Full Transcript Introduction and Dr. Rosatiu2019s Background 0:04 Hello, welcome to this week's episode of the Baby Manual Podcast. 0:08 Today, I have the pleasure of speaking with Dr. 0:10 Justin Rosati, MD, who is a pediatric neurologist. 0:15 Dr Rosatti, can you just tell us a little bit about yourself and pediatric Yeah, I'm a pediatric neurologist. 0:24 I actually have some specialty training in neonatal neurology and clinical neurophysiology, which means I can look at brain waves. 0:32 But yeah, i've been doing this for, oh God, now three full years as faculty. 0:39 And I am an assistant professor at the University of Rochester in the Department of Neurology. 0:46 That's really cool. 0:47 Well, awesome. 0:48 So can you just tell us about a couple of things that you see really commonly, like reasons that parents come to see you and things they can watch out 0:55 for at home? 0:57 Yeah, the things that I see most as a pediatric neurologist are seizures, developmental delays, concerns, headaches, and sometimes, 1:08 well, actually a lot of this is kind of overlap with its developmental delay, but motor weakness, gross motor delays. 1:15 Speaking speech delays things like that. 1:18 That's cool. 1:19 I know parents are often really worried about seizures and there are a lot of things that can look like seizures. 1:25 And also if a baby is having seizures, it can be pretty serious. 1:28 So maybe you can just tell parents a little bit about like what to look out for for infantile spasms, for example. 1:34 So seizures really depend, different seizure types for different ages.
Common Pediatric Neurology Concerns 1:39 Infantile spasms are definitely the one that we worry about most, especially in infancy, obviously the name infantile spacems. 1:47 Typically we see them around four months to eight months. 1:50 but they can go anywhere from two months to a year or even longer. 1:54 They are very different than the traditional seizures that people think about of like the shaking, loss of consciousness type of seizures, 2:04 whole body. 2:06 Actually, they look like startles and they could be very subtle, often involve flexion of the head and neck. 2:13 So I'm trying to demonstrate here. 2:15 But they come over and over, and their unprovoked. 2:19 We often see them in clusters. 2:21 So once they start, sometimes people notice them one or two here or there, but then as they go and develop, we start to see they're coming on in bunches. 2:33 One of the things that is particularly noticeable or concerning with infantile spasms is once the start we often notice a plateauing in development or 2:45 even some regression. 2:46 This is because the way infantile spasms work in the brain basically stops the brains from working correctly and we can really see this progression over, 2:56 you know, days to weeks and if not treated early, that progression can become more permanent. 3:03 And what are some things that sort of look like it? 3:05 So you mentioned it looks like startling but startle is okay and that is provoked by something like a sound.
Infantile Spasms and Seizure Warning Signs 3:12 Like I said, so startling, but these are unprovoked. 3:15 They can sometimes look like a condition that is benign, which is sleep myoclonus. 3:20 So if you've ever watched your baby go to sleep, you see them little jerks. 3:24 Actually, adults do this too. 3:26 And if started to fall asleep and feel like you're falling and jerk yourself awake. 3:30 That's what we call a hypnic jerk or sleep myoclonus. 3:35 Those are totally normal. 3:36 And if a baby is falling in and out of sleep, that's okay. 3:39 But these often come when babies are awake, usually sitting up, sometimes eating or doing things that would require them to have some level of consciousness. 3:49 So if you start to see that when they're doing other things, it's definitely something that is more concerning and something to look out for. 3:57 And then, like I said, an increase in the amount or coming in clusters is definitely something we look for. 4:05 One other thing that comes to mind is that when babies have reflux, sometimes they'll arch their backs and sometimes that can sort of mimic something that 4:12 looks like a seizure in adults and that's not a seizures as well. 4:16 Yeah, very common question we get. 4:20 And then a couple of things that can help you with that is if it's around the time of feeding, that's one. 4:25 Babies will often arch and they'll get red and it can have like coughing sounds. 