Syndrome of early childhood nervousness treatment. Children's nervousness material on the topic. Scary dreams in children

Syndrome of neuropathy or congenital childhood nervousness most common at the age of 0 to 3 years, the peak of clinical manifestations occurs at the age of 2 years, then the symptoms gradually fade away, but in a transformed form it can be observed at preschool and primary school age.

In infancy, the main manifestations of neuropathy are somatovegetative disorders and sleep disturbance. The former include dysfunction of the digestive organs: regurgitation, vomiting, constipation, diarrhea, loss of appetite, malnutrition. Vegetative disorders - pallor of the skin, instability, lability of the pulse, lively vasomotor reactions, fever, not associated with a somatic disease. Sleep disturbance - insufficient depth and a perverted formula. Such children are characterized by increased sensitivity to any stimuli - motor restlessness, tearfulness in response to common stimuli (change of linen, change in body position, etc.). There is a pathology of instincts, first of all, the instinct of self-preservation is increased; associated with this is the poor portability of everything new. Somatovegetative disorders are aggravated by a change in the environment, a change in the regime of the day, care, etc. The fear of strangers and new toys is expressed. At preschool age, somatovegetative disorders fade into the background, but persist for a long time. poor appetite, selectivity in food, chewing laziness. Constipation, superficial sleep with frightening dreams are often noted. In the foreground - increased affective excitability, impressionability, a tendency to fear. Against this background, under the influence of adverse factors, neurotic disorders easily arise. By school age, the manifestations of the syndrome completely disappear. In rare cases, it is transformed into neurotic disorders or pathological character traits are formed. asthenic type. Often a symptom of neuropathy or its components precede the development of schizophrenia.

For children with neuropathy characterized by poor adaptability to changing meteorological conditions. During periods of lower barometric pressure, increased air humidity, strong winds, the somato-vegetative disorders described above intensify in them, and headaches may appear.

Some children have an increased tendency to affective respiratory attacks, which develop under the influence of various psychogenic factors - irritation, fear, joy, excitement. Often, seizures occur after crying or screaming. The child holds his breath while inhaling, turns blue. Sometimes, after a long breath holding, generalized convulsions appear.

In children with neuropathy there may be attacks resembling bronchial asthma. They develop after whooping cough, and sometimes after ordinary bronchitis, pharyngitis, laryngitis, and continue for many months. After a false croup, a child may also long time to remain a strong barking cough.

Typical reaction of the child with neuropathy to infection. It is manifested by pronounced phenomena of excitation in the form of anxiety, screaming, sometimes convulsions and delirium. In some cases, on the contrary, lethargy, apathy, drowsiness, lethargy are noted. All somatovegetative disorders in the period of any infectious disease are sharply intensified, often there are phenomena of toxicosis with impaired cardiac activity and collapse.
An increased tendency of children with neuropathy to manifestations of late rickets was noted.

important a sign of childhood anxiety in infancy and toddlerhood is sleep disturbance in the form of difficulty falling asleep, restless sleep, sometimes very early awakening. The child cannot fall asleep for a long time, becomes capricious, motor restless. Sleep disorders sometimes develop into insomnia: the child does not sleep all night, screams incessantly. If at first the cry is caused by some unpleasant irritation, then later the child cries for no reason (fixed cry). Some children seem to develop a negative conditioned reflex to sleep at night. At first, insomnia occurs as a reaction to an uncomfortable position in the crib, noise or silence, light or darkness, hunger, abdominal pain, overheating or cooling of the body, etc. One interrupted soy is fixed in the child's psyche for a long time.

Sometimes difficulty falling asleep depends on the emotional overexcitation of the child before bedtime. This happens in cases where adults give him excessive attention in the evening, caress, hug, kiss. As a result, the child is not only overexcited, but also, trying to get more attention and prolong the pleasure of communicating with loved ones, does not fall asleep for a long time. A child with neuropathy is especially sensitive to affection, but he must be given affection and attention not during the hours of falling asleep, but during the day and wakefulness.

Due to the reduced excitation threshold nervous system children with neuropathy, they sleep restlessly, startle and wake up from the slightest noise, at an older age (from the 2nd half of life) they sometimes scream in their sleep. Sleep disturbances usually worsen after any illness during which the child receives increased attention at night. Children with neuropathy at the time of falling asleep and sleeping often rhythmically sway, suck their fingers, bite their nails, itch, some of them have a constant shaking of their heads to the side. In a dream, there may be shudders under the influence of various sharp stimuli, especially sound ones.

