Download - Cranial Nerve Exam Handout 1
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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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CRANIAL NERVE EXAMINATION
Cranial Nerve: Infant Testing: Toddler Testing: School-Aged Testing:
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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CRANIAL NERVE EXAMINATION
Cranial Nerve: Infant Testing: Toddler Testing: School-Aged Testing:
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
Assess same as toddler.
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
Assess same as toddler.
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CRANIAL NERVE EXAMINATION
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