4:29 That's two that kind of pushes you in the other direction. 4:33 Though there are some cases that are a little bit more difficult, especially when a baby turns red, and you're not sure if they're breathing or not. 4:40 My advice for any type of seizure or abnormal movement is if you can get a video of it, grab your phone, take a quick 30 seconds to just document what 4:50 you're seeing because that helps us a ton. 4:53 It'll help your pediatrician. 4:55 And it'll definitely help us as neurologists when you come to see us. 4:59 Yeah, that's great advice. 5:01 Now, febrile seizures are actual seizures as well. 5:05 Is that still six months to six years when we see that? 5:08 Yeah, primarily six months to six years. 5:11 If it happens before six month, we often think about other types of epilepsies. 5:17 And really the six-years, it should start to fade around six year. 5:21 It's very rare to have your first febrile seizure from five to 6. So we usually see them mostly around, I would say a year to three years, 5:32 that's when the peak of february seizures are. 5:35 They definitely start fade as kids get bigger. 5:39 Yeah, so a simple febrile seizure, maybe you could just sort of describe what that looks like and I know there's often a family history as well with that. 5:47 There's two types of febrile seizures. 5:48 We'll talk about simple febrale seizures first. 5:50 So, um, simple February seizures are short, generalized, and they, those are really the two characteristics. 6:00 Short being less than five minutes. 6:02 we sort of changed this definition over the last few years or so. 6:06 It used to be when I was a medical student, it was 15 minutes now we're down to five. 6:10 And generalized meaning the whole body is involved and it doesn't start like with one arm, one leg. 6:19 That then puts it into the classification of complex. 6:22 So complex febrile seizures are usually longer, so longer than five minutes in this case. 6:30 They typically have some sort of, and they could have a focal onset. 6:34 So if they start with one arm or one side of the face is moving and then generalizes into a full body seizure, that makes us think more complex. 6:43 And then the one other thing that could put them in the complex category, which is somewhat debatable depending on the neurologist you ask, 6:50 is if you've had more than one in 24 hours. 6:53 For me, the big thing is, if we've more that one without returning to your baseline, Now with simple febrile seizures, I know a lot of parents say, 7:01 it's very scary to watch your kid having a seizure. 7:04 So I always recommend if it does happen, look at the clock because five minutes can feel like a half hour.
Febrile Seizures: Types and What to Expect 7:11 Like it can be very, scary, to be in that moment. 7:15 But simple February seizures don't cause developmental delays. 7:19 They don' turn into epilepsy. 7:20 If they don''t cause any problems down the road, they, don ''t need medications for it, things like that. 7:26 I know sometimes for kids that would have more than one febrile seizure like months or years apart, we would sometimes give a rescue medicine for seizures. 7:33 Is that still done? 7:36 We tend to give the rescue medication mostly for those complex febrile seizures, especially for the long ones, because most seizures will stop on their 7:48 own within a few minutes. 7:49 It is rare for a seizure to go longer than five minutes into what we would then categorize as status epilepticus. 7:57 The reason that we would give a rescue medication, and we tend to do this more for our complex febrile seizure kids who will have, 8:05 when they have their february seizures, they tend be long, is to break that seizure. 8:11 Usually after three to five minutes, we'd recommend doing it so it doesn't end up being one of those long seizures. 8:18 A lot of people ask me, how do you prevent febrile seizures? 8:21 And unfortunately, kids will, if they're prone to having febrow seizures, they will just have them. 8:27 You can't really pre-medicate with Tylenol or ibuprofen to try to keep the child from getting a fever when they're sick, 8:36 because a couple of reasons why. 8:39 One is that a febrile seizure can happen 24 hours before or after a afeever. 