5.2 Pediatric Neurological Differences/Assessments

Question 1

Differences in CNS

Answer 1

• Majority of brain cells are developed before birth
• Brain grows from 25% adult size at birth to 90% by age 5. Most brain growth happens in the first 2 years of life
• Brain continues to mature until mid 20s
• Synaptic connections and myelination developing in infancy/toddlerhood

Question 2

Neurological Assessment

Answer 2

Glascow Coma Scale
- Eye opening, motor response, verbal response
- 15 is the highest (most optimal)
- 3 is the lowest (worst)

OTHER IMPORTANT ASSESSMENT FACTORS
- Changes in LOC are early signs of neurological decline
- Test the cranial nerves
- Fontanels/Suture lines (especially when open) - Bulging fontanel means increased intracranial pressure or fluid overload, sunken fontanels indicates dehydration
- Cognitive function (based on age group like how they interact with you and what commands can they follow)
- Motor functioning (especially important during infancy to check reflex to check overall neurologic functioning)
- Family history of neurologic disorders

Question 3

LOC

Answer 3

• Awake, alert, oriented & age appropriate behavior
• Pediatric population can move very quickly across the spectrum of LOC (they decompensate very quickly)
• Confusion (impaired decision making)
• Lethargy (Confused to time and place)
• Obtundation (Arousable w/stimulation)
• Stupor (Vigorous shake and shout to arouse from deep sleep. Returns to sleep with no stimulation)
• Coma (no motor or verbal response or reactions to stimuli)

Question 4

Altered States of Consciousness

Answer 4

• Initial changes may be subtle
  (slight disorientation to person/place/time)
• Child then becomes restless/fussy/unable to be calmed
• After this responsiveness decreases and they are much harder to arouse (only to loud sounds or pain)
• Progression continues to only responding to pain
• Response to pain progresses from purposeful to non-purposeful
• They can slip into coma/seizures
• CERTAIN STAGES CAN BE SKIPPED DUE TO RAPID DECLINE OF PEDIATRICS

Question 5

Eyes

Answer 5

• Eyes give a lot of information especially with neurologic issues
• WHEN EYES ARE SUDDENLY FIXED (DOES NOT REACT TO LIGHT) AND DILATED THIS IS AN EMERGENCY

Pinpoint (small) Pupils - Poisoning/Drug Use
Widely Dilated and Reactive - Post seizure
Unilateral Fixed (on one side but reactive on other side) - Lesion on that side of the brain
Dilated & Non-reactive - Hypothermia, poisoning, ischemia, anoxia

Question 6

CNS Differences

Answer 6

• Fontanelles maybe open
• Primitive reflexes may be present
• Increased proportion of head size to rest of body
• Poorly developed neck muscles
• Excessive spinal mobility
• Observation of neurological status is used commonly because infants/toddlers wont follow commands

Question 7

Neurological Assessment

Answer 7

• GCS for LOC
• Cranial Nerve Assessment
• Characteristics of fontanelles
• Pupil responses
• Movement of extremities
• Posture/Reflexes
• Neuromuscular response/tone
• Size/shape of skull
• Cry characteristics
• Vitals
• Developmental Milestones