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.