Inside the Mind of a Pediatric Neurologist

Welcome to mapabear, where we bring you insights from leading experts to help you navigate the wonderful, yet sometimes challenging, journey of parenting. We have had the privilege of speaking with Dr. Anaita Hegde from SRCC Narayana Hospital, Mumbai, a renowned pediatric neurologist, about the crucial stages of early brain development and how parents can support their children's growth. This engaging and informative interview will help parents and caregivers understand the milestones, challenges, and ways to nurture their child's developing brain

Team mapa: Dr. Hegde, can you explain how brain development begins after birth and the key milestones parents should watch for in infancy?

Dr Anaita: Brain development in children is truly fascinating and it unfolds in four major categories: gross motor, fine motor, social, and communication milestones. Each category encompasses different aspects of growth and development. 

- Gross Motor Milestones: These involve the big movements of the body such as running, jumping, hopping, skipping, and cycling. These milestones are particularly significant in the first year of life and continue to improve for a few years. However, after this initial period, it’s more about refining these skills in terms of dexterity, speed, and strength rather than achieving new milestones.

- Fine Motor Milestones: This is where things get intricate. Fine motor skills involve hand functions, which are among the most complex brain activities. They include actions like handwriting, buttoning, feeding, and combing. Essentially, anything that requires precise hand or finger movements. Fine motor skills begin to develop as early as five months with the baby’s first attempt to approach and play with toys, leading up to more complex tasks like the pincer grasp by nine months.

- Social Milestones: These milestones reflect how a baby interacts with the world. The first major social milestone is the social smile, which typically appears by six weeks. Initially, babies smile without recognition, but by six weeks, they start smiling in response to their mother’s voice and presence, indicating recognition.

- Communication Milestones: Communication isn’t just about speech. It includes all the ways a baby interacts, such as making eye contact, body language, and eventually, spoken words. Babies start to coo and babble as early forms of communication, progressing to their first words like “mama” and “dada” with meaning around one year, and by two years, they typically have a vocabulary of about 50 words and can form simple two-word sentences.

It’s important to remember that not all children fit neatly into these timelines. Boys, for example, often develop speech skills a bit later than girls. So, parents shouldn’t panic if milestones are reached a little later than expected. A month or two of variation is generally acceptable.

How can parents help or assess their children in reaching these milestones at the right time?

Dr Anaita: It’s essential to understand that brain development and reaching milestones is a natural process that unfolds with time. While we have what we call hyper-parents who try to accelerate their child’s development, there is ample proof that proper stimulation can significantly aid in achieving these milestones. Parents can support their children's development by providing a nurturing and stimulating environment that encourages exploration and learning. Activities such as reading, playing interactive games, and engaging in conversations can promote cognitive and language development. Additionally, observing and responding to a child's cues and providing age-appropriate challenges can help them build confidence and skills. Regular check-ups with a pediatrician can also help monitor progress and address any concerns early on.

Can you elaborate on Stimulation a bit..?

Dr Anaita: Stimulation can be incredibly varied and doesn’t need to be complicated. Talking to your child, interacting with them, playing, showing them different textures, sounds, and people are all great ways to stimulate their brain. Simple activities such as reading stories, singing songs, and playing peek-a-boo can make a big difference. Exposure to different languages is also beneficial as children’s brains grow rapidly in the first four years of life, making them more receptive to learning multiple languages. Introducing music, art, and outdoor activities can further enhance their sensory experiences and cognitive development. The key is to provide a loving, warm, and engaging environment where the child feels safe and encouraged to explore and learn. Structured routines mixed with free play can help balance stimulation with the necessary rest and downtime that are equally crucial for healthy brain development.

What are some common neurological disorders that parents should be aware of?

Dr Anaita: While certain neurological disorders like craniosynostosis are relatively rare, there are several common signs and conditions parents should monitor. Milestones should generally be age-appropriate, and it’s vital not to dismiss delays based on familial anecdotes. For instance, a common but concerning misconception is that if a parent or grandparent spoke late, it’s acceptable for the child to do so as well. Other conditions include seizures, infections of the brain, gait abnormalities, and early markers of autism, such as a lack of eye contact, reduced vocalization, and being in their own world. If a parent notices any of these signs, it’s crucial to seek professional advice rather than waiting.

How do infections manifest in children, and what should parents look out for?

Dr Anaita: Infections of the brain usually present with a fever and irritability. As the infection progresses, the child may become lethargic, drowsy, and refuse to feed. They might also experience seizures and become comatose. Other signs to watch for include a stiff neck, sensitivity to light, persistent vomiting, and a rash that doesn’t fade when pressed. Parents should also be alert to any sudden, unexplained crying or high-pitched cries, which can be a sign of discomfort or pain associated with serious infections. If parents notice severe lethargy, unresponsiveness, or significant changes in behavior, they should seek medical attention immediately. Early intervention is crucial in preventing potential long-term complications and ensuring the best possible outcome for the child.