In the 2nd year of life children with neuropathy, frightening dreams, nocturnal episodes in the form of attacks of fright and dreaming are noted. With a night fright, a child has a peculiar state, transitional between sleep and wakefulness. The child, not waking up completely, starts screaming, sometimes trying to run somewhere. Wide-open eyes express a state of fear; by the expression on the face and by individual statements of the child, one might think that he is seeing a nightmare. Often they do not recognize relatives, they are poorly oriented in the environment. The next day, the child usually does not remember the nighttime episode, or only a few fragmentary memories remain. Night fright arises under the influence of insignificant psychogenic factors, which acquire a more pronounced pathogenic significance in cases where they act before falling asleep or at night. Once having arisen, night fears, by the type of an established conditioned connection, usually persist for a long time.

For many children characteristic phobic syndrome(syndrome of fear). Fears usually arise under the influence of various exogenous factors - physical or mental. So, in children who have experienced any painful manipulation, for a long time there is a fear of everything that is connected with it. After injections of medicinal substances, the child may be afraid of white coats for a long time. A child with neuropathy who is learning to walk, after a fall, experiences fear of walking for a long time and does not resume it again for a long time.
Along with fears for children with neuropathy, an increased tendency to onanism is characteristic.

Motor and speech development in children with neuropathy normal, sometimes even accelerated in comparison with healthy peers. They start raising their heads early, sitting, walking, talking. In some children, graceful movements, an unchildishly serious facial expression attract attention. Acrocyanosis, cold extremities, excessive sweating, a tendency to allergic rhinitis and manifestations of skin diathesis.

in neurological status in these children, lability and excessive vivacity of tendon and skin reflexes are observed along with weakening or disappearance of the pharyngeal and corneal reflexes. The lability of muscle tone is also characteristic. Before the start of the examination, due to the increased excitability of the child, muscle tone increases and a false impression of muscle spasticity may be created. In addition, children with neuropathy sometimes have a tendency to walk on their toes, especially during periods of general arousal. However, unlike children with cerebral palsy, all these violations of tone and motility are transient and depend on the general excited state of the child.

At neuropathy the threshold of pain and tactile sensitivity can be lowered. When examining pupillary reactions, dilated pupils (mydriasis), uneven reaction to light, restlessness of the pupils (jumping mydriasis) are often detected.

At study of the autonomic nervous system vegetative dystonia is detected: significant fluctuations in the pulse with a change in body position, instability of blood pressure, respiratory arrhythmia, sharp dermographism (usually red, sometimes white). intellectual development with neuropathy is usually normal.

Mental features are manifested by irritable weakness, mild excitability and rapid exhaustion, combined with increased susceptibility. Children are distinguished by curiosity, with interest and desire they are taken to various activities, but due to increased mental exhaustion, they do not complete the work they have begun.

- a neuropsychiatric disorder characterized by instability of autonomic functions, increased excitability, and easy exhaustion of nervous processes. Manifested by sleep and appetite disorders, excessive sensitivity to external and internal stimuli (to pain, light, sounds), emotional lability, timidity, tearfulness. Diagnosis is carried out by a pediatrician, neurologist, psychiatrist. Includes questioning, examination, observation, supplemented by instrumental studies. Treatment is based on the observance of the regime of activity and rest, the exclusion of strong irritants, the use of restorative agents, sedatives, nootropics.

General information

Syndrome of early childhood neuropathy has a number of synonymous names: syndrome of early childhood nervousness, congenital nervousness, endogenous nervousness, nervous dysontogenesis. This pathological condition does not belong to independent diseases, but is considered as a factor predisposing to the development of neurotic disorders, psychoses, psychopathy, vegetative-vascular dystonia. The prevalence of congenital childhood nervousness is highest among babies from birth to 3-5 years old, reaching 0.6%. There is an epidemiological prevalence of the syndrome in residents of large cities, first-born and "late" children. The incidence is higher among boys, the gender ratio is 1:1.8. In girls, the symptoms are less pronounced, the consequences are better amenable to correction.

