Emotional cross-leg syndrome in children

　　First, etiology

　　The etiology of this symptom is not yet clear. Local stimulation, such as inflammation of the vulva, eczema, phimosis, paraphimosis, pinworm infection, etc., often causes local itching, which is a common诱因 for infants to rub their external genitalia, and then develops into a habitual action. Some children also play with their genitals because of loneliness, which is more common in boys. Poor environment, emotional tension, anxiety, and other factors often exacerbate this behavior, and children use it as a means to alleviate emotional anxiety and self-gratification.

　　Second, pathogenesis

　　1. The current research results show that the onset of the disease may be related to neurotransmitter disorder. It can be caused by metabolic disorders in the choline system, leading to hyperactivity of dopamine.

　　2. Specifically, there are two types of theories, one called traditional views; the other is the theory of neurotransmitter disorder.

　　3. Traditional views include:

　　(1) Bad habits.

　　(2) Vulvar inflammation, pinworm disease, and other causes.

　　(3) Precocious puberty. There have been those who have different opinions on these traditional views and have overturned them one by one. Some children may have symptoms when they are less than 2 months old, so it is not talking about forming a habit. Drug treatment is effective, and recurrence can occur after stopping the medication, which is enough to prove that it is not 'habits'. Antiphlogistic treatment is ineffective for children with vulvar congestion, and the symptoms of those with pinworms also do not improve after deworming treatment. It is proposed that vulvar congestion is the result of cross-leg rubbing rather than vulvar inflammation. For cases with relatively severe clinical symptoms, blood tests for follicle-stimulating hormone and luteinizing hormone were performed, and the results were all normal. The level of estradiol measured by vaginal deep film was also normal, so the children did not show signs of precocious puberty.

　　The basis for the theory of neurotransmitter disorder is that the urine amino acid analysis of the children shows an increase of 82%, and 70% of them return to normal after the symptoms disappear, suggesting that this symptom may be related to amino acid metabolism. In addition, the ferritin test results of the children show that 75% are lower than normal, indicating a lack of stored iron. The reduction in stored iron can lead to a disorder in the metabolism of catecholamines. In the process of the decomposition and metabolism of catecholamines, monoamine oxidase is a key enzyme and also an iron-dependent enzyme. Therefore, children need to have sufficient iron in their bodies to activate monoamine oxidase, in order to maintain the normal function of catecholamines.

　　The etiology of this symptom is not yet clear. Local stimulation, such as inflammation of the vulva, eczema, phimosis, paraphimosis, pinworm infection, etc., often causes local itching, which is a common cause of infants rubbing their external genitalia, and then develops into a habitual action. Some children also play with their genitals because of loneliness, which is more common in boys. Poor environment, emotional tension, anxiety, and other factors often exacerbate this behavior, and children use it as a means to alleviate emotional anxiety and self-gratification. There are generally no special complications associated with pediatric emotional cross-leg syndrome.

　　2. When children perform these behaviors, they usually have red cheeks, tense expressions, fixed eyes, slight sweating, and even shortness of breath. Afterward, children feel drowsy and sleepy. If they are forcibly stopped, it may cause children's dissatisfaction or even opposition. Young children may have attacks in any place, while older children tend to have attacks before going to bed or after waking up in the morning, which may be accompanied by sexual climax, sexual fantasy, and normal intelligence.

　　1. Both males and females are susceptible to the disease. In the 109 cases reported by Ye Qifeng in China, 93 girls accounted for more than 85% of the total group. This syndrome often presents with episodic extension and crossing of both lower limbs or clamping with frictioning movements, with a fist or holding something tightly, girls prefer to sit on hard objects, press their legs or lower abdomen, or like to have objects between their legs, boys mostly manifest as lying on the bed and rubbing back and forth, with an erection, girls have vaginal congestion, increased secretion, and darkening of the labia, slight congestion of the urethral opening, mild edema, consciousness during the attack, and the attack can suddenly stop due to external factors.

　　For occasional attacks, parents should adopt an attitude of ignoring them and distract their attention to correct them. At the same time, actively seek and remove local irritant factors. It is recommended that parents let children wear loose underwear and not tight underwear. Try to let children go to bed when they feel tired at night, and call them up to get up as soon as they wake up in the morning, to shorten the time children spend alone in bed after waking up, and develop good sleeping habits of going to bed to sleep and waking up to get up. When the baby finds that the baby's legs are crossed, gently separate them and transfer their attention with toys or other methods, do not scold loudly, as this may cause the baby to misunderstand that this behavior can attract parents' attention and improperly reinforce this behavior. For older children who frequently rub their external genitalia with their hands, positive reinforcement can be used. Mainly let children understand the harm of this behavior, but do not scare children to avoid increasing their emotional anxiety and fear. Actively reinforce their good behavior and increase their ability to self-control.

　　1. Examination items for children with emotional cross-leg syndrome: serum iron, serum ferritin, amino acid test, blood routine, EEG examination, and six sexual hormone tests.

　　2. Normal serum follicle-stimulating hormone, luteinizing hormone, and vaginal estradiol levels; 82% increase in urinary amino acid chromatography, and serum ferritin below the normal value by 2 standard deviations.

　　3. Normal EEG and ultrasound examination.

　　The dietary preference for children with emotional cross-leg syndrome should include calcium-rich foods such as milk, cheese, yogurt, bean products; and eat more fresh green vegetables. Fresh fruits and vegetables such as figs, lichees, walnuts, loofah, portulaca, fermented soybean paste, olives, almonds, luffa, etc. Avoid overly greasy foods, and do not choose foods such as preserved bean curd, scallions, chili peppers, chives, etc. Do not drink stimulating beverages.

　　1. Psychological counseling guidance Due to the influence of traditional Chinese cultural and moral concepts, parents often regard this behavior as immoral, so when children show such behavior, it often causes excessive panic and emotional anxiety among parents, and they often treat children in粗暴 ways such as beating and scolding. Some parents even threaten children, so psychological counseling guidance should be given to parents. Occasional habitual cross-leg rubbing is a normal phenomenon in the process of children's growth and development and is not pathological. However, frequent recurrence can affect physical health and children's learning. For occasional attacks, parents should adopt an attitude of neglect and distract their attention to correct it. At the same time, actively find and remove local irritative factors. It is also recommended that parents let children wear loose underwear and not tight underwear. Try to let children go to bed when they feel tired at night, and call them up to get up in the morning, shorten the time children stay alone in bed after waking up, and develop good sleeping habits of going to bed to sleep and waking up to get up. When the baby discovers that the baby's legs are crossed, gently separate the baby's legs and use toys or other methods to distract their attention, do not scold loudly, so as not to make the baby misunderstand that this behavior can attract parents' attention and make this behavior improperly reinforced. For older children who frequently rub their external genitalia with their hands, positive reinforcement can be used. Mainly let children understand the harm of this behavior, but do not scare children to avoid increasing their emotional anxiety and fear. Actively reinforce their good behavior and increase their self-control ability.

　　2. Drug treatment According to the results of research on the pathogenesis, due to hyperdopaminergic function, dopamine receptor antagonists such as haloperidol should be used for treatment. Haloperidol 0.5-1mg/(kg·time), twice a day, taken orally. Some people advocate the combined treatment of trihexyphenidyl (Antanal) and haloperidol with the same dose as haloperidol. The symptoms can be quickly controlled, the frequency of attacks can be reduced or disappear after the above drug treatment. However, more than half of the cases recur after discontinuation of medication, and long-term medication is needed to maintain.