Table 3

Some possible pointers to ANS dysfunction in general paediatrics: history

SymptomsSigns
Postural tachycardia or hypotension
Palpitations, dizziness, syncope
Symptoms worse with vasodilatation: standing, fatigue, hot environment, menstruation, exercise, meals, infections
Coat hanger’ shoulder pain, orthostatic headache
Baseline tachycardia, lying and standing pulse differential 30 bpm*; orthostatic hypotension
Deterioration of neurological function when upright
Acrocyanosis
Sympathetic overactivity
Abnormal sweating
Nausea, premature satiety, vomiting, diarrhoea, constipation, abdominal pain, distension
Nocturia, urgency, frequency
Sleep disturbance, vivid dreams, fatigue, unrefreshing sleep
Tremor
Blurred vision, ‘floaters’
Generalised pain, migraine, ‘growing pains’
Hypersensitivity to light, sound, touch, odour
Concentration difficulty
Emotional dysregulation, anxiety, panic
Symptoms worse with physical or psychological stress
Pallor, cold peripheries, bruising, blotchy skin, abnormal sweating, puffy hands, dermatographia
Abdominal distension, increased or decreased bowel sounds, succussion splash, ‘squelchy’ bowel
Unstable temperature
Distended bladder
Dilated pupils
Pain trigger points
Hyperreflexia, tremor
Prominent startle
Indicators of hypermobility
Previous congenital dislocation of hip
Late walking; bottom shuffling
‘Double jointedness’ (eg, unusual gymnastic ability)
Joint dislocations and sprains
Hypermobility: for example, ability to touch nose with the tongue, put hands flat on the floor with straight legs; Beighton and Brighton criteria27
Unusual sitting posture (eg, legs curled up on the chair)
Stretchy skin, abnormal scarring
Associated symptoms
Ineffective local anaesthetic
Poor ball skills
Impaired proprioception, positive Romberg sign
  • *Orthostatic tachycardia may be apparent only after standing for up to 10 min, after meals, exercise etc.43

  • ANS, autonomic nervous system.