This document provides an overview of assessing the pediatric nervous system. It discusses examining the patient's history, including birth history, developmental milestones, past medical/surgical history. A full neurological exam evaluates mental status, cranial nerves, motor and sensory systems, reflexes, coordination, and gait. For infants, the exam focuses on posture, muscle tone, and primitive reflexes like sucking, rooting, and Moro reflex. Together, this history and exam allow clinicians to identify potential neurological issues.

1. Assessment of Pediatric Nerves System

2. INTRODUCTION
• The nervous system consists of the
• Central Nervous System (CNS),
• Peripheral Nervous System(PNS),
• Autonomic Nervous System(ANS).
• Together these three components integrate all
Physical, Emotional, and Intellectual Activities.

3. INTRODUCTION
• The CNS includes the
• Brain .
• Spinal Cord.
• These two structures collect
and interpret Voluntary and
Involuntary sensory and
motor signals.

4. Assessment :-
• The Assessment of nerves System consist of
• History
• Examination
• Investigation

5. PRESENTING COMPLAINT
Brief Statement Of Primary Problem (Including Duration) That
ThatCausedFamilyToSeekMedicalAttention
• Ask about the symptoms:
• What are they?
• Which part of the body do they affect? Are they localised or
more widespread?
• When did they start?
• How long do they last for?
• Were they sudden, rapid or gradual in onset?
• Is there a history of trauma?
History

6. Ask About Any Associated Symptoms
•Fever
•Headache
•Numbness, cold or warmth
•Weakness, unsteadiness, stiffness
•Nausea or vomiting
•Visual disturbance
•Altered consciousness
•Photophobia

7. • Past Medical History
• Some neurological problems can present years
years after a causative event.
• Major medical illnesses
• Previous hospital admissions with dates and
diagnoses
• Current medications
• Known allergies (not just drugs)
• Immunization status - be specific, not just up to
date

8. • Past Surgical History
• Major surgical illnesses-list operations and dates
• Trauma-fractures, lacerations

9. Con, History
• Post Natal History
• Delivery & Post Delivery Are Important In The
History Its Give Clue In The Diagnosis In Some
Diseases

10. • Pregnancy and Birth History
• Maternal health during pregnancy: bleeding,
trauma, hypertension, fevers, infectious illnesses,
medications, drugs, alcohol, smoking, rupture of
membranes
• Gestational age at delivery
• Labor and delivery - length of labor, fetal distress,
type of delivery (vaginal, cesarean section), use of
forceps, anesthesia, breech delivery
• Neonatal period - Apgar scores, breathing
problems, use of oxygen, need for intensive care,
hyperbilirubinemia, birth injuries, feeding

11. • Developmental History
• Ages at which milestones were achieved and current
developmental abilities - smiling, rolling, sitting alone,
crawling, walking, running, 1st word, toilet training,
riding tricycle, etc
• School-present grade, specific problems.
• Behavior - enuresis, thumb sucking, pica, nightmares
etc.
• Feeding History
• Breast or bottle fed, types of formula, frequency and
amount, reasons for any changes in formula
• Solids - when introduced, problems created by specific
types

12. • Family History
• Illnesses - cardiac disease, hypertension, stroke, diabetes,
cancer, abnormal bleeding, allergy and asthma, epilepsy
• Mental retardation, congenital anomalies, chromosomal
problems, growth problems, consanguinity.
• Social
•Living situation and conditions - daycare, safety issues
•Composition of family
•Occupation of parents

13. Examination
• General Examination
• Weigh
• Height
• Head Circumference
• Systemic Examination

14. meningeal signs
•Kernig's sign.
•Brudzinski's sign.

15. • A Complete Neurologic Assessment Consists Of :
• MentalStatus(Memory, Orientation, Calculations )
• CranialNerveAssessment
• ReflexTesting
• MotorSystemAssessment
• SensorySystemAssessment
• Coordination
• Gait

16. Cranial Nerves
I. Olfactory
II. Optic
III.Oculomotor
IV.Trochlear
V. Trigeminal
VI.Abducens
VII.Facial

17. VIII.Vestibulocochlear
IX.Glosopharyngeal
X. Vagus
XI.spinal Accessory
XII. Hypoglossal
Cranial Nerves

18. Motor System
• Observing the child's posture and simple
maneuvers such as retrieving a ball or
running outside the examination room
can check motor integrity. The following
grading system can be used for assessing
muscle strength:
• 0 - No muscle contraction
• 1 - Flicker or trace of contraction
• 2 - Active movement without gravity
• 3 - Active movement against gravity
• 4 - Active movement against gravity and
resistance

19. Sensory
• The sensory exam includes testing for: pain
sensation (pin prick), light touch sensation
(brush), position sense
• Object Discrimination, Which Tests For
Higher Cortical Functions, Can Be Done
Using Coins, Paper Clips, Or Rubber Bands.
• Stereognosis: The ability to recognize an object
by feel.
• Graphesthesis: “Draw” a number in the palm
of the person’s hand and ask them to identify
the number.

20. Reflexes.
• Jaw Jerk (CN V)
• Biceps (C5-6)
• Triceps (C6-8)
• Brachioradialis (C5-6),
• Patellar (L2-4)
• Ankle (S1-2).
• + Babinski's sign = dorsiflexion of the great toe and fanning of
the toes. Can be normal up to 1 year of age
• Clonus =abnormal movement marked by alternating contraction
and relaxation of a muscle occurring in rapid succession.
Grade Description
0 Absent
1+ Hypoactive
2+ "Normal"
3+
Hyperactive without
clonus
4+ Hyperactive with Clonus

21. Coordination
• Rapid Alternating Movements
• Point-to-Point Movements
• Balance Test
• Romberg's Sign
• patient's inability to remain immobile with
his feet together and eyes closed.

22. Gait
Ask the patient to:
•Walk across the room, turn and come
back
•Walk heel-to-toe in a straight line
•Walk on their toes in a straight line
S1
•Walk on their heels in a straight line
L5
•Rise from a sitting position

23. Neurological examination of the infant.
• 1) Posture and muscle
tone
• 2) Primitive reflexes

24. Posture and muscle tone.
• 1) Resting Posture -
observing the infant
undressed. The infant
should have flexion of the
elbows, hips, and knees .
• 2) Passive Tone -
determining resistance of
passive movements of the
joints while the infant is
awake and not crying.
• 3) Active Tone - traction
response up to 3 months of

25. Primitive reflexes.
• -Present From The Time Of
Birth
• -Represents Spinal Reflexes
Until The Infant Becomes
Older And Higher Cortical
Functions Suppress Them.

26. • Sucking Reflex
• Rooting Reflex
• Moro Reflex
• Tonic Neck Response
• Palmar And Plantar Grasp Reflexes
• Parachute Response
• Reflex Placing And Stepping Responses
• Horizontal (Ventral) Suspension (Landau
(Landau Reflex)
Primitive reflexes.

27. Thank you