Increased intracranial pressure (ICP) in children - symptoms, diagnosis, treatment

What is increased intracranial pressure?

Inside the brain there is a system of interconnected ventricles, which are also filled with cerebrospinal fluid (CSF). This protects the human brain from injuries, concussions, as much as possible. The pressure of cerebrospinal fluid on brain structures is called intracranial pressure. Exceeding the permissible norms entails a number of consequences.

The main question for parents is what are the signs of intracranial pressure in a child, and what threat does this pose to the child?

What complications can there be in children? If left untreated, increased intracranial pressure can lead to the following consequences: the occurrence of epileptic syndrome, blurred vision, mental disorders, strokes, disorders of consciousness, breathing problems, weakness in the limbs, etc.

What should parents of a child with this diagnosis know? ICP is not a disease, but only a symptom, a consequence of various diseases. There are several misconceptions among parents regarding increased intracranial pressure. For example, the fact that this is an incurable condition. However, with timely treatment, the child’s recovery is possible. The main thing that needs to be done is to consult a specialist in time and follow the doctor’s instructions.

Facts and misconceptions of perinatal neurology

neurologist S.V. Zaitsev

Key words: perinatal encephalopathy (PEP) or perinatal damage to the central nervous system (PP CNS), hypertensive-hydrocephalic syndrome (HHS); dilatation of the cerebral ventricles, interhemispheric fissure and subarachnoid spaces, pseudocysts on neurosonography (NSG), muscular dystonia syndrome (MSD), hyperexcitability syndrome, perinatal convulsions.

It turns out... more than 70-80%! Children of the first year of life come for consultation to neurological centers about a non-existent diagnosis - perinatal encephalopathy (PEP):

Child neurology is a relatively new field, but is already going through difficult times. At the moment, many doctors practicing in the field of infant neurology, as well as parents of infants with any changes in the nervous system and mental sphere, find themselves “between two fires.” On the one hand, the school of “Soviet child neurology” is excessive diagnosis and incorrect assessment of functional and physiological changes in the nervous system of a child in the first year of life, combined with long-outdated recommendations for intensive treatment with a variety of medications. On the other hand, there is often an obvious underestimation of existing psychoneurological symptoms, ignorance of general pediatrics and the fundamentals of medical psychology, some therapeutic nihilism and fear of using the potential of modern drug therapy; and as a result - lost time and missed opportunities. At the same time, unfortunately, a certain (and sometimes significant) “formality” and “automaticity” of modern medical technologies lead, at a minimum, to the development of psychological problems in the child and his family members. The concept of “norm” in neurology at the end of the 20th century was sharply narrowed; now it is intensively and not always justifiably expanding. Probably the truth is somewhere in the middle...

According to data from the Perinatal Neurology Medical Clinic and other leading medical centers in Moscow (and probably in other places), so far, more than 80%!!! Children in their first year of life are referred by a pediatrician or neurologist from a district clinic for a consultation regarding a non-existent diagnosis - perinatal encephalopathy (PEP):

The diagnosis of “perinatal encephalopathy” (PEP) in Soviet child neurology very vaguely characterized almost any dysfunction (and even structure) of the brain in the perinatal period of a child’s life (from about 7 months of intrauterine development of the child and up to 1 month of life after childbirth), arising as a result pathologies of cerebral blood flow and oxygen deficiency.

Such a diagnosis was usually based on one or more sets of any signs (syndromes) of a possible disorder of the nervous system, for example, hypertensive-hydrocephalic syndrome (HHS), muscular dystonia syndrome (MDS), hyperexcitability syndrome.

After conducting an appropriate comprehensive examination: clinical examination in combination with analysis of data from additional research methods (ultrasound of the brain - neurosonography) and cerebral circulation (Dopplerography of cerebral vessels), fundus examination and other methods, the percentage of reliable diagnoses of perinatal brain damage (hypoxic, traumatic, toxic-metabolic, infectious) is reduced to 3-4% - this is more than 20 times!

The most bleak thing about these figures is not only a certain reluctance of individual doctors to use the knowledge of modern neurology and conscientious delusion, but also a clearly visible psychological (and not only) comfort in the pursuit of such “overdiagnosis.”

