What to do if a child complains of leg pain for no apparent reason: symptoms and treatment. Causes and signs of hypotension in an infant and how to make the child's muscles work

Hypertonicity is a violation of the muscle tone of the body, which is expressed in muscle overstrain. Almost all babies are born with severe muscle hypertonicity. Indeed, during the time inside the womb, the baby is constantly in the position of the embryo. The limbs and chin in this position are closely pressed against the body and the muscles of the fetus are constantly tense.

hypertension in children under one year old

Up to about six months, the nervous system of the crumbs "learns" to work in conditions other than intrauterine. The baby gradually develops and slowly begins to control the movements of his muscles and skeleton. At month old baby hypertonicity is very pronounced. This is displayed in clamped fists and bent legs, in tilting the head back. The tone of the extensor muscles in a monthly baby is higher than that of the flexors.

With physiological hypertonicity, the child's legs move apart only by 45 0 each. When moving the legs away, a pronounced resistance to movement is felt. By three months, muscle hypertonicity in a child without pathologies practically disappears. If after the child reaches six months, tension in the muscles persists, you should urgently consult a doctor.

Symptoms of hypertonicity

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Complications during pregnancy, birth trauma, Rh conflict, incompatibility of the blood of parents, place of residence with poor environmental situation and many other factors will cause hypertonicity. You should carefully consider the symptoms of hypertonicity, because it can be an expression of a serious neurological disease.

Signs of severe hypertonicity:

1. Restless and short sleep.
2. In the supine position, the head is thrown back, and the arms and legs are tucked in.
3. When you try to spread the legs or arms of the baby, strong resistance is felt. The child is crying. Secondary dilution increases muscle resistance.
4. Vertically on a hard surface, the child tries to stand on the front of the foot, that is, stands on tiptoe ( Information: ).
5. When crying, the child throws his head back, arches and at the same time his chin muscles tremble ( See article ).
6. Frequent vomiting.
7. Painful reaction to various stimuli: light, sound.
8. From birth, the baby "holds" his head due to constant voltage neck muscles.

It is important to determine as early as possible that the child has hypertension. The detection of at least one of the above symptoms in a baby is a good reason to contact a pediatric neurologist. The diagnosis of "hypertonicity" will be made if the flexion tone is higher than it should be at a given age.

Muscle hypertonicity is determined by several reflex tests:

• Sitting by the hands: it is impossible to take the baby's hands away from the chest.
• Step reflex. In an upright position, the child seems to be trying to take a step. Remains after two months.
• Support reflex: while standing, the child leans on the toes.
• Preservation after three months of asymmetric and symmetrical reflexes. When the head is tilted to the chest while lying on the back, the child's arms are bent and the legs are unbent. When turning the head to the left in the same position left hand stretches forward, left leg unfolds, and the right bends. When tilted to the right side, everything is repeated in a mirror image.
• Preservation after three months of the tonic reflex: lying on his back, the child straightens the limbs, and bends them on the stomach.

If by a certain age these reflexes do not weaken, and then do not disappear, then the child has pronounced muscle hypertonicity. Therefore, you need to see a doctor.

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Consequences and danger

Why is hypertonicity so dangerous if its occurrence is due to the very position of the fetus? Physiological hypertonicity disappears after three months without a trace. Pathological hypertonicity is caused by damage to the brain tissues that are responsible for the state of the muscles. Such disorders occur with increased intracranial pressure, perinatal encephalopathy, increased excitability and other pathologies.

muscle hypertonicity

If, after three months, hypertonicity in children persists, the consequences, in the absence of treatment, are deplorable. The lack of regulation of muscle tone will affect further development child:

• Violation of coordination of movements;
• Formation of incorrect gait;
• Incorrect formation of posture;
• Developmental delay, especially motor skills;
• Speech disorder.

Hypertonicity of the legs

It is especially dangerous if a child has a strong hypertonicity of the legs. It affects the rate of development of motor activity. Babies with this diagnosis start later and. For babies with hypertonicity of the legs, the use of and is especially contraindicated. These devices increase the state of tension in the muscles of the legs and spine due to the uneven distribution of gravity. The load increases precisely on the muscles of the pelvis and spine.

Hand hypertonicity

Hypertonicity of the hands is expressed in the resistance of the muscles when the handles are removed from the chest, strongly clenched fists. This condition is most often observed with physiological hypertonicity. However long-term preservation muscle tension should worry the child's parents.

