Infant neurological examination: what does the examination look like? What is it about?
Neurological disorders in children and their accompanying symptoms, make parents sometimes find out for the first time from what actually is a neurologist in the case of children. The following text is intended to familiarize readers with What is a neurological examination and what does it look like?when it should be performed, whether and how to prepare for it.
In the article you will also find the answer to the question "what is it from", or rather what a neurologist does and with what problems it is worth contacting him for advice. We will also tell you what such a visit looks like and what is the course of the examination at the neurologist.
Neurological disorders in children i i symptoms
What is a neurological examination? Neurological examination is aimed at assessing the function of the nervous system, which coordinates the work of the whole organism. Such an examination consists of many elements, and its course depends on the age and condition of the child.
In the basic scope, any doctor can perform a neurological examination, which is particularly important in the assessment after head injuries or in other emergency situations.
Neurological disorders in children: symptoms associated with movement, disturbances of consciousness and consciousness
The indication for performing a neurological examination is the occurrence or suspicion neurological disorders in childrenwhich can be very different symptoms. Starting from the most serious, such as disturbances of consciousness and consciousness, through various symptoms related to movement.
Symptoms belonging to the latter group may include muscle weakness, abnormal muscle tone (i.e. resistance felt when passively moving e.g. a limb), incomplete range of motion or incorrect movements, problems with movement and maintaining proper balance, accuracy and efficiency of movements.
Neurological disorders in children: symptoms about the senses
Another group of neurological disorders in children that lead to an assessment in a neurological examination are disorders related to our senses - for example:
- abnormal touch sensationthe symptoms of which may include: decreased sensation, tingling, numbness, and abnormal deep sensationwhich may manifest as problems with maintaining balance, difficulties with recognizing the shapes of objects by touch with eyes closed;
- abnormal sense of tasteor persistent problems with smell despite the absence of infection;
- blurred vision (if ophthalmic causes are excluded), similarly hearing and balance disorders, including dizziness (if ENT causes are excluded).
Neurological disorders in an infant
In infancy and early childhood, an important group of neurological disorders are: retardation and abnormal course of psychomotor development, by which we mean, first of all, a delay in achieving the so-called milestones in each of the spheres, i.e. in gross and small motor skills and social contacts.
In order to exclude neurological disorders in the infant, the child should be examined by a neurologist. A check-up with a specialist should take place especially when the baby has had serious problems in the perinatal period. The prerequisites for performing tests to exclude neurological disorders in an infant are:
- premature birth;
- asphyxiating childbirth;
- severe infection;
- perinatal injuries;
- periventricular bleeding.
What is a neurological examination i What does a visit to a neurologist look like??
We know At the beginning of such a visit, it is very important for the doctor to collect an anamnesis regarding both the patient's current ailments and the course of pregnancy, the perinatal period and the child's development. Information about diseases occurring in the family, and sometimes also about the patient's social situation, is also very important.
Expert advises
If the problem is behaviors or disorders that occur paroxysmally or only in specific situations, it is worth preparing a detailed schedule for a visit to a neurologist about how exactly they occur, when and under what circumstances they occur, and how long they last. It is worth trying to observe whether there is a logical contact with the child during their occurrence, or whether there are any circumstances that interrupt these disorders. It is also worth bringing a recording with you, presenting the disturbing symptoms.
Often already at this stage, the doctor, by observing the patient, performs his initial assessment in terms of neurological disorders, because he can then observe his way of moving, posture, behavior, facial expressions and many other details leading to a diagnosis. After a thorough history taking, the doctor proceeds to the physical examination of the little patient.
What does a neurological examination look like at a neurologist?
The neurological examination itself consists of many elements, various tests are performed, reflexes are checked, i.e. automatic reactions with a known course, in response to a given stimulus. During the examination, the doctor uses a neurological hammer, flashlight, measuring tape, sometimes a tuning fork and other tools.
