Recognizing Guillain-Barre syndrome in preschool children

To determine whether recognition of Guillain-Barré syndrome (GBS) is delayed in preschool children, what causes this delay, and if the clinical presentation differs from older children.

In a retrospective cohort study, standardized data from all children with GBS seen at the Erasmus MC Sophia Children's University Hospital in Rotterdam from 1987 to 2009 were collected regarding clinical presentation, patient's delay, initial diagnosis, and doctor's delay to the diagnosis. We compared preschool children (<6 years old) with older children (6-18 years old).

GBS was diagnosed in 23 preschool children and in 32 older children. Fifteen (68%) of the preschool children were initially misdiagnosed compared to 6 (21%) of the older children (p = 0.001). Median patient delay to consult a pediatrician in both age groups was the same (5.0 days). The median doctor's delay to diagnose possible GBS in preschool children was significantly longer than in older children (3 days vs 0 days). In one-quarter of preschool children, this doctor's delay was more than 1 week, up to 22 days. In preschool children, refusal to walk and pain in the legs were the most frequent presenting symptoms (65%), while older children presented with more classic symptoms of weakness and paresthesias. The preschool children were initially misdiagnosed with myopathy, tonsillitis, meningitis, rheumatoid disorders, coxitis, or discitis.

The diagnosis of GBS in preschool children is delayed compared to older children. This delay is partly explained by the nonspecific clinical presentation, challenging neurologic examination, and alternative diagnoses in preschool children.