Hypertension-hydrocephalic syndrome (HHS): increased intracranial pressure (ICP) and hydrocephalus

Until now, the diagnosis of “intracranial hypertension” (increased intracranial pressure (ICP)) is one of the most commonly used and “favorite” medical terms among pediatric neurologists and pediatricians, which can explain almost everything! and at any age, complaints from parents.

For example, a child often cries and shudders, sleeps poorly, spits up a lot, eats poorly and gains little weight, eyes widen, walks on tiptoes, his arms and chin tremble, there are convulsions and there is a lag in psycho-speech and motor development: “it’s only his fault - increased intracranial pressure." Isn't that a convenient diagnosis?

Quite often, the main argument for parents is “heavy artillery” - data from instrumental diagnostic methods with mysterious scientific graphs and figures. Methods can be used either completely outdated and uninformative / echoencephalography (ECHO-EG) and rheoencephalography (REG) /, or examinations “from the wrong opera” (EEG), or incorrect, in isolation from clinical manifestations, subjective interpretation of normal variants during neurosonodopplerography or tomography.

Unhappy mothers of such children unwittingly, at the suggestion of doctors (or voluntarily, feeding on their own anxiety and fears), pick up the flag of “intracranial hypertension” and for a long time end up in the system of monitoring and treatment of perinatal encephalopathy.

In fact, intracranial hypertension is a very serious and quite rare neurological and neurosurgical pathology. It accompanies severe neuroinfections and brain injuries, hydrocephalus, cerebrovascular accidents, brain tumors, etc.

Hospitalization is mandatory and urgent!!!

Intracranial hypertension (if it really exists) is not difficult for attentive parents to notice: it is characterized by constant or paroxysmal headaches (usually in the morning), nausea and vomiting not associated with food. The child is often lethargic and sad, is constantly capricious, refuses to eat, he always wants to lie down and cuddle with his mother.

A very serious symptom can be strabismus or difference in pupils, and, of course, disturbances of consciousness. In infants, bulging and tension of the fontanelle, divergence of the sutures between the bones of the skull, as well as excessive growth of the head circumference are very suspicious.

Without a doubt, in such cases the child must be shown to specialists as soon as possible. Quite often, one clinical examination is enough to exclude or preliminarily diagnose this pathology. Sometimes additional research methods are required (fundus examination, neurosonodopplerography, computed tomography or magnetic resonance imaging of the brain)

Of course, expansion of the interhemispheric fissure, cerebral ventricles, subarachnoid and other spaces of the cerebrospinal fluid system on neurosonography (NSG) images or brain tomograms (CT or MRI) cannot serve as evidence of intracranial hypertension. The same applies to cerebral blood flow disorders isolated from the clinic, identified by vascular Dopplerography, and “finger impressions” on a skull x-ray

In addition, there is no connection between intracranial hypertension and translucent vessels on the face and scalp, walking on tiptoes, trembling hands and chin, hyperexcitability, developmental disorders, poor academic performance, nosebleeds, tics, stuttering, bad behavior, etc. and so on.

That’s why, if your baby has been diagnosed with “PEP, intracranial hypertension”, based on “goggle” eyes (Graefe’s symptom, “setting sun”) and walking on tiptoes, then you shouldn’t go crazy in advance. In fact, these reactions may be characteristic of easily excitable young children. They react very emotionally to everything that surrounds them and what happens. Attentive parents will easily notice these connections.

Thus, when diagnosing PEP and increased intracranial pressure, it is naturally best to contact a specialized neurological clinic. This is the only way to be sure of the correct diagnosis and treatment.

It is absolutely unreasonable to begin treatment of this serious pathology on the recommendations of one doctor based on the above “arguments”; in addition, such unreasonable treatment is not at all safe.

Just look at the diuretic drugs that are prescribed to children for a long time, which has an extremely adverse effect on the growing body, causing metabolic disorders.

There is another, no less important aspect of the problem that must be taken into account in this situation. Sometimes medications are necessary and the wrongful refusal of them, based only on the mother’s (and more often than not the father’s) own conviction that medications are harmful, can lead to serious troubles. In addition, if there really is a serious progressive increase in intracranial pressure and the development of hydrocephalus, then often incorrect drug therapy for intracranial hypertension entails the loss of a favorable moment for surgical intervention (shunt surgery) and the development of severe irreversible consequences for the child: hydrocephalus, developmental disorders, blindness , deafness, etc.