See video:

Treatment

Correct and timely treatment of hypertonicity is carried out exclusively by a specialist doctor - a pediatric neuropathologist. All procedures are prescribed only by the attending physician. The sooner treatment is started, the better and faster the positive results will appear.

There are several techniques and directions in medicine that allow you to remove hypertonicity:

1. Relaxing massage.
2. Physiotherapy.
3. Electrophoresis.
4. Paraffin applications (thermotherapy).
5. Swimming.
6. Medical treatment.

As you can see from the list, to remove hypertonicity, drugs are used last. These are drugs that relax the muscles, reducing their tone and diuretics to reduce the level of fluid in the brain. In addition to massage, Dibazol and B vitamins can be prescribed.

Massage

Massage with hypertonicity can be carried out independently at home from the age of two weeks. Naturally, you first need to consult with a baby massage specialist and get instructions and recommendations from him on how to conduct a massage. In total, ten sessions are carried out, which after six months are best repeated again.

Massage consists of three types of exposure techniques: stroking, rubbing and wiggling:

1. With the back of the hand, stroke the surface of the arms, legs and back. Can be alternated superficial stroking fingers with embracing stroking with the whole brush.
2. Circular rubbing of the skin. The baby is placed on the tummy and the fingers make circular rubbing with dashed movements from the bottom up. Then the same is done with the limbs, turning the child on his back.
3. Take the baby by the hand and shake it slightly. In this case, the hand must be held in the forearm. Carry out the procedure with both hands and feet.
4. Take the baby by the handles above the wrist and rhythmically shake the arms in different directions.
5. Grasp the legs of the child by the shins and shake.
6. Finish the massage with gentle stroking of the hands and feet.

With hypertonicity, deep kneading of muscles, patting and chopping techniques should not be used. All movements should be smooth and relaxing, but rhythmic.

Video: how to massage with hypertension

Baths

An excellent remedy for relieving hypertonicity are herbal baths. Water itself has a relaxing property, and in combination with herbs it becomes an excellent remedy for hypertonicity. In turn, for four days, warm baths are carried out with valerian root, lingonberry leaf, motherwort and sage. One day a break is made, the procedures are repeated again and so on for 10 days. Coniferous baths also have an excellent relaxing effect.

Often in children under one year there is such a pathology as muscle weakness, it is most often associated with developmental disorders and hypoxia, from which the baby suffered during pregnancy. But sometimes muscle weakness can be a sign of a serious illness that requires timely treatment.

Usually, a neurologist immediately detects hypotonia, if it is present, since the baby is behind in development, cannot hold his head, roll over and walk. In older children, the legs can be deformed, they quickly get tired when physical activity. It is very important to immediately identify the pathology and begin to treat it in order to avoid serious complications in adulthood.

Hypotension

Hypotension is a violation of muscle tone, in which they are all the time in a too relaxed state. Normally, the muscles in both children and adults contract constantly to maintain the normal functioning of the body. Thanks to muscle tone, a person can stand, sit, although these postures are static, the muscles still contract.

With hypotension, the muscles are weakened, the child cannot sit and stand normally, since the fibers simply cannot withstand such a load. If this condition is not treated, then the baby cannot develop normally. In addition, hypotension can also occur against the background of serious diseases.

Hypotension in infants usually occurs due to birth trauma or lack of oxygen in the womb. This condition is quite fixable, gymnastics, massage, sometimes physiotherapy are prescribed for treatment, less often drug treatment if the therapeutic did not work. It is important to understand that the sooner you start treating hypotension, the faster it will pass, and the less consequences there will be.

As mentioned above, weak muscles in a child do not always indicate a serious illness, quite often this is a complication of difficult childbirth and birth trauma which is treated with massage. But it is worth considering such situations when muscle weakness is a symptom of pathology:

• With myasthenia gravis, a severe chronic autoimmune disease, pronounced muscle weakness is observed;
• Children with Down syndrome suffer from muscle weakness and problems with their endurance;
• There is a genetic pathology, the disease is called Prader-Willi syndrome, in this case, several genes are missing in the child's body, he suffers from obesity, hypotension and mental disorders.
• With botulism, bacteria live in the child's body that secrete toxic waste products, which, in turn, negatively affect the muscle fibers, paralyzing them;
• At severe forms reactive jaundice is also possible hypotension in infants;
• In a disease during which collagen production is disrupted, muscles and skin become flabby and weak, the disease is called Marfan syndrome;
• In severe cases of cerebellar ataxia, muscle weakness develops;
• Blood poisoning;
• Excessive intake of vitamin D;
• Muscle dystrophy in older children;
• Rickets is a disease that destroys bones due to a lack of vitamin D in the body.

