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There are two key aspects in the prevention, detection, and treatment of cognitive-behavioral disorders: the observation made by parents and the observation made by the child’s pediatrician. This highlights the importance of routine pediatric visits.
During the first year of life, stimulation through play and singing is essential. The brain’s plasticity for learning during this period is greater than at any other stage of life, and brain weight grows exponentially. Stimuli are crucial; both smiling and passive movement of the limbs naturally occur through play.
Observing the child is also important to identify which areas need additional support, such as teaching them to roll over, crawl, or walk. In case of doubt or if a significant abnormality is detected, a multidisciplinary approach is needed to establish an early diagnosis and the most appropriate treatment.
It is essential in child development—especially during the first year of life—to provide stimulation through play and singing. The brain’s plasticity for learning during the first year is greater than at any other stage of life, and the brain’s weight increases exponentially. Stimuli are essential; both smiling and passive limb movements naturally occur through play.
Observing the child is also important to identify which areas need more support: teaching them to roll over, crawl, or walk. In case of doubt or if a significant abnormality is detected, a multidisciplinary approach will be necessary to establish the diagnosis and provide appropriate therapy as early as possible.
The treatment of cognitive-behavioral disorders depends on the specific condition detected.
In the case of genetic disorders, a specific treatment is often not possible, but early analysis and detection are always necessary.
In the case of metabolic disorders, there are specific diets or medications aimed at fully or partially correcting the detected metabolic disorder.
Human genome ultra-sequencing currently allows the detection of hundreds of genetic alterations from a small blood sample, from which genetic information is extracted. There are databases in all developed countries that, working in a network, share information to group sporadic cases from around the world, enabling joint research into how these alterations affect a person’s behavior or learning.
Likewise, the biochemical study of the body’s metabolic pathways is becoming increasingly comprehensive, allowing the design of specific drugs for each situation.
A new treatment approach, currently under development, is the shift from pills to cells as therapy—working directly on the affected cell to modify its behavior. This approach is still very preliminary, but it is a field that will undoubtedly see significant development in the future.
The neurosensory development of children is a complex process that begins during intrauterine life and continues from the neonatal stage throughout childhood and into adolescence. All disorders or dysfunctions related to learning or behavior are grouped under cognitive-behavioral disorders.
Learning is a constant part of human behavior throughout life, but the quantity and quality of knowledge acquired during the first year of life is far greater—or at least comparable—to that acquired over the rest of a lifetime. The human brain increases in weight by one gram per day during the first year, followed by the formation of neuronal connections and networks that enable social smiling at one month of age, recognition of unfamiliar people at seven months, and learning to refuse to release objects around one year of age. In parallel, motor development progresses, allowing children to walk between 12 and 16 months. As development continues, cognitive (learning) and behavioral (approach–avoidance) growth intertwine, along with social interactions with parents and siblings. Many times, it is the parents—and sometimes pediatricians—who first notice that a child seems “different” or shows behaviors that draw attention.
The spectrum of cognitive-behavioral disorders is very broad, as are their symptoms. In general, symptoms include not achieving cognitive or behavioral milestones within the age range considered normal. For example, not exhibiting a social smile by the second month of life or not recognizing strangers by twelve months. Cognitive-behavioral disorders often form part of a broader condition, frequently with a genetic basis that may also affect other organs.
The incidence of cognitive-behavioral disorders is estimated to be between 1% and 3% of all children.
Parents are often the first to notice atypical signs in development or behavior, sometimes by comparing with siblings. During routine visits, the pediatrician evaluates age-appropriate developmental skills. If further assessment is needed, pediatric neurologists and geneticists can provide a more precise diagnosis. Diagnostic tests for these disorders always include a physical examination, genetic analysis, and laboratory tests that evaluate for metabolic diseases. Neuroimaging studies may also be helpful.
Treatment depends on the cause of the cognitive-behavioral developmental disorder. If the cause is metabolic, effective and sometimes curative treatments may exist. If the cause is genetic, it is possible to predict the course of the condition and recommend supportive educational strategies, although fully effective treatments are not yet available.