8:45 So sometimes the seizure is actually the first sign that the child is sick. 8:49 And it's not uncommon that kid will have a seizure, come to the emergency department, And then we check their temperature and it's, 8:59 oh, it' 39 or 102. And we're like, Oh, yep, that was a febrile seizure. 9:05 It's not so much the height of the fever. 9:09 There are some kids that are just genetically predisposed. 9:12 The brain is really overly wired at that age. 9:17 So it doesn't take as much to have a seizure, but for the most part, like you said, they are usually not dangerous, and they do not cause any long-term 9:28 injury to the brain. 9:29 We usually also tell parents that if a child has had one febrile seizure, they are at higher risk than the general population of having another one. 9:38 But it doesn't mean that they're going to have one every time they have a fever. 9:41 They might just have 1, or they might have That's true. 9:47 There are some cases, most of the time, so with febrile seizures, it is unlikely that you're going to have one with every single time that your sick. 9:57 If you do, if children do have a fever every time they are sick, then sometimes we think about a little bit, you know, there are certain genetic conditions 10:07 that are very prone to febrale seizures. 10:10 And then there is a switch the moment you have your first seizure without a fever. 10:15 So once you a seizure that is not in the setting of a not sick, then you kind of, we think about it a little bit differently. 10:27 We don't always get EEGs or brainwave tests on kids with simple febrile seizures, but we often do it with kids, with complex february seizures. 10:36 And we will get one as soon as a child has a seizure without a fever. 10:42 So yeah, what other things do you think parents should know about? 10:44 I think ever since becoming a parent myself, development has been a thing that has an interesting change of pace. 10:57 I mean, I learned all kinds of things about development and I frequently see kids for developmental delays. 11:05 The big things that I like to tell people, because I do get referrals for kids who aren't meeting their milestones, and the milestone checklists are a 11:19 fantastic guide. 11:20 They do not necessarily mean there's something wrong with your child if they do no meet a milestone. 11:27 All of those milestones are ranges. 11:29 And when you or your when your child starts to either miss a milestone or is behind on a Milestone, there triggers a question of, 11:39 OK, why is this child delayed on their milestone? 11:42 And that's usually when they end up in my office. 11:45 So we look at things like low muscle tone. 11:48 We look At things. 11:49 Like, you know, was there an injury to their brain at some point, either around the time that they were born or in utero? 11:57 Is there a genetic condition going on? 11:59 A lot of times, I would say about half the time when kids come to see me for developmental delays, they have a totally normal neurologic examination and 12:11 it's just they need more time. 12:14 But then there's those kids who do need some further testing and work up, especially if they had low muscle tone or pretty significant delays. 12:25 And I think some of the red flags that are sort of general red flag to look out for, if a child has a hand preference before age two or is only using one 12:36 of their hands, that's something that you should ask the doctor about.
Developmental Delays and Early Red Flags 12:41 If they're only eating food that in pouches after a year, I get a little nervous about that because they should be at least trying to like chew and swallow 12:50 some foods at that point. 12:51 Do you have other sort red flags that you think there might be some like a neurologic cause of that? 13:00 Yeah, other red Flags are usually like lifting your head. 13:04 So head lag is a big one. 13:07 If you notice, like every time you're trying to pick your baby up there, usually after about four months, and they won't lift their head up. 13:14 Um, if they can't get their heads up off a tummy time after like two to three months. 13:20 That's, that's usually a concern for me. 13:23 The one that isn't a concern that I get asked about all the time is crawling. 