Symptoms

Symptoms generally depend on the diagnosis, but in all cases there is muscle weakness, the child cannot withstand physical exertion. Weakness can be observed throughout the body, or it can occur only in the affected area, for example, when one limb does not work well.

With muscular hypotension, the child cannot stand on his feet straight, he spreads them apart to maintain balance. Also, due to the weakness of the neck muscles, the baby cannot keep his head in an even position for a long time, he constantly tilts it.

During sleep, healthy children bend their arms and legs, and with muscular hypotension, they observe the opposite effect - the limbs are straightened along the body, while this position does not cause inconvenience to the child, although it looks rather unusual. This is often observed in infants, because newborns normally have hypertonicity, which causes the fists to clench, and with hypotonicity, the arms are straightened.

Also, with muscle weakness, such a sign is observed when the child is taken in his arms, placing his palms in the armpits, in a child with muscle weakness, the arms automatically rise up and he falls down, while a healthy baby remains hanging in the arms of an adult.

Diagnostics

Only a doctor can diagnose any disease. Therefore, parents should not hesitate to visit a neurologist and orthopedistif the child has muscle weakness or muscle spasm. In any case, it will be necessary to undergo treatment, and which one depends on the underlying cause.

To confirm the diagnosis, the patient will be sent for blood and urine tests, it will be necessary to take samples for antibodies. You may also need to undergo an ultrasound, CT or MRI, as well as x-rays.

Usually, to detect muscle hypotension, an examination by a neurologist is sufficient. The doctor checks the reflexes, the capabilities of the child. Children with hypotension lag behind in development and the neurologist immediately sees this.

Treatment

Treatment will depend on the cause of hypotension. Pathology in infants is treated with physiotherapeutic methods, a small patient is prescribed a course of therapeutic massage to restore muscle tone. As well as gymnastics and physiotherapy to normalize blood circulation and strengthen muscles.

If a serious pathology was found, then the treatment is prescribed taking it into account. In this case, you will need to consult not only a pediatrician and a neuropathologist, the patient is referred to a cardiologist, endocrinologist, orthopedist, speech therapist and other specialists. It is very important to control the growth and development of the child in order to prevent future disorders of the musculoskeletal system.

All drugs for the treatment of muscle weakness in children should be prescribed by a doctor, individually calculating the dosage. Misuse of medications can lead to serious complications and side effects Therefore, self-medication with such a pathology is not recommended.

Prevention of muscle hypotonia in infants is primarily a healthy pregnancy. During the planning period, the mother and father should stop drinking alcohol, stop smoking, start a healthy and balanced diet, and be examined to rule out or cure infections.

During pregnancy, a woman needs to spend enough time on fresh air, eat right and be observed by a gynecologist in a antenatal clinic, regularly take tests. If the child is provided with normal development in the womb, then many serious pathologies can be avoided.

The prognosis for muscle weakness in children depends on the diagnosis. With hypotension caused by hypoxia, they usually talk about a favorable prognosis. At proper treatment everything passes without a trace, the child is fully restored.

But with such diagnoses as myasthenia gravis, Down's syndrome, Prader-Willi syndrome and other severe pathologies, they do not speak of a complete recovery. But, if a child is treated, dealt with, and developed, then he will become a full-fledged member of society and will live a normal life. The prognosis in this case depends on the parents, their efforts. The more effort they put into the health and development of the baby, the better it will be for him.

Massage (video)

In medical circles, such a clinical unit as "growing pains" causes a lot of controversy. It is generally accepted that “growing pains” is a diagnosis of exclusion. After all, children and adolescents begin to complain of pain in the legs for no apparent reason. The child was not injured, and after the examination, he did not have any organic diseases. Why, during sleep and in a state of complete rest, does he periodically suffer from pain in the lower extremities? Moreover, these pains are of a “flying” nature. Now the child has a knee, then a shin, then the pain is concentrated in the thigh.

Causes

Growing pains usually affect children between the ages of 3 and 15. It is at this time that children grow rapidly. Basically, this growth is due to the lower extremities. Physicians do not have an unequivocal opinion about the appearance of these pains.

