Physical Special Needs in Preschoolers: muscular dystrophy, multiple sclerosis, chronic asthma, epilepsy

Children with physical special needs have a physical difference or difficulty that requires more assistance, care, and/or services. These conditions can be something that the child is born with, or something that develops later. Either way, having a specialized doctor diagnosis, treat, and oversee care is pivotal in the child’s overall outcome.

MUSCULAR DYSTROPHY

Muscular Dystrophy is a disease that causes muscle weakness and a loss of muscle mass. There are more than thirty types of Muscular Dystrophy with varying symptoms. This disease can appear in early childhood, or not show up until the teen years or even later. Muscular Dystrophy is caused genetic mutations that effect the production of proteins that protect the muscles. Here are some of the symptoms a child with Muscular Dystrophy may experience.

Symptoms

• Progressive muscle weakness
• Muscle pain and stiffness
• Waddling gait
• Walking on toes
• Trouble running
• Delayed growth
• Difficulty getting up from a sitting position
• Learning disabilities

Diagnosis

If Muscular Dystrophy is suspected, your child’s doctor will start by taking a medical history and performing a physical examination. After that, they may order the following tests.

• Enzyme tests
• Muscle biopsy
• Genetic testing
• Electromyography
• Lung-monitoring tests
• Heart-monitoring tests (particularly for Myotonic Muscular Dystrophy)

Treatment

There is no treatment that will stop any form of Muscular Dystrophy. Instead, the focus is on treating the symptoms of the disease. This may include physical therapy, speech therapy, respiratory therapy, and corrective surgery. There are also some medications that have been approved by the FDA for treatment of specific types of Muscular Dystrophy.

MULTIPLE SCLEROSIS

Pediatric-onset Multiple Sclerosis (POMS) is an autoimmune disease that effects children and teens. In POMS inflammation causes harm because the white blood cells attack the nervous system to fight off infection. This then causes the antibodies created to strip the nerves of their protective layer called the myelin sheath. The damage of the myelin sheath (demyelination) causes neurological symptoms that are relapsing and progressively worsen over time.

Symptoms

• Weakness and/or numbness/tingling
• Dizziness/vertigo
• Trouble with balance
• Muscle spasms
• Blurred vision, double vision, or trouble seeing
• Sensitivity to heat
• Problems with memory
• Optic Neuritis (painful loss of vision)
• Depression

Diagnosis

Multiple Sclerosis, including Pediatric-onset Multiple Sclerosis is diagnosed by a neurologist. The neurologist will ask about symptoms, conduct a neurological exam, and take a medical history. Then, if the neurologist suspects MS or another demyelinating condition, the following tests would be ordered.

• MRI
• Bloodwork
• Urine tests
• Cerebral Spinal Fluid test (spinal tap)
• Evoked Potentials testing (tests how quickly and completely nerve signals reach the brain)

Treatment

Treatment of Pediatric-onset Multiple Sclerosis is mainly aimed at treating the symptoms. Until recently, there were no treatments approved specifically for POMS and these patients only option was to use the same treatments approved for adults with MS. In 2018 though, an oral form of a medication called Fingolimod was approved for the use in children with MS. Fingolimod is a disease modifying therapy that slows the progression of the disease.

CHRONIC ASTHMA

Asthma is a condition that affects the airways in the lungs. It causes the airways to become narrowed due to inflammation. This causes difficulty breathing, or asthma attacks. Allergies, colds, and exercise can trigger an attack in a child with asthma. Here are the symptoms to watch out for.

Symptoms

• Shortness of breath
• Faster than normal breathing
• Chest tightness
• Chest pain
• Coughing
• Recurring wheezing
• Trouble sleeping due to coughing and shortness of breath
• Symptoms triggered by cold air, exercise, or allergens

Diagnosis

Talk to your child’s pediatrician if you have any concerns about your child’s breathing. Their doctor will ask you questions about symptoms and how often they occur. They will also perform a physical exam, focusing on the nose, throat, and upper airways and listening to the heart and lungs.

Diagnosing asthma in children under 5 years old is difficult because there are many conditions that cause the same symptoms. Also, lung functioning tests are not generally used for children under 5 years old. For children under 5 years old the following tests may be used to determine if the child has asthma.

• Blood tests
• Chest x-ray
• Sinus x-ray
• Allergy tests

Treatment

When treating chronic asthma in children younger than 5 years old, the goal is to help the child maintain normal activity levels by identifying and avoiding triggers. After that, symptoms can be minimized by treating the inflammation in the airways with short-acting bronchodilators. For most young children with asthma this is all the treatment that is needed. Some children do also need long-term control drugs in addition to the short-acting bronchodilators.

EPILEPSY

Epilepsy is a neurological disorder associated with abnormal electrical activity in the brain. This leads to seizures, which involve sensory disturbances, convulsions, and even loss of consciousness. There are several causes of epilepsy, including a lack of oxygen at birth, head injury, brain infection, and stroke. Here are the symptoms that you may observe during an epileptic seizure.

Symptoms

• Staring spells
• Uncontrollable jerking movements of arms and legs
• Loss of consciousness
• Stiffening of the body
• Breathing problems
• Loss of bladder and/or bowel control
• Not responding to noise
• Appearing confused or in a haze

Diagnosis

When Epilepsy is suspected in a young child, the doctor will ask about the child’s symptoms and take a medical history. They will also ask questions that will give them more information about the child’s risk factors for Epilepsy, such as asking about the birth, any congenital conditions, recent infections, or head injuries. After that, they may also order the following tests.

• Neurological exam
• MRI of the brain
• Blood tests
• Lumbar puncture (spinal tap)
• Electroencephalogram

Treatment

There are medicines that can often be effective in reducing, or even stopping, seizures. This treatment does not work for everyone with Epilepsy though. The medicine used to treat Epilepsy is determined based on the type of seizures, age of the child, side effects, and ease of use of the medication. Other treatment options for Epilepsy include vagus nerve stimulation and surgery, but these options are not for everyone and typically require the patient to be older.