Pediatric Neurological Examination

What is a neurological exam?

A neurological exam is a simple series of tests that allows your child’s doctor to watch her nervous system in action and can assess her:

mental status (level of awareness and interaction with the environment)
motor and sensory skills
balance and coordination
reflexes

There are different parts to a standard neurological exam, and the ones that your child’s doctor focus on depends on factors including your child’s symptoms, age, and health.

Why does my child need a neurological exam?

If your child’s nervous system isn’t working properly, it can cause delays in her normal development and functioning. Early detection means that we have a better chance of identifying the cause, quickly treating her, and decreasing the chance that she’ll have long-term complications.

Your child’s doctor may request a neurological exam if your child:

complains of symptoms including:
- headaches
- blurry vision
- fatigue
- fever of unknown cause
- change in balance or coordination
- numbness or tingling in the arms or legs
- decrease in movement of the arms or legs
- tremor
has had an injury to her head, neck, or back
is experiencing a change in behavior, or in balance or coordination
has any type of birth defect to her head or spine
is currently being treated for a disease or condition

Neurological exams may also be performed during a routine physical exam, either right after birth or later in childhood or adolescence, in order to investigate possible problems or rule something out.

Where is the exam performed?

They’re done right in a doctor’s office, usually by a neurologist. If your child is in the hospital being treated for something else, it can often be done in her room, too.

How long does the exam take?

The first thing the doctor will do is talk to you and your child about her symptoms, in order to get a good idea of which areas to concentrate on. After that part, the actual exam takes about 30 minutes.

What happens during a neurological exam?

Our pediatric neurologists talk to you and your child, and take your child’s medical history. Based on what we learn, we form theories about what may be causing the symptoms. Then, we perform a series of “tests” that let us do two things: gain more information about how your child’s central nervous system is functioning, and test the theories we’ve made from the interview.

The most common neurological tests look at:

Mental status. We’ll assess your child’s level of awareness and how she interacts with the environment. As you can imagine, the way we do this is highly dependent on her age. For older children, we ask them to follow directions or answer questions. For younger children, we watch how they interact with their parents.
Motor function and balance. If your child is old enough, we may ask her to:
- push and pull against the doctors hands with her arms and legs
- hop, skip, or jump
- walk on tip-toes, walk on heels, walk on outsides of feet, or walk on insides of feet
- squeeze fingers
- stand with her eyes closed while being gently pushed to one side
We may check how her joints move. If your child isn’t old enough to follow instructions, we may just observe how she moves.
Sensory perception. This examines your child’s ability to feel. We may touch your child's legs, arms, or other parts of her body and have her identify the sensation (hot/cold, sharp/dull).
Reflexes. If your child is older, we examine her reflexes by gently tapping a small, soft reflex hammer on different points on her body.
Cranial nerves. There are 12 main nerves of the brain, called the cranial nerves, each of which has a number. During a complete neurological exam, we evaluate most of them, but we may choose to concentrate on certain areas, depending on her symptoms.

Can you give a neurological exam to an infant?

Yes — newborns and infants have a special series of reflexes that we can test, including:

blinking: your infant will close her eyes in response to bright lights
Babinski reflex: as your infant's foot is stroked, her toes will extend upward
crawling: if your infant is placed on her belly, she’ll make crawling motions
Moro's reflex: a quick change in your infant's position will cause her to throw her arms outward, open her hands, and throw back her head
startle: a loud noise will cause your infant to extend and flex her arms while her hands remain closed in a fist
palmar and plantar grasp: her fingers or toes will curl around a finger placed in the area

Each one of these reflexes disappear at a certain age.

When do we get the results of the exam?

Right after the exam. Your child’s doctor will talk with you about the initial hypothesis, what the exam showed, and what your next steps should be. The exam may indicate that another test is needed, such as a blood test, an MRI, or a nerve conduction study. Your child’s doctor will be happy to answer any questions you may have.

How Boston Children's Hospital approaches neurological exams

The Department of Neurology at Boston Children's is the oldest, largest, and best-known program in pediatric neurology in the world.

Our department includes child neurologists with special expertise in such areas as epilepsy, learning disabilities and other developmental disabilities, attention deficit disorders, sleep disorders, neuromuscular disorders, brain tumors, neurogenetic disorders, neonatal neurology, intellectual disability and cerebral palsy, pediatric neuro-immunology, and pediatric multiple sclerosis and related disorders, among other neurological disorders in children. You and your child are in good hands with us.