Causes of early childhood neuropathy

The etiology of the syndrome is represented by a complex interaction of external and internal factors. Their influence can be genetically predetermined, carried out in the prenatal, natal and early postnatal period. Children's nervousness manifests itself from birth or after a few months, the clinical picture is dominated by emotional-personal or cerebrosthenic symptoms. The reasons are divided into three groups:

hereditary factors. In children with neuropathy, family members are distinguished by emotional lability, asthenia, and anxious and suspicious traits. In 79% of cases of childhood nervousness, high excitability is detected in one or both parents.
Prenatal and natal negative factors. Toxicosis, chronic diseases, and stress experienced by the expectant mother are considered common exogenous influences. Also, the development of neuropathy in a child contributes to asphyxia during childbirth.
Early postnatal CNS lesions. Severe illnesses suffered in the first weeks and months of life increase the risk of childhood nervousness. Organic brain lesions are formed during infections, intoxications, traumas, hypoxic conditions.

Pathogenesis

The pathogenetic basis of early childhood neuropathy is the lack of formation of higher centers of autonomic regulation - interconnected formations in the brain structures that regulate the integration of sympathetic and parasympathetic reflexes, the coordination of somatic and autonomic reflex acts, and the autonomic provision of voluntary activity. Anatomically, they are located in the brainstem, hypothalamus, midbrain, reticular formation, cerebellum, limbic system, and cerebral cortex.

Functional insufficiency of the centers of regulation of the autonomic nervous system may be due to hereditary-constitutional features, organic damage to the prenatal, natal and early postnatal period. In the structure of residual organic pathologies, the syndrome of childhood nervousness manifests itself immediately after childbirth, has the character of cerebrostenia, and in the future is often combined with a delay in psychomotor and speech development. The constitutional type syndrome is detected from 3-4 months, it is expressed less roughly, it becomes the basis of emotional and behavioral disorders.

Classification

There are two most common classifications of early childhood neuropathy. The first takes into account the features of the clinical picture. According to her, two types of syndrome are distinguished: asthenic, manifested by anxiety, timidity of children, and excitable with symptoms of affective capture, irritability, hyperactivity. According to the etiological basis, three types of children's nervousness are distinguished:

True. Another name is constitutional neuropathy. It is diagnosed from the age of three months and later, it is distinguished by a greater severity of emotional-volitional, personal deviations.
Organic. Symptoms appear from birth. Autonomic dysfunction predominates - sleep disturbances, digestion, severity of reactions to physical stimuli.
Mixed genesis. Constitutional-encephalopathic type of nervousness. Up to a year, the symptoms of organic pathology prevail, later - emotional-volitional, behavioral deviations.

Symptoms of early childhood neuropathy

Clinical manifestations are most noticeable up to the age of two, then they become less pronounced, transforming into neuropsychic and autonomic pathologies. At infants there is increased excitability, a state of anxiety, screaming, crying, interrupted sleep. Attachment to the breast calms the child for a short time, refusal to feed is not uncommon. After eating, there are abundant regurgitation, colic, stool disorders are possible. The formation of circadian rhythms is slowed down: frequent and short sleep during the day, wakefulness at night is preserved. Characterized by increased susceptibility to noise and changes in illumination, startling in a dream. Awakenings are accompanied by crying. Children can hardly endure loneliness, they prefer to be in the arms of an adult.

In the period of early childhood, increased anxiety and anxiety are manifested by excessive mobility, stereotypical movements and actions. Children sway to the sides, suck their fingers, bite their nails. High mobility and lack of coordination lead to falls, bruises, which increases the crying and anxiety of the child. Dysfunction of the gastrointestinal tract due to the immaturity of autonomic coordination, combined with increased emotional arousal, causes refusal of complementary foods, bloating, nausea, vomiting, diarrhea and constipation. There may be violations of the act of swallowing, chewing, selectivity in food up to the rejection of all products except one or two.

With changes in the weather, atmospheric pressure, the well-being of children worsens - vegetative disorders increase, weakness, headaches, tearfulness, capriciousness appear. Seasonal colds and infections are difficult to tolerate. With an increase in body temperature, convulsive seizures and other disorders of the neurological spectrum occur. Contradictory situations are defined in the sphere of social interactions. On the one hand, the child wants to play with peers, asks to go for a walk, to the playground, to visit. On the other hand, a large number of unfamiliar stimuli - the screams of children, noise, tactile contacts - quickly tire, increase excitability, provoke hysteria. Children with early neuropathy syndrome feel better at home, in a narrow circle of close relatives. They are strongly attached to their mother, prefer to spend time with her, do not like to be alone.

