The Pediatric Neurologic Examination

• General

o Anterior fontanelle (soft, flat, full, bulging, closed)

o Head circumference

• Obtain and record measurement and plot on an appropriate head growth chart)

§ More important than the actual percentile is the deviation of growth from a previous curve

• Rectal tone
• Level of Consciousness

o Easily aroused

o Lethargic

o Obtunded

• Cranial Nerves

o Pupillary responses

o Eye movements

o Gag

o Facial symmetry

• Motor

o Muscle tone (flaccid, rigid, normal)

o Spontaneous movements of all extremities

o Response to noxious stimulation

• Sensory
• Careful observation with pin exam can reveal pin levels or areas of anesthesia
• Reflexes
• Check deep tendon reflexes
• Other reflexes and when they disappear:
• Step reflex (2 months)
• Moro reflex (4-6 months)
• Suck/Root reflex (4 months (awake); 7 months (asleep)
• Grasp reflex (6 months)
• Plantar grasp reflex (11 months)
• Developmental Milestones:
• 1 week – Extends head in prone position
• 2 months – Follows moving object
• 3-4 months – Has head control
• 5-6 months – Rolls prone to supine
• 6-7 months – Rolls supine to prone
• 7-8 months – Sits alone; transfers objects from hand to hand
• 9-11 months – Stands; picks up object with pincer grasp
• 12 months – Knows 2-4 single words; helps dress self
• 14-15 months – Walks
• 18 months – Feeds self; 10 word vocabulary
• 24 months – Runs well; 2-3 word sentences; organized play