Now a few words about the equally “adored” hydrocephalus and hydrocephalic syndrome. In fact, we are talking about a progressive increase in intracranial and intracerebral spaces filled with cerebrospinal fluid (CSF) due to the existing! at that moment of intracranial hypertension. In this case, neurosonograms (NSG) or tomograms reveal dilations of the ventricles of the brain, interhemispheric fissure and other parts of the cerebrospinal fluid system that change over time. Everything depends on the severity and dynamics of the symptoms, and most importantly, on the correct assessment of the relationships between the increase in intracerebral spaces and other neural changes. This can be easily determined by a qualified neurologist. True hydrocephalus, which does require treatment, like intracranial hypertension, is relatively rare. Such children must be observed by neurologists and neurosurgeons at specialized medical centers.

Unfortunately, in ordinary life such an erroneous “diagnosis” occurs in almost every fourth or fifth baby. It turns out that some doctors often incorrectly call a stable (usually slight) increase in the ventricles and other cerebrospinal fluid spaces of the brain hydrocephalus (hydrocephalic syndrome). This does not manifest itself in any way through external signs or complaints and does not require treatment. Moreover, if the child is suspected of having hydrocephalus based on a “large” head, translucent vessels on the face and scalp, etc. - this should not cause panic among parents. The large size of the head in this case plays practically no role. However, the dynamics of head circumference growth is very important. In addition, you need to know that among modern children it is not uncommon to have so-called “tadpoles” whose heads are relatively large for their age (macrocephaly). In most of these cases, infants with large heads show signs of rickets, less often macrocephaly due to the family constitution. For example, dad or mom, or maybe grandpa has a big head, in a word, it’s a family matter and doesn’t require treatment.

Sometimes, when performing neurosonography, an ultrasound doctor finds pseudocysts in the brain - but this is not a reason to panic at all! Pseudocysts are single round tiny formations (cavities) containing cerebrospinal fluid and located in typical areas of the brain. The reasons for their appearance, as a rule, are not reliably known; they usually disappear by 8-12 months. life. It is important to know that the existence of such cysts in most children is not a risk factor for further neuropsychic development and does not require treatment. However, although quite rare, pseudocysts form at the site of subependymal hemorrhages, or are associated with perinatal cerebral ischemia or intrauterine infection. The number, size, structure and location of cysts provide specialists with very important information, taking into account which, based on a clinical examination, final conclusions are formed.

Description of NSG is not a diagnosis! and not necessarily a reason for treatment.

Most often, NSG data provide indirect and uncertain results, and are taken into account only in conjunction with the results of a clinical examination.

Once again, I remind you of the other extreme: in difficult cases, sometimes there is a clear underestimation on the part of parents (less often, doctors) of the child’s problems, which leads to a complete refusal of the necessary dynamic observation and examination, as a result of which the correct diagnosis is made late, and treatment does not lead to the desired result.

Undoubtedly, therefore, if increased intracranial pressure and hydrocephalus are suspected, diagnosis should be carried out at the highest professional level.

What is muscle tone and why is it so “loved”?

Look at your child’s medical record: is there no such diagnosis as “muscular dystonia”, “hypertension” and “hypotension”? — you probably just didn’t go with your baby to the neurologist’s clinic until he was a year old. This is, of course, a joke. However, the diagnosis of “muscular dystonia” is no less common (and perhaps more common) than hydrocephalic syndrome and increased intracranial pressure.

Changes in muscle tone can be, depending on the severity, either a variant of the norm (most often) or a serious neurological problem (this is much less common).

Briefly about external signs of changes in muscle tone.

Muscular hypotonia is characterized by a decrease in resistance to passive movements and an increase in their volume. Spontaneous and voluntary motor activity may be limited; palpation of the muscles is somewhat reminiscent of “jelly or very soft dough.” Severe muscle hypotonia can significantly affect the rate of motor development (for more details, see the chapter on movement disorders in children of the first year of life).

Muscular dystonia is characterized by a condition where muscle hypotonia alternates with hypertension, as well as a variant of disharmony and asymmetry of muscle tension in individual muscle groups (for example, more in the arms than in the legs, more on the right than on the left, etc.)

At rest, these children may experience some muscle hypotonia during passive movements. When trying to actively perform any movement, during emotional reactions, when the body changes in space, muscle tone increases sharply, pathological tonic reflexes become pronounced. Often, such disorders subsequently lead to improper development of motor skills and orthopedic problems (for example, torticollis, scoliosis).