13:27 Crawling is kind of a range. 13:29 Some kids will do it at like six months, some kids we'll do at 10 to 11 months. 13:37 And some kid will skip it altogether. 13:39 It's really if you have the skills around it. 13:42 So crawling is great at building core strength and being able to move around. 13:49 But other kids sometimes figure out other ways to do that. 13:53 And as long as they are building that strength and moving, then I worry a little bit less about it. 14:00 And a lot of different things count as crawling, right? 14:02 So it doesn't necessarily have to be all fours, typical crawling like their bum shuffle. 14:09 Yes. 14:10 Crawling backwards. 14:11 All those. 14:13 Yeah, we think about it more of locomotion, like how you get from A to B. 14:17 As long as you are able to get form A-to-B in some way, then that is a good sign. 14:23 Well, that's great, because those are, you gave us some signs that parents can look for really early on to look at baby's muscle tone to make sure everything 14:31 is going okay and went to ask their doctor. 14:33 One in 26 people have epilepsy, so it is a fairly common condition, and I tell parents this all the time because, you know, 14:39 whenever we do a new diagnosis of epilepsy we say, there's probably a kid in their classroom at school who has epilepsy. 14:47 And actually, like, even taking a step back, one in about 10 children, actually I think it's one and seven children will have a seizure at some point. 14:58 which is very common. 15:00 About 50% of kids, it's around 40 to 50%, will just have one seizure and never have a seizure again. 15:06 So if your child has a seizures, its not an automatic, they have epilepsy. 15:13 Usually once you've had multiple seizures then we consider you as having epilepsy Yeah, is it still two seizures kind of buys you an anti-epileptic medicine for? 15:22 Yeah, we say two unprovoked seizures. 15:25 So if there is another reason that we could say, oh, you had a seizure, so for example, if you're a diabetic and you have a really low blood sugar and 15:34 that triggered you to have the seizure. 15:36 We don't count that towards your two. 15:39 Infebrile seizures don't count. 15:41 Correct. 15:41 And febrial seizures are also a provoked seizure that we would not count, it's very common. 15:46 Once you have two, we will usually do some sort of evaluation. 15:50 Usually you would see a neurologist that usually involves a brainwave test, an EEG. 15:58 It may or may not involve imaging of your brain. 16:00 A lot of epilepsies are actually generalized and we call them idiopathic or genetic generalized epilepies. 16:10 These are ones like people often use the term grand mal or GTC is generalized tonic clonic. 16:18 Those are fairly common genetic epilepsy syndromes. 16:24 And just because they're genetic does not actually mean there's a gene. 16:26 So I should, you know, say that too. 16:29 We just think that they are genetic and most kids will outgrow those. 16:33 we typically do two years on a seizure medication. 16:37 and then after two of being on the seizure, medication, and you've been seizure free, we do a trial off. 16:45 And some kids just never need a seizure medication again. 16:47 The type of seizure that I get asked about a lot, especially in younger children, is staring spells or absence epilepsy. 16:56 A lot of overlap between absence, epilepsy and ADHD. 17:02 And both of those things can have staring spells. 17:04 And so I'll give kind of the what to look for. 17:07 So absinthe seizures, this is the one where kids stare off for a few seconds and then come back to what they're doing. 17:16 These are very brief, so usually five to 10 seconds max. 17:21 They will usually stop whatever they are doing stare straight ahead maybe stare slightly off and then come back to what they were doing like as if nothing happened. 17:33 It usually involves loss of time because during that these are generalized seizures so the whole brain is basically turned off for those five to ten seconds 17:42 so they will not remember anything during After the seizure, they go right back. 17:48 They don't have the typical postictal after like a generalized larger seizure with body shaking. 17:56 And they can sometimes have during the seizures things that we call automatisms. 18:02 So sometimes it can be like lip smacking.
Epilepsy Basics and Absence Seizures 18:07 eye blinking and sometimes like grimacing, sniffing, things that are seem like they're automatic and they seem odd. 18:17 And they might not remember that. 18:18 Then they go right back to doing what they are doing. 18:22 longer spells, so things that are a minute plus usually we are less concerned with. 18:31 And the one thing you can do as a parent or a teacher is, calling somebody's name for a staring spell doesn't really break them out of it, 18:39 even an inattentive one, but tapping on their forehead or even blowing into their eyes, if they blink and react, then you know it's not a seizure. 18:50 I get asked a lot about migraines. 18:52 Should we talk a little bit about my grains? 18:53 And I know like abdominal migraine is a new thing and cyclic vomiting syndrome, not that it's a thing that exists, but a knew like name for it. 19:05 Yeah. 19:07 Migraines are super common. 19:08 About one in five people have migrains, so it is one of the more common neurologic conditions. 19:16 In general, a migraine for our classic definition is usually a unilateral headache. 19:22 It could be both sides, but usually starts unilaterally. 19:25 it's a throbbing type of headache, It often comes with what we call photophobia, so sensitivity to lights. 19:33 Bonophobia sensitivity, to sounds. 19:36 Nausea can sometimes have vomiting. 19:39 They last usually like half an hour to a couple of hours and they often are treated pretty well by just ibuprofen. 19:52 I think there is often a misunderstanding about migraine. 20:00 Migraine is a type of headache, not the severity of the headache. 20:03 As a neurologist, I hear this all the time, a parent will come in with a child who is describing a migrain headache and then I'll ask the parents because 20:15 they are typically genetic. 20:16 I said, do you have migraines? 20:17 And they say no. 20:19 and the visit will go on and they were like, well, I get like normal headaches. 20:24 And I'm like well you also have migraines. 20:27 There's no such thing as a normal headache. 20:31 Growing up I have my migraine myself and I had no idea I'd had migrane until medical school because my mom was always like oh yeah, 20:38 we just get headaches, that's just like a thing. 20:42 It's funny me too actually. 20:43 Yeah, same thing, figured it out in medical. 20:50 But it happens to children. 20:52 Oh yeah. 20:53 I think once a year I diagnose like a handful of medical students with migraines because we'll talk about migraine and they'll be like, 21:00 I don't have migranes and then they will describe their headaches to me and I'm like you have Um, but yeah, so, uh, and then there's migraines with aura, 21:10 um, which various auras. 21:14 So the most common when we hear about is the visual aura, spots, wavy lines. 21:20 Sometimes some people see like flashes of color. 21:23 Um then, there are the more sensory auras. 21:25 And sometimes you'll get tingles down a, down an arm or a leg before, or a headache. 21:31 Usually the auras are before, but they can be like during the beginning of the headache and then there are the more severe kind of hemiplegic type migraines 21:40 where you can actually have weakness of like whole side of your body. 21:43 Those are typically genetic, those we absolutely look into a little bit more. 21:49 But interestingly, in kids, so we talk about migraines, most of the time we think about it's very hard to describe this kind of headache. 21:56 But in Kids, there are a lot of things that we've actually found turn into migraine. 22:03 So like you brought up abdominal migrain, cyclic vomiting, car sickness. 22:10 I had that when I was a kid. 22:13 There you go. 22:14 Even colic has been tied to migraines. 22:19 I mean, these are not like one-to-one like a kid with coli will have it. 22:22 But looking back, like, a lot of people with migraine had colics as babies and the rates are just higher. 22:29 There are a couple of weird things in in late infancy, early toddlerhood that can be precursor to migraines. 22:37 So there's a condition called benign paroxysmal torticollis, where suddenly a kid will just turn their head to the side and could last like an hour. 22:48 And it's like, what is going on? 22:50 And actually, they're having sort of this vestibular syndrome that they are trying to correct for. 22:58 The other is a condition called paroxysmal vertigo of childhood. 23:04 It's also very scary. 23:06 Kids, usually toddlers, will suddenly be unable to walk. 23:10 They can have nystagmus or their eyes can be shaking and they will vomit with this. 23:16 And they just will turn pale. 23:19 And they, we, a lot of times we end up admitting children with like this because it can be very scary when it first happens. 23:29 But these, these syndromes often if you have, so if have cyclic vomiting, if see these paroxysmal vertigo, there's a family history,
Migraines, Aura, and Childhood Variants 23:38 strong family story of migraines. 23:40 We will sometimes treat it as migraine headache and see if that actually makes things better. 23:45 Yeah, with those sorts of syndraumes, do you end supportively with like medicines that help with the nausea and vomiting and Yeah. 23:57 Usually in the young kids, we'll try acetaminophen and ibuprofen. 24:01 Um, sometimes we will add like an anti-nausea medication as well. 24:06 Some anti nausea medications actually work really well for migraines and even in absence of, um, some of those, uh, pain, 24:16 typical pain relieving medications. 24:19 Like Zofran, right? 24:21 Yeah, Zofran compazine actually works really well. 24:26 But also for car sickness, right? 24:28 Yes. 24:29 Yes, it's one of those like, yeah, hits all the other receptors in the brain and the gut to help. 24:35 Yeah. 24:36 It's all that. 24:37 A little bit of all those serotonin receptors. 24:42 For kids for older kids will sometimes use a board, we can use the mixture of a Board of Medications like triptan so like it attracts, 24:50 and then for for younger kids. 24:53 We don't really have as many options. 24:57 We typically don't do daily migraine medications unless the migraines are to the point where they are becoming debilitating. 25:07 In kids under the age of 10 or so, we don' have that many options. 25:12 The main stay option that we use is usually superheptadiene periactin. 25:16 It's an appetite stimulator, but it also works on all those serotonin receptors, so it does do really well. 25:25 With migraines and children, we tend to start with some of the basic, what we call lifestyle interventions. 25:33 So the big five, I would say, are sleep, hydration, nutrition, caffeine, and exercise. 25:42 And that would be getting enough sleep. 25:45 Especially kids, usually in the adolescent era, start to not sleep as well. 25:52 School schedules. 25:54 kind of change, circadian rhythms change. 25:56 And so there's often not as much sleep. 25:59 Devices, social media, those kinds of things also add to that. 26:04 So we usually say make sure that kids don't have their phones or devices when they're going to bed. 26:10 Eating three, nutrition, not so much as like, you know, eating the right foods, but just eating consistently. 26:16 I would say the biggest trigger I see for a lot of kids is they don't eat breakfast in the morning. 26:22 Some kids don t even eat lunch at school. 26:25 how they make it through the day. 26:26 But that is a big thing. 26:29 And then not drinking enough water, I would say like most teenagers, especially are just dehydrated all the time. 26:37 Kids in general dehydrate all time, you know, do they not want to go to the bathroom at school? 26:41 There's usually a multitude of reasons, but just making sure they have a water bottle is a key. 26:47 And then drinking too much caffeine. 26:49 Caffeine can help with headaches. 26:51 It's interesting, a lot of elevated counter headache medicines have caffeine in them. 26:56 But if you overuse it, not only does it affect your sleep, it also causes a dependency on the caffeine and so you'll start having overused headaches, 27:06 you have chronic daily headaches that are a little different. 27:09 Just improving exercise tends to be good for everybody. 27:12 Thank you so much. 27:13 Is there any other things we should talk about? 27:15 I feel like we covered. 27:17 I'll give you my little spiel on head trauma in toddlers so that way we cover it. 27:21 But because I get asked about this all the time, when do you need to worry about your kid hitting their head? 27:29 I usually tell this to a lot of my parents all of the times. 27:32 Toddlers fall and older kids fall, and they hit their heads a lots. 27:36 And I always say the skull is hard for a reason. 27:41 There's a couple of red flags that you do need think about. 27:43 This is bring them to the hospital. 27:46 Like just get them checked out immediately is one if they lose consciousness. 27:50 So if their head and they are out cold That is something that you need to check on if They hit their and and are then nauseous and vomit afterwards. 28:03 That's something you should probably get checked and then the third one is just change in their So sometimes there will be a head injury and maybe they're 28:13 dazed and a little out of it. 28:14 If that persists, that's definitely something you should check on. 28:19 Most head injuries, they can cause some headaches, potentially lead to concussions. 28:25 But concussion is an interesting thing because it's not the degree of the head-injury. 28:34 So anybody can get a concusion with a small head, injury versus a large head. 28:39 So that's not really what we worry about. 28:40 We worry more about, did they hit their head hard enough that they caused some bleeding in the brain? 28:46 And if there is, do we need to act on it? 28:51 That's one thing to really make sure of. 28:55 If a child falls, hits their head, cries for a minute, but keeps going and they're back to themselves, you can just kind of watch them and make sure they 29:04 are okay. 29:04 Also, old wives tell that if you hit your head you need to keep somebody awake. 29:10 That's actually bad for head injuries. 29:14 As long as they didn't pass out to begin with, then you don't have to like keep them up all night to make they aren't going to. 29:22 A lot of kids do get tired after a head injury.
