunction , irritability and, often, rapid exhaustion of the nervous system. These violations in the form of various combinations are particularly clearly manifested during the first 2 years of life, and then gradually disappear or go to other borderline neuropsychiatric disorders.
In a study of these children drew the attention of the child’s overall appearance: marked pallor tinged with notichnym Additional physical layer can quickly be replaced by hyperemia, already in the second half of life in otde ial cases be obmoro current-like state with a change in body position from horizontal to vertical. Pupils are usually dilated, their size and response to light may be uneven. Sometimes within 1-2 months there is a spontaneous constriction or expansion of the pupil. Pulse is usually labile and unstable, breathing is arrhythmic.
Especially characterized by increased excitability, general anxiety and sleep disturbance. Such children almost constantly cry, cry. It is difficult for parents to determine the cause of anxiety of a child He may initially calm down during feeding, but soon this does not bring the desired relief. It should take him in his arms while crying and shake, as he will demand this in the future with an insistent cry. Such children do not want to be alone; they, with their constant cry, demand increased attention. In almost all cases, sleep is severely disturbed: its formula is distorted — daytime sleepiness, frequent waking or sleeplessness at night. At the slightest rustle, a short sleep suddenly ends. Often, with absolute silence, the child wakes up with a sudden cry. In the future, this can turn into nightmares and night terrors, which can only be differentiated in the 2nd or 3rd year of life.
Early short-term quick startle in a dream. Such states, as a rule, have nothing in common with generalized and focal attacks, and the administration of anticonvulsants does not reduce the frequency of twitches. It is also characteristic that there are common winches in the waking state, which usually occur under the influence of even minor stimuli, and sometimes spontaneously. By the end of the first – in the second year of life, they sit, sway before bedtime, are too mobile, cannot find a place for themselves, suck their fingers, bite their nails, itch, hit their heads on the bed. It seems that the child deliberately inflicts damage to itself, in order to shout even more and show anxiety.
An early sign of neuropathy is digestive disorders. His first manifestation – the rejection of the breast. The cause of this condition is difficult to establish. Perhaps due to autonomic dysfunction in a child, the coordinated activity of the gastrointestinal tract does not occur immediately. Such children, only starting to suckle, become restless, cry, cry. It is possible that the cause of this condition is temporary pylorospasm, intestinal spasms and other disorders. Shortly after feeding, regurgitation, vomiting, rather frequent intestinal disorders in the form of increased or decreased peristalsis, bloating, diarrhea, or constipation, which may alternate, may appear.
Especially great difficulties arise with the start of feeding a baby. He often selectively reacts to different nutritional mixtures, refuses to eat. In some cases, only an attempt at feeding, including breast feeding, or one type of food, causes a sharply negative behavioral state. Disruption of appetite is gradually increasing. The transition to coarser food also causes a number of negative changes. This is primarily a violation of the act of chewing. Such children chew slowly, reluctantly or altogether refuse to accept dense food. In some cases, the phenomenon of disintegration of the chewing act may occur , when the slowly chewed food can not be swallowed and spits out of the mouth. Disruption of food intake and loss of appetite can turn into anorexia, which is accompanied by trophic changes.
Such children are very sensitive to changes in the weather, which contributes to increased autonomic disturbances. They do not tolerate childhood infections and various cold diseases in general. In response to an increase in body temperature, they often have generalized convulsive seizures, general arousal, and delirium. In some cases, an increase in body temperature is non-infectious in nature and is accompanied by an increase in somatovegetative and neurological disorders.
When observing children suffering from early childhood nervousness, a decrease in the threshold of sensitivity to various exogenous and endogenous effects is detected. In particular, they react painfully to indifferent stimuli (light, sound, tactile stimuli, wet diapers, changes in body position, etc.). Especially negative reactions to injections, routine examinations and manipulations. All this is quickly fixed, and in the future only a view of a similar situation is accompanied by pronounced fear. For example, such children, who were given injections, are very restless when they are examined by a doctor and any medical staff (fear of white coats). Constantly arises an increased instinct of self-preservation. It is expressed in the fear of novelty. In response to a slight change in the external environment, capriciousness and tearfulness sharply increase. Such children are very attached to the house, to the mother, they constantly go after her , they are afraid even to stay in the room for a short time, they react negatively to the arrival of unauthorized persons, do not come into contact with them, behave timidly and shyly.
Some clinical differences have also been established depending on the form of early childhood nervousness. Thus, in the syndrome of true neuropathy, autonomic and psychopathological disorders usually begin to manifest themselves not immediately after birth, but in the 3-4th month of life. This is due to the fact that a violation of vegetative regulation begins to manifest itself only with a more active interaction with the environment – a manifestation of social emotional reactions. In such cases, sleep disturbances come to the fore, although disorders of the digestive tract are also quite clearly represented, as well as various deviations in the emotional-volitional sphere. The overall psychomotor development of such children is usually normal, and may even go some way ahead of the average age norms; the child can quite early hold the head, sit, walk, and often begins at the age of up to a year.
The syndrome of organic neuropathy, as a rule, manifests itself from the first days of life. Even in the maternity hospital, such a child has an increased neuroreflex excitability and signs of a light organic lesion of the nervous system are identified. They are characterized by variability in muscle tone, which periodically may be somewhat elevated, then decreased (muscular dystonia). As a rule, spontaneous muscle activity is increased.