• Some experts believe that the reason for their appearance is an unreasonably high load on the fragile muscular and bone apparatus of the child.
• Others believe that the cause is too rapid an increase in the length of the legs, resulting in tension in the tendons and muscle fibers. Which leads to the appearance of quite severe pain.

What symptoms accompany growing pains in children and adolescents?

• Usually, night pains may increase with increased physical activity during the day. Children can talk about pain under the knees, in the ankles, on the outer thighs.
• It is often possible to observe muscle cramps in the legs.
• Some children complain about muscle numbness or stiffness when walking .
• Often "growing pains" are localized in the calves, thighs and feet . They can occur alternately, then in the thigh, then in one foot, then in the other, then in the right, then in the left leg. Pain attacks are short-lived, they do not cause any harm and go away on their own.

Why are growth pains absent during the day, but appear at night?

During the day, children lead an active lifestyle, forgetting about nighttime “adventures”. Even if the child had a rather strong pain attack at night, in the morning he will feel great - run, jump, frolic.

Indeed, children complain of pain when they are completely at rest - during sleep or daytime rest, immediately after waking up. And this is quite natural, because it is at this time that the vascular tone is reduced, and the blood supply is slowed down. And for physiological growth bone tissue a good blood supply is vital. Even with minor physical exertion, blood circulation normalizes, and the bones of the limbs receive everything necessary for their further growth. That is why, when moving while awake, no pains bother children.

Doctors explain the absence of pain during the day by the fact that at this time the child leads an active lifestyle, moves a lot. Hence his brain gets mass new information, thereby pushing back memories of pain coming from stretched tendons and muscles. At night, when the child is relaxed, pain impulses freely reach nerve centers and children wake up with pain in their legs.

How to distinguish growing pains from other diseases?

Let's first denote the anamnesis of which diseases there is a symptom of "pain in the legs":

• With most orthopedic pathologies. And also in diseases of Perthes and Ostud Shpatter, etc.
• With tuberculosis. Positive - an occasion to urgently show the child to a phthisiatrician.
• Night pains in the lower extremities are a symptom of neurocircular dystonia. The anamnesis of this diagnosis also includes: headaches and heart pains, insomnia, shortness of breath and lack of air.
• This symptom can also be present in congenital pathology of the heart and blood vessels. In this case, the pulse on the legs is weakly audible, and sometimes absent altogether. The patient often falls, stumbles, his legs do not obey well.
• If your baby complains of constant heel pain, then he should be shown to the surgeon. Maybe he has a sprained Achilles tendon.
• With rheumatism, arthritis, with pathology in the thyroid gland.
• Often, pain in the legs is associated with water calluses, which parents can see for themselves by carefully examining the child's legs.
• Children (from three years and older) often suffer from pain in the calves. This means that phosphorus and calcium do not enter the child's body enough. Similar pains are often experienced by pregnant women.
• Sudden pain in one of the joints is most often a symptom of an injury. As a rule, the joint swells when injured.
• Teenagers sharp pain in the knee may indicate the presence of Schlatter's disease.
• A severely swollen and reddened joint on the leg requires urgent medical attention. Perhaps the development of an infectious process.
• Also, joint pain can be a symptom of the flu or any other respiratory illness. As a rule, other cold symptoms join the joint pains: runny nose, sore throat, fever, etc.
• But the most common causes complaints of pain are rightfully considered bruises and all kinds of injuries.

In what cases should you go to the doctor?

1. If the child is lame for several days.
2. His joints are red and inflamed.
3. And, of course, if the parents do not rule out a possible dislocation or fracture.

How to distinguish "growing pains" from serious diseases?

As you already understood, the flow and clinical picture"growing pains" are different from the symptoms of more serious diseases.

• Growth pains make themselves felt during complete rest.
• The pain begins to disturb a couple of hours after falling asleep.
• Sometimes, the baby may cry from pain and late at night.
• The pain completely disappears in about a quarter of an hour.
• In most cases, children are concerned about pain in large joints.
• In the morning, children do not even remember the pain, they run with pleasure and feel great.
• These are "flying pains" that are not localized in the same place. The kid may complain about pain in the knee, then in the hip, then in the ankle.
• Seizures are short.
• The temperature never rises.
• The general condition of the child does not worsen.
• No redness, swelling on the lower extremities is observed.
• The child is not lame.
• Bone joints are mobile.
• These pains can torment the child for several nights in a row or appear occasionally.
• As soon as the growth spurts are left behind, the pain will disappear forever.

