Neurological assessment in pediatrics

Running head: NEUROLOGICAL EXAMINATION 1

NEUROLOGICAL EXAMINATION 2

Neurological examination

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Introduction

Neurological assessment in pediatrics is an important component and involves a lot of physical activities. Most of the body assessment techniques that are used are commonly done in the nursing field. There are different milestones that should be achieved in the neurological development of the child. The different ages of development are significant in the development of the child. In this exam, the critical areas that need to be assessed include mental status, evaluation of the motor function, balance and coordination, evaluation of the sensory functions, and reflex testing.

Mental status

The newborns should be assessed on their mental status by looking at the level of consciousness. The infant should show some sense of alert and response for most of the activities that they are shown. In case the baby has felt asleep, it should be easy to wake them up. They should be easily aroused. The assessor should also look at how the child interacts with the parent or caregivers. Infants of 26 weeks of gestation should be able to respond to blinks effectively. There should be sustained eye closure at the age of 32 weeks of gestation. The child should be able to turn toward light at 37 weeks.

Head growth

There should also be the measurement and ploting of the head circumference. The plotting should be done differently for boys and girls. This measurement should be able to increase at a rate of 0.5cm per week.

Neurodevelopment

The use of finger-identification is useful in differentiating development that is considered aberrant (autism) with delayed but normal development. There are developmental milestones that should be assessed in the neurodevelopment assessment. When an infant has attained 3 months, they should, while lying prone, be able to lift their head off the table, while a 4 month child should be able to support their torso with the use of both hands. On the other hand, a 5-month child should be able to balance on one hand and reach out using the other hand. At the age of 6 months, an infant should be able to roll from supine to prone. After attaining the age of 8 months, infants should be able to sit without any form of support. At the age of 10 months, an infant should be able to crawl and pull up to a position that they are able to stand. At 12 months, there should be evidence of the infant crawling and walking up to with some form of support (DiPietro et al., 2010).

Reflex development the reflexes that are used for developmental purposes are seen during birth. These developmental reflexes should be able to disappear at some specific ages. The disappearance of truncal incurvature should disappear when the child is 2 months while rooting reflex should be disappear when the child is 3 months old. The Moro’s reflex should be able to disappear when the child is 4 months old (Hadders‐Algra et al., 2010).

Cranial nerve development

The examination of the funduscopy is possible if there will be the use of the ophthalmoscope in the “peek-a-boo” game. The fixation of the child can be achieved with the use of toys. The tongue should be checked for fasciculation. The signs can be used to be valuable indication of motor neuron disease.

Motor function

There should be a manifestation of handedness when the child is 1 year old. If there are earlier manifestations of preference, it shows that there is a unilateral weakness. The grasp reflex that is found in the hand should be able to disappear when the child is six months old. If there is persistence of this reflex, there is a high possibility of having neural dysfunction. When a child is between 8 and 10 months old, there should be functional and useful grasp with the use of the thumb and two fingers. In the case of a newborn, there should be observation of tremulousness, responses that can be said to be exaggerated and startle. They indicate the possibility of abnormalities in the central nervous system (Illingworth, 2013).

References

DiPietro, J. A., Kivlighan, K. T., Costigan, K. A., Rubin, S. E., Shiffler, D. E., Henderson, J. L., & Pillion, J. P. (2010). Prenatal antecedents of newborn neurological maturation. Child development, 81(1), 115-130.

Hadders‐Algra, M. I. J. N. A., Heineman, K. R., Bos, A. F., & Middelburg, K. J. (2010). The assessment of minor neurological dysfunction in infancy using the Touwen Infant Neurological Examination: strengths and limitations. Developmental Medicine & Child Neurology, 52(1), 87-92.

Illingworth, R. S. (2013). The development of the infant and the young child: Normal and abnormal. Elsevier Health Sciences.