Fixed spinal cord in children: symptoms, causes and treatment features. Spina bifida in newborns

2. Timely and adequate correction of hydrocephalic-hypertensive syndrome. 3. Carrying out rehabilitation with the aim of influencing the processes of restoration of spinal cord function includes: neuroprotection to stabilize surviving structures, preserve functional fibers; the use of physical factors to stimulate the regeneration of nerve elements. Therapeutic and physiotherapeutic measures should be determined taking into account dysfunction pelvic organs.

Problems during treatment in children with spina bifida: 1. Difficulties in accessing the central veins (infusion, sedation) and anesthesia. 2. Immunity is not formed, risk of infections. 3. Gastroenterological problems (mucositis,

thrush, need for parenteral nutrition, pseudomembranous colitis). 4. Care in the pre- and postoperative period.

Conclusions: 1. Hydrocephalus, size

hernial sac and sluggish regenerative capabilities of soft tissues have

significant impact on results and

effectiveness of surgical intervention. 2. The choice of treatment tactics for children with SMG is determined comprehensive examination

patients. 3. When SMG is combined with hydrocephalus, it is advisable to perform a CSF shunt operation as the first stage. 4. Differentiated surgical tactics for SMG with concomitant hydrocephalus requires compliance with the specified diagnostic and treatment recommendations.

DIAGNOSIS OF DEVELOPMENTAL ANOMALIES OF THE SPINE AND SPINAL CORD IN NEWBORNS AND CHILDREN IN THE FIRST YEAR OF LIFE

MM. Akhdiev, Sh.D. Makhmudov

Republican science Center neurosurgery, Tashkent, Uzbekistan

The primary diagnosis of developmental anomalies of the caudal spine and spinal cord is based on the presence local changes and the degree of damage to the spinal cord and its roots. In newborns and children of the first year of life, neurosonography (NSG) in the diagnosis of developmental anomalies of the caudal spinal cord and spinal column is an informative and also publicly accessible method. In this category of patients, the possibility of ultrasound diagnostics is largely determined by the presence of natural ultrasound windows. Ossification on the posteromedial surface of the spine

ends only by the end of the first year of life, which allows visualization of the spinous and transverse processes, arches, vertebral bodies, as well as a detailed examination of the spinal canal, cervical and lumbar enlargements of the spinal cord, the fifth ventricle and conus.

Research methodology: two main positions are used to examine a child. First: the child is in a lying position on the left side, facing the mother (breastfeeding or feeding from a bottle is allowed for relaxation and creating physiological comfort for the child). Second: the child lies on his stomach, on the assistant’s lap with the head pronated. This position is most convenient for examining the atlanto-occipital junction. Usage

linear ultrasonic sensors with a frequency of 3.5-5.0-7.5 MHz makes it possible to visualize all the main structures of the spinal cord and spine in newborns and children of the first year of life. An ultrasound examination is carried out in the longitudinal and transverse directions and takes 15-20 minutes. During longitudinal scanning, the sensor is located along the spinous processes of the vertebrae and slowly moves in the caudal direction. On echograms, in real mode, the skin is visualized layer by layer, subcutaneous tissue, longitudinal muscles of the back, spinous processes of the vertebrae, membranes, spinal cord, spinal canal and vertebral body. Bone structures, the membranes and walls of the spinal canal look like hyperechoic formations. The white matter has a hypoechoic echostructure, the cerebrospinal fluid is anechoic. U healthy child The conus medullaris contains a natural extension of the central canal - the fifth ventricle (ventriculum terminale). The spinal cord ends at the level of L2-L3 and passes into the cauda equina (filum), which is visualized as separate filaments. In itself, the presence of evidence of a thick (more than 1.0 - 1.5 mm in diameter) filum terminale and a somewhat unusually low (L2-L3) location of the spinal cord conus is not considered a manifestation of pathology. When scanning in the transverse direction, they are clearly visualized

arches, meninges and spinal canal. Using state-of-the-art equipment, it is possible to visualize the “butterfly” of the gray matter, the dorsal and ventral roots of the spinal cord. Color Doppler imaging reveals epidural venous plexus, anterior spinal artery and paired posterior spinal arteries. Klippel-Feil syndrome, spinal dysraphism (syringomyelia, spina bifida occulta, spina bifida aperta) can be differentiated from meningo- and meningomyelocele, intramedullary tumors. Expansion of the central spinal canal at the level lumbar region allows you to differentiate myelocystocele from sacrococcygeal teratoma.