Be that as it may, pediatricians strongly recommend that you undergo an examination and take a blood test. Once again, it will not hurt to check the ESR. As the saying goes: "God saves the safe"

Growing pains in the legs in children: how to treat?

1. The most important recommendation is to be attentive to your child, monitor his behavior and listen to his complaints. Do not try to diagnose yourself, there is a doctor for this!
2. For growing pains, the treatment is usually light massage, which can be done by the parents themselves.
3. At severe pain doctors recommend giving the child one third of a tablet of Ibuprofen or Nurofen. This dose is enough to relieve pain, and at the same time not burden the liver. If your baby wakes up with leg pain for several nights in a row, doctors recommend giving ibuprofen at bedtime rather than during an attack. The medicine will relieve the pain, the attack will pass and the baby will sleep through the night peacefully.
4. You can use a warm bath to relieve pain. Or apply a warm compress to the painful area.
5. Sometimes doctors recommend using Butadion ointment. Some pediatricians prefer to prescribe diclofenac ointment.

Attention! Any medications and ointments should be prescribed by a pediatrician. No self-activity.

Growing pains come and go spontaneously. The child is frightened, and fear only intensifies the pain. So parents should first of all reassure the child, explaining to him that his legs are growing, and soon he will become quite big.

Feeding children during active growth

- Parents should know that the first growth spurt in girls is observed at 6 years old, and in boys at 5 years old.

- The second - for girls at 10 years old, and for boys at 9. At this time, children grow rapidly, in one year they can grow by 15-20 cm.

- The third leap begins at 13-15 years old.

It is during the period of active growth that children especially need a balanced diet. Their diet must necessarily include proteins, trace elements, vitamins. Especially A and D. Children should get enough minerals from food.

As a rule, a light massage or a warm bath is enough for the pain to go away. If the pain persists, other more serious diseases should be ruled out. And for this you need to pass an examination in specialized agency. A visit to the doctor in this case is inevitable.

For any parents there is nothing worse than the disease child. Even the usual SARS makes them worried. What can we say about incomprehensible night pains in the legs. We have tried to outline the main symptoms of growing pains in children. But, of course, no, even the most detailed article, can replace a consultation with a pediatrician. And this should not be forgotten.

The muscular system includes more than 600 muscles, most of which are involved in the performance of various movements.

Muscular system in children

Anatomical and physiological features muscular system in children:

By the time of birth, the number of muscles in a child is almost the same as in an adult, but there are significant differences in terms of mass, size, structure, biochemistry, physiology of muscles and neuromuscular units.

Skeletal muscles in a newborn are anatomically formed and relatively well developed, their total weight makes up 20-22% of body weight. By 2 years relative mass muscles slightly decreases (up to 16.6%), and then, due to the increase in the motor activity of the child, it increases again and reaches 21.7% by the age of 6, by 8 - 2728%, and by 15 - 3233%. In adults, it averages 40-44% of body weight. In total, muscle mass during childhood increases 37 times.

The structure of skeletal muscle tissue in children different ages has a number of differences. In a newborn, muscle fibers are located loosely, their thickness is 4-22 microns. AT postnatal period growth muscle mass occurs mainly due to the thickening of muscle fibers, and by the age of 18-20 their diameter reaches 20-90 microns. In general, muscles in children early age thinner and weaker, and the muscular relief is smoothed and usually becomes distinct only by 5-7 years of age.

The fasciae of a newborn are thin, loose, easily separated from the muscles. Thus, the weak development of the tendon helmet and its loose connection with the periosteum of the bones of the cranial vault predispose to the formation of hematomas when the child passes through the birth canal. The maturation of the fascia begins in the first months of a child's life and is associated with the functional activity of the muscles. The muscles of the newborn have a relatively large amount of interstitial tissue. In the first years of life, there is an absolute increase in loose intramuscular connective tissue, and the relative number of cellular elements per unit area decreases. Along with the development of muscle fibers, the formation of endomysium and perimysium takes place. Its differentiation ends by 8-10 years.

The nervous apparatus of the muscles at the time of birth is not fully formed, which is combined with the immaturity of the contractile apparatus of the skeletal muscles. As the child grows, both motor innervation of phasic skeletal muscle fibers matures (change of polyneuronal innervation to mononeuronal, decrease in the area of ​​sensitivity to acetylcholine, in mature neuromuscular synapses confined only to the postsynaptic membrane), and the formation of definitive neuromuscular units. There is also the formation of new proprioceptors with their concentration in the areas of the muscles experiencing the greatest stretch.

