Lost among the trees? The autonomic nervous system and paediatrics

Abstract

The autonomic nervous system (ANS) has been strikingly neglected in Western medicine. Despite its profound importance for regulation, adjustment and coordination of body systems, it lacks priority in training and practice and receives scant attention in numerous major textbooks. The ANS is integral to manifestations of illness, underlying familiar physical and psychological symptoms. When ANS activity is itself dysfunctional, usual indicators of acute illness may prove deceptive. Recognising the relevance of the ANS can involve seeing the familiar through fresh eyes, challenging assumptions in clinical assessment and in approaches to practice. Its importance extends from physical and psychological well-being to parenting and safeguarding, public services and the functioning of society. Exploration of its role in conditions ranging from neurological, gastrointestinal and connective tissue disorders, diabetes and chronic fatigue syndrome, to autism, behavioural and mental health difficulties may open therapeutic avenues. The ANS offers a mechanism for so-called functional illnesses and illustrates the importance of recognising that 'stress' takes many forms, physical, psychological and environmental, desirable and otherwise. Evidence of intrauterine and post-natal programming of ANS reactivity suggests that neonatal care and safeguarding practice may offer preventive opportunity, as may greater understanding of epigenetic change of ANS activity through, for example, accidental or psychological trauma or infection. The aim of this article is to accelerate recognition of the importance of the ANS throughout paediatrics, and of the potential physical and psychological cost of neglecting it.

A bihemispheric autonomic model for traumatic stress effects on health and behavior

“…A new and non-trivial insight about ANS functioning should have new and non-trivial consequences, given the pervasive and critical role of the ANS across organ systems and behaviors (Rees, 2014). It may be that polyvagal theory represented the beginning of a paradigm shift for understanding the ANS.…”

Clinical, hemispheric, and autonomic changes associated with use of closed-loop, allostatic neurotechnology by a case series of individuals with self-reported symptoms of post-traumatic stress

“…For example, the BHAM predicts the observation that PTSD is associated with a range of physical health disorders [16–18] including, effectively, accelerated physiological aging [19]. While the role of the ANS for mediating adverse behavioral and health states tends to be systematically under-recognized in clinical medicine [20], numerous researchers have used the metrics of heart rate variability (HRV) and baroreflex sensitivity (BRS), which are indicators of the capacity of the parasympathetic division to buffer sympathetic arousal, as a window on neural regulation of the cardiovascular system. Studies consistently show that HRV and BRS are diminished in patients with PTSD [21–25].…”

Negative Temperature Differential in Preterm Infants Less Than 29 Weeks Gestational Age

“…Premature birth delays ANS maturity (Patural et al, 2014) and being born to a mother who has received antenatal steroids can cause suppression of the HPA axis for up to six weeks (Davis et al, 2006). Dysregulation of the ANS and HPA axis can be related to maternal infection and maternal smoking (Stéphan-Blanchard et al, 2016) and can lead to infection in the infant (Rees, 2014). Dysregulated ANS is also associated with morbid conditions related to the GI tract, connective tissue and immunological system, as well as neurological development (Rees, 2014).…”

“…Dysregulation of the ANS and HPA axis can be related to maternal infection and maternal smoking (Stéphan-Blanchard et al, 2016) and can lead to infection in the infant (Rees, 2014). Dysregulated ANS is also associated with morbid conditions related to the GI tract, connective tissue and immunological system, as well as neurological development (Rees, 2014). Therefore, this mechanism should be studied in detail.…”