The NSG determines not only hernial opening, but also the contents of the hernia, accompanying

herniated defects and anomalies of the skull and spine, brain and spinal cord: hydrocephalus, deformation and

asymmetry of the structure of the brain and skull, aplasia of the septum pellucidum, atrophy of the brain and spinal cord, connections of the contents of the sac with the ventricles of the brain and the subarachnoid space. The severity of hydrocephalus in SMG correlates with the severity of the spinal cord defect. Hydrocephalus is most common when SMG is localized in the lumbar and lumbosacral spine.

Thus, knowledge of the normal echographic anatomy of the spinal cord, as well as the use of modern ultrasound technology, makes it possible to diagnose congenital anomalies spinal cord spinal cord and spinal column.

RESULTS OF TREATMENT FOR CHILDREN WITH LIPOMATOUS SPINAL FORMATIONS

G.M. Elikbaev, V.A. Khachatryan

Russian Research Neurosurgical Institute named after. prof. A.L. Polenova, St. Petersburg, Russia

The results of examination and treatment of 34 children with spinal lipomas aged from 4 months to 18 years, treated at the Federal State Institution RNHI named after. prof. A.L. Polenov from 1991 to 2008 There were 23 boys, 11 girls. In 27 (79.4%) cases, lipomas were located at the lumbar level sacral region spine.

The main clinical feature in the diagnosis of spinal lipomas were skin stigmas in the lumbosacral region and neurological disorders.

79.4% of children with lipomas have various skin changes manifested by hyperpigmentation, elongated hair, funnel-shaped retraction, tumor-like formation. In 70.6% of cases, dysfunction of the pelvic organs was detected, which in all cases was combined with motor disorders. Gradually progressive clubfoot was observed in 73.5% of children and more in children over 3 years of age. Hydrocephalus was observed in 5 patients.

Spinal lipoma was combined with spina bifida of the lumbar and sacral vertebrae (32), with spina bifida (10), and with tethered spinal cord syndrome of the lumbosacral region (18).

Lipomas were located extra-intravertebrally in 30 cases and only extravertebrally in 4 cases. Among intravertebral spreading tumors

The location of the tumor was epidural in 13 cases, epi-subdural, subdural with ingrowth into the conus of the spinal cord in 8 cases. Among the various forms of fatty formations related to spinal dysraphism, lipomeningocele was the most common type (in 31 cases).

MRI examination of the spine and spinal cord was performed in 24 (70.6%) children, CT examination was performed in 26% of cases. Spondylography in two projections was performed in patients with lipomatous formations in 16 (47.1%) cases, which showed expansion of the bone canal. 7 (20.6%) patients underwent myelography with water-soluble contrast “Omniopak”, which revealed a defect in the filling of the subarochnoid space at the location of the lipoma. The complex of preoperative examination included electroneuromyography (10 children), evoked potentials and ultrasound (3 patients each).

Target surgical treatment spinal cord lipomas were release, decompression of the spinal cord, nerve roots and prevention of re-compression of the spinal cord. Concomitant diseases and anomalies in children operated on with lipomatous spinal formations were identified from the urinary (32.4%), osteoarticular and respiratory systems(according to 2 observations).

The content of the article:

Did you know that during the first year of life, a newborn baby's brain doubles in size? Biologists confirm that if not for size restrictions female pelvis, the baby remained in the belly for some time to be able to develop longer.
But since there is a special biological program, pregnancy ends at 39 - 40 weeks, and the child is born with a brain that is only a quarter developed. In this case, the immaturity of the newborn’s brain is not considered a pathology.

Some experts call the first 3 months of life the fourth trimester.

The brain of a newborn weighs on average 390 grams (340 - 430) in boys and 355 grams (330 - 370) in girls, which is 10-12% of body weight. For comparison: in an adult, the brain mass is only 2.5%. As they grow older, by the age of 20 - 27 years, the weight of the brain becomes maximum: on average, 1355 g in men and 1220 g in women.

Note that individual variability in one direction or the other is possible.
It’s wonderful when a child meets normal standards in all respects. But it is very important to make sure that there is no serious pathologies, and if there is, courageously accept the situation and make every effort to normalize the condition, if possible. And in these cases, ultrasound diagnostics comes to the rescue.

Neurosonography of the brain of newborns

Informative and safe method Ultrasound diagnostics, or neurosonography, is used to diagnose brain pathologies in babies under 12 months.

