NEUROLOGICAL EXAMINATION

IN CHILD
Supervised :
dr. Linda Suryakusuma, Sp.S
Shanen Ribkha – Faculty of Medicine Atma Jaya Catholic University
 INTRODUCTION
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Neurological examination is an important part in
diagnosing neurological disease and in a child it is
important to determine developmental disorder
because neurological disorder in a child is not always
caused by neurological disease, it can also be
caused by low birth weight, poor nutrition and lack of
sensoric stimulation. These things could inhibit
development in motoric, sensoric, and mental
function.

According to Swaiman’s Pediatric Neurology,

neurological examination in pediatrics are divided
into 3 age range.
Term and Preterm Infant
Newborn Period after 2 Years of Age
Older Children

“Balita” which is a term used in Indonesia is an age

range from 2 years old until 5 years old and therefore
is included in the older child age range. And so in this
paper, we will be more focused on discussing
neurological examination in older child.
 LITERATURE REVIEW
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Examination
Age HC
Neonate 35 cm
3 months old 40 cm
9 months old 45 cm Neurologic
3 years old 50 cm Examination
9 years old 55 cm
History General Tips
General
1. Use small objects, toys
Examination
2. Do not wear white coat
Acute/insidious?
3. Postpone uncomfortable (HC,
Focal/generalized?
funduscopy, corneal & gag
Progressive/static?
reflex, sensory testing)
What age?
4. Make the most of opportunity
Family History ?
5. Examine on parent’s lap
 Neurologic Examination

Motoric

Cranial
Nerves Sensoric

Mental Coordination/
Status
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cerebellar
Screening gross D
motor function
 Neurologic Examination

Motoric

Cranial
Nerves Sensoric

Mental Coordination/
Status
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cerebellar

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Screening gross
motor function
 Cranial Nerve

Nervus II
Opticus Nervus I
Olfactory

Nervus III, IV, VI

Oculomotor, Trochlear,
Abducens
 Cranial Nerve

Nervus II
Opticus Nervus I
Olfactory

Nervus III, IV, VI

Oculomotor, Trochlear, Nervus V
Abducens Trigeminal
 Cranial Nerve

Nervus VIII
Nervus VII Vestibulocochlear
Facialis
Nervus XII
Hypoglossal
Nervus XI
Spinal accessory Nervus IX, X
Glossopharyngeal,
Vagus
 Neurologic Examination
Motoric

Cranial
Nerves Sensoric

Mental Coordination/
Status
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cerebellar

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Screening gross
motor function
 Motoric

Motoric Strength Deep tendon reflexes Other reflexes

Strength and Tone Physiologic Reflex
5: normal power 0: absent Plantar reflex
4: inability to maintain position against 1: hyporeflexic (trace, or Hoffman-Trommer
moderate resistance only seen with reinforce Abdominal reflex
3: inability to maintain position against ment) Cremasteric reflex
slight resistance or gravity 2: normal
2: active movement with gravity elimin 3: hyperreflexic
ated 4: unsustained clonus
1: trace of contraction 5: sustained clonus
0: no contraction.
 Neurologic Examination
Motoric

Cranial
Nerves Sensoric

Mental Coordination/
Status
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cerebellar

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Screening gross
motor function
 Sensoric System
TOUCH PAIN VIBRATION
Limited
Pinprick, flicking 
Cloth or cotton Tuning fork
pulling
COOPERATION
Fingers, big toe,
Gently, rapidly, in a
Single or double touch maleolus lateral and
playful manner
medial joint

POSITION STEREOGNOSIS GRAPHESTHESIA

Cortical
sensory Recognize numbers,
Moving the finger and Familiar objects by
function can letters, symbols on
toe up and down touch
be tested in skin
older child Buttons, coins, safety
Closed eyes Open and closed eyes
pin, keys
 Neurologic Examination
Motoric

Cranial
Nerves Sensoric

Mental
Status Coordination/

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cerebellar
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Screening gross
motor function
 Conclusion
Neurological examination is important in supporting
the diagnosis of a neurological disease. In children a
neurological examination basically has the same
component as a physical examination of neurology in
adults but with a slightly different approach.
The examination consisted of history, general physical
examination and neurological examination consisting
of mental status examination, motor screening, cranial
nerve, motor, sensory nerves, and cerebellar function.
 Conclusion

The examiner must be able to understand what he/she

wants to examine and know how to do it. Accuracy
and observation are very important in neurological
examination in children.
Especially children under 5 years, patience and
adaptability and creativity in carrying out examinations
are required. The examiner is expected to be able to
adapt to the behavior and mood of the child and grabs
every oppurtunity.
 Literature
1. What is a Neurologic Disorder? - Child Neurology Foundation [Internet]. Child
Neurology Foundation. 2018 [cited 25 December 2018]. Available from: https://
www.childneurologyfoundation.org/patients-or-caregivers/living-neurological-co
ndition/what-is-a-neurologic-disorder/
2. [Internet]. 2018 [cited 25 December 2018]. Available from: http://www.depkes.g
o.id/folder/view/01/structure-publikasi-pusdatin-info-datin.html
3. Soetomenggolo TS & Ismael S., Buku Ajar Neurologi Anak. Cetakan ke-2
.Jakarta: IDAI. 2000
4. Swaiman K, Ashwal S, Ferriero D, Schor N, Finkel R, Gropman A et al. Swaim
an's pediatric neurology. Sixth Edition. China. Elsevier. 2018.
5. Hills, William, Pediatric and Infant Neurologic Examination. 2013.
6. Haslam, RHA. Handbook of Clinical Neurology, Vol. 111 (3rd series) Pediatric
Neurology Part I. Philadelphia. Elsevier. 2013
7. Paine R. Neurologic Examination of Infants and Children. Pediatric Clinics of N
orth America. 1960;7(3):471-510.
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Thank you