Recommendations

There are two basic aspects in the prevention, detection, and treatment of cognitive-behavioral disorders: observation by the parents and observation by the child’s pediatrician. This highlights the importance of routine visits to the pediatrician.

During the first year of life, stimulation through play and singing is fundamental. The brain’s plasticity for learning during the first year is higher than at any other stage of life, and the brain’s weight grows exponentially. Stimuli are essential; both smiling and passive limb mobilization naturally occur through play. Observing the child is also important to see which areas need more work, such as teaching them to roll over, crawl, or walk. In case of doubt or detection of a significant alteration, a multidisciplinary approach is necessary to establish the diagnosis and appropriate treatment as early as possible.

Treatment

The treatment of cognitive-behavioral disorders depends on the specific condition detected.

• In the case of genetic disorders, specific treatment is often not possible, but early analysis and detection are always necessary. 
• For metabolic disorders, there are specific diets or medications aimed at partially or fully correcting the detected metabolic disorder.

Human genome ultra-sequencing now 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 work in a network, sharing information to compile sporadic cases worldwide for joint research into how these alterations affect behavior or learning in individuals.

Similarly, biochemical studies of the body’s metabolic pathways are increasingly comprehensive, allowing the design of specific drugs for each situation.

A treatment shift currently under development involves moving from the pill to the cell, aiming to work directly on the affected cell to modify its behavior. This approach is still very preliminary but is a field that is certain to see significant development in the future.

Recommendations for Family and Caregivers

Use an FFP3 mask when entering the hospital or areas at risk of infection. Risk areas include enclosed public spaces such as cinemas, public transport, restaurants, swimming pools, etc., as well as construction or excavation sites.

Clean the home with diluted bleach (20 ml of bleach per 1 l of water).

Patients may attend school when authorized by their doctor.

Should be avoided

A high number of visitors at home on the same day.

Contact with people who have flu-like symptoms or other viral illnesses.

Contact with animals (if there is a pet at home, consult the risks with the doctor).

Indoor plants.

Having the patient in the room while vacuuming.

Hygienic handling of food

Food can transmit infections due to improper handling or storage. To prevent this, the following precautions should be taken:

• Wash hands with soap and water before preparing or consuming food.
• Clean kitchen utensils and surfaces with soap and water.
• To dry surfaces, use kitchen paper and wash dishcloths frequently (if used).
• Cook food thoroughly (at least 65 °C internally).
• Consume food immediately after cooking and refrigerate within 2 hours.
• Never defrost food at room temperature; refrigerate prepared foods as soon as possible (within 2 hours).
• Protect food from insects, rodents, and other animals.
• Keep high-risk foods (meat, poultry, dairy products, fish, seafood, eggs, and mayonnaise) below 5 °C (in the fridge).
• Discard slimy, moldy, bruised, or damaged fruit.
• Wash fruit thoroughly before peeling and consume immediately.
• Mince meat using a clean machine and cook it immediately or within 2 hours.
• If eggs are consumed, both the yolk and white must be fully cooked.
• Purchased eggs should have clean shells and should never be washed.
• Follow storage, handling, and expiration instructions for packaged foods once opened.
• Transfer opened canned products to another container to avoid can oxidation.
• The patient should not knead bread dough containing yeast.
• To prevent anisakis, freeze fish before consumption.

Diet considerations

Some foods may carry bacteria or fungi, so they should be temporarily avoided.

During the first few days, raw vegetables and salad are not recommended. After the first medical visit, and if approved, the doctor will indicate the necessary precautions.

General dietary recommendations

It is important to drink an adequate amount of fluids, especially water.

If taking corticosteroids, avoid excessive salt (to prevent edema) and excessive sugar.

Special recommendations in case of diarrhea

• Avoid excessive fiber (legumes, cereals, and fruit).
• Avoid high-fat foods (processed meats and nuts).
• Consume low-fat products.
• Lactose consumption is not recommended.
• If indicated by the doctor, gluten intake may also be restricted.

Personal hygiene

Skin hygiene and care

• Protect the patient from the sun using SPF 50 sunscreen, sunglasses, a hat, parasol, or umbrella.
• Use moisturizer (respecting the manufacturer’s expiration date once opened).
• Shower with neutral soap.
• Do not use a sponge.
• In case of cutaneous GVHD (graft-versus-host disease), consult the doctor for necessary care.

Oral hygiene

• Brush teeth with a soft toothbrush (according to platelet count).
• After each meal, use an alcohol-free antiseptic mouthwash.

Other care

• Avoid using tampons.
• Consult the doctor about tattoos, piercings, hair removal, shaving, and sexual activity.

Physical activity

Exercise should always be within the patient’s capabilities.

Physical activity should be moderate: walking, stretching, passive exercises, stationary cycling, and exercises that improve flexibility.

Warning signs requiring hospital attention

• Fever over 38 °C.
• Diarrhea and/or vomiting.
• Bruising or bleeding.
• Headache or blurred vision.
• Joint pain.
• Difficulty breathing.

A person’s immune status depends on their overall health: proper nutrition and avoiding exposure to tobacco smoke and chemicals whenever possible. In early childhood, the vaccines and immunizations recommended in the vaccination schedule help build a competent immune system.

Recommendations

In primary immunodeficiencies, early detection is important, usually indicated by the presence of frequent infectious diseases. Secondary immunodeficiencies occur during treatment for neoplasms or in transplant patients who must take lifelong immunosuppressive medication.

In autoimmune diseases, it is essential to follow the prescribed medication, often for life, and to avoid excessive cold and sun exposure, which can trigger disease manifestations. To maintain the functionality of joints and muscles, following specific rehabilitation guidelines is important.

Treatment

In immune deficiency, administering immunoglobulins (blood proteins responsible for our defense) can play an important role. When the deficiency affects immune cells, immunoglobulins are not effective; in such cases, antibiotics can prevent or reduce infections.

In diseases caused by excessive or poorly regulated immune responses, anti-inflammatory drugs and medications that modulate immunity are used, such as corticosteroids and biologics, which block specific inflammatory pathways. Other drugs may also have beneficial effects through less well-understood mechanisms, such as some medications used to treat malaria.