Complications

The nature of complications of early childhood neuropathy depends on the type of syndrome, the timeliness and adequacy of treatment. With constitutional childhood nervousness, the vegetative component is leveled, mental disorders are often formed, based on increased affective excitability, anxiety, exhaustion of the functions of the nervous system. Violations of emotions and behavior are fixed in the form of neuroses and neurosis-like syndromes, serve as the basis for the formation of psychopathy. Organic neuropathy is complicated by vegetative-vascular pathologies, hyperactivity syndrome. Often there are night terrors, nightmares, fainting, enuresis, VVD with respiratory failure, pain in the region of the heart, abdomen.

Diagnostics

Early childhood neuropathy is determined during the examination by a neurologist and a psychiatrist. The diagnosis is based on the early manifestation of characteristic symptoms that are not associated with somatic and neurological pathologies that develop in the postpartum period. Comprehensive examination of the child basic set procedures include:

General examination, survey of the pediatrician. The doctor conducts an initial conversation with the parent, collects an anamnesis, clarifies complaints, examines the skin, measures body temperature, height and weight of the child. Characteristic signs of early neuropathy are acrocyanosis (blue fingers, tip of the nose, hands, feet), cold and wet extremities, allergic rhinitis, dermatitis, respiratory rhythm disturbances, tearfulness.
Neurologist examination. Lability, excessive activity of skin and tendon reflexes are determined, insufficiency of the pharyngeal and corneal reflexes is possible. Muscle tone is labile, in a situation of medical examination, due to increased excitability, overstrain occurs (false spasticity). The pupils are often dilated, anxiety, uneven reaction to light is determined. Pain and tactile sensitivity are increased.
Consultation of a psychiatrist. The specialist talks with parents, observes the characteristics of the reactions and behavior of the child. There is irritability, weakness (asthenia), slight excitability, rapid exhaustion, a normal level of intellectual development. In conversation, the child is timid, shy, frightened, sometimes motorally disinhibited. When a productive contact is established, curiosity is detected, but interest in communication quickly fades.

Differential diagnosis of early childhood neuropathy is based on the establishment of a causal relationship between a somatic, neurological disease (exposure to negative factors) and the manifestation of symptoms. IN controversial situations laboratory and instrumental examinations are prescribed: general, biochemical analysis of blood and urine, ultrasound internal organs, EEG , MRI of the brain .

Treatment of early childhood neuropathy

The treatment of children's nervousness includes a set of procedures, in which the central place is occupied by general regimen and recreational activities. In the first year of life, it is necessary to organize the correct mode of feeding and sleeping, to exclude moments that provoke anxiety and crying of the child (bright and loud toys, visiting guests). In early childhood, it is important to pay attention to the peculiarities of upbringing - to create situations of predictability (day plan, routine), to demonstrate calmness, confidence, preventing fluctuations in emotions, the formation of fears. The help of doctors in the treatment of early childhood neuropathy includes:

. Often, the symptoms of neuropathy are aggravated and supported by the peculiarities of the behavior of parents - anxiety, anxiety, fears, inconsistency of actions. At the consultation, the psychologist talks about the most favorable methods of education, ways of interacting with the child to avoid exacerbation of symptoms.
Medical treatment. The drugs are prescribed by a psychiatrist, a neurologist. The use of restorative, sedatives, nootropics is shown.
Physiotherapy. To improve the regulation of the vegetative link, water procedures (hydromassage, shower, swimming), massage, therapeutic and hygienic gymnastics are recommended. Therapy using currents is individually prescribed.

Forecast and prevention

The prognosis of early childhood neuropathy is largely determined by proper upbringing, adherence to regimen and restorative measures. The more efforts made by parents under the age of 2-3 years, the less pronounced will be the consequences of the syndrome. With timely assistance, by the age of 5-7, signs of childhood nervousness completely disappear. To prevent early neuropathy, it is important to exclude the influence of unfavorable factors during and after pregnancy, to minimize the risk of complications during childbirth, early illnesses of the child. After birth, prevention is based on correct educational methods, creating a calm, predictable environment. It is necessary to reduce the impact of stress factors: do not seek to visit guests, entertainment events, do not buy toys that can cause arousal of the child (with loud sound, pungent smell, bright).

