Ultrasound examination is a fairly common method for diagnosing various diseases and conditions in childhood. It allows you to get fairly informative results in a non-invasive way. Ultrasound does not have age restrictions, and therefore is carried out for a newborn in a maternity hospital, and for an infant at any period of life, both for medical reasons and as part of a comprehensive screening study.
We will tell in this material about what types of children's ultrasound are, what they can show how to prepare a child for ultrasound diagnostics and whether it can be harmful.
The essence of the diagnosis
Ultrasound research was adopted by physicians only a little over 20 years ago. The essence of the method lies in the ability of ultrasonic waves to be reflected in different ways from different media - liquid or the walls of internal organs. The ultrasonic signal is generated by a special sensor. It also receives the reflected, returned signal and projects the image onto the scanner monitor.
The equipment is always equipped with sophisticated programs that allow you to analyze the image, avoiding long and difficult mathematical calculations. The sizes of organs, volume, structure allow to establish with high accuracy the special mathematical algorithms incorporated in the program for ultrasound scanners.
Ultrasound, which produces a black and white image, is called two-dimensional. Sometimes it becomes necessary not only to inspect something, but also to evaluate the functionality. Such a need often arises when assessing the work of blood vessels. Then they do an ultrasound with a Doppler. Duplex examination gives a color picture. If desired, you can also carry out a color three-dimensional 3D ultrasound, but this is mainly necessary for pregnant women who want to know the gender and consider the appearance of the unborn child. Although it is not contraindicated for children, three-dimensional ultrasound is, in fact, unnecessary.
Varieties
Ultrasound is divided by purpose into emergency and planned. An emergency is carried out in order to establish an accurate diagnosis in the presence of objective complaints. Routine research is carried out as part of the mandatory screening recommended by the Ministry of Health - at 1 month, and then when the child is registered in an educational institution. A comprehensive screening study includes an ultrasound scan of the brain, hip joints, abdomen, bladder and kidneys.
When applying to an educational institution, a child undergoes an ultrasound of the heart, abdominal organs, kidneys and bladder. If necessary, ultrasound of the retroperitoneal space and superficially located organs - the thyroid gland, thymus gland (thymus), etc.
Let's talk about the main types in more detail.
Neurosonography
NSG is an ultrasound scan of the structures of the brain. An informative study is carried out for children from birth to the moment when the fontanelles tighten and close on the head. The mobility of the cranial bones and the presence of the so-called “fontanelles” make it possible to examine the brain structures with a sensor applied to the area of the large “fontanelle”. If an assessment of the blood supply to the brain is required - duplex scanning, the cervical spine and blood vessels of the neck are additionally examined with a sensor.
The method makes it possible to assess the symmetry of the hemispheres, the state of the cerebral cortex, individual parts of the organ that are important for normal development and functioning. By means of ultrasound, it is possible to establish ischemia, the presence of cerebral hemorrhage, hydrocephalus, expansion of the ventricles, neoplasms and edema. Also, neurosonographic examination is recommended after falling and hitting the head to exclude craniocerebral trauma.
It should be noted that the diagnosis is not made only on the basis of the ultrasound results. But the negative markers detected by an ultrasound diagnostic specialist will be a good reason for prescribing a more detailed and more informative brain examination for a child - computed tomography, MRI.
Abdominal organs
The abdominal organs are a large list of the most important internal organs. During the study, the condition of the liver, stomach, gallbladder and bile ducts, esophagus, pancreas, spleen, part of the intestinal loops, large vessels of the abdominal cavity, as well as the kidneys and the urinary bladder are assessed.
Not all anomalies, including congenital ones, immediately make themselves felt. Some in the early stages in babies practically do not appear in any way, and it will be possible to find out about their presence only with a careful ultrasound examination.
Preventive ultrasound is aimed at eliminating malformations of internal organs. Then the child may be prescribed this type of examination at any time if symptoms such as indigestion, frequent constipation or diarrhea, vomiting, bad breath, foreign matter in feces, abnormal urine color and pungent odor, impaired hemostasis, unexplained weight loss, or on the contrary, pathological weight gain.
Diagnosis is especially indicated for premature babies, babies born with low birth weight or very large babies. Problems with the digestive tract they have, according to statistics, much more often.
This type of ultrasound is characterized by the largest number of medical errors. Internal organs grow, while much depends on the weight and height of the baby, on concomitant diseases, therefore, the baby often has ailments that actually do not exist, and also do not see the beginning signs of pathologies.
Kidney and bladder
For a healthy child, a study of the abdominal organs, in which the kidneys and bladder are evaluated, will be sufficient. But sometimes situations arise when it is necessary to examine the urinary system. If the child has pain when urinating, changes in the amount and color of urine, the appearance of a pungent odor from the fluid secreted by the kidneys, when the temperature rises in combination with the listed symptoms, as well as in case of poor laboratory urine test results, the doctor will definitely recommend an ultrasound scan.
The study allows you to establish the structure of the kidneys, pelvis, their possible expansion, the state of the ureters and bladder. Certain changes in the echogenicity of the organs of the system will allow the doctor to judge the presence of inflammatory processes in a certain place of the urinary system, which will greatly facilitate the task of the doctor who will plan treatment.
Given the steady increase in the number of kidney diseases, the Ministry of Health has recently decided to add this type of ultrasound to the screening study for children not only in 1 month, but also in a year and a half.
Hip joints
This type of diagnosis is also included in the screening of infants, but can be prescribed outside of a routine examination if the orthopedist sees that the baby has problems with the maturation of the joints. Ultrasound allows you to establish the condition of the joint, the correctness of its location relative to the axis, the presence of subluxation, preluxation or dislocation.