Before the introduction of these unique devices into practice, examinations of the child’s brain were performed according to strict health conditions using tomography under anesthesia. There were a huge number of contraindications to the study, and there were also many undesirable consequences.

Ultrasound of the brain in a newborn is currently considered a screening test and is performed for preventive purposes on every newly born baby in order to identify abnormalities in the early stages.

The procedure itself does not require the use of anesthetics or any preparation and lasts 10 - 12 minutes.

Features of ultrasound examination of the brain in children under one year of age

There are some nuances in conducting neurosonography in infants. The fact is that visualization is carried out through a large fontanel, which is reduced after a year. The dense fused bones of the skull are an obstacle for the ultrasonic wave, and after the fontanelles are closed, obtaining a reliable sonogram (picture ultrasound examination) impossible. If necessary, use methods computer diagnostics(magnetic - resonance tomography, CT scan), but carrying out these studies is very difficult, since not a single Small child will not be able to lie quietly alone in a closed space for 35 to 40 minutes while the scan is being performed.

Some mothers ask whether the gel that the ultrasound doctor applies to the baby’s head is harmful? Experts say that the use hypoallergenic gel and ultrasound itself is absolutely harmless and is used in diagnostic purposes even in the intensive care unit for the most weakened small patients.

The mother is present during the study and holds the baby’s head. How calmer baby, those better conditions for the work of a doctor. Therefore, so that the child does not cry and does not show increased activity, he should not be hungry or wet.

Indications for neurosonography

A neonatologist, in order to clarify the diagnosis, prescribes an ultrasound scan of the child’s brain for the following indications:

Difficult childbirth;
delay intrauterine development;
low birth weight;
neurological symptoms in a newborn;
hypotonicity;
hypertonicity;
brain hypoxia during pregnancy and childbirth;
stigmas and visible fetal abnormalities;
a burdened obstetric history in the mother associated with the birth of a defective child or fetal death;
intrauterine infection;
with various visible deformations of the skull;
fetoplacental insufficiency;
overlay obstetric forceps;
asphyxia;
increase in head volume;
burdened genetics;
any suspicion of brain damage in a newborn.

The normal size of the brain is a fairly flexible concept; a slight decrease or increase cannot be the final criterion for diagnosis. Neonatologists believe that 70% of newly born babies with ultrasound diagnostics one or another neurological pathology is detected, which goes away on its own by 12-14 months of age.
This fact must be taken into account when obtaining a conclusion with the described changes. Taking into account the imperfection of a child's brain at birth, before panicking and assuming the worst, it is wiser to have a thorough conversation with a pediatric neurologist and neonatologist.

Neurosonography of infants: norms of indicators

During the examination, all data and measurements are recorded in a special protocol.

Pay attention to the following aspects:

Symmetry of the right and left hemispheres;
clarity of grooves and convolutions;
presence or absence of neoplasms;
symmetrical structure of the cerebellum;
absence free liquid;
homogeneity of the ventricles;
vascular condition;
developmental defects.

What does the conclusion (normal) of an ultrasound scan of the brain look like in a newborn?

Of course, each specialist describes a sonogram in his own way, but a normal description of a brain ultrasound in a newborn might look like this:

There is no displacement of the midline structures, the brain tissue is of normal echogenicity. The differentiation of brain structures is satisfactory, the relief of the cortex is well visualized. Structure subcortical nuclei clearly expressed. The lateral ventricles are located symmetrically.

The foramina of Monroe on the right and left are patent.

The choroid plexuses are homogeneous, no neoplasms were found.

Conclusion: no pathology.

What pathologies can an ultrasound of a newborn’s brain detect?

With an ultrasound, the doctor can diagnose the following changes in the newborn’s brain:

Hemorrhages;
hematomas;
congenital tumors;
cysts;
ischemic disorders;
ventricular changes;
inflammatory - infectious diseases eg meningitis.

Some changes do not pose a threat to the life and development of the child, while others may require urgent hospitalization with possible surgical treatment.

What are brain development abnormalities in a child?

If you reproduce the meaning of the word “anomaly”, you get “irregularity, deviation from normal indicators, violation of the general pattern.”

In neonatology and neurology, abnormalities in the structure of the child’s brain are structural deviations from the norm that occurred during embryogenesis. If the anomalies are too obvious, we're talking about about developmental defects. Significant Vices development are considered deformities; for obvious reasons, this name is not entirely correct for use in pediatric practice.

Brain malformations

Malformations of the brain in a newborn can be genetically determined and manifest themselves in a variety of combinations.