In children with neuropathy there may be attacks resembling bronchial asthma. They develop after whooping cough, and sometimes after ordinary bronchitis, pharyngitis, laryngitis, and continue for many months. After a false croup, the child may also have a strong barking cough for a long time.

Due to the reduced threshold of excitation of the nervous system children with neuropathy, they sleep restlessly, startle and wake up from the slightest noise, at an older age (from the 2nd half of life) they sometimes scream in their sleep. Sleep disturbances usually worsen after any illness during which the child receives increased attention at night. Children with neuropathy at the time of falling asleep and sleeping often rhythmically sway, suck their fingers, bite their nails, itch, some of them have a constant shaking of their heads to the side. In a dream, there may be shudders under the influence of various sharp stimuli, especially sound ones.

At study of the autonomic nervous system vegetative dystonia is detected: significant fluctuations in the pulse with a change in body position, instability of blood pressure, respiratory arrhythmia, sharp dermographism (usually red, sometimes white). Intellectual development in neuropathy is usually normal.

early childhood nervousness(neuropathy, congenital nervousness, constitutional nervousness, neuropathic constitution, endogenous nervousness, nervous diathesis, etc.) is the most common form of neuropsychiatric disorders in young children, which is manifested by severe autonomic dysfunction, emotional and behavioral disorders. In a pediatric neurological clinic, the term “early childhood nervousness” is usually used, psychiatrists often write about neuropathy. This condition is not a specific disease in the true sense, but is only a background that predisposes to the subsequent emergence of neuroses and neurosis-like states, psychoses, and pathological development of the personality.

Causes of early childhood nervousness. In the occurrence of early childhood nervousness, decisive importance is attached to heredity and organic damage to the brain in the early stages of its development (before childbirth, during childbirth and in the first months of life). The role of constitutional and genetic factors is confirmed by family history data. In many cases, one or both parents were highly excitable, and in the pedigree there are often individuals with severe emotional disorders, anxious and suspicious character traits. Of no less importance are residual-organic cerebral disorders, in which brain damage occurs mainly before and during childbirth. This is indicated by the high frequency of the pathological course of pregnancy in the mother - genital and extragenital diseases, especially of cardio-vascular system, gestosis of pregnancy, threatening miscarriage, fetal presentation, primary and secondary weakness labor activity, premature birth, fetal asphyxia, birth traumatic brain injury, etc.

The cause of organic brain damage can also be various infections, intoxication, hypoxic conditions in the first months of postnatal ontogenesis.

Mechanisms of development of early childhood nervousness. The mechanism of occurrence of early childhood nervousness should be considered from the standpoint of the age-related evolution of the brain in the postpartum period. As is known, during certain periods of life, etiological factors can cause similar changes in the nervous system and mental sphere. This is due to the predominant functioning of certain nervous structures that provide the body's responses and its adaptation to the environment. During the first 3 years of life, the greatest load falls on the autonomic nervous system, since the regulation of autonomic functions (nutrition, growth, etc.) is formed earlier than the regulation of motor skills. In this regard, V. V. Kovalev (1969, 1973) identifies four age levels of neuropsychic response in children and adolescents: somatovegetative (from birth to 3 years), psychomotor (4-10 years), affective (7-12 years) and emotional-but-ideational (12-16 years old). At the somatovegetative level of response, various pathological processes affecting the body mainly lead to polymorphic autonomic disorders.

Classification of early childhood nervousness. In accordance with the results of studies 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 neuropathy syndrome of mixed genesis (constitutional-encephalopathic). G. E. Sukhareva (1955), depending on the predominance of inhibition or affective excitability in the behavior of children, distinguishes two clinical variants of neuropathy: asthenic, characterized by shyness, timidity of children, increased impressionability, and excitable, in which affective excitability, irritability, and motor disinhibition predominate.

Clinical manifestations of early childhood nervousness. Early childhood nervousness is characterized by pronounced autonomic dysfunction, increased excitability and, often, rapid exhaustion of the nervous system. These disorders in the form of various combinations are especially clearly manifested during the first 2 years of life, and then gradually level out or turn into other borderline neuropsychiatric disorders.

When examining such children, the general appearance of the child attracts attention: pronounced pallor of the skin with a cyanotic tinge can quickly be replaced by hyperemia, already in the second half of life, in some cases, there may be fainting-like states when the body position changes from horizontal to vertical. Pupils are usually dilated, their size and reaction to light may be uneven. Sometimes within 1-2 months there is a spontaneous narrowing or dilation of the pupil. The pulse is usually labile and unstable, breathing is irregular.

