Common paediatric neurological concerns
Childhood migraine is the most common neurological condition in children and adolescents. Presentation differs from adults: children often describe bilateral frontal or periorbital pain, have shorter attacks (2–48 hours), and nausea may be less prominent while abdominal symptoms are more common. Migraine without aura is most frequent; migraine with aura (visual disturbances preceding headache) occurs in some children. Recurrent headache without migraine features may be tension-type, which is usually bilateral, pressing and mild-to-moderate. Red flags — progressive worsening, morning headache with vomiting, fever, focal neurological signs — require urgent evaluation.
Childhood seizures include febrile seizures (common in toddlers, benign, associated with fever), absence seizures (brief staring spells), and focal seizures. First afebrile seizure warrants same-day or urgent neurological evaluation to distinguish epileptic events from non-epileptic mimics such as breath-holding spells, syncope or night terrors. Tremor in children may be essential tremor (action-related, often familial), physiological tremor (present in everyone, amplified by stress or fatigue) or dystonic tremor. History, family history and examination guide characterization before any investigation.
- Childhood migraine — bilateral, shorter attacks, abdominal symptoms common
- Tension-type headache — bilateral, pressing, mild-to-moderate
- First seizure — same-day or urgent evaluation, distinguish from mimics
- Childhood tremor — essential, physiological, or dystonic patterns
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Evaluation approach for children
Evaluation of a child or adolescent requires age-appropriate history-taking with both the child and caregiver present. History covers onset, frequency, duration, triggers, associated symptoms, family history, sleep patterns and school impact. Headache diary adapted for children (recording pain location, quality, duration, associated symptoms, activity missed) is essential for classification. Seizure evaluation requires detailed event description — ideally with a witness account or video — plus neurological examination and targeted investigations.
Neurological examination in children includes assessment of tone, power, reflexes, coordination, gait, cranial nerves and cognitive screening where appropriate. Investigations — EEG, MRI, blood tests — are ordered selectively when clinical findings suggest they would change management. The clinic discusses findings transparently with caregivers and provides age-appropriate education. Follow-up is planned with the same consultant for continuity, with adjustments made based on response and developmental milestones.
- Caregiver plus child history — age-appropriate questions
- Headache diary adapted for children — pain, duration, missed activity
- Seizure evaluation — event description, video if available, EEG when indicated
- Neurological exam — tone, power, reflexes, coordination, cranial nerves