Hello - excessive yawning
 

Hello!

Just wanted to introduce myself. My son, BJ, is 4-years-old and was born with a rare cluster of birth defects called VACTERL Association. He also had tethered cord. He has had 7 surgeries and is doing awesome...you wouln't know a thing was ever wrong with him.

Until recently. About three weeks ago he started yawning excessively. On average about once every 25-seconds, but sometimes even more intensely. He may go for several hours with only yawning a couple of times and then have a couple of hours where he will yawn several times a minute. It doesn't look like his usual yawn or sound normal.

We took him to his pediatrician who believes this is most likely a tic. At my request we had basic bloodwork done which came back normal. We self-referred to a neurologist who ordered an EEG. That came back normal. But, the neurologist saw his yawning in clinic and agreed it was odd...either an usual tic or an atypical seizure. He recommended doing an inpatient study EEG with video 24-48 hours. That is schedule in a couple of weeks.

In the meantime, we are very anxious. We got a pulseox to check his oxygen levels...which have been fine.

We have noticed that he seems to blink a lot, but maybe it's because the yawning is making his eyes water.

We have also noticed that he complains of itching - most on his right hip, but also the side of his head.

His sleeping and eating and everything else has been normal. He says he's not tired and doesn't hurt anywhere and doesn't feel out of breath.

So, here I am hoping that one of you out there has experience with something similar, has ideas, or recommendations.

It does seem the yawning has changed a bit in the past two days...it's more breathy and not as much like a yawn.

Any ideas at all are much appreciated!

Thank you,
Rebecca

Welcome, Rebecca. I'm glad you found NeuroTalk.
 

I can imagine how frantic you are, especially after all you've been through. I know some very wise folks will be by here who will know where to best direct you--which of the forums are most likely to put you in touch with people who might recognize your precious child's symptoms.

I don't know whether or not you'd like to be in touch with our Sanctuary/Spiritual Support Forum in the meantime. Here's the link, just in case: http://neurotalk.psychcentral.com/forum27.html

Take care. You & your husband remember to take care of each other during this difficult time, too, you hear? Best thoughts going out to B.J.:In-Lurve:.

--:rolleyes: C.G.. . . . a work still being worked on

I am a french physician and work on yawning

*edit*
European neurology search yawning

*edit*
I thing that the baby needs an RMI to search a brain pathology

with best regards

Thank you for your reply! I will certainly look at the research you describe.

My son had a full spine and brain MRI as a newborn (May 2007) and again at just before 1-year-old (March 2008) and again after tethered cord surgery (July 2008). None were with contrast. None showed any brain abnormalities, just tethered cord with a lumbar syrinx.

Do you still believe another MRI is prudent? If so, should it be with contrast or performed in any special manner?

My best regards and thanks,
Rebecca

I set up a baby monitor in my son's room last night and heard him yawning as he fell asleep, had two 5-minute yawning episodes in the middle of the night, and then another yawning episode when he woke up in the morning.

Excessive yawning videos
 

Here are several videos of some yawning episodes. Please ignore the 2-year-old and 1-year-old in the background! :)

http://www.youtube.com/watch?v=qsBty5o_uBU

http://www.youtube.com/watch?v=MG-ru_HJOJY

http://www.youtube.com/watch?v=ZyvGJGbxY5w

http://www.youtube.com/watch?v=XnlZ2I9GoSg

http://www.youtube.com/watch?v=Jiwri5-MUKk

Excessive yawning can indicate vagus nerve and subsequent heart problems. I would have him evaluated by another doctor. Being the sudden onset and frequency, this sounds very abnormal.

Please post an update when you find out what's causing it.

Should we see a cardiologist then? He had a cardiology eval after echocardiogram as a newborn and everything was structurally fine. The only thing was "mild tricuspid insufficiency" but wasn't concerning to anybody so he was released from that specialty.

I guess what I'm trying to figure out is what you mean by "evaluated by another doctor"...another pediatrician? Another neurologist? Or a new sub-specialty altogether?

Thanks!
Rebecca

I would take him back to his pediatrician and discuss whether he thinks a cardio consult is warranted, just to rule out any problems. Has he seen the videos or a log of how many events? This just seems way outside normal limits. Have they done routine blood work recently? I'm glad the neuro is doing the extended EEG to rule out atypical seizures. The pulse ox hopefully rules out any O2 desaturation..,.which is a good thing.

The pediatrician saw him yawn during the appointment a few times, but not as severely as in the videos. At the time of the appointment I hadn't yet kept a formal log. We did do basic bloodwork and that was fine...everything wrhin normal range - including bicarb (it was 28), which is something usually below normal for him because of kidney issues. Kidneys were our main worry at first, but when the bloodwork came back normal we felt okay.