First, the doctor assesses contact with the patient, speech and orientation in time and space, of course, the questions are adapted to the child's age. During the conversation, the doctor also evaluates the behavior, facial expressions and posture of the patient.
How it looks further part visits with child at the neurologist?
After the initial assessment, the neurologist checks the correct functioning of the child's nervous system, focusing on specific areas of the body and senses. To reassure the child, it is worth telling him what a neurological examination at a neurologist may look like, in relation to specific activities undertaken by the doctor.
- Patient's head: At the beginning, the patient's head is examined, its shape, pain when pressed, and circumference are assessed, which is compared to the norms contained in the centile charts. Next, the functions of the cranial nerves are assessed.
- Smell: The sense of smell is assessed as far as possible with the child's cooperation.
- Eyesight: Then, the correct arrangement, alignment and movements of the eyeballs, the shape and size of the pupils and their reactions to light, convergence and accommodation are assessed. The field of view and visual acuity are also assessed indicatively.
- Face: Subsequently, the subject of the examination and price is facial expressions and muscle strength within the face - m.in. by wrinkling the forehead, clenching the eyelids, clenching the jaw, baring the teeth, inflating balloons from the cheeks, sticking out and licking the tongue, opening the mouth wide and saying "Aaaaaa" or "Eeeee", swallowing fluids correctly.
- Hearing: Hearing is subject to an indicative assessment.
- Reflexes: During the examination, various reflexes are also checked, e.g. The doctor can also examine the palatine reflex - which consists in lifting the palatine arches after irritation with a spatula and the pharyngeal reflex - i.e. coughing, vomiting reflex after throat irritation, or the reflex from the masseter muscle caused by a blow by a neurological hammer.
- Head ranges: Later, the doctor proceeds to check the range of head movements - both passively, i.e. without the patient's help, and actively, i.e. by making movements independently by the examined person.
- Muscle strength: If the child is able to cooperate, the test is performed with resistance, i.e. opposing the strength of the doctor who assesses muscle strength in this way. Children often treat such wrestling as good fun and they are very happy to participate in it.
- Limbs and trunk: In the next stage of the examination, muscle strength and tone as well as the range of their movements are assessed. Children perform various tasks such as squatting, unsupported squats, jumping, walking on heels, toes and in a line.
- sense of feeling: Sensation is also tested. In the examination of sensation, touch is used with the hand, sometimes with a cool object, by means of a gentle prick, recognition of shapes drawn on the back with a finger or the handle of a hammer, giving the position of the fingers and toes moved by the doctor with the patient's eyes closed. Additionally, using a tuning fork, applied to the appropriate points on the body, the feeling of vibration is checked.
- Tendon reflexes: Subsequently, during the examination, tendon reflexes are checked, consisting in the contraction of the appropriate muscle in response to a blow with a neurological hammer at a fixed place within the tendon - here the knee reflex is the most recognizable, where after hitting the quadriceps tendon slightly below the kneecap, we observe knee extension, caused by contraction of the quadriceps muscle.
- Surface reflexes: Surface reflexes are also tested, such as skin abdominal reflexes, which are triggered by irritating the skin of the abdomen from the outside to the midline, which should cause tension of the rectus abdominis muscle. Attempts are also made to look for abnormal symptoms, e.g. Babinski's sign, which consists in dorsal bending (upward) of the big toe and toes after irritation of the sole of the foot in the direction from the heel to the toe (in the shape of the letter L).
- Tire symptoms test: Another element is the examination of meningeal symptoms, i.e. those that appear as a result of irritation of the meninges, most often in the course of inflammation - these include, among others, neck stiffness, Brudziński's and Flatau's signs, the detailed description of which goes beyond the scope of this study. During the examination, cerebellar tests are performed, in which the patient's speech is assessed, the ability to make quick alternating movements, finger-nose tests consisting in hitting the tip of the nose with the index finger with the eyes open and closed, the heel-knee test and the Romberg test are performed.
How it looks child's participation in examination by a neurologist?