Muscular hypertension is characterized by increased resistance to passive movements and limitation of spontaneous and voluntary motor activity. Severe muscle hypertension can also significantly affect the rate of motor development.

Violation of muscle tone (muscle tension at rest) can be limited to one limb or one muscle group (obstetric paresis of the arm, traumatic paresis of the leg) - and this is the most noticeable and very alarming sign, forcing parents to immediately consult a neurologist.

It is sometimes quite difficult for even a competent doctor to notice the difference between physiological changes and pathological symptoms in one consultation. The fact is that changes in muscle tone are not only associated with neurological disorders, but also strongly depend on the specific age period and other characteristics of the child’s condition (excited, crying, hungry, drowsy, cold, etc.). Thus, the presence of individual deviations in the characteristics of muscle tone does not always cause concern and require any treatment.

But even if functional disorders of muscle tone are confirmed, there is nothing to worry about. A good neurologist will most likely prescribe massage and physical therapy (exercises on large balls are very effective). Medicines are prescribed extremely rarely.

Hyperexcitability syndrome

(syndrome of increased neuro-reflex excitability)

Frequent crying and whims with or without cause, emotional instability and increased sensitivity to external stimuli, sleep and appetite disturbances, excessive frequent regurgitation, motor restlessness and shuddering, trembling of the chin and arms (etc.), often combined with poor growth weight and bowel dysfunction - do you recognize such a child?

All motor, sensitive and emotional reactions to external stimuli in a hyperexcitable child arise intensely and abruptly, and can fade away just as quickly. Having mastered certain motor skills, children constantly move, change positions, constantly reach for and grab objects. Children usually show a keen interest in their surroundings, but increased emotional lability often makes it difficult for them to communicate with others. They are very impressionable, emotional and vulnerable! They fall asleep extremely poorly, only with their mother, they constantly wake up and cry in their sleep. Many of them have a long-term reaction of fear when communicating with unfamiliar adults with active reactions of protest. Typically, hyperexcitability syndrome is combined with increased mental exhaustion.

The presence of such manifestations in a child is just a reason to contact a neurologist, but in no case is it a reason for parental panic, much less drug treatment.

Constant hyperexcitability is not causally specific and can most often be observed in children with temperamental characteristics (for example, the so-called choleric type of reaction).

Much less frequently, hyperexcitability can be associated and explained by perinatal pathology of the central nervous system. In addition, if a child’s behavior is suddenly disrupted unexpectedly and for a long time for virtually no apparent reason, and he or she develops hyperexcitability, the possibility of developing an adaptation disorder reaction (adaptation to external environmental conditions) due to stress cannot be ruled out. And the sooner the child is examined by specialists, the easier and faster it is possible to cope with the problem.

And, finally, most often, transient hyperexcitability is associated with pediatric problems (rickets, digestive disorders and intestinal colic, hernia, teething, etc.).

There are two extremes in the tactics of monitoring such children. Or an “explanation” of hyperexcitability using “intracranial hypertension” and intense drug treatment often using drugs with serious side effects (diacarb, phenobarbital, etc.). Or complete neglect of the problem, which can subsequently lead to the formation of persistent neurotic disorders (fears, tics, stuttering, anxiety disorders, obsessions, sleep disorders) in the child and his family members, and will require long-term psychological correction.

Of course, it is logical to assume that an adequate approach is somewhere in between...

Separately, I would like to draw the attention of parents to seizures - one of the few disorders of the nervous system that really deserves close attention and serious treatment. Epileptic seizures do not occur often in infancy, but they are sometimes severe, insidious and disguised, and immediate drug therapy is almost always necessary.

Such attacks can be hidden behind any stereotypical and repetitive episodes in the child’s behavior. Incomprehensible shudders, head nods, involuntary eye movements, “freezing,” “squeezing,” “limping,” especially with a fixed gaze and lack of response to external stimuli, should alert parents and force them to turn to specialists. Otherwise, a late diagnosis and untimely prescribed drug therapy significantly reduce the chances of treatment success.

All circumstances of the seizure episode must be accurately and completely remembered and, if possible, recorded on video for further detailed description at the consultation. If convulsions last a long time or are repeated, call “03” and urgently consult a doctor.