What about head injuries? When should parents be concerned?

Dr Anaita: Head injuries are common in young children, but significant falls that lead to vomiting, seizures, altered consciousness, or bleeding from the nose or mouth require immediate medical attention. Even if these symptoms are absent, it’s wise to monitor the child closely for 24 hours and consult a pediatrician if any concerning signs appear.How can teachers and school staff support children with neurological disorders in an educational setting?

Dr Anaita: This is a critical area that needs more focus. Children with neurological disorders should be included in all academic and extracurricular activities just like their peers. Often, teachers and staff are fearful and uncertain about handling these children, leading to exclusion or stigmatization. Educating and empowering teachers to understand and support these children can make a significant difference. This ensures that children with neurological disorders feel included and build a positive self-image.

Q: What role can a magazine like mapabear play in supporting parents and caregivers of children with neurological disorders?

A: A magazine like mapabear can empower parents by providing them with the information and confidence they need to advocate for their children. It can highlight success stories, offer expert advice, and create a community where parents feel supported and informed. Encouraging parents to confidently approach schools and ensure their children’s rights to education are upheld is crucial. Additionally, articles can educate the broader community about the importance of inclusion and the rights of children with neurological disorders.

What are the long-term effects of delayed intervention in neurological disorders?

Dr Anaita: Early intervention is crucial because the brain’s plasticity is at its peak in the first few years of life. This is the time when the brain is most capable of forming new circuits and pathways. If intervention is delayed, it becomes much harder to address the issues later on. For instance, if a child suffers a stroke, early intervention can help the surrounding brain areas compensate for the damaged parts. In contrast, if an adult has a stroke, the recovery process is much slower because the brain’s circuits are more rigidly formed.

Can you explain the role of multidisciplinary teams in the early intervention process?

Dr Anaita: Multidisciplinary teams are essential because brain damage can affect various functions, including motor skills, sensory processing, vision, hearing, cognition, and more. Different specialists address different areas: physiotherapists focus on gross motor skills, occupational therapists on fine motor skills, speech therapists on communication, and so on. A comprehensive assessment and coordinated intervention plan are crucial to address all aspects of the child’s development effectively.

Are there any specific activities or play that you would recommend for brain development?

Dr Anaita: While structured academic activities have their place, natural, fun activities like art, finger painting, and music can significantly enhance brain development. These activities stimulate different parts of the brain and are enjoyable for children, making learning more effective. Pets and animals also have a positive impact on children’s emotional and social development.

Could you share a success story that highlights the impact of early intervention?

Dr Anaita: Certainly. I recall a young girl who had her first seizure at four and a half years of age . Within a year, she was experiencing continuous seizures, and her condition deteriorated rapidly. We diagnosed her with a rare condition called Rasmussen's encephalitis, which caused her to lose function on one side of her body due to the relentless seizures. Early intervention through epilepsy surgery, which involved disconnecting one hemisphere of her brain was a challenging decision. However, it stopped the seizures and with intensive physiotherapy, she regained significant function. Her cognitive abilities improved, her behavior normalized, and she was able to return to school and lead a more typical life. This case underscores the incredible potential of early intervention and the brain’s ability to adapt and recover.

What are some common misconceptions about child brain development and neurological disorders that you’d like to address?

Dr Anaita: There are several misconceptions that need addressing:

- Epilepsy is hereditary: While there can be a genetic component, not all epilepsy cases are hereditary.

- Genetic disorders only occur if there's a family history: Genetic disorders can arise even without a family history; particularly in cases of consanguinity.

- Children will outgrow conditions like autism or ADHD: These conditions are lifelong and require ongoing support and intervention.

- Children don’t get migraines or headaches: These are common in children and should be taken seriously.

- Delayed speech is not a concern if a parent or grandparent spoke late: Developmental milestones should be closely monitored, and delays should be evaluated by a professional.

Dr. Hegde’s experience and insights provide a profound understanding of child brain development and underscore the critical role of early intervention. In a world where there’s a new challenge everyday and there is so much information available at the click of a button, Dr. Anaita Hegde helps us realize the importance of creating a nurturing and stimulating environment. She helps us understand how to recognize developmental delays, and seek professional guidance, and what are the key steps parents can take to support their children's growth. Education and empowerment of parents and educators are vital to ensure that every child, including those with neurological disorders, receive the support and opportunities they deserve. Her expertise is a valuable resource for parents, caregivers, and educators, offering practical advice which empowers parents and educators to be the champions of every child's unique journey. Together, we can create a world where every child thrives, celebrated for who they are and supported in all they can become.