Skeletal muscles in newborns are characterized by a lower content of contractile proteins (in newborns they are 2 times less than in older children), the presence of a fetal form of myosin, which has a small ATPase activity. As the child grows, fetal myosin is replaced by definitive myosins, the content of tropomyosin and sarcoplasmic proteins increases, and the amount of glycogen, lactic acid, and water decreases.

Features of the muscular system in children

The muscles of the child are characterized by a number of functional features. So, children note hypersensitivity muscles to some humoral agents (in particular, to acetylcholine). In the intrauterine period, skeletal muscles are characterized by low excitability. The muscle reproduces only 3-4 contractions per second. With age, the number of contractions reaches 60-80 per second. The maturation of the neuromuscular synapse leads to a significant acceleration of the transition of excitation from the nerve to the muscle. In newborns, muscles do not relax not only during wakefulness, but also during sleep. Their constant activity is explained by the participation of muscles in heat production (the so-called contractile thermogenesis) and the metabolic processes of the body, stimulating the development of the muscle tissue itself.

Muscle tone can be a guide in determining the gestational age of a newborn. So, in healthy children, the first 2-3 months of life are noted increased tone flexor muscles, the so-called physiological hypertonicity, associated with the peculiarities of the functioning of the central nervous system and leading to some limitation of mobility in the joints. Hypertonicity in the upper limbs disappears in 2-2.5 months, and in the lower - in 3-4 months. Deeply premature babies (gestational age less than 30 weeks) are born with general muscular hypotension. In a child born at 30-34 weeks of gestation, the lower limbs are bent at the hip and knee joints. Flexion of the upper limbs appears only in children born after the 34th week of gestation. After the 36-38th week, the flexor position of both the lower and upper limbs is noted.

Growth and development of muscles in children

The growth and development of muscles in children occurs unevenly and depends on their functional activity. So, in a newborn, mimic and chewing muscles are poorly developed. They are noticeably strengthened after the eruption of milk teeth. distinctly expressed age features diaphragm. Its dome in newborns is more convex, the tendon center occupies a relatively small area. As the lungs develop, the bulge of the diaphragm decreases. In children under 5 years of age, the diaphragm is located high, which is associated with the horizontal course of the ribs.

The muscular system in newborns is poorly developed, as are the aponeuroses and fascia of the abdomen, which leads to a convex shape of the anterior abdominal wall, which lasts up to 3-5 years. The umbilical ring in a newborn has not yet been formed, especially in its upper part, and therefore the formation of umbilical hernia. The superficial inguinal ring forms a funnel-shaped protrusion, more pronounced in girls.

In a newborn, the mass of the muscles of the body predominates. In the first years of a child's life, due to the increase in motor activity, the muscles of the limbs grow rapidly, and the development of the muscles of the upper limbs at all stages outstrips the development of the muscles of the lower limbs. First of all, large muscles of the shoulder, forearm develop, much later - the muscles of the hand, which leads to difficulties in performing fine handmade up to 5-6 years of age. Until the age of 7, children have insufficiently developed leg muscles, and therefore they do not tolerate long-term loads. At the age of 2-4 years, the gluteus maximus and long back muscles grow intensively. The muscles that provide the vertical position of the body grow most intensively after 7 years, especially in adolescents 12-16 years old. Improving the accuracy and coordination of movements occurs most intensively after 10 years, and the ability for rapid movements develops only by the age of 14.

The intensity of muscle growth and muscle strength is related to gender. So, the indicators of dynamometry in boys are higher than in girls. The exception is the period from 10 to 12 years, when the body strength of girls is higher than that of boys. Relative muscle strength (per 1 kg of body weight) changes slightly until the age of 6-7 years, and then rapidly increases by the age of 13-14 years. Muscular endurance also increases with age and in 17-year-olds it is twice as high as in 7-year-old children.

Congenital muscle anomalies

The most common congenital muscle anomaly is underdevelopment of the sternocleidomastoid muscle, leading to torticollis.

Often there are anomalies in the structure of the diaphragm with the formation of hernias.

Underdevelopment or absence of the pectoralis major or deltoid muscle leads to the development of deformities of the shoulder girdle.

The muscular system of the child - examination, palpation

Methodology for the study of the muscular system in children

questioning. The most common complaints in children with damage to the muscular system are muscle pain (myalgia) and decreased muscle strength. When collecting an anamnesis, it is necessary, if possible, to find out the time of occurrence of these complaints, provoking factors, the relationship with other pathological symptoms that the child has, and family and hereditary anamnesis.