At an early age, the child’s condition is extremely changeable, so developmental deviations and other disorders of the nervous system can sometimes be detected only during long-term dynamic monitoring of the baby, with repeated consultations. For this purpose, specific dates for planned consultations with a pediatric neurologist in the first year of life have been determined: usually at 1, 3, 6 and 12 months. It is during these periods that most serious diseases of the nervous system of children in the first year of life can be detected (hydrocephalus, epilepsy, cerebral palsy, metabolic disorders, etc.). Thus, identifying a specific neurological pathology in the early stages of development makes it possible to begin complex therapy on time and achieve the maximum possible result.

And in conclusion, I would like to remind parents: be sensitive and attentive to your kids! First of all, it is your meaningful participation in the lives of children that is the basis for their future well-being. Do not treat them for “supposed illnesses,” but if something worries and concerns you, find the opportunity to get independent advice from a qualified specialist.

Symptoms of increased intracranial pressure

Increased intracranial pressure in children, symptoms of which can appear in the first minutes and hours after birth, often leads to the development of serious complications.

When parents may suspect something is wrong:

In young children:

The baby constantly cries and does not calm down;
Lack of thirst in the child, reluctance to drink;
The baby is irritated by bright lights and sharp sounds;
The child burps frequently and profusely;
The baby's fontanel bulges;
The baby's chin is shaking;
Rapid head growth (this is due to stagnation of venous blood);
The child throws his head back.

In older children

Severe headaches;
Nausea, vomiting;
Increased fatigue, weakness;
Drowsiness;
Tearfulness, irritability;
Apathy;
Double vision.

Knowing the key signs of the disease, you can establish the correct diagnosis in the early stages and prescribe the correct treatment for your child. Even if you have only one of the listed symptoms, you need to immediately contact a neurologist! The sooner your baby receives help, the fewer consequences it will have for the child’s body in the future.

general information

In recent years, the frequency of cases of ICP in childhood has increased sharply, but this is due to the development of examination methods, which has led to overdiagnosis based on indirect symptoms. It is important to understand that intracranial hypertension cannot be an independent diagnosis and is only one of the signs.

In children, due to the structural features of the cranium, pressure inside the skull is a relative concept, and even the identification of signs of pathology on ultrasound without the presence of other symptoms does not indicate the presence of the disease. Any deviations in the structure inside the head may be normal if there are no complaints or signals of brain damage.

Diagnosis of intracranial pressure

Before prescribing treatment for your child, we perform a comprehensive neurological examination. It includes:

Collecting anamnesis (conversation with the mother, studying the child’s medical record, history of pregnancy and childbirth and the results of previous studies);
special neurological tests;
active and muscle tests;
reflex diagnostics;
local palpation examination of the spine and musculoskeletal system.

In addition to the main examination, if necessary, the doctor may prescribe:

NSG (neurosonography, ultrasound of the brain);
MRI;
Ultrasound;
X-ray;
Lab tests;
EEG;

Prevention

In order to normalize intracranial pressure, preventive measures should be taken.

It is recommended to adhere to the following rules:

Adhere to the healthy lifestyle your child needs. Feed him in a timely manner and put him back to bed.
Be sure to ventilate the room from time to time.
Create a loving atmosphere in your home to give your baby positive emotions.
Always use breast milk, which contains all the nutrients your baby needs.

To prevent negative consequences from high intracranial pressure, it is necessary to monitor any changes and manifestations in the child’s behavior. At the first suspicion, contact your doctor for advice. If the fears are confirmed, it will be possible to start treatment earlier and avoid unnecessary problems.

Treatment of intracranial pressure

To treat our little patients, we use only painless, gentle treatment methods that do not cause discomfort to the baby.

We use methods:

Transcranial micropolarization (TCMP) is the effect of a low-power direct electric current (less than 1 mA) on brain tissue in order to activate individual brain centers (speech, motor, psychomotor, etc.);
Manual therapy;
Osteopathy - treatment by the hands of a doctor, a gentle effect on the musculoskeletal system, nervous and vascular systems, internal organs;
Acupuncture - exposure to biologically active points with microneedles;
Pharmacopuncture - the introduction of medicinal drugs of natural origin to the source of the problem;
Isometric kinesiotherapy - individual gymnastic techniques/exercises, according to indications, with elements of joint massage;
Isometric kinesiotherapy using the Exart installation;
Ozone therapy - treatment with active oxygen;
Physiotherapy;
Physiotherapy with enzyme preparations;
Medical massage;
Therapeutic droppers;
Hirudotherapy - treatment with leeches;
Botulinum therapy - treatment with botulinum toxin;
Tsubotherapy is a gentle effect on the reflex points of the body.