Especially characteristic are increased excitability, general anxiety and sleep disturbance. Such children almost constantly scream and cry. It is difficult for parents to determine the cause of a child's anxiety. At first, he can calm down during feeding, but soon this does not bring the desired relief. It is worth picking him up while crying and shaking him, as he will demand this in the future with an insistent cry. Such children do not want to be alone, they require increased attention with their constant cry. In almost all cases, sleep is sharply disturbed: its formula is perverted - drowsiness during the day, frequent awakenings or insomnia at night. At the slightest rustle, a short-term dream is suddenly interrupted. Often, even in absolute silence, the child wakes up with a sudden cry. In the future, this can turn into nightmares and night terrors, which can be differentiated only at the 2-3rd year of life.

Short-term rapid startling in a dream occurs early. Such conditions, as a rule, have nothing to do with generalized and focal seizures, and the appointment of anticonvulsants does not lead to a decrease in the frequency of twitches. Also characteristic is the presence of general shudders in the waking state, which usually occur under the influence of even minor stimuli, and sometimes spontaneously. Already by the end of the first - in the second year of life, they sit, sway before going to bed, are overly mobile, do not find a place for themselves, suck their fingers, bite their nails, itch, hit their heads on the bed. It seems that the child deliberately injures himself in order to scream even more and show anxiety.

Digestive disorders are an early sign of neuropathy. Its first manifestation is the refusal of the breast. The cause of this condition is difficult to establish. Perhaps, due to autonomic dysfunction in a child, coordinated activity of the gastrointestinal tract does not immediately occur. Such children, just starting to suck at the breast, become restless, scream, 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 complementary feeding of an infant. He often selectively reacts to various nutrient mixtures, refuses to eat. In a number of cases, only an attempt to feed, including breastfeeding, or one type of food causes a sharply negative behavioral state in him. Loss of appetite gradually increases. 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 refuse to eat solid foods altogether. In some cases, phenomena of disintegration of the chewing-swallowing act may occur, when he cannot swallow slowly chewed food and spits out of his mouth. Eating disorders and loss of appetite can turn into anorexia, which is accompanied by trophic changes.

Such children are very sensitive to weather changes, which contributes to the intensification of vegetative disorders. They do not tolerate childhood infections and, in general, various colds. In response to an increase in body temperature, they often experience generalized convulsive seizures, general arousal, and delirium. In some cases, the increase in body temperature is non-infectious in nature and is accompanied by an increase in somato-vegetative and neurological disorders.

When observing children suffering from early childhood nervousness, a decrease in the threshold of sensitivity to various exogenous and endogenous influences is revealed. In particular, they painfully react to indifferent stimuli (light, sound, tactile influences, wet diapers, changes in body position, etc.). Especially negative reaction to injections, routine examinations and manipulations. All this is quickly fixed, and in the future only the sight of a similar situation is accompanied by pronounced fear. For example, such children who have been given injections are very restless during examinations by a doctor and any medical staff (fear of white coats). Constantly there is an increased instinct of self-preservation. It expresses itself in the fear of novelty. In response to a slight change in the external situation, capriciousness and tearfulness sharply increase. Such children are very attached to the house, to their mother, they constantly follow her, they are afraid to stay alone in the room even for a short time, react negatively to the arrival of strangers, 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. So, with the syndrome of true neuropathy, vegetative and psychopathological disorders usually begin to appear not immediately after birth, but at the 3-4th month of life. This is due to the fact that the violation of autonomic regulation begins to manifest itself only with more active interaction with environment- manifestation of emotional reactions of a social nature. In such cases, sleep disturbances come first, although digestive tract disorders, as well as various deviations in the emotional-volitional sphere, are quite clearly represented. The general psychomotor development of such children, as a rule, is normal, and may even go ahead of average age norms; the child can quite early hold the head, sit, walk, 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 develops increased neuroreflex excitability and signs of a slight organic lesion of the nervous system are revealed. They are characterized by variability in muscle tone, which can periodically be either slightly increased or reduced (muscle dystonia). As a rule, spontaneous muscle activity is increased.

In such children, the personality component of the neuropathic syndrome is less pronounced than in the syndrome of true (constitutional) neuropathy, and cerebrosthenic disorders come first. Emotional and personality disorders in patients of this group are poorly differentiated, the inertness of mental processes is determined.