These children personal component of neuropathic syndrome is less pronounced than with the true syndrome (constitutional) neuropathy, and in the first place are the tserebrastenicheskom s disorder. Emotional and personality disorders in patients of this group are poorly differentiated , the inertness of mental processes is determined.
With organic neuropathy syndrome, there may be a slight delay in psychomotor development, in most cases, 2-3 months later, their peers begin to stand and walk on their own, there may be a general underdevelopment of speech, usually mild.
Syndrome of neuropathy of mixed genesis takes the middle position between the two above mentioned forms. It is characterized by the presence of both constitutional and mild organic neurological disorders. At the same time, in the first year of life, the clinical manifestations of this pathology are more dependent on encephalopathic disorders, while in subsequent years it approaches the manifestations of true neuropathy syndrome. The overall psychomotor development of such children is in most cases normal, although it may be somewhat delayed, but rarely accelerated.
Diagnostics. The diagnosis of early childhood nervousness and its various clinical variants presents no particular difficulty. It is based on the early occurrence (early days or months of life) of characteristic symptoms, the appearance of which in most cases is not associated with somatic and neurological diseases in the postpartum period. In the event of autonomic dysfunction, emotional and behavioral disorders after suffering exogenous diseases, there is a clear causal link between these conditions. In addition, in such cases, there is often varying severity of delayed psychomotor development, which is not characteristic of true neuropathy syndrome.
Various autonomic and behavioral disorders can occur in children, even the first months of life, after psycho- traumatic effects (usually with a sudden change in the external environment). Here, too, the analysis of cause-effect relationships plays a significant role.
Current and forecast. With an increase in the child’s age, the clinical manifestations of neuropathy are modified, which to a certain extent depends on the form of this pathology. Only in isolated cases, by the preschool period of life, all neuropsychiatric disorders disappear and the child becomes practically healthy. He often reveals various vegetative-vascular disorders and emotional-behavioral changes, disorders of the motor sphere, and gradually forms specific forms of neurosis (including pathological habits of childhood) or neurosis-like states. With long-term preservation of clinical manifestations of neuropathy, a background is created for the formation of psychopathy.
In children with true neuropathy, autonomic disturbances in most cases regress, and psychic deviations in the form of increased affective excitability combined with exhaustion, emotional instability, fearfulness, and a tendency to undifferentiated fears, come to the fore. Against this background, systemic or general neuroses in the form of tics, stuttering, enuresis , encopresis , etc. often arose under the influence of acute or chronic psychotraumatic conflict situations .
In patients with organic neuropathy at the age of 4–6 years, vegetative-vascular disorders, motor disinhibition syndrome (hyperactivity) and neurosis-like states of a monosymptomatic nature are predominantly observed . According to our data, the transformation of vegetative-vascular disorders into a more outlined syndrome of vegetative dystonia is very characteristic . Thus, in the third year of life, vegetative paroxysms often arise during sleep (night terrors and nightmares) or in a waking state (for example, fainting). By the end of preschool age, such children often complained of pain in the region of the heart, abdomen, and from time to time they had breathing problems. Gradually, to the middle school age, vegetative dystonia develops with the presence of permanent (more often) or paroxysmal disorders.
In the earlier periods, motor disinhibition syndrome (hyperactivity) occurs, which becomes noticeable in the second year of life. It is manifested by unbridled behavior, emotional lability, instability of attention, frequent switching to other activities, lack of focus, inertia, and rapid depletion of mental processes.
Monosymptomatic disorders on the background of organic neuropathy in external manifestations are similar to those in true neuropathy (enuresis, encopresis, tics, stuttering), but the mechanism of their occurrence is different. In this case , the main role is played not by psychotraumatic factors, but by somatic diseases. True neuroses in these children are relatively rare.
In the mixed-type neuropathy syndrome, affective respiratory attacks, various types of protest reactions often occur. Such children are more excitable, self-centered, they show pathological stubbornness and capriciousness when they achieve their desires. It was also noted that they lack correspondence between poorly represented organic neurological disorders and distinct neuropathic disorders.
Treatment. With the treatment of early childhood nervousness, regardless of its clinical forms, the organization of the correct mode and upbringing of the child is of paramount importance. This is especially true for feeding and sleeping, which should be carried out at the same time. However, the child, due to severe anxiety and vegetative disturbances, often leaves a particular regime. Therefore, you should, if possible, identify the various points that cause anxiety and crying, and try to eliminate them. If, after feeding, the child has frequent breakdowns, vomiting, and gradually develops an aversion to food, then it should not be fed by force. This will only aggravate undesirable manifestations. In such cases, feed less frequently to create a feeling of hunger. It is also necessary to avoid overexcitement of children, especially before bedtime. Attitude to the child should be calm, demanding – according to age. Excessive stimuli, including an abundance of toys, the desire to give him a maximum of positive emotions only exacerbates neuropathic disorders. When fears arise with age, constant attachment to only one family member (more often to the mother), one should not frighten him, push him away by force, but rather cultivate courage, resilience, gradually accustom to independence and overcome difficulties.
Drug treatment is prescribed if necessary by the doctor, includes bracing means and sedatives, including Noofen . Water procedures (baths, swimming, showers, rubdowns), hygienic exercises with adults should be widely used.