Mental retardation in children

Introduction to mental retardation in children Mental retardation (MR), also known as mentaldeficiency, or oligophrenia, is a developmental disability common in children. Mental retardation is mainly manifested in low social adaptability, learning ability and self-care ability. Its speech, attention, memory, understanding, insight, abstract thinking, imagination, etc., mental activity ability is obviously behind the same age children. The diagnosis of mental retardation is based on psychological tests and assessment of fitness. The cause of mental retardation is biomedical or psychosocial. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: dementia, hearing impairment, cleft lip and palate, epilepsy

Pediatric mental retardation etiology

(1) Causes of the disease

1. The causes of mental retardation can be broadly summarized into two categories:

(1) Biomedical reasons, such as various genetic diseases, acquired diseases, injuries, etc.

(2) Social and psychological reasons are caused by social and cultural bad environments.

In 1988, in China, in 8 cities and 6 rural areas, 1.4 million children under the age of 14 were investigated. Among 85,170 children, 862 people were found to have mental retardation. The causes are shown in Table 1, among which biomedical factors accounted for 89.6. %, social and cultural psychological factors accounted for 10.4%, in biomedical factors, various causes of brain damage, hypoxia, other perinatal abnormalities, central nervous system infection or poisoning, congenital and hereditary diseases occupy an important position, Among the factors before birth, the proportion of hereditary diseases is more, other such as malformation, intrauterine infection, and perinatal abnormalities are also very important. Among the factors of birth time, birth injury, asphyxia, intracranial hemorrhage is the most common, born. The latter causes are mainly acquired diseases after birth, such as infection, trauma, poisoning, malnutrition and so on.

The mental retardation caused by social and cultural psychological factors is caused by poor social and cultural environment and psychological trauma during the long period of life.

2. Classification of mental retardation: The mental retardation is divided into four levels: light, medium, heavy and extremely heavy. As shown in Table 2, the above 4 types can be simplified into mild and severe types. The mild IQ is 50 to 70, the severity includes the medium, heavy, and extremely heavy three types in Table 2, and the IQ is below 49. The severe factors are mainly biological factors, less common, and mildly based on psychosocial factors, more common.

(two) pathogenesis

The occurrence of mental retardation is the result of disturbance, blockage or damage of the brain during development. From the third week of embryonic development to the first three months of birth, it is the critical period for the formation of the nervous system in the intrauterine structure. At this stage, it can cause obvious deformity of the brain. From 3 months before birth to 1 year after birth to 6 years old, it is a critical period of brain development, and nerve cells undergo proliferation and differentiation, in any process in the process. Interference and inhibition of the link may seriously affect the development of the brain, leading to mental retardation.

Pediatric mental retardation prevention

Primary prevention

Mainly to eliminate the cause, to carry out genetic counseling, to avoid marriage of close relatives, strengthen pregnancy care, pay attention to nutrition during pregnancy, avoid exposure to harmful chemicals, quit smoking, abstain from alcohol, absolutely prohibit the intake of drugs, avoid taking teratogenic drugs, avoid exposure to radiation Prevent virus and protozoal infections; do prenatal checkups, prevent pregnancy complications, improve obstetric techniques, avoid pathological delivery, do a good job in child health, implement planned immunization, prevent infectious diseases, especially nervous system infections, pay attention to nutrition and health To prevent poisoning, avoid brain trauma, publicize parenting knowledge, improve parental culture, arrange a good parenting environment, provide good stimulation to infants and children, and manage preschool education.

2. Secondary prevention

Early detection of diseases that may cause mental retardation, treatment before the symptoms have not appeared, thus preventing brain damage, such work includes prenatal diagnosis, neonatal metabolic disease screening, heterozygous detection of genetic diseases, birth defects Monitoring, health screening of preschool children with high risk factors.