If an orthopedist is able to see the general signs of pathology with the naked eye, then ultrasound can reveal the exact degree and form of dysplasia, which is important in therapeutic tactics.
In the case of HJ pathologies, timeliness is extremely important - the sooner deviations are detected, the more favorable the prognosis for a complete cure. Late diagnosis in case of mother's refusal from ultrasound as part of screening can lead to disability of the baby.
This type of ultrasound is of the greatest importance for premature babies, for babies born in families where relatives have joint pathologies, for children who preferred to sit on their bottom in their mother's belly - they were in breech presentation, as well as small residents of large cities with poor the state of the environment, children with birth injuries and twins and twins.
During the study, the sensor is applied to the joints on the right and left, with simultaneous flexion of the legs. It is painless and quite fast.
Other diagnostics
It is difficult to list in one article all the situations in which an ultrasound scan may be prescribed. So, if the testicles are not descended, boys are prescribed an ultrasound of the scrotum in combination with an ultrasound of the abdominal cavity and retroperitoneal space in order to establish the location of the sex glands. Girls can undergo an ultrasound scan of the pelvic organs if they suspect malformations of the internal genital organs, gynecological diseases of an inflammatory and non-inflammatory nature.
If the child is overweight, he may be shown a study of the thyroid gland, and with severe pallor and arrhythmia, an ultrasound of the heart and blood vessels is performed.
Parents should be aware that ultrasound does not give 100% accuracy. The maximum accuracy of this type of diagnosis is estimated at 80-95%. Therefore, the results of an ultrasound scan are not a verdict, but only a basis for further examination of the child, if necessary.
Training
Special training is not always required. Children's ultrasound differs from an adult in that a child cannot always lie down calmly and give the doctor the opportunity to carefully consider and describe everything. Therefore, the most important preparation is psychological. If the baby is at a reasonable age and can understand what his mother is explaining to him, it is imperative to tell the baby that the upcoming examination will not give him any pain or discomfort. Babies under one year old are best examined during sleep.
Before neurosonography, the child should be fed, well-fed and happy. The chances of such a baby falling asleep are higher. But an ultrasound of the abdominal cavity is recommended to be done on an empty stomach, since during the process of digestion, many organs of the gastrointestinal tract can change their shape and size. The only exception is ultrasound of the gallbladder, which is carried out with a load - the child needs to "start" the processes of bile formation and outflow, for which it is recommended to give him a choleretic breakfast - banana or sour cream.
Ultrasound diagnostics of the bladder requires pre-filling it - the child must be given a drink 15-20 minutes before visiting the doctor's office.
No preparation is required before ultrasound of the hip joints, before ultrasound of the scrotum.
In all other cases, doctors recommend to exclude foods that increase the amount and production of intestinal gases - legumes, cabbage, yeast baked goods - one day before visiting the doctor. Before ultrasound of the vessels, it is undesirable to take antispasmodic drugs, if they are not an obligatory component of the course of treatment prescribed for the child.
The nuances of diagnosis in childhood
From the point of view of the Ministry of Health, there is absolutely no difference between an ultrasound scan for an adult patient and a similar diagnosis for a child. Therefore, doctors who have received the appropriate education can do ultrasound for children. But an important nuance lies in the peculiarities of the physiology of children - their internal organs grow intensively, and therefore the age norm by a doctor who has received a conventional therapeutic education can be perceived as pathology. It is for this reason that it is recommended to do an ultrasound examination for a child in specialized children's medical centers and polyclinics where pediatricians work.
There are slight differences in the equipment itself. For ultrasound scanning of children, special pediatric sensors are used - their resolution is high, as is the frequency of radiation. Conventional sensors allow you to examine an internal organ at a distance of up to 30 centimeters from the point of application of the sensor. Children's sensors allow you to see an organ at a distance of up to 15 centimeters, but the quality of the resulting image will be much higher.
One and the same doctor, even if he is the owner of the highest professional category, is unlikely to be able to evaluate all internal organs and conduct all types of ultrasound with the same accuracy. That is why in specialized children's centers there is a so-called internal specialization - one doctor specializes in neurosonography, and knows everything about it, and the other is an excellent specialist in the field of ultrasound of the heart, and the best cardiologists trust his opinion. This is another argument in favor of undergoing ultrasound for children in special children's medical institutions.
In general, children's ultrasound requires a lot of experience from the doctor, attention, concentration, knowledge of the age characteristics of the development of internal organs, as well as a lot of patience and tact to answer the questions of worried parents.
Potential harm
This is the most important question for parents. Rumors that ultrasound is harmful sometimes force moms and dads to refuse the recommended examination, especially the screening one. In diagnostics, as follows from the description of the essence of the method, neither electromagnetic radiation nor X-ray X-waves are used, and therefore there is no reason to talk about the harm of ultrasound as such.
Information about the danger of diagnostics was not born out of nowhere - a young technique (it is just over 20 years old) does not yet have statistical data on the long-term consequences of ultrasound. The first children to have ultrasound scans are now just 20 years old or slightly older. For evidence-based medicine to obtain evidence of adverse effects, information is required on the health status of patients in adulthood and old age. So far, there is no data on the harm of the method. That is why ultrasound is recommended for pregnant women and infants.
Sometimes there is more harm from the parents' refusal to examine the child in this way, after all, the pathology remains unnoticed as long as it is severely neglected and any of its symptoms appear. So, after a series of official letters from pediatric oncologists, neurologists, surgeons, who are faced with such "neglected" cases, the Ministry of Health decided to introduce ultrasound diagnostics into complex screening studies.
About why it is necessary to do ultrasound for children of the first year of life, see below.