I will call the ped on Monday to schedule another appointment. Or should we throw in the towel and head to the ER? It may sound silly, but I feel like we has been through so much with him that we are desensitized to what is or isn't an emergency.

Thanks again,
Rebecca

Of course I cannot give medical advise so these are just my personal opinions:

I would get on the books for another appt, but if the events get worse or he appears to be in distress (which he doesn't look to be now), then by all means don't wait. Mom's have good instincts for when to throw in the towel. I think you will know what the best call is based upon what you see and feel.

You said the EEG was coming up...when?

Can he relate to you anything he feels during these times? Does he feel tired, have any chest discomfort or strange feelings in his chest (pressure, shaking/jumping/fluttering), any breathing changes, etc? Have you checked his pulse during these times for high or low rates?

Have you checked side-effects to any of his meds?

BTW, he is a handsome young man!!!

He says he isn't tired. When I've asked what the yawning feels like he says "like air" hahaha...so tha doesn't tell me much. I tried an evil experiment tonight where I promised him a piece of candy if he could go a certain time without yawning. That resulted in him coming up with some pretty comical ways of hiding the yawns behind his hands, under his shirt, and blaming them on various toys. So, at least I know he really can't control them. (He got the candy anyway!)

I will try asking him more specific questions tomorrow and look for the things you list. I'll also put the pulseox back on him and watch the heart rate as I was only paying attention to oxygen saturation before.

The video EEG is September 13th. He doesn't take any serious medications - multivitamin and senna laxative, neither has any side effects like this of which I am aware.

Thanks again for your time and consideration.

Rebecca

Hi Rebecca,
You certainly have a lot on your plate there.

I just wanted to mention to you that "mouth opening" can be a tic. Not sure it's that "unusual".

The 3rd video down shows more clearly that it is more of a yawn (as in: drawing in air) than just opening of the mouth but I've seen yawing tics before.

I just wanted to leave you this link from Leslie Packer's site. I personally would advise that you show no more attention to your son about this yawning or blinking. I'd just ignore it actually. With more tests coming up soon you'll hopefully get more answers. Now you have the videos on record, it might be a good idea to just let him be for a while and see how he does.

Anyway, in the meantime, here's a List of Common Tics from what I think is a good source.
http://www.tourettesyndrome.net/wp-c...CommonTics.pdf

All the best to him and to you in your endeavours to find information to help your family.

you take care of YOU too hey?

Edited to add: Just also wanted to mention that a lot of children around the age of 4 have a transient tic. There are a number of conditions which involve tics. Simple childhood tics or transient tics usually disappear over several months.

Tics can sometimes be internal although I'm not sure if there was any Diaphragm involvement during his surgeries and whether that could be causing some sort of "irritation"?

You're doing the right thing by having him checked for seizures.

Thank you! My understanding is that tics are a diagnosis of exclusion. So, while we work on excluding the other possibilities I think your recommendation to treat this as a tic and "ignore" is a good idea, too. The pediatrician gave us a handout about tics, which I glanced over, but we so rarely get to have something normal going on that I hardly pay attention to handouts from the ped. Thanks for the reminder about how to approach tics at home. :)

I do believe it's most likely a tic as his father has some OCD-like psychological issues going on (yet to be formally diagnosed).

Because of his medical history I feel we need to be extra careful in excluding the possibilities. Cardiac anomalies are a feature of his overall diagnosis, although he has never had that particular feature presented. My husband and I were talking last night and have decided we will work on getting another cardiac evaluation done as soon as possible. Although he had a cardiac work-up done as a newborn, we have been sorely disappointed in other areas managed by that particular hospital, so we feel it's more than warranted to get this area re-evaluated. Besides, ECG and echocardiogram are easy, painless tests.

We have, for the most part, been ignoring the yawning as much as possible...if yawns weren't contagious that would be a whole lot easier!

His prior surgeries did not penetrate the diaphram. Three were through the abdominal wall, one along the gluteal cleft, and another through the lumbar spine...the others were exploratory. So, I don't imagine this is a diaphragmatic spasm or whatever.

Another concern of ours is his pulmonary function. He has multiple vertebral anomalies (hemivertebra, kyphoscoliosis, rib fusions, etc), so thoracic insufficiency is a general concern. However, his spine and rib cage has remained stable at every 6-month check-up with the orthopedic surgeon. I cannot imagine that things would deteriorate so quickly and suddenly in this area. So, I feel this is far down on our list of issues to exclude.

Thanks again to everyone for the thoughtful (and very helpful!) replies!