3. Three levels of prevention

Take comprehensive measures for brain diseases, injuries, defects, etc., when the disease has already occurred, adopt various comprehensive treatments to prevent or reduce the adverse consequences caused by the disease, so that it does not develop into intellectual disability, and the treatment should be from medicine and psychology. And education in two aspects, as far as possible to enable the sick child to achieve self-care, enhance independence, learn to interact with people and social life, for some congenital metabolic diseases, such as phenylketonuria, galactosemia, maple syrup, etc. If early diagnosis and early dietary treatment, thyroxine treatment for congenital cretinism can improve their intelligence, homocystrine supplementation with its coenzyme (vitamin B6, B12), for some congenital craniocerebral malformations Such as narrow cranial disease, congenital hydrocephalus, etc., surgical treatment can reduce brain pressure, help its development, strengthen education and training is very important, mild mentally retarded school-age children can be educated in ordinary primary schools, moderate mental retardation You need to study in a special education class. For severe and extremely severe patients, you need to take care of you for life, but you can still teach them through long-term training. Habits and basic living ability, there is no certain effective drug that can improve intelligence.

Pediatric mental retardation complications Complications dementia hearing impairment cleft lip and palate epilepsy

In addition to mental retardation and social maladjustment, mental retardation is often accompanied by physical abnormalities, such as:

1. Growth retardation, height, head circumference, body weight, etc. are lower than the standard value of the same age.

2. Facial features, such as tongue-like dementia, congenital stupid, special face.

3. Abnormal skin and hair, yellow hair, fair skin, brown spots.

4. Skull bone abnormalities, such as microcephaly.

5. Abnormal body odor, such as urine.

6. Limb dyskinesia, such as cross gait.

7. Congenital malformations, such as auricular malformations, ocular fissures, cleft lip and palate, finger toe and joint deformities.

8. Sensory organ disorders, vision and hearing impairment.

9. Secondary epilepsy.

Symptoms of mental retardation in children Common symptoms Learning difficulties Language development retardation Responsive mental age is less than physiological age Molars sleepiness Dysphagia Children behaviors

Grading

Regardless of the cause, it is divided into 4 levels based on the level of mental retardation and the degree of social adaptability.

(1) Mild: IQ is 50-69 (80%-85%). It is not easy to be detected in the early stage. In the early childhood, there may be language and motor function development, and there is no obvious abnormality in the development of the body and nervous system. In school age, it is found that learning difficulties gradually appear. Although language development is slightly backward, social language is still acceptable. Personal life can still take care of themselves. It can be used for simple labor and technical operations. It is difficult to calculate, read, write, apply abstract thinking, and lack flexibility. Sex and dependence on others, in terms of personality characteristics, there are mainly stable (stabilized) and unstable (excitatory).

(2) Moderate: IQ is 35 to 49 (10% to 20%), language function is obviously backward, and you can learn to speak in preschool, but you can't express more complicated content, and more children than children of the same age. Play, poor learning ability, rarely rise to the third grade, life self-care, need the care of others, some with physical development defects and abnormalities of the nervous system.

(3) Severe: IQ is 2034 (accounting for less than 10%). It has been found to have abnormal body and nervous system since childhood, poor exercise and language ability, special face, difficult learning, poor understanding, often accompanied by epilepsy and congenital Abnormalities and abnormal signs of the nervous system.

(4) Extremely severe: IQ is below 20, there are obvious physical deformities and nervous system abnormalities at birth, generally can not learn to walk and talk, poor understanding, lack of self-care ability, completely dependent on others.

2. Early performance

The following conditions may be early manifestations of mental retardation:

(1) Smiles appear late, do not pay attention to others, accompanied by lack of exercise.

(2) dysplasia of the eye function, because it does not look around, is often misdiagnosed as blind.

(3) Due to lack of response to the sound, it is often misdiagnosed as deafness.

(4) Due to late chewing, feeding is difficult, and when solid food is given, dysphagia may occur and vomiting may occur.

