Neuropathy in children refers to a problem with the nervous system outside of the central nervous system (which is comprised of the brain and spinal cord). For this reason, it is often referred to as “peripheral neuropathy” after the peripheral nervous system that carries signals from the spinal cord to the rest of the body.
Neuropathy can be caused by a wide range of underlying medical, biochemical and neurological conditions. The links between neuropathy and many conditions have been studied, but there are still cases that receive an idiopathic diagnosis (a diagnosis where there isn’t a known or proven cause).
Three different types of nerves are most often affected by neuropathy, either singly or in combination with each other. Mononeuropathy will be part of the diagnosis when only one type of nerve is affected, and polyneuropathy will be noted when multiple nerves are affected.
As their name suggests, sensory nerves control the body’s senses. Motor nerves control the power and movement of the body, and autonomic nerves control the functioning of the body’s internal organs. Based on the type of nerves affected, symptoms can range from constant tingling sensations in the hands to irregularities in the child’s heart rate.
The types of symptoms a child may experience vary according to the type of nerves affected. Because children often experience polyneuropathy, these symptoms may overlap or be present across types.
Because motor neuropathy affects the nerves that mainly control the body’s muscles, symptoms normally show up as muscle weakness, cramping and uncontrollable twitching. Motor neuropathy can also cause changes in the child’s skin, hair and nails as well loss of muscle and bone tissue.
Sensory neuropathy most usually affects the nerves that facilitate the body’s sense of touch. Numbness, tingling sensations and the loss of feeling in parts of the body can all be experienced by a child with neuropathy. Children may also experience problems with balance and movement as a side effect of the loss of feeling.
Symptoms of autonomic neuropathy focus around the nerves that maintain some of the automatic functions of the body. Children can experience abnormal sweating that causes an inability to tolerate heat. They’re often unable to properly control their bladder or colon, which can lead to constipation and/or incontinence. A chronically racing heart can also be a sign of autonomic neuropathy in children.
The leading cause of neuropathy overall is diabetes, followed by neuropathy induced by chemotherapy. However, the most common cause for peripheral neuropathy in children is hereditary, so idiopathic diagnoses are more prevalent in younger patients.
Diabetic peripheral neuropathy is caused from nerve damage that arises as a complication of diabetes. It can cause loss of sensation and pain in the feet and hands. This type of neuropathy is a progressive illness worsens with the severity of the diabetes.
Nerve damage is a common side effect of medications used to treat cancer and HIV/AIDS and is the cause of chemo-induced neuropathy. It usually results in the loss of sensation or numbness in part of the body. Though the damage can be permanent in rare cases, most often this condition will heal after discontinuing the use of the medication.
Doctors and medical staff on the pediatric neurology team will use laboratory tests and observation along with computerized tomography and magnetic-resonance imaging in making their diagnosis.
Because neuropathy arises from other conditions, treatment usually focuses on curing or relieving the underlying condition rather than the peripheral neuropathy itself. The child may be prescribed medication to ease pain or discomfort by the pediatric neurology team, but for less severe cases, over-the-counter pain medication is effective in managing discomfort.
Medication to treat some symptoms of neuropathy, such as irregular heart rhythms, may be prescribed if needed. In very rare situations, surgery can be used to ease neuropathic pain and other symptoms.
Children with peripheral neuropathy can also benefit from arm and leg braces to compensate for weakness in the muscles. Relaxation techniques such as yoga, meditation or aromatherapy may help ease both stress and the physical challenges that come with neuropathy.
Special care should be taken of limbs affected by neuropathy, especially if a loss of feeling has occurred. Wounds should be treated immediately and maintained until fully healed, as complications are more likely to occur that could result in the loss of the limb.