A separate group of anomalies includes secondary malformations of the skull and brain.

There are many reasons for the appearance of brain development abnormalities in the fetus:

Diseases suffered during pregnancy;
primary infection with herpes virus, rubella;
exposure to radiation;
chronic alcohol, nicotine intoxication, drug use;
taking teratogenic drugs;
genetic diseases, etc.

Let us dwell on frequently occurring pathological changes in the brain, which are not gross malformations and can be leveled out over time.

Brain cyst in newborns

Cystic formations are divided into congenital and acquired.

Congenital cysts are formed due to abnormalities in the development of the membranes of the brain, past diseases during pregnancy, chronic hypoxia.

The reasons that lead to the formation of acquired (secondary) cysts are more often associated with traumatic effects, and look like this:

Hemorrhages,
birth head injuries
past illnesses.

A cyst is a cavity delimited by a capsule and filled with some content, in most cases liquid. Brain cysts in newborns are classified according to location and period of occurrence. The neoplasm can occur anywhere; some cysts arise in utero, but by the time of birth they resolve on their own.

Predisposing factors lead to the death of tissue in the brain and the formation of a cavity, which can affect the full development of the baby.

The following types are distinguished:

Arachnoid cyst: localization - between the arachnoid membrane and the brain. It tends to grow aggressively, which leads to compression of brain structures and the appearance of corresponding symptoms.

Subelendemal cyst: may increase in size, which requires adequate dynamic monitoring. Arises as a result birth trauma or hemorrhage. With a pronounced increase in the cystic neoplasm, there is a possibility of surgical intervention.

Choroid plexus cysts: they are formed during intrauterine development and can resolve on their own. Common reason– intrauterine infection.

The choroid plexuses of the brain in newborns do not have nerve cells; their role is to produce cerebrospinal fluid, which is so necessary for normal functioning and nutrition of brain cells. At accelerated growth In the brain, cerebrospinal fluid fills the space between the choroid plexuses, which is considered a cyst. The prognosis for life is quite favorable if no other pathology is found during a brain examination.

The examination is carried out every 3 months during the first year of life.

Symptoms and signs of a brain cyst in a child

What symptoms will appear directly depends on the size of the tumor and its location.

We list common symptoms that are not pathognomonic for cysts, but may be signs of a brain tumor in a newborn, or may represent any neurological disorders. Possible signs bad looks like this:

Anxiety;
swelling and pulsation of the fontanel;
restless sleep;
tremor of the limbs;
lack of sensitivity to pain;
regurgitation;
convulsive syndrome;
sudden losses consciousness;
muscle hypertonicity/hypotonicity.

As you get older, the following symptoms may appear:

Visual impairment, hearing impairment;
headache;
incoordination of movements;
limb weakness/paralysis;
developmental delay.

At the first signs of pathology from the outside nervous system you should consult a doctor.

Treatment of neonatal brain cysts

If the pathology is diagnosed by ultrasound and does not manifest itself in any way, it is indicated dynamic observation. Treatment begins with conservative therapy.

Medicines for cysts in newborns:

Antiviral and antibacterial agents with confirmed viral or microbial origin of the pathology;

Drugs that improve blood supply to the brain, nootropics, antihypoxants.

If treatment is unsuccessful, they resort to surgical intervention: open (craniotomy), endoscopic (a minimally invasive method when a cyst is removed from a newborn using an endoscope).

Hydrocephalus

The accumulation of fluid in the brain of a newborn is eliminated using shunting: a shunt is inserted and drainage is installed.

Hydrocephalus is not independent disease, this is a syndrome. Dropsy (swelling) of the brain in a child can be congenital or acquired. The causes leading to congenital hydrocephalus include:

Malformations of the liquor system;
intrauterine infection of the fetus;
birth trauma.

The development of acquired hydrocele of the brain is caused by the following diseases:

All types of inflammation of the brain and its membranes;
vascular disorders;
tumor processes.

Signs of hydrocephalus in children and treatment

In newborns, hydrocephalus is manifested by an enlarged head, bulging veins, lack of pulsation of the large fontanel, and developmental delays.

Treatment of congenital hydrocele in a child is always surgical; intervention is performed to eliminate the cause. If you refuse the proposed operation, there is a risk of cerebral hemorrhage and an unfavorable outcome. Without surgical treatment As you grow older, mental and physical development suffers.

What is a cerebral pseudocyst in a newborn?

