cranial nerve exam handout 1

8/12/2019 Cranial Nerve Exam Handout 1

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CRANIAL NERVE EXAMINATION

Cranial Nerve: Infant Testing: Toddler Testing: School-Aged Testing:

I. Olfactory No reliable method of testing;

observe facial expressions toscents

Present child with familiar smells

(ie. Chocolate, orange) and ask toidentify it while their eyes are

closed; child must be able to

communicate effectively

Not usually tested unless

parents express concerns; childshould be able to identify

familiar smells with their eyes

closed

II. Optic Shine penlight into eye, observe

infant tightly close their eyes in

response; ability to fixate on a

brightly colored object

Test vision of each eye using cover-

uncover test, child should have the

ability to recognize and identify

pictures of familiar objects or

letters; child may have problem if

they try to push cover away from"good" eye during testing;

peripheral vision may be tested if

child cooperates

Use Snellen eye chart or "E"

chart to test vision using cover-

uncover test; perform

ophthalmoscopic examination of

fundi

III. Oculomotor

IV. Trochlear

VI. Abducens

Tracking of an object can be

used after 6 weeks of age;

Observe for persistant deviation,

nystagmus, or unequal pupil

size; Evaluate red reflex;

perform Rotation test (Doll's Eye

Maneuver)

Track eyes following an object in the

cardinal planes of gaze; look for

pupil deviation, internal strabismus,

nystagmus or unequal pupil size

during motion and while at rest

Same as toddler testing


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V. Trigeminal Rooting Reflex-infant should turn

head and open mouth indirection of stimulus; Suckling

Reflex-finger placed in infant's

mouth should be pushed up

against palate evenly and with

good strength by the tongue;

Corneal Reflex-blow a puff of air

into cornea, which should elicit a

blinking response

Observe the child chewing a cookie

or cracker, noting bilateral jawstrength; touch the child's forehead

and cheeks with cotton and watch

the child bat it away

Have child clench jaw while you

palpate masseter muscles forequal contraction; have child

open jaw wide and look for

deviation of the mandible; use

cotton swab to test light touch

on face while eyes are closed,

ask child to point to where you

touched

VII. Facial (mostcommonly injured

at birth)

Observe facial expressions forsymmetry during feeding and

crying. (Can stimulate Moro

Reflex to initiate crying). Note

infant's ability to wrinkle

forehead and the symmetry of

smile

Ask child to "make a funny face","show your teeth", and "puff your

cheeks", watch for symmetry of

facial expressions; taste is difficult

to test at this age

Ask child to "wrinkle yourforehead", "close your eyes

tightly", "show your teeth",

"wink with each eye", "whistle"

and "puff your cheeks", watch

for ability and symmetry of

expressions; Test taste (sweet,

salty, sour and bitter) only if

problem is suspected


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VIII. Acoustic Perform Acoustic Blink Reflex;

ring bell and watch infant'sresponse, depending upon age,

infant will stop what it's doing

and turn in the direction of the

noise; Perform Rotation Test

(Doll's Eye Maneuver) for

vestibular function

Observe the child turn towards

sounds; whisper a commonly usedword behind the child's back and

have him repeat it; use a tuning

fork to create a sound and hold it a

few inches from the child's ear. The

child will usually remain quiet while

listening.

Ask child if they can hear the

ticking of your wrist watchbilaterally; perform Webber and

Rinne Tests

IX.

Glossopharyngeal

X. Vagus

Place finger in infant's mouth to

assess swallowing and gag

responses, also assessmovement of tongue and

suckling strength

Assess swallowing and gag reflexes;

Visually inspect palate and uvula

with the child saying "AH" and "K"for symmetry

Assess same as toddler.

XI. Spinal

Accessory

Examine rotation and lateral

flexion in response to an

auditory or visual stimulus

Place hand on cheek and ask child

to push into hand; Place hands on

shoulders and ask child to push your

hands up


XII. Hypoglossal Place finger in mouth and assessmovement of tongue and

strength of suckling; Pinch

infant's nose, their mouth should

open and the tip of their tongue

will rise in a midline position

Ask child to "stick your tongue out",check that it is midline; ask child to

push tongue into cheek against the

resistance of your fingers



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References:

Fysh, P. Chiropractic Care for the Pediatric Patient, 1st ed.Arlington; ICA Council on Chiropractic Pediatrics; 2002

Seidel H, Ball J, Dains J, Benedict GW. Mosby's Guide to Physical Examination, 3rd ed. St. Louis, Von Hoffman Press Inc.;

1995

cranial nerve exam handout 1

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