Tetany in children?

Tetany is a common disease in children. Most cases of tetany are caused by vitamin D deficiency. This disease is most common in infants and young children aged four months to three years. Therefore, babies need to be supplemented with vitamin D shortly after birth to restore their phosphorus metabolism to normal. It is best for parents to take their babies to outdoor activities every day and give them appropriate calcium supplements.

Seizures

Seizures are more common in infants. Symptoms include sudden rolling of the eyes, twitching of the facial muscles, twitching of the limbs, and confusion. The attack lasts from a few seconds to a few minutes, and cyanosis may occur if the attack lasts for a long time. After the attack stops, consciousness is restored, the patient falls asleep due to lethargy, and becomes active as usual after waking up. The frequency of attacks can range from once a few days to several times or even dozens of times a day. There is generally no fever. When the attack is mild, there is only a brief twitching of the eyeballs and facial muscles, but the patient remains conscious.

Tetany

Tetany is more common in older infants, toddlers, and older children. It manifests as sudden spasm of the muscles in the hands and feet into an arch shape, flexion of the wrist, stiffness of the fingers, adduction of the thumb against the palm, stiffness of the ankle joint, and bending of the toes downward. The muscles can move freely after the attack stops.

Laryngeal spasm

Laryngospasm mainly occurs in children under 2 years old. It manifests as sudden spasm of the laryngeal muscles and glottis, difficulty breathing, and hoarseness in the throat during inhalation. In severe cases, suffocation and death may occur.

When not having an attack, neuromuscular stimulation can elicit the following signs:

(1) Facial nerve sign: If tapping the cheek between the zygomatic arch and the corner of the mouth with the fingertips or a percussion hammer causes twitching of the eyelids and corners of the mouth, the sign is positive. This may be a false positive in newborns.

(2) Towser's sign: Wrap a blood pressure cuff around the upper arm and inflate it to maintain the pressure between systolic and diastolic pressures. If the hand twitches within 5 minutes, the test is positive.

(3) Peroneal reflex: Use a percussion hammer to tap the upper part of the fibula head on the outside of the knee. If the foot can be contracted outward, it is positive. Blood calcium is lower than 1.75-1.88 mmol/L (7.0-7.5 mg/dl), and blood phosphorus is normal or slightly high.

Nursing measures

Control convulsions and laryngeal spasms

Use sedatives and calcium supplements immediately as directed by your doctor. When calcium is injected intravenously, it needs to be pushed slowly (over 10 minutes) or dripped to avoid vomiting or even cardiac arrest due to a sudden increase in blood calcium; avoid extravasation of the drug solution to avoid local necrosis.

Prevent suffocation

Closely observe the occurrence of syncope and laryngeal spasm, and make preoperative preparations for endotracheal intubation or tracheotomy. Once symptoms are detected, oxygen should be administered promptly. For those with laryngeal spasm, the tongue should be pulled out of the mouth immediately. At the same time, the child's head should be tilted to one side, oral and nasal secretions should be cleared, the airway should be kept open, and suffocation by inhalation should be avoided. For children who have already grown teeth, a dental pad should be placed between the upper and lower incisors to prevent the tongue from being bitten. If necessary, endotracheal intubation or tracheotomy should be performed.

Exercise outdoors regularly and get more sun exposure; supplement with cod liver oil.

Health Education

Provide guidance on proper feeding, arrange children's daily life reasonably, insist on a certain amount of outdoor activities every day, supplement vitamin D as prescribed by the doctor, and supplement calcium in appropriate amounts to prevent the recurrence of vitamin D deficiency tetany and treat rickets. Teach parents how to deal with convulsions and laryngeal spasms, such as having the child lie flat, loosen the collar, straighten the neck, and tilt the head back to keep the airway open, and call medical staff at the same time.