Guillain Barré Syndrome In Children

Guillain Barré syndrome is an acute immune mediated polyradiculoneuropathy, usually triggered by infection. Campylobacter jejuni is a classic antecedent pathogen.

Weakness often progresses over hours to days and can involve respiratory and bulbar muscles.

• Symmetrical ascending weakness
• Reduced or absent reflexes
• Neuropathic pain
• Paraesthesia
• Facial weakness
• Bulbar dysfunction
• Autonomic instability

Danger signs are rapidly progressive weakness, inability to walk, weak cough, bulbar dysfunction and respiratory compromise.

• Diagnosis is clinical.

• CSF typically shows elevated protein with few or no cells, although this may be absent early.

• Nerve conduction studies support the diagnosis and define subtype.

• Measure forced vital capacity serially in significant weakness.

• Significant CSF pleocytosis should prompt reconsideration of the diagnosis.

• IV immunoglobulin 2 g/kg total, usually 0.4 g/kg/day IV for 5 days, is first line.

• Plasma exchange is similarly effective and is an alternative in severe disease.

• Corticosteroids are not effective for Guillain Barré syndrome.

• Monitor respiratory function, ECG, blood pressure and autonomic instability.

• Intubate before respiratory collapse when vital capacity declines significantly, bulbar weakness compromises airway protection or respiratory fatigue develops.

• Provide physiotherapy, thrombosis prevention where indicated, pain management and pressure area care.