The nervous system of a child develops rapidly during childhood. Because of this, it is valuable to have some guidelines about when neurologic symptoms suggest a visit with neurologist would be beneficial. 

Persistent headaches or developmental delay issues are often the symptoms that indicate a referral may be desirable. 

Dr. Mohamad A. Mikati, chief of Duke Children's Division of Neurology, describes from the neurologist's point of view when a referral would be a good idea.

-- Dennis Clements MD, PhD, MPH

Mohamad A. Mikati, MD

A pediatric neurologist specializes in treating children who have problems of the nervous system, including the brain, spinal cord, and peripheral nerves.

If your child experiences the symptoms below, you should see your pediatrician for an initial consultation. If warranted, your pediatrician can then refer you to a neurologist for more specialized attention.

Headaches

Persistent headaches that do not have a clear-cut explanation or that have some "red flags" may warrant consultation with a child neurologist. However, they do not necessarily always indicate that there is something serious.

Red flag headache warning signs include:

• Headache that wakes the child up at night or is associated with vomiting
• Sudden, very severe headaches, or recurrent headaches that are associated with change in personality and behavior
• Neurological signs associated with the headache including blurring of vision or numbness, dizziness, and problems with walking or weakness

Sudden Changes in Consciousness

Symptoms such as obtundation (unable to arouse) and lethargy require an evaluation by a neurologist, particularly if they are associated with fever or sudden loss of consciousness.

Other symptoms such as dizziness and  vertigo (which is not readily explained) also warrant additional consultation.

Episodes of Focal Weakness

Focal weakness on one side or generalized weakness (on both sides) can be secondary to neurological problems of the brain, spinal cord, or peripheral nerves, and, at times, muscles. These require neurologic consultation and testing.

Seizures 

Seizures are episodes of involuntary movements or sensations with or without loss of consciousness that result from abnormal electrical surges in the brain. They can take the form of stiffening or shaking of all or part of the body.

They can also manifest as staring eye flutter or automatic movements with partial change  of consciousness.

Febrile seizures (seizures with fever that occur between the age of five months and five years) that are short and do not recur are usually handled by the pediatrician.

However, if they occur only on one side of the body or are prolonged or recur, then an evaluation by a neurologist is usually warranted. Seizures that occur without fever will require an evaluation by a neurologist. 

Involuntary Movements, Loss of Consciousness, or Abnormal Sensations

These may be due to epileptic seizures or to other disorders such as habit tics (like eye blinking or twitching). They can also be symptoms of localized abnormalities in the nervous system.

A neurologist should evaluate your child if he or she exhibits these symptoms. At times, special therapies may be needed.

Development Problems

If the child isn't acquiring the usual milestones including sitting, walking, talking, and socialization, or has abnormalities in these functions (e.g. unstable to walk or abnormal articulation comprehension or reading), then this requires an evaluation by a neurologist. 

In addition, if a child acquires the milestones and starts to lose them, you should see a neurologist for evaluation. For example, a child who has difficulty going up the stairs even though that it was possible for him before should be evaluated.

School Difficulties

School difficulties that cannot be addressed by the teachers -- such as difficulties with attention, reading or specific subjects -- may also need a referral to a neurologist.

What to Do

In general, your child see his or her primary care physician first if you see any of these symptoms.

Your child's primary care doctor may be able to diagnose the easier issues and refer on the neurologist the more serious issues.

For more information pediatric neurology services at Duke, visit us at dukechildrens.org.

-- Mohamad A. Mikati, MD, is chief of Duke Children's Division of Neurology.

-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.