WHAT IS A PEDIATRIC NEUROLOGIST?

Problems involving the nervous system in children is often treated by a pediatric neurologist who has the special training and experience to treat your child, some examples are seizures, delayed speech, weakness or headaches.

WHAT IS A NEUROLOGICAL EXAM?

A neurological exam is an evaluation of your child's nervous system. It may be performed with instruments, such as lights and reflex hammers, and does not usually cause any pain to the child.

The nervous system consists of the brain, the spinal cord, and the nerves from these areas, as well as the muscles (the neuromuscular system.) There are many aspects of this exam, including an assessment of motor and sensory skills, balance and coordination, mental status (the child's level of awareness and interaction with the environment), reflexes and functioning of the nerves. The extent of the exam depends on many factors, including the initial problem that the child is experiencing, the age of the child, and the condition of the child.

WHY IS A NEUROLOGICAL EXAM PERFORMED?

A complete and thorough evaluation of your child's nervous system is important if there is any reason to think there may be an underlying problem, or during a complete physical.

Damage to the nervous system can cause delays in the child's normal development and functioning and early identification may help to identify the cause and decrease long-term complications. A complete neurological exam may be performed:

• During a routine physical
• During a newborn physical
• To follow the progression of a disease
• Following any type of birth defect to the head or spine
• If the child has any of the following complaints:
  • Headaches
  • Blurry vision
  • Change in behavior
  • Fatigue
  • Change in balance or coordination
  • Numbness or tingling in the arms or legs
  • Decrease in movement of the arms or legs
  • Injury to the head, neck, or back
  • Temperature of unknown source
  • Seizures
  • Slurred speech
  • Weakness
  • Tremor

TYPES OF CONDITIONS TREATED:

• Epilepsy
• Muscle diseases
• Cerebral palsy
• Diseases of the peripheral nerves
• Headaches
• Movement disorders
• Neurogenetic diseases
• Neurobehavior disorders
• Congenital defects of the brain and spinal cord
• Mental retardation and development delay
• Neurological complications of medical diseases
• Stroke
• Brain tumors
• Neurofibromatosis

WHAT TO EXPECT DURING A NEUROLOGICAL EXAMINATION

During a neurological exam, your child will be tested on the functioning of his or her nervous system. The nervous system is very complex and controls many different parts of the body, the nervous system regulates the muscles. The circulation to the brain, arising from the arteries in the neck, is also frequently examined. In infants and younger children, a neurological exam includes the measurement of the head circumference. The following is an overview of some of the areas that may be tested and evaluated during a neurological exam:

• Evaluation of the cranial nerves - There are 12 main nerves of the brain, called the cranial nerves (CN I-XII). During a complete neurological examination, most of these nerves are evaluated to help determine the functioning of the brain.
• Muscle stretch reflexes in older children - Also previously referred to as "deep tendon reflexes" and is usually examined with the use of a reflex hammer. The reflex hammer is used at different points on the body, such as the knee or elbow, to test the reflex arc between the nerves that cause the muscle contraction  and those that send signals back to the brain. This will test both the peripheral nerves and the spinal cord.
• Mental status - This is the child's level of awareness and interaction with the environment. This is assessed by watching the child interact with the parent, or by asking an older child to follow directions or answer questions appropriately. The older child will also be observed for clear speech and making sense while talking.
• Motor function and balance - This is tested by having an older child who will push and pull against the examiner with his or her arms and legs. The may be asked to squeeze fingers, hop, skip or jump. Balance may be checked by assessing how the child stands and walks or having the child stand with his or her eyes closed while being gently pushed to one side or the other. Your child's joints may also be checked simply by passive and active movement.
• Newborn and infant reflexes - There are different types of reflexes that may be tested. In newborn and infants, reflexes called infant reflexes (or primitive reflexes) are evaluated. Each of these reflexes disappears at a certain age as the infant grows. These reflexes include:Sensory exam - This is performed to test and check your child's ability to feel. This may be done by using different instruments: dull needles, tuning forks, alcohol swabs, or other objects. The child's legs, arms, or other parts of the body will be tested to see if he or she is able to identify the sensation (e.g hot or cold, sharp or dull).
  • Blinking - An infant will close his or her eyes in response to bright lights.
  • Plantar reflex (also known as Babinski reflex) - Normally as an infant's foot is stroked, the toes will extend upward. This response usually disappears after a year of age. It is considered abnormal for this reflex to remain present after 2 years.
  • Crawling - If the infant is placed on his or her stomach, he or she will make crawling motions.
  • Moro's reflex (or startle reflex) - A quick change in the infant's position will cause the infant to throw the arms outward, open the hands and throw back the head. This reflex normally is gone after 6 months of age.
  • Tonic neck reflex - The newborn is tested lying down with face up. If the head is passively turned to one side, the arm on that side will extend, with the other arm flexing at the elbow and shoulder. This reflex normally goes away after 6 months of age.
  • Palmar and plantar grasp - The infant's fingers or toes will curl around a finger placed in the area.
• Sensory exam - This is a test that checks your child's ability to feel. This may be done by using different instruments: dull needles, tuning forks, alcohol swabs, or other objects. Your child's legs, arms, or other parts of the body will be tested to see if he or she is able to identify the sensation (e.g hot or cold, sharp or dull).