Pseudocyst– a neoplasm that is a consequence of prolonged hypoxia or hemorrhage. To date, there are no clear criteria by which a pseudocyst differs from a cyst. Some experts believe that the difference is histological structure shells.

Even without therapy, pseudocysts in newborns resolve without consequences. If by one year the tumor remains in the brain tissue, a diagnosis is made: a true cyst, which requires lifelong observation by a neurologist.

Dilatation of the ventricles of the brain in newborns

Experts call the expansion of the ventricles ventriculomegaly. If the ventricles of a newborn are dilated symmetrically, this may be a variant of the norm; this is often found in large newborns.

Besides this, the reason similar condition can be:

Intrauterine hypoxia;
hydrocephalus - accumulation of fluid in the brain in a newborn;
disorders in the development of the central nervous system;
prematurity.

If the sonogram shows signs of ventricular asymmetry, the possibility of hemorrhage is first considered.

Posthypoxic changes in the brain in newborns

Some neurological pathologies are associated with oxygen starvation during intrauterine development.

If hypoxia was significantly expressed and adequate trophism was impaired, most likely the pregnancy ended unfavorably. With prolonged chronic hypoxia, which has some signs of compensation, the risk of having a low-weight, weakened child is increased. In the future, the baby can become a patient of a neurologist and undergo regular treatment.

The consequences of hypoxia depend on the duration, severity and changes in the structure of the brain. Acute hypoxia can develop during childbirth. The life of a child depends on the literacy and speed of action of doctors.

The most favorable prognosis is mild degree oxygen starvation, it can go away on its own and without consequences.

Read on baby.ru: newborn head size chart

The brain is the largest organ of a newborn. Its weight averages 1/8-1/9 of body weight, and by the end of the first year of life - 1/11-1/12, while in an adult it is only 1/40 of body weight. IN childhood the brain grows relatively little: its mass increases by 3.76 times, and the mass of the entire body - by 21 times. By appearance baby's brain general outline resembles the adult brain, although the grooves are less pronounced, some are completely absent. However, in its own way microscopic structure the brain is an immature organ. Brain tissue in newborns is very rich in water. There are almost no myelin sheaths of nerve fibers; on a section, the gray matter differs little from the white matter. This feature of the brain is microscopically determined at 4-5 years of age, when it is still developing morphologically. But signs of immaturity in various departments expressed differently. Mature areas are evolutionarily old, containing vital centers ( brain stem and hypothalamus). The most mature (morphologically and functionally) is cerebral cortex . Although it already functions in a newborn, its significance at this age is small. In newborns, in functional terms, the influence of the thalamopalidal system predominates, causing a reflex-stereotypic and athetosis-like nature of movements. Subsequently, the function becomes increasingly important striatum and the cerebral cortex, movements become coordinated and purposeful; conditioned reflexes, which begin to form in the first months of life, play an increasingly important role in the child’s behavior.

The spinal cord is a mature structure at birth. Relative to the spine, it is larger than in an adult, reaching in newborns the lower edge of the second lumbar vertebra.

The cerebrospinal fluid of a newborn baby is somewhat different from the cerebrospinal fluid of older children. There are an average of 15 cells in 1 ml of cerebrospinal fluid of a newborn baby. The protein content can reach 600-1000 mg/l, and in premature babies - 1500-1800 mg/l. The content of cells gradually decreases with age and in the first month is an age-independent amount - 4 cells per 1 ml. Protein content also decreases, reaching a minimum at 3-9 months of age (200 mg/l). In children under 10 years of age upper limit The protein norm is 300 mg/l, and in adults - 400 mg/l. Since the BBB of newborn children is permeable, the ratio between the level of glucose in the cerebrospinal fluid and blood is higher than in children outside the neonatal period. It is at least 2/3, while later the cerebrospinal fluid glucose level may be equal to half of its blood level.

Peripheral nerves. The main feature is the relatively late myelination of cranial nerves, which ends at 15 months of age, and spinal nerves at 3-5 years. Due to the absence of the myelin sheath or incomplete myelination, the speed of excitation along the nerve is reduced in the first months of life.

The autonomic nervous system functions in a child from the moment of birth, when individual nodes merge and powerful plexuses of the sympathetic part - the autonomic nervous system - are formed.

The spinal cord is the part of the central nervous system located in the spinal canal. The conventional boundary between the medulla oblongata and the spinal cord is considered to be the place of decussion and origin of the first cervical root.

The spinal cord, like the brain, is covered meninges(cm.).

