Prepared by :

There are key principles of neurodevelopment:

The development of motor control proceeds in a head to toe fashion.

The baby first develops head control, then trunk control (sitting), and

finally controls the lower extremities (walking).

Primitive reflexes are normally present in the term infant and diminish

over the next 4 to 6 months of life.

Postural reflexes emerge at 3 to 8 months of age.

Persistence of primitive reflexes and the lack of development of the

postural reflexes are the hallmark of an upper motor neuron

abnormality in the infant.

Important part of assessing brain development is measuring thegrowth of the brain.

The brain grows to 80% of its adult volume during the first 2 years oflife.

A small head (microcephaly) or a large head (macrocephaly orhydrocephalus) can be key findings in explaining the neurologicalabnormalities of a child.

CON…

Save the worst for the last

Stop look, listen

Make it A game

Because the infant and child are unable to fully cooperate for the standard neurological examination, the examination must be tailored to the child and their developmental level and temperament.

Stop

looklisten

To learn more about the child’s neurologic status by initial hands-

off careful observation than you will by forcing the child to conform

to your pattern of performing the neurological examination.

By watching the baby’s spontaneous activity, to determine a great

deal about their mental status, cranial nerve, coordination and motor

status.

CON…

Stop look, listen example

Make it a game

The second part is the HANDS ON PART, which extends and further

clarifies your initial observations.

The examination, make it into a game that engages the child’s

curiosity and imagination.

The exam is less threatening and the child much more cooperative

when toys are used and the examination tools are turned into inviting

play objects.

Make it a game example

The last part of the examination are all those things that are the most

threatening and unsettling for the child such as:

Undressing the child for a complete examination.

Looking at the Fundus with an ophthalmoscope.

Using the Otoscope.

Testing the GAG reflex.

Measuring the head circumference.

Save the worst for the last example

General Physical Examination :-

In the neurological assessment of the child don’t neglect the

general physical examination.

Somatic Growth :-

Measure height and weight and compare percentiles with head

circumference.

CON…

Search for Dysmorphic features :-

Carefully study the face especially the midface. There is the old

adage that the face reflects the brain because anomalies of the

midface are often associated with underlying brain malformations.

CON…

Spine :-

Look for scoliosis and any sacral anomalies.

CON…

Eye examination :-

children are often uncooperative and it is hard to get a good look at

the fundus but patience and perseverance pays off. The retina is said

to be the window to the brain and the retinal examination can give

valuable information for the neurological assessment.

Age dependent…

CON…

SKin search :-

A careful complete skin search is important. Look for the stigmata

of the neurocutaneous syndromes such as café au lait or ash leaf

lesions.

CON…

Abdomen :-

Palpate for visceromegaly, which can indicate the presence of

one of the storage diseases.