Positive Parenting Tips for Toddlers
Factors That May Explain the Propensity of the Immature Brain to Develop Frequent Seizures Compared to the Adult Brain
In this case a rat less than 8-10 days old may be considered as equivalent to a human premature infant (7-10). On the other end, the male rat undergoes puberty from 35-36 to 55 days of age, whereas the female rat is in puberty between days 33 to 45 postnatally (11). Thus, the brain development in the rat at 2-3 weeks postnatally may be equivalent to a human infant toddler, while at 4-5 weeks it may be considered as equivalent to an older, pre- or peripubescent child (7). Additionally, there may be different developmental dynamics. In a previous review (12), we attempted to calculate the aging rate in developing rat versus developing human. Although our calculations were purely mathematical and did not consider major developmental milestones, we can conclude that the rate of aging in the immature rat compared to that in the child is much higher.
Initially pyridoxine dependency was felt to cause only neonatal seizures and drug-resistant neonatal status epilepticus. However, over time the spectrum of epileptic disorders attributable to pyridoxine dependency expanded to include epilepsies with onsets ranging from in utero to early childhood. Many types of seizures and epileptic syndromes were the result. Seizure types included partial, multifocal, hemiclonic, infantile spasms, myoclonic and generalized convulsive seizures in infants and young toddlers 28 , The syndromes include uncategorized encephalopathic disorders with partial and generalized seizures along with West syndrome and Lennox-Gastaut syndrome (LGS) 29-31 , Furthermore, some cases of infantile and early childhood onset epilepsy caused by pyridoxine dependency respond temporarily to antiepileptic drugs 32,33 , Inadequately treated, pyridoxine dependency has been linked to progressive brain atrophy and catastrophic neurological outcomes 34,35 ,
Dystonia is a sustained abnormal posture that occurs from the contraction of both the agonist and antagonist muscle groups of an extremity. Dystonic postures may be generalized or focal. Spells of paroxysmal dystonias are difficult to differentiate from tonic seizures. In infants, a common etiology of sudden dystonia is an acute drug reaction. These reactions may manifest themselves as opisthotonic posturing, torticollis, and an ocu-logyric crisis. Metoclopramide, a parasympathomimetic drug often used for the treatment of gastroesophageal reflux, is a common medication used in infants that can cause this drug reaction. Other medications associated with dystonic drug reactions, such as phenothiazines and haloperidol, are used less often in toddlers.
Thank you for asking me to see this 7-year-old young man. As a toddler he began to have attacks of loss of awareness, rigidity, and eye rolling which would be induced by minor knocks. This has continued and recently an episode occurred in which he had an undoubted tonic-clonic seizure with incontinence of urine. Curiously, as far as I can tell from mother's account, every attack has been triggered by a minor bump on the head, and he has never had an attack out of the blue. He had difficulties at birth. The family history is clear except for a convulsion in the mother when she was tiny, about which there is no further information. It seems to me that this boy is having a form of reflex epileptic seizure, and my inclination would have been to start treatment with sodium valproate. In fact mother told me that he was started on Epilim just a couple of weeks ago. Even though two EEGs have been normal, I do not doubt that he has an epileptic tendency, and I am sure that he...
NREM arousal disorders likely represent a disordered balance between the drive to wake and the drive to sleep. They are more common in toddlers who sleep very deeply, in children who are overtired because of insufficient sleep, and in those who are unwell or on certain medications. An increased drive to wake occurs if the child has an irregular sleep schedule, is unwell, or needs environmental associations to fall asleep normally. These disorders are therefore primarily managed by reassurance, explanation, and behavioral means to establish stable sleep routines and ensure good sleep hygiene. Home videotape recording is invaluable, particularly if the camera can be left running to capture the onset of the event. It is generally true that home videotape of nocturnal
A small pilot study showed that TPM (doses 8-25 mg kg day) suppressed spasms in 5 of 11 (45 ) young children, who did not respond to other anti-epileptic drugs. One child relapsed (20 ) and after 18 months, four (36 ) remained seizure free. Adverse effects were irritability, sleep disturbance, rapid breathing and unsteadiness. Data from recent case series are more disappointing, showing cessation of spasms in 0-20 in the short term 62, 63 , in 16 (9 out of 54) after long-term follow-up 64 and around one-third of patients showed 50 seizure reduction 62, 63 . The mean doses of TPM were lower in two of these studies (4.7 mg kg day and 5.2 mg kg day) 63, 64 . The most common reported side-effects included irritability, weight loss and anorexia. In addition, clinically symptomatic metabolic acidosis has been reported recently in case series of infants and toddlers 65 .
Rhythmic movement disorders such as nocturnal head banging (jactatio capitis nocturna), body rocking, and head rolling typically occur in infants and toddlers as they are trying to fall asleep. They can be present in deep sleep and in wakefulness. They are more common in children with ID. They will typically remit by five years of age but may persist into adult life. Management relies on good sleep hygiene and
The following suggestions can also protect the baby or toddler 6. Fireguards, playpens, and stair gates will protect your toddler from dangers in the home should you have a seizure and be unable to supervise the child. 7. Consider attaching toddler reins to your wrist until your child understands the importance of staying near you in the event you have a seizure. Let your family and friends know if you need help in caring for your new baby or toddler. You can also contact local community services, including those specializing in services for people with epilepsy.
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