Anatomy (structure). Along its length, the spinal cord is divided into 5 sections, or parts: cervical, thoracic, lumbar, sacral and coccygeal. The spinal cord has two thickenings: the cervical, associated with the innervation of the arms, and the lumbar, associated with the innervation of the legs.

Rice. 1. Cross section of the thoracic spinal cord: 1 - posterior median sulcus; 2 - posterior horn; 3 - side horn; 4 - front horn; 5-central channel; 6 - anterior median fissure; 7 - anterior cord; 8 - lateral cord; 9 - posterior cord.

Rice. 2. Location of the spinal cord in the spinal canal (cross-section) and exit of the spinal nerve roots: 1 - spinal cord; 2 - posterior root; 3 - anterior root; 4 - spinal node; 5 - spinal nerve; 6 - vertebral body.

Rice. 3. Diagram of the location of the spinal cord in the spinal canal (longitudinal section) and the exit of the spinal nerve roots: A - cervical; B - breast; B - lumbar; G - sacral; D - coccygeal.

The spinal cord is divided into gray and white matter. Gray matter is a collection of nerve cells to which nerve fibers approach and depart. In a cross section, the gray matter has the appearance of a butterfly. In the center of the gray matter of the spinal cord is the central canal of the spinal cord, barely visible to the naked eye. In the gray matter, there are anterior, posterior, and in the thoracic region, lateral horns (Fig. 1). Cell processes approach the sensitive cells of the dorsal horns spinal nodes, components dorsal roots; The anterior roots of the spinal cord extend from the motor cells of the anterior horns. The cells of the lateral horns belong to (see) and provide sympathetic innervation internal organs, vessels, glands, and cell groups of the gray matter of the sacral region - parasympathetic innervation pelvic organs. The processes of the cells of the lateral horns are part of the anterior roots.

The roots of the spinal cord exit the spinal canal through the intervertebral foramina of their vertebrae, going from top to bottom over a more or less significant distance. They travel a particularly long way in lower section the vertebral dripped, forming the cauda equina (lumbar, sacral and coccygeal roots). The anterior and posterior roots come close to each other, forming the spinal nerve (Fig. 2). A section of the spinal cord with two pairs of roots is called a spinal cord segment. In total, 31 pairs of anterior (motor, ending in the muscles) and 31 pairs of sensory (coming from the spinal ganglia) roots depart from the spinal cord. There are eight cervical, twelve thoracic, five lumbar, five sacral segments and one coccygeal. The spinal cord ends at the level of the I - II lumbar vertebra, therefore the level of location of the spinal cord segments does not correspond to the vertebrae of the same name (Fig. 3).

White matter is located along the periphery of the spinal cord, consists of nerve fibers collected in bundles - these are descending and ascending pathways; distinguish between anterior, posterior and lateral funiculi.

The spinal cord is relatively longer than that of an adult, and reaches the third lumbar vertebra. Subsequently, the spinal cord lags somewhat behind its growth, and therefore its lower end moves upward. The spinal canal of a newborn is large in relation to the spinal cord, but by 5-6 years the ratio of the spinal cord to the spinal canal becomes the same as in an adult. Growth of the spinal cord continues until approximately 20 years of age, and the weight of the spinal cord increases approximately 8 times compared to the neonatal period.

The blood supply to the spinal cord is carried out by the anterior and posterior spinal arteries and spinal branches arising from the segmental branches of the descending aorta (intercostal and lumbar arteries).

Rice. 1-6. Transverse sections of the spinal cord various levels(semi-schematically). Rice. 1. Transition of the first cervical segment into the medulla oblongata. Rice. 2. I cervical segment. Rice. 3. VII cervical segment. Rice. 4. X thoracic segment. Rice. 5. III lumbar segment. Rice. 6. I sacral segment.

Ascending (blue) and descending (red) paths and their further connections: 1 - tractus corticospinalis ant .; 2 and 3 - tractus corticospinalis lat. (fibers after decussatio pyramidum); 4 - nucleus fasciculi gracilis (Gaull); 5, 6 and 8 - motor nuclei cranial nerves; 7 - lemniscus medlalis; 9 - tractus corticospinalis; 10 - tractus corticonuclearis; 11 - capsule interna; 12 and 19 - pyramidal cells of the lower parts of the precentral gyrus; 13 - nucleus lentiformis; 14 - fasciculus thalamocorticalis; 15 - corpus callosum; 16 - nucleus caudatus; 17 - ventrulculus tertius; 18 - nucleus ventrals thalami; 20 - nucleus lat. thalami; 21 - crossed fibers of tractus corticonuclearis; 22 - tractus nucleothalamlcus; 23 - tractus bulbothalamicus; 24 - nodes of the brain stem; 25 - sensitive peripheral fibers of the trunk nodes; 26 - sensitive nuclei of the trunk; 27 - tractus bulbocerebellaris; 28 - nucleus fasciculi cuneati; 29 - fasciculus cuneatus; 30 - ganglion splnale; 31 - peripheral sensory fibers of the spinal cord; 32 - fasciculus gracilis; 33 - tractus spinothalamicus lat.; 34 - cells of the posterior horn of the spinal cord; 35 - tractus spinothalamicus lat., its decussation in the white commissure of the spinal cord.

