NEUROLOGICAL

ASSESSMENT IN CHILDREN
COMPONENTS

 History
 Behaviour and development

 Glasgow/Blantyre Coma Scale

 Assess head and neck for meningism

 Cranial Nerves

 The Motor System

Power
Tone
Co-ordination
 The Sensory System

 Deep Tendon reflexes

HISTORY

 Loss of consciousness
 Reduced muscle tone
ASSESSING LEVEL OF
CONSCIOUSNESS
 GCS
 BCS: Motor response, verbal response, and eye
movement.
 Rating of 0 to 5

 Valid in children 6 months or more

Score Motor Verbal Eye to object
response to response
pain
2 Localises pain Appropriate cry
1 Withdraws Innapropriate Direct gaze
limb
0 None None Does not follow
HEAD AND NECK
 Head size and shape and anterior fontanelle (if
not closed)
 Measure head circumference

 Crossing upward centiles may indicate increased

intracranial pressure Macrocephaly
 Downwards- 2SD below mean indicate small
brain and risk for developmental delay (cognitive
impairment)
 Parents with big head
HEAD AND NECK
 Palpate the anterior fontanelle for size, shape
and firmness
 Palpate the posterior fontanelle if present

 Anterior fontanelle closes by 18 months

 Posterior closes by 6 weeks

 Bulging fontanelle-increased intracranial

pressure
 Depressed sunken fontanelle- dehydration
FONTANELLE
HEAD SHAPE
 Head shape- assess and comment on head shape
 Long head (sarocephaly) or wide head
(brachycephaly)- craniosysnostosis (premature
closure of sutures
 Note any asymmetry

 Frontal bossing may indicate rickets

FACIAL DYSMORPHISM
 Assess for dysymorphic features which may
indicate abnormality
 Recognize facial features for fetal alcohol
syndrome and Downs syndrome
DOWN’S SYNDROME (TRISOMY 21)
DOWN’S SYNDROME
ASSESS HEAD AND NECK
 Neck mobility-chin to chest
Brudzinski’s Sign
Flex neck and watch movement of hips and
knees.
 If hips and/or knees flex, sign present

Kernig’s Sign
Flex patient’s leg at hip and knee, then
straighten knee.
 If painful on extension, sign present

 Kernig sign unreliable in under 3

BRUDZINSKI’S AND KERNIG’S SIGNS
ASSESSMENT OF INTELLIGENCE
 Receptive language- meaning of common 6
objects, its use 1 year, 18 months point out 6 body
parts
 Expressive language- use of words
appropriately use of single words 1 yr, 2 word
sentence at 2 yrs, 3 word sentence 3+
 Non verbal intelligence- child’s manipulative
skills. Building blocks
 CRANIAL NERVES

1 Olfactory Smell

2 Optic Visual acuity, visual fields and ocular

fundi
3 Oculomotor Pupil reflexes and eye movements
4 Trochlear Eye movements
5 Trigeminal Jaw movements, facial sensations and
corneal reflexes
6 Abducens Eye movements

7 Facial Facial muscles: raise eyebrows, close

eyes tightly, purse lips, show teeth
CRANIAL NERVES

8 Auditory/Acoustic Hearing and balance (vestibular)

9 Glosopharyngeal Uvula movement, gag reflex, dysphagia

10 Vagus Laryngeal paralysis, hoarseness,

ineffective cough reflex
11 Accessory Shrug shoulders against resistance
Turn head against resistance
12 Hypoglossal Protruding tongue, rapid movements,
tongue to cheek
MOTOR EXAMINATION
 General observation
posture movement and hand function
 Power and tone

 Young child who cannot walk (test positions)

 Supine, pull to sit, prone position, vertical

suspension, horizontal suspension
 Don’t do test position in a child with decreased
level of consciousness- no head control and unsafe
MOTOR EXAMINATION (INSPECT)
 Asymmetry / deformity
 Abnormal posture / movement

 Muscle wasting / hypertrophy

 Tremors or involuntary movements

MOTOR EXAMINATION (POWER)
Arms
 Shoulders-abduct/adduct

 Elbows-flex/extend

 Wrists-flex/extend

 Grasp-test grip

Legs
 Abduct/adduct

 Hips-flex/extend

 Knees-flex/extend

 Ankles-flex (dorsiflex)/extend(plantar flex)

 Feet-invert/evert
MOTOR EXAMINATION (TONE)
Determine resistance to passive movement
Arms
 Forearm – supinate/pronate

 Elbow - flex/extend

 Wrist – circumduction

 Fingers-flex/extend

Legs
 Support leg and roll gently from side to side

 Knees-flex/extend

 Ankles-flex/extend
DEVELOPMENTAL MILESTONES
 Gross motor
 Fine motor

 Hearing and speech

 Vision

 Personal social skills

ASSESSMENT OF THE REFLEXES
 Important part of neurological assessment
 The newborn reflexes, the time they appear and
disappear reflect the maturity and intactness of
the developing system
 Persistence of primitive reflexes, loss of reflexes
or hyperactivity of deep tendon reflexes is usually
a result of cerebral insult
PRIMITIVE REFLEXES
 Rooting reflex
 Sucking reflex

 swallowing

 Palmar grasp

 Plantar grasp

 Tonic neck reflex

 Moro or startle

 Stepping or walking reflex

 Babinski
PRIMITIVE REFLEXES
 Crawling
 Glabellar reflex

 Deep tendon

 Galent

 Magnet
ASSESSMENT OF REFLEXES IN CHILDREN
 Plantar
 Biceps

 Cremaster

 Abdominal

 Jaw

 Corneal reflexes