History and Examination of a Baby Flashcards
What should particular attention be paid to in neurological history taking?
- Age of onset
- Developmental history, including age of milestones and loss of any skills
- Deterioration in school performance
- Detailed family history
- Impact of the problem on family life and functioning
What categories do neurological presentations typically fall into?
- Developmental delay
- Developmental regression
- Weakness
- Abnormal movements
- Change in level of consciousness
- Paroxysmal events
- Headache
- Traumatic injury
Give an example of a condition causing developmental regression?
Rett’s syndrome
Give an example of a condition causing weakness?
Muscular dystrophy
Give an example of a type of abnormal movement
Ataxia
Give an example of a condition causing a change in level of consciousness
Encephalopathy
Give an example of a condition causing paroxysmal events?
Epilepsy
Give an example of a condition causing headache?
Migraine
When is a full neurological examination required?
When a neurological disorder is suspected
In what positions should a baby be examined?
- Supine
- Sitting
- Standing
- Prone suspension
What should be looked for on examination when the baby is supine?
- General movements, posture, and alertness
- Birthmarks
- Measure and plot head circumference
- Assess fontanelles and head shape
- Lift head and do Moro reflex if necessary
- Individually assess tone, power, movement, and reflexes in each limb
- Observe response to sound
- Assess pupil responses, reaction to light, object fixation, and red reflexes/fundoscopy
- Take both hands
- Pull baby by hands to siting
Why is it important to check for birthmarks?
To look for neurocutaneous markers
Why is it important to assess fontanelles?
To look for hydrocephalus
Why is it important to assess head shape?
To look for craniosynotosis
How do you elicit the Moro reflex?
Allow head to fall back quickly supported in your hand by a short distance, and assess reaction of arms
Why should you not always do the Moro reflex?
Usually unnecessary and unpopular with parents
What will be found on assessing reflexes in babies?
Babinski will be positive
What are you looking for when you take both hands in babies?
Grasp reflex
What are you looking for when you pull a baby by hands to sitting?
Head lag
What should be looked for on examination when the baby is sitting?
- Degree of back rounding
- Ability to self support
What are you assessing when looking for the degree of back rounding in a sitting baby?
Tone
What are you assessing for when looking for the ability to self support in a sitting baby?
Tone and posture
What should be looked for on examination when the baby is standing?
- Are they ‘slipping through your hands’
- Rigid legs
- Stepping and walking reflexes
What does it show if the baby is ‘slipping through your hands’?
Hypotonia
What does it show if a standing baby has rigid legs?
Hypertonia
How should you hold a baby in prone suspension?
Lay infant prone across your hand/forearm
What should be looked for on examination when the baby is in prone suspension?
- Degree of drape/ability to lift head and legs
- Examine spine for abnormalities or defects
- Galant reflex
- Lay infant back down on bed, prone
What are you looking for when assessing degree of drape/ability to lift head and legs in a baby in prone suspension?
Tone
How do you elicit the Galant reflex?
Stroke side of spine to see if infant curls towards stimulus
What are you looking for when you lay the infant back down on the bed, prone?
- Head raise
- Rolling
- Attempt to crawl
