When Do Children Need Further Neurological Evaluation?

As a pediatric neurosurgeon, Heather Spader, MD, often meets families during a time wrought with concerns and fears.

Many of the conditions she treats are complex and require interdisciplinary teams. Not only does she work with medical professionals from a wide-range of specialties, but also involves patients and their families in decision-making.

The result? A personalized treatment plan for every child, designed around their unique needs, and from a holistic approach.

Why did you focus on pediatric neurosurgery?

I was drawn to pediatric neurosurgery because it combines complex problem-solving with the opportunity to make a lifelong difference for children and their families. I enjoy caring for children with conditions that can have a profound impact on development and quality of life, and it is incredibly rewarding to watch them do so well after surgery. One of my favorite things is the relationships we build with patients and families over time.

Many of the conditions we treat require long-term follow-up, and I enjoy seeing our children grow up and flourish. 

When should referring providers contact pediatric neurosurgery, and what should they be on the lookout for?

We want referring providers to feel comfortable reaching out whenever they have a concern that something simply does not seem right. We are always available to discuss cases, help triage concerns, and determine whether a patient needs urgent evaluation, routine consultation, or can be managed collaboratively with their pediatrician. We want to know about:

• Persistent headaches
• Developmental delays
• Abnormal head growth
• Progressive neurologic symptoms
• Seizures
• Gait abnormalities
• Concerns about spinal or craniofacial disorders

These observations should prompt further evaluation 
Early referral can often provide reassurance, facilitate timely diagnosis, and ensure the best possible outcomes for children and their families. 

How can providers pick up on these concerns early?

Carefully track growth and development over time. Trends in head circumference, developmental milestones, and neurologic function often provide the earliest clues that a child may need further evaluation. 

How do you partner with referring providers?

Our referring providers are essential partners in caring for children with neurosurgical conditions. Because many of our patients travel long distances to receive care at UVA, we strive to keep as much of their care as possible close to home. We work closely with pediatricians and local providers to coordinate evaluations, share treatment plans, and minimize unnecessary travel. Through telemedicine visits and ongoing communication, we aim to provide specialized expertise while allowing families to receive much of their care within their own communities whenever it is safe and appropriate to do so. 

How do you handle meeting a newly referred patient? 

I start by listening. Families often arrive with concerns, fears, and many questions. I take time to understand their goals, explain the diagnosis in understandable terms, and develop a treatment plan together that is individualized for the child and family. 

What’s one thing UVA Health Children's can offer these patients that you think makes their experience better? 

UVA Health Children's provides truly multidisciplinary care. Our patients have access to pediatric neurosurgery, neurology, neuroradiology, neuropsychology, rehabilitation, and numerous pediatric subspecialists working together to provide comprehensive care close to home.