Head Injuries in Toddlers and When to Worry 29:25 They cry a lot and then they're wiped out and they want to sleep. 29:27 So yeah, let them rest. 29:30 With the vomiting, I tell parents two or more times, just because also a lot of young children, so like, toddlers fall down the stairs I feel like all 29:38 the time or have similar type of falls and they'll cry and sometimes they get so upset while they're crying, they like gulp air and throw up. 29:44 So if it's that sort of a thing, that's like two more or times because one time could a lotta times just be that, if they are so up that they threw up Yeah, 29:52 I tend to more think like if they're dazed and out of it and they just start vomiting, yeah, that's a little bit more scary than the hyperventilating. 29:59 I can't breathe and then, oh, throwing up. 30:02 Yeah. 30:03 And then also if their walking crooked or using one side of their body differently than they have a sudden personality change after a head injury, 30:10 those are all kind of red flags they tell parents to watch out for. 30:14 I have learned that if a head injury is going to come with serious symptoms, it's always in the first 24 hours and typically in first six. 30:22 Is that still a good guideline? 30:25 Yeah, that's generally the guidelines that we use. 30:28 We often will, even if there is a head bleed inside the head for whatever reason, like a hematoma, hemorrhage, whatever, 30:38 we typically will make sure that there's at least six hours of stability on imaging before we will say that it's stopped doing what it is doing. 30:48 But yeah, it that is pretty good. 30:51 So yeah, if it happens at bedtime, maybe be safe and get it checked out or at least sleep in the same room as your child in case they are vomiting in middle 30:59 of the night. 31:00 I feel like we covered like the entirety of pediatric neurology. 31:03 This is amazing. 31:03 Oh, I for only if only, oh my goodness. 31:09 But no, I'll give you some closing recommendations and this is just anything neurologic because we see a lot of weird movements. 31:16 We see. 31:16 A lot. 31:17 Of concerns always video, whatever you're concerned about. 31:20 It is we live in an era where we have video machines in our pockets, which is what previous generations didn't have. 31:26 So. 31:27 If it's a funny walk, if it is a weird behavior, it it a staring spell, something that's concerning for a seizure for you, 31:35 just videotape it. 31:37 It helps us immensely when you come in for visit. 31:41 People often, I can't tell you how many times, you see something and then you try to explain it and your explanation just changes and changes over time,
Final Advice: Record Concerning Symptoms 31:50 especially as you're telling different people. 31:53 and it is just way more helpful if we see exactly what you are worried about. 31:58 Awesome. 31:59 Well, thanks. 32:00 Everyone here, you should follow Dr. 32:02 Vasadi on social media. 32:03 That is where we first met in the first place, so we'll put some links below that people can find you. 32:08 You have so many amazing videos that are a minute long that just give so much information all at once. 32:15 Thank you so for being here. 32:16 This is really a pleasure. 32:17 And thank you for having me. 32:19 I hope we covered enough for your listeners. 32:23 Awesome, well, take care. 32:43 and you can also check out my YouTube channel. 32:45 I have lots of videos and shorts that will help you feel empowered as a new parent as I talk about all the common stuff that comes up in the first couple 32:51 of years of life. 32:52 Thank you so much. 32:53 Have a wonderful day.
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