(5) After the normal child walks, the two feet will no longer collide with each other when walking. The children with stunting will collide with each other after walking, and some will still be visible when they are 2 to 3 years old.

(6) The action of playing with hands continues. Normal children spend 3 to 4 months, often lying in bed watching their hands, playing with their hands repeatedly; the children with mental retardation continue to exist after 6 months.

(7) Normal children often put things in the mouth when they are 6 to 12 months old, but they are no longer used when the movements of the hands are more skilled. The movements of children with backward development persist in the mouth, sometimes to 2 to 3 years old. The building blocks will also be placed in the import.

(8) Normal children no longer intentionally throw things underground in 15 to 16 months, and children with stunted growth last longer.

(9) Normal children stop mouthwash when they are about 1 year old, and children with defects last longer.

(10) When awake, the child with low mentality can see the molar movement, which is not available to normal children.

(11) Inferior children sometimes need repeated or continuous stimulation to cause crying, often throat, cries sharply, or screaming, or high-pitched, sometimes crying, normal children cry often have a tone Variety.

(12) Lack of interest and lack of concentration are two important characteristics of children with mental retardation. Lack of interest is not interested in things around them. Interest in toys is also short-lived and unresponsive. Children with mental retardation often appear to sleep more often. Unintentional hyperactivity.

Pediatric mental retardation check

Those who are caused by hypothyroidism or chromosomal aberrations may have corresponding laboratory abnormalities. Select items according to clinical manifestations and diagnostic needs. If necessary, check blood amino acids and urinary organic acids (when there is a history of infancy convulsions, neurodevelopment declines, urine has Odor, small head, hair color, dermatitis, acidosis); urine reducing sugar (with cataract, liver, convulsions); blood ammonia (with vomiting, metabolic acidosis); blood lead (anemia) , bloody zinc (asthma dermatitis); urinary mucopolysaccharide (have a rough face, liver and spleen, skeletal deformity, corneal opacity, sputum), blood copper and ceruloplasmin (involuntary movement, Cirrhosis, corneal ring); chromosomal analysis, including fragile X (multiple malformations, autism, family mental retardation, maternal exposure to teratogenic conditions, etc.); in addition, from iodine-deficient areas, check thyroid function; Have self-mutilation, violent attacks, gout, chorea, should check blood uric acid; metabolic acidosis, myoclonic seizures, weak sexual, ataxia, ophthalmoplegia, stroke, blood lactic acid, Pyruvic acid and special mitochondria ; Suspected congenital infection, do virological examination (cytomegalovirus, rubella virus, etc.).

Diagnosis and diagnosis of mental retardation in children

Diagnostic criteria

1. History: including maternal pregnancy history, childbirth history, growth and development history, disease history, family history, etc.

2. Physical examination: including general physical examination, neurological examination, mental state examination, psychological test, intelligence test or intelligent evaluation, adaptive behavior assessment.

3. Laboratory examination: including biochemical routine, chromosome examination, endocrine examination, cerebrospinal fluid examination.

4. Auxiliary examination: including head X-ray, head CT, MRI, EEG, TCD, ECT, brain evoked potential examination.

Differential diagnosis

According to the detailed medical history, family history and high-risk factors analysis, in addition to biomedical factors, we must also pay attention to social, psychological and cultural factors, living environment, etc., physical examination should have a detailed and comprehensive neurological examination, laboratory The examination includes neuroimaging, biochemical metabolism, chromosomal and molecular genetic analysis, early diagnosis of mental retardation as early as possible for early intervention, early diagnosis of genetic diseases can be found through prenatal diagnosis and neonatal screening to find chromosomal disorders Congenital metabolic diseases and neurological abnormalities can also predict the occurrence of mental retardation according to some abnormal signs, such as gnomes, small heads, big heads, retinopathy, cataracts, skin pigmentation abnormalities, eye and tooth malformations, enamel hypoplasia, abnormalities The smell and so on.

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