During examination and palpation, the degree of muscle development is primarily assessed. It is also necessary to evaluate key indicators the state of the child's muscular system, such as tone, strength and motor activity of the muscles.

Degree of muscle development

In healthy children, the muscles are elastic to the touch, the same in symmetrical parts of the body and limbs. There are 3 degrees of muscle development:

Good - the contours of the muscles of the trunk and limbs at rest are clearly visible, the stomach is retracted or slightly protrudes forward, the shoulder blades are pulled up to the chest, with tension, the relief of contracted muscles increases.

Medium - the muscles of the trunk are moderately developed, and the limbs are well developed, with tension, their shape and volume clearly change.

Weak - at rest, the muscles of the trunk and limbs are poorly contoured, with tension, the relief of the muscles changes hardly noticeably, Bottom part the abdomen sags, the lower corners of the shoulder blades diverge and lag behind chest.

Underdevelopment of muscles occurs in children leading sedentary image life, with dystrophy caused by malnutrition, the presence of chronic somatic diseases, pathology nervous system, generalized joint damage, etc.

The extreme degree of weak muscle development is atrophy. In this condition, the mass of muscle tissue is sharply reduced, and the belly of the muscles in its thickness and consistency becomes similar to a tendon. With muscle atrophy, a reversible or irreversible violation of muscle trophism occurs with the development of thinning and degeneration of muscle fibers, weakening or loss of their contractility.

Muscle asymmetry

The asymmetry of muscle mass implies an unequal degree of development of the same muscle groups. To identify asymmetry, analogous muscles of both halves of the face, trunk, and limbs are consistently compared. For a more accurate assessment, measure with a centimeter tape and compare the circumferences of the left and right limbs at the same levels. Muscular asymmetry can be the result of underdevelopment, trauma, pathology of the nervous system, some rheumatic diseases (hemiscleroderma, JRA), etc.

Palpation reveals local or widespread soreness, as well as seals along the muscles, which may be associated with inflammatory changes, focal or diffuse deposition of calcium in them.

Muscle tone in children

Muscle tone is a reflex muscle tension controlled by the central nervous system and also dependent on the metabolic processes occurring in the muscle. A decrease or absence of tone is called hypotonia or muscle atony, respectively, normal tone is muscle normotonia, and high tone is muscle hypertension.

Muscle Tone Assessment

A preliminary idea of ​​the state of muscle tone can be obtained by visual assessment of the posture and position of the child's limbs. So, for example, the posture of a healthy newborn (arms bent at the elbows, knees and hips pulled up to the stomach) indicates the presence of physiological hypertonicity of the flexors. With a decrease in muscle tone, the newborn lies on the table with outstretched arms and legs. In older children, a decrease in muscle tone leads to posture disorders, pterygoid shoulder blades, excessive lumbar lordosis, an increase in the abdomen, etc.

Muscle tone is examined by assessing the resistance of the muscles that occurs during passive movements in the corresponding joints (the limb should be as relaxed as possible).

Increased muscle tone

An increase in tone can be of two types:

Muscle spasticity - resistance to movement is expressed only at the beginning of passive flexion and extension, then the obstacle seems to decrease (the "jackknife" phenomenon). Occurs when there is a break in the central influence on the cells of the anterior horn spinal cord and disinhibition of the segmental reflex apparatus.

Muscle rigidity - hypertonicity is constant or increases with repetition of movements (the "wax doll" or "lead tube" phenomenon). In the study of muscle tone, discontinuity, step resistance may occur (the phenomenon of "gear wheel"). The limb can freeze in the position that it is given - a plastic tone. Occurs when the extrapyramidal system is damaged.

With muscular hypotension, a lack of resistance during passive movements, a flabby muscle consistency, an increase in the range of motion in the joints (for example, hyperextension) are revealed.

Muscle tone study

There are several tests that allow you to judge the state of muscle tone in children:

A symptom of a return - the legs of a newborn lying on his back are unbent, straightened and pressed against the table for 5 s, after which they are released. If the newborn has physiological hypertonicity, the legs immediately return to their original position; with a reduced tone, a complete return does not occur.

Traction test - the child lying on his back is taken by the wrists and they try to put him in a sitting position. The child first unbends his arms (first phase), and then bends them, pulling himself towards the examiner with his whole body (second phase). With hypertonicity, the first phase is absent, and with hypotonicity, the second phase is absent.