- Rebecca

Pediatrician appointment today
 

BJ had his first day of preschool today and I snatched him out early to take him to the pediatrician. He was yawning pretty intensely on our way to the school and when we first got there, but it seemed to calm down a bit after a few minutes. He did a good bit of yawning at the pediatrician's office, too. She agreed a cardiology work-up would be wise and ordered an EKG and echo. She was very reassuring that this is most likely a transient tic, but agreed with the need to rule out other possibilities.

He had the EKG done this afternoon and although I have no idea how it went, I always consider a good sign when a radiologist doesn't come rushing into the room. ;) I got in touch with a cardiologist at the hospital where he will be admitted for the video EEG and he said he would be happy to review his history and any tests. He also said he doesn't believe this is likely a cardiac issue, but feels these tests are warranted as he hasn't had any cardiology testing for several years.

The echo is scheduled for tomorrow morning and the video EEG will be next Tuesday.

So that is where we are!

Thanks again, everyone, for your valuable input and suggestions. This has been so helpful.

My best,
Rebecca

Glad they are working things up. Nothing like a little piece of mind. I will be looking for news and updates.

Thanks

Just got discharged from the inpatient video EEG...it was totally normal. Had an echocardiogram and EKG last week which were normal. So, now they are recommending an MRI of the brain and spine to especially see if his syrinx has grown. So that's where we are at now. Yay for no seizures!

Good news. thanks for the update

Tingling in hand
 

So, just to recap...my son has been excessively yawning. He has had bloodwork, EEG, echocardiogram, EKG, and video EEG which have all been normal. He is scheduled for an MRI of the brain and spine on the 27th.

Just now he told me his left hand "feels like sparklers" which I am guessing is tingling. He has never ever said anything like this before.

What do you think? Document it and mention it at Tuesday's appointment? Call someone now? Go to the ER?

Really...with this son of mine I never know. Thanks again for any time you devote to us.

I would ask him if the other hand ever feels like that or his feet. Also whether if it stays that way or if it's like that when he wakes up (like it fell asleep from sleeping on it, etc).

Of course, it's Saturday now (I just saw the post) so don't know if you call the doctor or not, but Tuesday is right around the corner....and of course it should be mentioned then.

Let us know what they say.

MRI results
 

BJ had his MRI yesterday and we met with the neurologist in clinic after. Nothing showed up to indicate a cause of the yawning. The neurologist said the overnight video EEG did show one "seizure-like burst" but it wasn't logged with any yawning, so he doesn't feel this is the cause of the yawning. He believes the yawning is a tic. We are to see him again in 6-months and sooner if we notice any seizure-like activity or any repetative, jerky movements or if the yawning starts to negatively impact his life.

The only issue in the MRI was apparently his syrinx has grown in width. It was 1.2mm at his last MRI two years ago and now it is 2mm. So, we are consulting with our neurosurgeon about that. I am very concerned this could be an indication of his cord retethering.

So, that is where we are at. Thoughts?

Glad to the tests are negative and that you may put your mind at ease. Hopefully the yawning will fade away with time.

Did the neurologist have any comment on the left hand tingling? Has it occurred again in that hand or any other extremity?

Radiology report
 

He hasn't complained about the tingling since that one time. So, we guess his hand just fell asleep.

I got the radiology report today and one the impressions listed is new to him - "Nonspecific signal increase within the central tegmental tracts, possibly a normal anatomic variant."

The findings section elaborated a bit more saying "brain parenchyma is notable only for abnormally conspicuous signal increase within the central tegmental tracts...signal of the brain parenchyma is otherwise normal reflecting myelination to a mature endpoint since the March 2008 study. The hippocampi have slighly reduced volume bilaterally on a subjective basis but appear to have normal internal architecture and normal signal."

Any idea if this could relate to the yawning? Or otherwise warrant any follow-up?

News
 

Hello Rebeca,
How your kid is doing? My 4y/o kid just start to do exactlly the same thing. We went at doctor two week ago we says that probably some alergy. We are concer because we ca yawing at list 30 times in one minute. The allergy medication isn't causing any improvement since that.

I hope that we can hear some good news from you!!

Thanks

Welcome to the gain!!
 

Deboragruskoski,

:Wave-Hello: It is great to have you come and be with us. You will fine a great number of dear friends to listen when you are in need of ears. Please, just let us know how we can help you out. You will find out we are supportive and relaxing place.

Please keep us up to date on your situation. Again welcome, looking forward to seeing you around. My thoughts and prayers are with you. :smileypray:

:hug:

Hello Debora!
 

Welcome to NT! :hug:

You've come to a wonderful place of support and understanding.
Make yourself right at home in this down-to-earth atmosphere, where people are easy to talk to and the care is truly genuine.

Look through the different forums and post anywhere you feel inclined.
Just holler if you have any questions or need help in finding your way around.
There's a friend around every corner :)

It's great to have you!

Rae
:grouphug: