Interview with Dr. Borbála Telcs, pediatric neurologist

You have been working at the Maternity Clinic for a short time. In this introductory conversation, I would like to ask what kinds of issues or problems patients might bring to you, as a developmental neurologist?

Developmental neurology addresses a wide range of questions and issues, including:

• If there were problems during pregnancy, and the obstetrician-gynaecologist believes these could affect the baby’s neurological development.
• If the parents have hereditary diseases or conditions that could impact the baby’s neurological development.
• If there were complications around the time of birth, such as a low Apgar score, or if the baby required medical care in the minutes or hours after birth.
• After a premature birth.
• If the baby shows delays in movement or other developmental areas, such as speech, or if there are changes in behavior following an illness.
• If a parent, nurse, or general practitioner notices abnormalities in muscle tone.
• If the baby is lagging behind in motor or cognitive development compared to age-appropriate milestones as assessed by a nurse, general practitioner, or other specialist.
• If the baby holds its body in an unusual or asymmetrical way (such as consistently in a C position or turning its head in only one direction).
• If there are recurring muscle twitches in any part of the body.
• If there are difficulties in speech development.

And now, if you don’t mind, let’s get to know you a little better! Why did you choose the medical profession?

In my childhood, I was always interested in natural sciences and nature. This fascination likely developed because my parents and I spent a lot of time outdoors, going on many hikes. I always had a keen eye for discovering interesting things in nature. Additionally, my elementary school biology teacher played a significant role; she was a dynamic and captivating personality. Over time, these experiences led me to focus on the human body. I considered biology and dentistry, but ultimately chose the most complex field, medicine. During my pediatric practice at the Tűzoltó Street Children’s Clinic, I found that pediatrics was a much more humane and compassionate field compared to others, and as a medical student, I received excellent practical training for future medical practice.

What makes pediatrics feel more humane compared to adult medicine?

The relationship is more personal. With young children, it is essential to involve the parents and family; their input is crucial because it helps us understand the baby better. A holistic approach is necessary, especially in developmental neurology, where we can only interpret emerging issues in the context of the family. Many problems arise that have not just a physical cause but need to be understood on a familial level. It is important to consider if similar issues have arisen within the family. Factors such as the pregnancy experience and how eagerly the baby was anticipated can significantly impact a baby’s development. Even a challenging life event can be crucial for a baby’s growth.

Why did you become a developmental neurologist?

In the final year of my pediatric residency, I chose child neurology as my first practical rotation at the clinic because I found the cases there to be the most challenging. It felt almost fated that, after my pediatric board exam, I ended up in the developmental neurology department, where Professor Berényi was looking for young doctors. Besides the complexity of the neurological field, I found it exciting to work specifically with children under two years old, as I had less practical experience with them compared to older children.

What does developmental neurology for children examine?

This field is a subset of child neurology that focuses on the neurological development of babies under three years old. It looks at the progression of their motor development, fine motor skills, cognitive abilities, and speech. We assess whether there are any delays or deviations from normal development. At developmental neurology clinics, we examine whether the nervous system of premature babies is developing optimally. We also evaluate those who experienced complications around birth, such as oxygen deprivation or injuries (e.g., arm injuries) during delivery. In such cases, close monitoring of the baby by both the doctor and the nurse occurs during the first months. If significant deviations or several smaller deviations are detected, the baby is referred to a developmental neurologist.

Nowadays, many parents notice deviations and bring their babies in, for instance, if the baby holds its head tilted. We then investigate the cause, which could range from an eye-related issue or weaker neck muscles to the baby’s in-utero position or something more serious. Beyond the physical examination, we need to consider the whole context, including how the pregnancy and delivery went, whether there are similar issues in the family, and if the baby has siblings with similar problems. Often, only by the end of the appointment or during a follow-up visit does it become clear that similar issues have occurred in the family before, such as slower motor development, delayed speech, or behavioral concerns. This can make it easier to determine the appropriate direction for further tests, therapies, or developmental interventions. Recently, an increasing number of parents seek help for issues that intersect with psychology and psychiatry, such as behavioral problems or difficulties with self-regulation, including excessive crying, early sleep disturbances, or feeding issues.

How clear is the line between healthy and unhealthy development?

There are objective criteria. For example, in motor development, we expect that between 3 and 6 months of age, babies should start to roll over; between 6 and 9 months, most will learn to crawl, possibly sit up, and many 1-year-olds will attempt to stand. By 18 months, children typically start walking. The achievement of these gross motor milestones usually falls within a 2-3 month range.

What about speech development?

By the age of two, a vocabulary of 50 words is expected, but there is variability. Newborns initially communicate only through crying, so the nature of the cry is also important. It’s crucial to observe if cooing appears and if there is more varied vocalization. Adequate hearing is a prerequisite for speech development, so if a baby is unusually loud, communicates only by crying, and does not start making varied sounds, there could be a hearing issue. In such cases, an ear, nose, and throat examination and audiological assessment are needed first.

Slow speech development can indicate more complex problems, which may be signaled by other associated symptoms, such as being on the autism spectrum.

How old is this field, and how many practitioners are there in Hungary?

This field has a history of nearly 50 years. There are few of us who specialize specifically in developmental neurology within pediatric neurology. There is one department dedicated to this in Budapest, but colleagues also work in this area as part of the follow-up care for premature infants in obstetric institutions and elsewhere in the country.

It is a significant step for Maternity to have such a specialist available for patients.

Over 1,200 children are born at Maternity each year, and with such a high number of births, there is an increase in premature births and babies born after pregnancies complicated by certain issues. These babies may need the expertise of a developmental neurologist.

What advice do you have for parents?

It is crucial to pay attention to the recommendations of the nurse, family doctor, or other pediatric specialist if they suggest further examination. It’s best to follow this advice before starting extensive therapy or developmental interventions. Additionally, if a therapy is not yielding the expected results, it should be reassessed. Parents should trust their instincts about whether something is right or not, and then consult with the specialist. I am a firm believer in this approach. I consider it very important that the combined efforts of the doctor, the baby, and the parents work together to achieve results.

What do you do in your free time, and what helps you unwind?

I live in Budapest with my family, and I spend most of my free time with my two children. I enjoy being in nature, engaging in good conversations, and I have a passion for gastronomy and theater. I know that as my children grow older, I’ll gradually have more time for activities like the theater.

Thank you for the conversation.