Peripheral neuropathy in children

What is peripheral neuropathy in children?

Peripheral neuropathy occurs when there is a problem with the peripheral nervous system, the network of nerves that transmits information from the central nervous system (the brain and spinal cord) to the rest of the body. It can be inherited or caused by injury or certain diseases like shingles, hormonal imbalance, trauma or tissue injury, or diabetes, or be caused by poor nutrition or exposure to toxins.

Peripheral neuropathy can also be caused by extended periods of being sedentary (such as sitting in a wheelchair or lying in bed), which puts pressure on nerves.

Children with peripheral neuropathy develop pain, burning or tingling in the area where the nerves are affected. This is typically in the hands and/or feet.

What are the signs and symptoms of peripheral neuropathy in children?

The symptoms of peripheral neuropathy vary depending upon what nerves are affected.

Children can experience:

• Pain, burning or tingling in hands or feet

• Muscle cramps or muscle twitching

• Numbness or loss of sensation in arms and legs

How is peripheral neuropathy in children diagnosed?

To diagnose peripheral neuropathy, your provider will want to do a detailed physical exam of your child, understand your child’s past medical history and family history, and learn as much as possible from you about the symptoms your child is experiencing. The provider may also test your child’s reflexes, muscle strength and tone, ability to feel certain sensations, posture and coordination.

The provider may order imaging tests – like X-rays, CT scans, or MRIs – to check for injuries, anatomical problems, and other conditions that could be affecting your child’s nerves. The provider may also order a nerve conduction test to measure signals from sensory nerves.

If your provider suspects your child may have an underlying autoimmune condition, metabolic disease or connective tissue disorder, he or she may order additional blood tests and/or refer your child to a rheumatologist, endocrinologist or geneticist.

The exam may include these tests:

• Monofilament test - Your provider will use a short piece of filament that looks like fishing line and press it against your child’s skin in various places to see if your child feels the line.

• Blood tests may be necessary to determine exposure to toxins.

• Nerve conduction studies (NCS), also called a nerve conduction velocity (NCV) test, is a measurement of the speed of conduction of an electrical impulse through a nerve to determine the extent of nerve damage. Your provider will place several patches on your child’s skin, which are attached to a testing machine. A very mild electric impulse is sent to each nerve your provider wants to test, and the electrical activity is recorded.

• Electromyelography (EMG) a needle electrode that is attached by wires to a recording machine is inserted into a muscle. The electrical activity in that muscle is recorded while the muscle is at rest. Then the technologist or provider will ask your child to tighten (contract) the muscle slowly and steadily. This electrical activity is also recorded. The electrode may be moved a number of times to record the activity in different areas of the muscle or in different muscles.

What are the causes of peripheral neuropathy in children?

Peripheral neuropathy can be inherited, caused by injury or disease, or result for exposure to toxins, poor nutrition or occur from prolonged pressure on a nerve.

How is peripheral neuropathy in children treated?

The treatment for peripheral neuropathy depends on its cause. Neuropathy that is caused by certain diseases can improve with treatment of the underlying conditions, such as diabetes or immune diseases.

The pain of peripheral neuropathy can be treated by:

• Pain relievers – over-the-counter or prescription

• Anti-seizure or anti-depressant medications, which can ease neuropathic pain

• Topical creams or patches

• Physical therapy (PT)

• Occupational therapy (OT)

• Desensitization therapy

• Exercise

• Psychological counseling

• Electrode nerve stimulation

• Lifestyle changes, such as weight loss or activity modifications

• Massage therapy

• Acupuncture

• Nerve blocks

• Surgery