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Recognition of HPTH in Infants and Children

by Hunter Heath III MD (USA)

The symptoms of hypoparathyroidism in infants and children are exclusively due to low blood calcium levels. There is no way for a parent to recognize low calcium levels in a child unless the symptoms or manifestations become rather striking. In families with known hereditary hypoparathyroidism, the obstetrician and the pediatrician should be alerted prior to the child's birth, and they will know what testing to do.

Low blood calcium levels early after birth are relatively common, particularly in premature infants and infants with diabetic mothers. If the low blood calcium is severe, the infants may have respiratory distress, periods of no breathing, low blood sugar, poor feeding, lethargy, and vomiting. Particularly in children with known hypoparathyroidism relatives, any or all of these symptoms suggest the need for measurement of blood calcium levels.

In older children, the symptoms of hypocalcemia may be more subtle. They include numbness and tingling of the lips, fingers and toes; feet going to sleep rapidly when sitting on the toilet or in unusual body positions (such as hanging an arm out of the car window or leaning on the back of a chair); muscular cramps; abdominal cramps and irritability. Exercise tolerance may be poor due to muscular cramping. In the most severe cases, there may be convulsions or seizures, often with loss of consciousness.

The full-blown manifestations of low blood calcium is "tetany," that is, spontaneous sustained contractions of the muscles of the upper and lower extremities. The classic sign is the stiffness of the hand with the fingers held straight but flexed at the first joint, the thumb drawn firmly into the palm, and the wrist flexed toward the arm. This position of the hands may be brought on during arm compression for determination of blood pressure. Spasm of the muscles of the throat can make breathing difficult.

Children born of healthy mothers without any prenatal complications are at very low risk of serious hypocalcemia. However, obstetricians and pediatricians generally know about the risk factors for hypoparathyroidism, and can advise concerned parents about the value of serum calcium measurement in a particular child.

Provided by Hunter Heath III, M.D.
Formally of the University of Utah
School of Medicine
Salt Lake City, Utah

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