With the syndrome of organic neuropathy, there may be a slight delay in the pace of psychomotor development, in most cases, 2-3 months later than their peers, they begin to stand and walk independently, there may be a general underdevelopment of speech, usually mild.

The syndrome of neuropathy of mixed genesis occupies a middle position between the two forms above. 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 the syndrome of true neuropathy. The general psychomotor development of such children in most cases is normal, although it may be somewhat slow, but very rarely accelerated.

Diagnostics. The diagnosis of early childhood nervousness and its various clinical variants is not particularly difficult. It is based on the early onset (first 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 case of autonomic dysfunction, emotional and behavioral disorders after suffering exogenous diseases, there is a clear causal relationship between these conditions. In addition, in such cases, there is often a delay in psychomotor development of varying severity, which is not characteristic of the syndrome of true neuropathy.

Various autonomic and behavioral disorders can occur in children, even in the first months of life, after psycho-traumatic effects (usually with a sudden change in the external environment). The analysis of cause-and-effect relationships also plays a significant role here.

Current and forecast. With an increase in the age of the child, the clinical manifestations of neuropathy change, 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 has various vegetative-vascular disorders and emotional-behavioral changes, disturbances in the motor sphere, and specific forms of neuroses (including pathological habits) are gradually formed. childhood) or neurosis-like states. With long-term preservation of the clinical manifestations of neuropathy, a background is created for the formation of psychopathy.

In children with true neuropathy syndrome, vegetative disorders in most cases regress, and mental deviations come to the fore in the form of increased affective excitability combined with exhaustion, emotional instability, fearfulness, and a tendency to undifferentiated fears. Against this background, under the influence of acute or chronic psycho-traumatic conflict situations, systemic or general neuroses often occurred in the form of tics, stuttering, enuresis, encopresis, etc.

In patients with organic neuropathy at the age of 4 years, vegetative-vascular disorders, a syndrome of motor disinhibition (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 pronounced syndrome of vegetative dystonia is very characteristic. So, in the third year of life, vegetative paroxysms often occur during sleep (night terrors and nightmares) or in the waking state (for example, fainting). By the end preschool age these children often complained about pain in the region of the heart, abdomen, periodically they had respiratory disorders. Gradually, by middle school age, vegetative dystonia develops with the presence of permanent (more often) or paroxysmal disorders.

In more early dates there is a syndrome of motor disinhibition (hyperactivity), which becomes noticeable already 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 exhaustion of mental processes.

Monosymptomatic disorders against the background of organic neuropathy are similar in external manifestations 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 psycho-traumatic factors, but by somatic diseases. True neuroses in these children are relatively rare.

In the mixed neuropathy syndrome, affective respiratory seizures often appear, different kinds protest reactions. Such children are highly excitable, egocentric, they show pathological obstinacy and capriciousness in achieving their desires. It is also noted that they do not have a correspondence between poorly represented organic neurological disorders and well-defined neuropathic disorders.

Treatment. In the treatment of early childhood nervousness, regardless of its clinical forms, the organization of the correct regimen and upbringing of the child is of paramount importance. This primarily concerns feeding and sleeping, which should be carried out at the same time. However, due to severe anxiety and autonomic disorders, the child often leaves a certain regimen. Therefore, one should, if possible, identify the various points that cause anxiety and crying, and try to eliminate them. If, after feeding, the child has frequent regurgitation, vomiting, and gradually develops an aversion to food, then you should not force-feed him. This will only exacerbate unwanted manifestations. In such cases, you should feed less often so that there is a feeling of hunger. It is also necessary to avoid overexciting children, especially at bedtime. Attitude towards the child should be calm, demanding - according to age. Excessive stimuli, including an abundance of toys, the desire to give him maximum positive emotions only exacerbate neuropathic disorders. When, with age, fears arise, constant attachment to only one family member (more often to the mother), one should not frighten him, forcibly push him away from himself, but it is better to cultivate courage, resilience, gradually accustom him to independence and overcoming difficulties.

Drug treatment is prescribed if necessary by a doctor, includes general tonic and sedatives, including Noofen. You should widely use water procedures (baths, swimming, showers, wiping), classes with adults in hygienic gymnastics.