Expert advises
In a neurological examination, it is very important to compare the patient to generally accepted norms. It is also important to compare the results obtained on one side of the body to the other, especially in terms of movement, muscle tone, strength and reflexes. As you can guess, a full neurological examination requires a lot of cooperation with the patient. Some conclusions can be drawn by a neurologist based on observations and examination of the child partly in the form of play. Neurological examination is completely painless for the patient, and it is often interesting and pleasant for children, the order of activities performed during the examination, as well as their scope can be modified depending on the situation.
Regardless of the child's age, it is worth making an appointment for a neurological examination at a time when there is the greatest chance that the child will be rested and willing to "cooperate" during the examination.
What does a neurological examination of newborns and infants look like at a neurologist?
Neurological examination in the newborn and infant has a slightly different course, due to the limited possibilities of cooperation and features related to the stages of the child's development. When diagnosing neurological disorders in an infant, an extremely important part of the examination is the observation of the child's free activity, it is also important to assess in the supine and prone position. As in older children, contact and interest in the environment are assessed.
Head:
The head is examined - in this area, the examination is extended to the assessment of fontanelles and cranial sutures. Then, according to age, the cranial nerves are assessed, including the assessment of the ability to make eye contact, focusing and guiding the eye, sucking reflex, assessing the effectiveness of swallowing and assessing facial expressions. Muscle tone and reflexes are tested. The cerebellum is also assessed, as in older children, but it consists in observation for tremors, proper motor coordination and possibly balance.
Reflexes:
In addition, in such a study, reactions and reflexes are assessed, which should appear and subside at a specific age and proceed in an appropriate manner.
Expert advises
An example of such reflexes is the Moro reflex, which is present from birth and is a reaction to fear. The Moro reflex should be biphasic. In the first phase there is an inhalation, a symmetrical quick throw and extension of the limbs, arching the trunk. In the second phase, however, there is exhalation, gradual adduction of the limbs, embracing the chest with the upper limbs, often additional screaming/crying. This reflex should begin to die out around 5-6 months of age, although in emergency situations, high stress and in sleep it may last a little longer. Another example of such a reflex is the automatic stepping reflex, which is also present from birth and disappears after 1 month of age.
Child's reactions:
Reactions that develop with the child's age are also studied, including, for example, the reaction to pulling up, the parachute reaction and equivalent reactions, the correct appearance of which is related to the maturation of the nervous system.
On the basis of the collected medical history, observation and examination of the patient, the doctor makes recommendations for further management of the little patient. It happens that it is required to extend the diagnostics by consulting doctors of other specialties, psychological consultation, laboratory tests, imaging tests, EEG, EMG, ENG or other necessary tests. Sometimes it is necessary to apply appropriate treatment and/or start rehabilitation.
Parents sometimes wonderwhat is a neurologist doctor for” and for what diseases to seek help from him?
The most common problems that pediatric neurologists deal with are:
- epileptic seizures;
- migraine and other types of headaches;
- disorders of psychomotor development;
- diagnosis of intellectual disability;
- cerebral palsy;
- many other, less frequent diseases such as: spina bifida, congenital defects of the nervous system, neuromuscular diseases, neurodegenerative diseases, metabolic diseases, inflammatory and autoimmune diseases of the nervous system, neuropathies, etc.;
- A neurologist also deals with the diagnosis and treatment of the neurological disorders listed at the beginning of the article.
In many of the diseases listed above, cooperation between a neurologist and physicians of other specializations, as well as educators, psychologists, physiotherapists, speech therapists, and dieticians is important. In this case, the neurologist is often the physician coordinating such cooperation.
Expert advises
Consultation with a neurologist and neurological examination are used to comprehensively assess the function of the nervous system. Such examination is friendly and painless, it provides a lot of information about the patient's condition, and in the case of neurological disorders in children, it helps to determine the further diagnostic path and the need for possible treatment depending on the symptoms.
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