Symptom of "rope" - the researcher, standing facing the child, takes him in his hands and performs rotational movements alternately in one direction or the other, while assessing the degree of active muscle resistance.

Symptom of "flabby shoulders" - the shoulders of the child are clasped from behind with both hands and actively lifted up. With muscular hypotonia, this movement is easy, while the shoulders touch the earlobes.

Volume of active and passive movements

Assess the volume of both active and passive movements:

Active movements are studied in the process of observing the child during the game, walking, performing certain movements (squats, tilts, raising arms and legs, stepping over obstacles, going up and down stairs, etc.). Limitation or absence of movements in individual muscle groups and joints indicates damage to the nervous system (paresis or paralysis), muscles, bones, joints.

Passive movements are examined by sequentially performing flexion and extension in the joints: elbow, hip, ankle, etc. In newborns and children of the first 3-4 months of life, limitation of movements in the joints is noted, due to physiological hypertonicity. Restriction of passive movements in older children indicates an increase in muscle tone or joint damage.

Muscle strength in children

Muscle strength is assessed by the degree of effort required to overcome the active resistance of one or another muscle group. At young children, they try to take away the toy they seized. Older children are asked to resist the extension of the bent arm (leg). The state of muscle strength can be indirectly judged by how the child performs squats, climbing and descending stairs, getting up from the floor or bed, dressing and undressing, etc. Muscular strength clearly increases with age. As a rule, the dominant hand is stronger, and in general, muscle strength in boys is greater than in girls. It is possible to more objectively judge muscle strength by the readings of a dynamometer (manual and dead).

Laboratory and instrumental studies of the muscular system

In diseases of the muscular system, blood biochemical parameters are examined [the activity of creatine phosphokinase, the muscle fraction of lactate dehydrogenase (LDH), transaminases, the concentration of amino acids and creatine in the blood and urine, the content of myoglobin in the blood and urine], autoantibodies are determined. To clarify the diagnosis, genetic and morphological studies of muscle biopsy are carried out.

Among the instrumental methods for finding out the cause of a decrease in muscle strength in clinical practice The most commonly used electromyography (EMG) is a method of recording the bioelectrical activity of muscles, which allows, for example, to differentiate primary muscle pathology from their lesions in diseases of the nervous system. Muscle excitability is assessed using chronaxis, muscle performance - ergograph and ergometer.

The methodology for performing these types of exercises is divided into several stages.

Flexion-extension

as the main and initial exercise can be applied alternate bending child's legs. In this case, the baby should himself try to perform these actions under the guidance of an adult. Exercise should be performed six to seven times. Very slowly at first, and then gradually accelerating.

Reach for the stick

In the next step, you can use more difficult exercise. The child lies on his back. The parent holds a stick at a certain height. The task of the child is to try to reach the stick with his feet. The frequency of repetition of this exercise is 7 times.

Hold your knees

The next exercise is aimed at immediately developing a complex of muscles, including the muscles of the legs. The starting position of the child is standing with his back to an adult. Right hand an adult should hold the child's torso, and hold his knees with his left. This type of exercise helps develop the muscles of the back, legs, and abdomen. Also an important point of this exercise is that it should use the child's favorite toy, which is placed at his feet. An adult should ask the child to reach for the toy. During the exercise, it is necessary to ensure that the child's legs are in a straight position. Repeat this exercise 3 times.

Assisted Squats

To perform it, an adult needs to keep the child's hands in rings. It is necessary to give the child rings, then lightly pull them down, then hold the child in this position for two or three seconds, and then give him the opportunity to rise. You can also ask the baby to stand on his toes, for this he must be taken by the handles and slightly pulled up. This exercise must be repeated 2 times.

Favorite position - on all fours

At this stage, the child should walk on all fours. This type of exercise will develop the muscles of the arms, legs, abdomen and back. Also in this exercise, your baby's favorite toy will come in handy. It should be put at a certain distance from the crumbs and tell him to get to her. In order for the child to get to the toy, he will need to move on all fours. With the moment of approaching the child to the toy, it should be moved away from him.

Steps

The last exercise is for the child to try to take independent steps. Putting him in the starting position on his legs, while holding his hands, you need to ask him to take a few steps. When performing the exercise, the child must be held.

Such exercises can be alternated or performed in combination: they are all good enough and will strengthen the baby's motor apparatus.