There is a special type of development of the child's nervous system, which is called neuropathy. Experts say that a significant role in the occurrence of neuropathy is assigned to the unfavorable course of pregnancy. This includes nervous shocks experienced by the mother of the child, chronic diseases, especially endocrine, toxicosis, birth asphyxia. You should also take into account the child's illnesses that accompany him during the first months of life. For example, it can be dyspeptic disorders, some infections. Given the cause of the violation, constitutional or congenital neuropathy is distinguished, there is also neuropathy, which is caused by a violation of the interaction between mother and child.

In particular, neuropathy is possible due to organic damage to the brain, including complicated and combined forms of neuropathy. In children, neuropathy can be detected even in the very first days. The newborn shows anxiety, wakes up at the slightest noise, he hardly falls asleep and shudders in a dream. Also, the baby can stay up all night and lie quietly, while his eyes are open. Such a baby is reluctant to take the mother's breast, and if he starts to suck, he is constantly distracted. In a later period, constipation, diarrhea, vomiting, and frequent regurgitation begin. The baby begins to cry and scream as if for no apparent reason. At the same time, pathological habits arise quite easily. Toddler child begins to suck fingers, irritate the genitals, rub the leg against the leg.

Even having reached the age of one, the child still falls asleep very badly, remains capricious in food, can refuse to write for a long time, skipping feeding time. Since the appetite is poor, he does not want to chew, such children are able to hold food in their cheeks for hours, because they do not want to swallow it. With neuropathy in children, stool is often disturbed, which leads to malnutrition. Children with neuropathy are hyperexcitable. If they are irritated, they turn red, there is a spasm of the larynx. Protesting, the child falls to the floor. Quite often, these babies have problems in the form of stuttering, tics, they are endowed with general motor anxiety.

Signs of childhood neuropathy

Toddlers suffering from neuropathy are hardly able to focus on something specific, any new impression immediately distracts them from what they were doing at the moment, and it is difficult for them to do assiduous work. Such children have rapid fatigue, the exhaustion of the nervous system leads to the fact that they begin to avoid the noisy society of other children. On the basis of this, an impression of isolation arises, which does not correspond to reality. Children with neuropathy most often have an asthenic physique. In addition, they have a tendency to allergies, asthmatic attacks often occur. Sometimes such children complain of dizziness, headaches, they experience fainting. This happens in the presence of negative stimuli. For example, fear, stuffiness in the room, the sight of blood.

Often, children with neuropathy suffer from a drop in blood pressure, its sharp fluctuations. There is a classification according to which there are two types of children with neuropathy. This is a group having increased excitability and another group having increased exhaustion. For the first, pronounced motor restlessness, changeable mood, affective outbursts, which are replaced by severe fatigue, are typical. Children belonging to the second group have difficulty adapting to various changes in their lives, they easily fall into a state of depression, as they are not confident in themselves. Hysterical attacks in such children may occur on the basis that even ordinary stimuli are perceived by them as excessive.

Children with neuropathy have mostly normal psychomotor development, and in some cases it is even accelerated when compared with their peers. Of particular importance in neuropathy is the proper upbringing of the baby. At the age of infancy and early childhood, parents should take care to protect the child from the influence of stronger environmental stimuli. It will be wrong if parents start to rush the development of the child with stories or reading that are not appropriate for his age. In this case, on the contrary, you should limit your child's visits to spectacles, and you should not allow him to sit at the TV for a long time and watch all the programs. Excessive demands on a baby with neuropathy are unacceptable, active inhibition skills should be developed slowly, without haste.

Parenting children with neuropathy

When raising children with neuropathy, special attention is paid to gymnastic exercises, hardening, outdoor sports. To get specific answers to questions of upbringing, as well as to learn how to care for neuropathic babies, parents should consult with a child psychologist, psychoneurologist, and pediatrician. Having learned from the doctor that the child has neuropathy, parents show great concern, and first of all the question arises whether it is necessary to treat neuropathy, or will this pathological condition go away on its own after a certain time? It should be emphasized that it is unacceptable to compare neuropathy with retardation mental development especially with mental retardation.

Treatment, if necessary, can only be prescribed by a doctor. It is important to know that children with neuropathy often have paradoxical reactions to many medications, and sedatives often produce a stimulating effect. Clinical practice proved that most of these violations disappear as they grow older, but for this the child must be created optimal conditions. It is necessary to create an atmosphere of calm and goodwill, to provide the child with a routine, to protect him from excessive stress.