Remember that with increased intracranial pressure in children, treatment should be comprehensive, individual and under the supervision of a doctor.

Diagnosis of the disease in children

The need and type of treatment for the baby is prescribed only after a detailed medical examination of the signs and causes of the disease.

If you encounter one of the symptoms listed above, be sure to consult a neurologist!

The research proceeds as follows:

Oral diagnosis (clarification of prenatal, birth and postpartum features of the baby’s life course).
Superficial examination (head measurement, checking reactions, muscle tone...).
Carrying out a procedure to measure intracranial pressure (neurosonography - ultrasound examination of the head cavity through an unopened fontanel).
An encephalogram and tomography can also be performed. These methods not only allow you to measure intracranial pressure, but also assess the condition of the ventricles of the brain.
Using puncture of the ventricles of the brain and spinal puncture, you can find out the exact indicators of the baby’s ICP. These 2 procedures can be prescribed if other research methods are ineffective or insufficiently informative.

If the problem is nevertheless diagnosed, the causes of ICP are simultaneously determined and a course of treatment is selected, taking into account age and individual characteristics.

Diseases caused by increased intracranial pressure

Our pediatric neurology department will help you not only make a correct diagnosis, but also undergo a course of treatment if your child has:

Hyperactivity (attention deficit hyperactivity disorder, ADHD);
Cerebral palsy (cerebral palsy);
Autism;
Delayed psychomotor development;
Delayed speech development;
Speech defects;
Stuttering;
Nervous tics;
Enuresis;
Sleep disturbances (sleeps poorly, sleeps little, wakes up frequently, does not fall asleep for a long time);
Hypertonicity;
Pyramid syndrome (pyramidal insufficiency syndrome);
Hypertensive syndrome;
Hydrocephalus (hydrocephalic syndrome, dropsy of the brain);
Perinatal encephalopathy (perinatal damage to the central nervous system, PEP, PPCNS);
Minimal brain dysfunction (MCD).

Causes of intracranial pressure:

Birth or traumatic brain injury;
Prematurity, pathologies during pregnancy or childbirth;
Untimely fusion of the skull bones in a child;
Benign brain tumors, which lead to increased blood pressure and changes in brain structures;
Malignant brain tumors;
Meningitis;
Encephalitis;
Toxic cerebral edema;
Hydrocephalus;
Genetic abnormalities and defects of the cerebrospinal fluid tract;
Traumatic brain injury;
Intracerebral hemorrhage.

HOW TO CORRECTLY MEASURE A CHILD'S BP?

1. First, understand what pressure will be normal for your child. To do this, you need to use three percentile tables (tables of percentages of different values):

In Table 1, find your child’s age and height (for boys and girls, these are different parts of the table) and remember your child’s “height percentile” (from 5% to 95%).
In Table 2 (for boys) or in Table 3 (for girls) look for the child’s age, correlate it with the “height percentile” and then find the value for the upper (systolic) and lower (diastolic) pressure. The optimal value will be up to 90%. Above is already above the norm.

2. In order to measure blood pressure, you need a tonometer, but most importantly, the correct - children's - cuff. For electronic tonometers there is only one children's cuff (diameter 15-22 cm). For mechanical ones, the diameter of the cuff for children starts from 7 cm. The size of the cuff corresponds to the circumference of the arm at the place where it is applied (measured with a measuring tape).

3. Measure blood pressure in your arms three times with an interval of 2-3 minutes, and calculate the average value. Compare with recommended.

4. Keep a blood pressure diary. If there was a one-time increase, it is recommended to measure 2-3 times during the day at rest while sitting, as well as in case of characteristic complaints (headaches, nosebleeds, dizziness).

Preventive measures

Measures aimed at preventing problems with ICP in children are quite simple:

more love, affection and attention;
regular walks in the fresh air;
comfortable emotional atmosphere in the house;
a diet rich in vitamins;
It is advisable to give preference to breastfeeding rather than dry formula.

Do not forget that the child is not able to help himself. Therefore, be extremely attentive to all the signs that he gives you, and at the slightest suspicion, go to the doctor for further diagnosis!