Neonatal

FACIAL NERVE (CN VII)

• Check the symmetry of the face at rest and movement (crying)
• Check size and symmetry of palpebral fissures, nasolabial folds
position of the corners of the mouth
VESTIBULOCOCHLEAR NERVE (VIII)
• Hearing is normally present in term babies
• Neonates blink or startle with loud noise
 GLOSSOPHARYNGEAL ,
VAGUS ,HYPOGLOSSAL NERVES (CN
IX,X,XII)
• Sucking-CN V, VII, XII
• SWALLOWING- CN IX, X
• GAG REFLEX- IX , X (use small tongue blade covered in gauze)
• Normal response is active contraction of the soft palate with upward
movement of the uvula of the posterior pharyngeal muscles.
• Observe for tongue movement and loss of bulk- CN XII
SPINAL ACCESSORY NERVE (CN XI)
• Testing cannot be done on sick neonates since this requires
flexion and rotation of the head
• For terms newborns, passive rotation of the head will show
the bulk of the neck muscles
ADOLESCENT
FACIAL NERVE CN VII
• The nuclei of the facial nerve lies in the ventral, lateral and caudal the
cranial nerve VI in the pons. The nerve innervates the muschles of the
facial expression and the stapedius
• To test the facial nerve :
• Test the muscle of expression . Ask the child to smile , frown , show his teeth
and close his eyes. Check for any asymmetry
• Test for sense of taste by applying solutions of sugar or salt to the previous
dried and protruded tongue using of a cotton tip applicator. Test one side
then the other making sure the child does not withdraw the tongue on the
mouth
Vesibulocochlear Nerve (CN VIII)
• The nerve containing fibers from the cochlea and the vestibular
apparatus enters the brain stem at the pontomedullary junction. It
subserves hearing and vestibular functions.

• Hearing can be tested in the younger child by observing the child

response to a bell, tickling of watch or rustling fingers. Older children
may be asked to repeat whispered word or numbers
Vesibulocochlear Nerve (CN VIII)
• Webers test – a vibrating tuning fork is placed on the vertex of the
patients head or over the forehead. A normal child appreciates sound
at the middle or equally on both sides
• Rinnes test- differentiate conductive hearing loss from sensorineural
loss. Place the vibrating fork behind the ear over mastoid bone and
just after the sound disappears, hold it beside the ear over the
external auditory canal. Normall , air conduction is more efficient than
bone conduction
Vesibulocochlear Nerve (CN VIII)
• Caloric test can be use fir gross assessment if the vestibular functions.
Complaint of nausea, ataxia, vertigo or unexplained vomiting, singly
or in combination, may indicate labyrinthine and vestibular pathologic
origins
Glossopharygeal and Vagus nerve (CN IX AND
X)
• The nuclei of the 9th CN lies in the medulla and is anatomically
indistinguishable from CN X and CN IX nuclei. The vagus nerve is
motor to pharyngeal muscles and larynx. It innervates the smooth
muscles of the tracheobronchial tree and the GI tract

• Test for palatal movements, uvular position and movement, gag reflex,
phonation, sucking and swallowing.
• Have the child say “ahh” or stick the tongue out then observe symmetry in
movement of the uvula and soft palate
• Test for gag reflex. Touch the of the pharynx with and tongue depressor and
watch elevation of the tongue
Spinal Accessory Nerve CN XI
• With the vagus nerve, it innervates the intrinsic muscles of the larynx.
The spinal portion from the upper C1- C5 innervates the
sternocleidomastoid and the trapezius muscle

• Test the function of the trapezius and sternocleidomastoid muscles. Me the

patient turn his head against resistance and shrug shoulders while you apply
resistance. Palpate for symmetry of the muscle bulk, tone and contraction of
them muscles during the head turning and shoulder elevation
Hypoglossal nerve (CN XIII)
• The nucleus lies in the lower medulla. It is motor to the intrinsic and
extrinsic muscles of the tongue except paraglossus.

• Test the tongue muscle . Check the position of the tongue at rest with the
mouth open and during protrusion