Thank you

The nervous system is responsible for all processes in the human body. Thanks to the nervous system, the human body combines metabolic processes, which occur in different tissues according to different patterns, and relationships with the surrounding external environment. It is necessary to understand the fact that the development of the nervous system, in particular the brain, does not come to an end at the birth of a child.

Brain mass

The mass of a child's brain relative to the mass of his body is large. For clarity, we can compare the mass newborn and an adult. In a newborn, there are about 100-110 g of brain per 1 kg of mass; in an adult, this mass is 5 times less.

Spinal cord

By the time a child is born, the spinal cord is more developed than the brain. Gradually, as you grow and child development, the composition of the brain and spinal cord changes. The amount of water in the brain decreases and protein accumulates. Its structure also changes. The differentiation of nerve cells reaches the structure of an adult at approximately 8 years of age.

From the very beginning, the child indicates his ability to move. Turns of the head, body, pushing off with the legs - he feels it all expectant mother. The child’s movements reflect the level of development of his reflex activity.

Thanks to the baby's movements and his adaptability, the birth process is facilitated.

Motor development of the newborn

The movements of a newborn are characterized by their chaotic nature and lack of coordination, which develops gradually after birth.

Gradually, with the general development of the child, movements become more coordinated and purposeful. The process of development of motor activity is very complex and is gradual:

2-3 weeks. At this stage, the eye muscles develop, thanks to which the child can fix his gaze on an object (at the beginning - brighter), then the child can observe the object in motion thanks to the development of the neck muscles. He can observe a highly raised object and turn his head in the direction where, for example, the toy is located.
Age 1 – 1.5 months. At this stage, the child makes coordinated movements with his hands, namely, studies his face. Later, he raises his arms above his head in order to examine himself. Also at this age, the child can hold his head.
Age 3-3.5 months. The child learns his position and the place where he sleeps. At this stage, purposeful movements are formed. The child studies the fingers and toys that hang over his bed. Moreover, the smaller the toy, the faster the development process will go.
Age 12-13 weeks. During this period, the child holds objects with both hands, namely a blanket, toys and other soft objects that surround him.

Beginning with 5 months grasping movements resemble those of an adult. Of course, they are accompanied by many other accompanying unnecessary movements. As a rule, the child mainly takes objects with his palm - the fingers play a smaller role and are an auxiliary link to bring the toy closer to the palm. In addition, other muscle groups are often involved in the act of grasping. At this age, the child rolls over from back to stomach, and at 6 months - from stomach to back. Such movements, new to the child, are formed due to the development of the back muscles and their coordinated contraction.

On 6-7 months the child is able to sit without the support of an adult, thanks to the development of the leg muscles.
At the age of 7-8 months coordinated work appears between the visual and motor analyzers. Thanks to this, the child’s actions and movements become more coordinated and purposeful.
By 9-10 months grasping is accomplished by closing the larger, second and third fingers of the hand. Later, at the age of 1 year, the child is able to use distal phalanges index and larger fingers, due to which more complex movements involving small parts are performed.

Crawling and walking

At 6 months of age The first attempts begin, which may not end entirely successfully.

More mature crawling with the participation of arms and legs appears during the period 7-9 months. By the end of the 9th month, the child masters the position on all fours.

At the same age, newer movements and experiments begin for the child, namely the beginning of walking. This process is as complex as it is interesting, so most children quickly begin to get used to walking. The most difficult element is the first step, so children begin their journey either in a playpen or crib, or with the help of adults.

At the age of 8-9 months the child, holding onto the crib, begins to get up and slowly, holding onto the support, moves around its perimeter. Then the child begins to step with the help of an adult, namely holding with both hands, and after some time - with one hand.

The timing of walking development may vary. Some children may begin their journey at the age of 1 year. Other, calmer children begin to walk at the age of 1.5 years. Of course, the gait is different from that of older children. Legs are bent at the hips and knee joints, back in upper section tilted forward, in the lower section - vice versa. In addition, the baby instinctively holds his hands to his chest, thus providing insurance in case of a possible fall. The first attempts may fail, but nothing happens without mistakes. The gait is characterized by a lack of balance when moving, the legs are widely spaced, the feet are directed to the sides.

Walking, arm movement, and learning more develop in this step-by-step manner. complex processes.

Confident walking is established at the age of 4-5 years. At the same time, everything is individual and may differ from any norms, since each child is unique. Every year, walking becomes more and more like an adult's.

The development mechanism is helped by the participation of parents and their emotional support, since the child feels the psychological atmosphere in the family better than anyone else.

Development of communication and emotional status.
Development of conditioned reflex activity

driving force

At the age of 2 years the child reaches general development and perfection.

The emotional background of the child is closer to negative character, since all emotions are a signal for parents. So, if the baby is cold, or hungry, or has abdominal pain, he screams to attract attention. Such a manifestation of feelings is the first step in communicating with adults.

The relationship between mother and child is established very early, and increases every day.

Development of communication, emotions and conditioned reflexes takes place in several periods:

The first days of a baby's life are only interested in feeding him. Therefore, in the first days the child only sleeps and eats, and this continues for a long time.
Beginning with 2-3 weeks, after feeding, the child stops and studies the face of his mother - sort of making an acquaintance with the one who feeds him, dresses him and takes care of him.
On 1-2 month In life, the child already gets acquainted not only after eating, and not only with the mother, but also with the people around him. Focuses on strangers.
On 6-7 weeks the child greets his mother with the first smile. Gradually, his revival will be more obvious, as arms and legs will take part in the greeting.
Beginning with 9-12 weeks the child becomes more liberated, physical activity accompanied by laughter and squealing.
Recognizing loved ones and strangers is installed at the age of 4 months. Among everyone else, the child singles out his mother, and therefore, in some situations, he may react negatively to the fact that someone else took him in his arms. Reaction to stranger Some children have a positive reaction, that is, the child smiles and laughs, but more often even such a reaction turns negative. As a rule, this element is self-defense against danger. After some time, this attitude disappears, especially if he sees an adult more often.
At the age of 6-7 months there is an interest in objects, especially in toys that surround him. At the same time, interest in adults, namely in their speech, increases. The child tries to repeat any sounds after them, and the child’s first speech is babbling.
Sensory speech is key point in the child’s contact with the outside world. The baby understands what adults are talking about and shows this by moving his head or extending his arms towards the object being discussed.
At 9 months of age the stock of emotions increases. They can be completely different, and different people The child reacts differently. Elements of shyness appear in his behavior - he understands what is possible and what is not. Subsequently, sensory speech is replaced by motor speech.

Speech development

1. Initial (preparatory) stage.

positive emotions

2. The origin of sensory speech. The term “sensory speech” refers to babbling, which is combined with an understanding of the meaning of words that a child hears from an adult. At this stage, the child responds to questions. As a rule, he visually observes the subject that is being talked about around him. At the age of one year, the vocabulary increases, babbling becomes richer every day. At this age, the stock of understandable words is close to 20. The child listens and distinguishes between the concepts “possible” and “impossible.” There is also an interest in communicating with adults. The child gestures, waves his arms, and greets strangers at the request of his parents.

3. Development of motor speech. All children reach a stage when they not only understand words, but when they want to be understood. At the age of 11 months, the child pronounces several words (15-20), understands their meaning, and subsequently develops this gift more and more. Girls begin to speak much faster than boys. All children's first words are simple words, consisting of the same syllables, for example: mom, dad, willow, uncle. By the second year of life, the supply doubles. This period is considered one of the brightest and most memorable in a child’s life. The baby understands the connection between sentences and freely perceives fairy tales from the words of an adult. Also during this period, auditory memory develops very well. By the end of the second year, the child pronounces words better, and the vocabulary increases to 300 words.

It should be noted that communication with parents helps the successful development of a child’s motor speech. If problems arise at one of the stages of speech development and parents are unable to cope on their own, then it is necessary to think about the help of a speech therapist. In any situation, you need to remember that only care and affection help normal development, A negative emotions can only slow down and frighten the baby. Therefore, the main task of parents is to maintain and ensure a family atmosphere.

Before use, you should consult a specialist.