Learning that your child has a disorder of the nervous system can cause you a great deal of worry, especially when it involves different aspects of your child's development. We understand, and if your child has Rett syndrome, our orthopedic specialists will be there for all musculoskeletal care, and work closely with your child's medical team as well as your family to provide the best possible outcome.
Rett syndrome (RTT) is a disorder of the nervous system. This condition leads to developmental problems in children. It mostly affects language skills and hand use. There are several different types of RTT:
- Classical (meets the diagnostic criteria)
- Provisional (some symptoms appear between ages 1 and 3)
RTT is classified as atypical if:
- It begins early (soon after birth) or late (beyond 18 months of age, sometimes as late as 3 or 4 years old)
- Speech and hand skill problems are mild
- If it appears in a boy (very rare)
RTT occurs almost always in girls. It may be diagnosed as autism or cerebral palsy.
Most RTT cases are due to a problem in the gene called MECP2. This gene is on the X chromosome. Females have 2 X chromosomes. Even when one chromosome has this defect, the other X chromosome is normal enough for the child to survive.
Symptoms may include:
- Breathing problems, which may get worse with stress. Breathing is usually normal during sleep and abnormal while awake.
- Change in development.
- Excessive saliva and drooling.
- Floppy arms and legs, which is frequently the first sign.
- Intellectual disabilities and learning difficulties.
- Shaky, unsteady, stiff gait or toe walking.
- Slowing head growth beginning at 5 to 6 months of age.
- Loss of normal sleep patterns.
- Loss of purposeful hand movements: For example, the grasp used to pick up small objects is replaced by repetitive hand motions like hand wringing or constant placement of hands in mouth.
- Loss of social engagement.
- Ongoing, severe constipation and gastroesophageal reflux (GERD).
- Poor circulation that can lead to cold and bluish arms and legs.
- Severe language development problems.
NOTE: Problems with breathing patterns may be the most upsetting and difficult symptom for parents to watch. Why they happen and what to do about them is not well understood. Most experts recommend that parents remain calm through an episode of irregular breathing like breath holding. It may help to remind yourself that normal breathing always returns and that your child will become used to the abnormal breathing pattern.
Genetic testing may be done to look for the gene defect. But, since the defect is not identified in everyone with the disease, the diagnosis of RTT is based on symptoms.
Help with feeding and diapering
- Methods to treat constipation and GERD
- Physical therapy to help prevent hand problems
- Weight bearing exercises with scoliosis
Supplemental feedings can help with slowed growth. A feeding tube may be needed if the child breathes in (aspirates) food. A diet high in calories and fat combined with feeding tubes can help increase weight and height. Weight gain may improve alertness and social interaction.
Medicines may be used to treat seizures. Supplements may be tried for constipation, alertness, or rigid muscles.
Stem cell therapy, alone or in combination with gene therapy, is another hopeful treatment.