Autonomic Dysreflexia in Pediatrics: What You Will Want to Know About Detection, Prevention, and Treatment
Autonomic Dysreflexia (AD) is a miscommunication in the nervous system. The Autonomic Nervous System (ANS) is a part of the nervous system that controls bodily functions without conscious thought. This includes examples such as heartbeats, breathing, blinking, infection control, and the processing of bowel and bladder functions.
The brain controls all automatic functions, but with ANS neurological issues, messages may be misinterpreted, slow in response, or unable to respond. AD occurs when there is miscommunication in the ANS. The result is a full-body crisis response.
Children with healthcare issues such as spinal cord injury above thoracic level 6 (T6) and some as low as T10, some head injuries, or other neurological issues may have autonomic dysreflexia. Depending on the child’s diagnosis, healthcare professionals will alert you to the diagnosis.
Over time, AD events affect the cardiovascular system (heart and blood vessels). Fewer episodes protect the health of your child.
Detection
The diagnosis of AD occurs when blood pressure (BP) is elevated. In children, BP elevation of 15mmHg over their average normal. Teens, depending on body size, will be diagnosed with AD using the adult threshold of 20mmHg above their average normal. The most common symptom is a pounding headache; however, many individuals have other symptoms with or without the headache. None should be overlooked.
Children and teens who are able to communicate and express their feelings can report symptoms of AD to you. Children and teens unable to communicate may express their discomfort through agitation or crying.
Children with SCI can have symptoms related to their level of injury. Those with head injury or neurological disease may have any combination. Your child may have some or all symptoms:
| Above the Level of Injury | Below the Level of Injury |
| Slow or fast heart rate (pulse) | Upset stomach/nausea |
| Headache | Chills but no fever |
| Nervousness/Agitation/Scared/Doom/Worried | Clammy/cold/sweaty |
| Redness in the face, neck, shoulders | Cool to the touch skin |
| Blurry vision | Pale |
| Stuffy nose | |
| Sweating | |
| Goosebumps |
Prevention
The diagnosis of AD cannot be prevented at this time. Episodes of AD can be avoided.
Occasionally, check your child’s blood pressure using a home blood pressure cuff at random times during the day and night and in various activities. Silent AD (elevated blood pressure) can be present without symptoms. Keep a record of the day, time, blood pressure, and activity.
Treatment
An AD episode tells you something is bothering the body. Treat AD immediately by sitting the child upright. This takes advantage of orthostatic hypotension (sudden drop in blood pressure). Then remove the irritation.
The three main causes of AD are:
- Bladder issues caused by overdistension, infection, kinks, or clogs in catheters.
- Bowel issues caused by overdistention of the bowel or diarrhea.
- Skin issues caused by pressure injury, positioning, wrinkles, too-tight clothes, rashes, etc.
Other issues can also lead to an AD episode. These can include illness, temperature control, overuse of computers, or essentially anything!
Remove or resolve the offending issue. Monitor blood pressure to ensure the AD episode has resolved.
If you cannot resolve the AD episode quickly, call 911. AD is a medical emergency.
Recurrent AD can be treated with medication.
Always carry the Christopher & Dana Reeve Foundation Pediatric AD Wallet Card to provide to family members, healthcare professionals, educators, or anyone in your child’s life for safety. Spinal Cord Injury Wallet Cards | Reeve Foundation
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