Sudden Behavioral Changes in Children: A Case Study

Sudden onset of abnormal behavior in children?

My niece is currently 6 years old.
Ten days ago, one night she suddenly could not sleep at all, and the next morning she was unable to walk due to weakness in her legs, accompanied by vomiting, but without any fever.
Her consciousness was relatively clear.
After being taken to the hospital, blood tests showed no abnormalities.
The doctor suspected possible encephalitis but was uncertain and advised to observe her at home first.
However, her condition did not improve at all after returning home; she refused to eat and barely drank any water.
The next day, we hurriedly took her back to the pediatric neurosurgery outpatient department.
She was hospitalized for 5 days, during which she completely stopped speaking, slept very little, and walked around continuously, not recognizing people.
During this time, an EEG was performed, and the doctor indicated that some parts of the EEG showed sleep patterns, but no other abnormalities were detected.
A lumbar puncture was also performed, and initially, no viral infection was found, but the doctor stated that a complete report would take about 20 days.
Before the lumbar puncture, when she was administered anesthesia, she suddenly became alert and conscious for a brief moment but quickly returned to her previous state.
She is currently back home for observation, but she continues to walk incessantly, day and night.
When someone approaches her, she wants to be held, but she only stands while being held; as soon as she sits down, she immediately walks away.
She resists being forced to sit or sleep, yet she still does not speak at all.
Her mother had transferred to work in Taipei a week before her onset, which led her to live with her grandmother, while her younger brother stayed at home.
Previously, her grandmother was the one taking care of her, but her mother would bring her home after work every day.
We are unsure if this caused her psychological stress.
Her mother has taken a week off to accompany her, but the doctor stated that until a clear diagnosis of non-encephalitis is made, the psychiatric department will not accept a referral.
It has been over 10 days since the onset of her condition, and there has been no progress.
The family has even sought help from spiritual sources, as we are at a loss about what to do.
The child has visibly lost weight, which is very distressing.
We would like to know what other medical assistance we can seek.
Do we really have to wait for the complete lumbar puncture results in over 10 days? Could this delay treatment and potentially lead to future complications? We are also worried that the child may not be able to hold on much longer.
Please help us.
Thank you!

mia, 20~29 year old female. Ask Date: 2005/03/29

Dr. Gu Qingxian reply Pediatrics

Hello, this case should first check if the symptoms are caused by encephalitis, as the recent temperature is a time when viruses are rampant.
Thank you!

Reply Date: 2005/03/29

More Info

I'm sorry to hear about your niece's condition; it sounds incredibly distressing for both her and your family. Based on the symptoms you've described, it seems that your niece is experiencing a complex set of issues that could stem from a variety of causes, including both physical and psychological factors.

Initially, the sudden onset of inability to sleep, weakness in her legs, vomiting, and the lack of fever are concerning symptoms that warrant thorough medical evaluation. The fact that the initial blood tests and other examinations did not reveal any immediate abnormalities is somewhat reassuring, but it does not rule out the possibility of underlying conditions, such as viral infections, neurological issues, or even psychological stressors.

Given that her mother recently changed jobs and that your niece has had to adjust to living with her grandmother, it is possible that she is experiencing significant emotional distress. Children can react to changes in their environment and family dynamics in ways that may not be immediately apparent. This could manifest as behavioral changes, such as withdrawal, refusal to speak, or changes in eating and sleeping patterns. The psychological impact of such changes can sometimes be as profound as physical illness, and it is essential to consider this aspect when evaluating her condition.

The fact that she has been hospitalized and subjected to various tests, including EEG and lumbar puncture, indicates that the medical team is taking her symptoms seriously. However, the waiting period for test results can be agonizing for families, especially when a child is in distress. It's crucial to maintain open communication with her healthcare providers during this time. If you feel that her condition is not improving and that her mental state is deteriorating, do not hesitate to advocate for her. Request a consultation with a pediatric neurologist or a child psychologist who can provide further insights into her behavior and emotional state.

In terms of immediate steps you can take, here are a few suggestions:
1. Maintain a Routine: Children often find comfort in routine. Try to establish a daily schedule that includes regular meal times, play, and rest. This can help provide a sense of stability.

2. Encourage Communication: Even if she is not speaking, encourage her to express herself through drawing or play. Sometimes, children find it easier to communicate their feelings through creative outlets.

3. Monitor Symptoms: Keep a detailed log of her symptoms, including any changes in behavior, eating, sleeping, and physical health. This information can be invaluable for her healthcare providers.

4. Seek Support: If you feel that her current medical team is not addressing your concerns adequately, consider seeking a second opinion. It’s essential to feel confident in the care she is receiving.

5. Consider Psychological Support: If her physical health stabilizes but her behavior remains concerning, it may be beneficial to involve a child psychologist. They can help assess her emotional state and provide strategies to cope with her feelings.

6. Stay Informed: While waiting for test results, educate yourself about potential conditions that could explain her symptoms. This knowledge can empower you to ask informed questions and advocate for her care.

In conclusion, while it is essential to wait for the results of the lumbar puncture and other tests, do not hesitate to seek further medical advice if her condition does not improve. Early intervention can be critical in addressing both physical and psychological issues in children. Your niece's well-being is paramount, and advocating for her needs is the best course of action. I hope she finds relief soon and that your family receives the support you need during this challenging time.

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