The physical examination helps determine whether the child is reaching developmental milestones appropriate for their age.
Genetic tests detect whether there is an alteration in the patient’s genes that could explain the observed anomaly.
Laboratory tests—typically using blood or urine—help confirm or rule out abnormalities in the body’s normal metabolic pathways.
Pediatric neurological examination, imaging studies, metabolic laboratory tests, genetic studies based on sequencing or ultra-sequencing, and evaluation by Child Psychiatry (Pediatric Psychiatry).
If there is a family history of cognitive-behavioral disorders, genetic counseling prior to pregnancy may be useful. The neurosensory development of children is a complex process that begins during intrauterine life and continues from the neonatal stage through childhood and adolescence. Adequate monitoring during pregnancy and childbirth is also essential to help prevent these types of disorders.
Paediatrics, Children's Hospital and Woman's Hospital
Malaria is an infectious disease caused by the parasitic protozoan Plasmodium.
It is transmitted through the bite of mosquitoes of the genus Anopheles. The mosquito acts as a vector or transmitter of the disease. The mosquito bites an already infected person. The parasite reproduces and develops inside the mosquito. The mosquito subsequently bites another person who in turn becomes infected.
It cannot be transmitted from one person to another without the presence of a mosquito, except in the case of an infected blood transfusion or from mother to foetus through the placenta.
Mosquitoes generally bite during hours of low light: dusk, during the night and dawn. They live in urban as well as rural areas. During the rainy season there are more mosquitoes, therefore the risk of being bitten and contracting the disease is higher.
Malaria was eradicated in Europe over 50 years ago, and so cases seen are due to travel to endemic countries for reasons such as immigration, tourism, and business. The majority of cases are seen in immigrants after having returned to their native countries to visit family. This occurs due to the fact that although they should be taking the same measures as tourists, more often than not they do not. 95% of cases are imported from Africa, 3% from Asia and 1% from South America.
The incubation period varies from one week to over a month. As such, symptoms may present themselves shortly after entering an endemic area or several months after having returned from one.
Symptoms generally include high fever, chills, headache,sweating, and generalised joint and muscle pain. Some patients experience symptoms every 2-3 days and others experience a persistent fever. If the disease is not diagnosed and treated accordingly it can develop rapidly and become life-threatening. Alterations in consciousness, convulsions, coma, difficulty breathing and haemorrhaging are signs of a bad prognosis. Requires immediate medical attention.
It is important to keep in mind that any child with a fever and history of travel to an endemic country should be suspected of having malaria unless proved otherwise.
Malaria is common in tropical and subtropical areas (both sides of the equator). The countries in which malaria is endemic have been grouped into 4 regions: Africa, America, Asia and the Pacific, and the Middle East and Eurasia. More than 90% of the malaria cases in Africa are caused by Plasmodiumfalciparum, the most serious and deadly. America and the Middle East and Eurasia are dominated by Plasmodiumvivax. A much more common form of malaria with a lower mortality rate.
In Asia and the Pacific, infections are a mix of Pl. vivax and Pl. falciparum with a moderate number of cases of mortality. Generally speaking, the areas with the highest risk for travellers are Sub-Saharan Africa, South East Asia, Papua New Guinea and the Indian subcontinent.
A diagnosis is reached through detection of the parasite either in the red blood cells, or through processes of molecular biology.
Early diagnosis is crucial. The pharmaceuticals used in Europe differ from those used in endemic countries in places like Africa. Depending on the severity, certain intravenous drugs may be required immediately. Severe malaria is usually treated in Intensive Care Units in anticipation of serious complications.
In a case of suspected malaria, blood testing is crucial. If there are alterations in any organs, individual exploration of said organs is necessary; for example, brain image scanning in the event of nervous system impairment, which is very common in severe cases of malaria.
With malaria, prevention is crucial.The use of antimalarial medication before travelling to endemic countries is vital, as failure to do so means the probability of contracting the disease is very high due to the fact that it is almost impossible to avoid mosquito bites even by using insect repellent and mosquito nets.
Antimalarial medication, to be prescribed by a doctor in each case, should be started before beginning a trip up until a few days after returning.
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