Assessment of Cranial Nerves in The Child

Assessment of cranial nerves in the child. Obtained from Hadley (1994). S Sensory, M motor, EOM extraocular movement.

Cranial	Test for function
I Olfactory (S)
Olfactory nerve, mucous membrane of nasal passages and turbinates	With eyes closed child is asked to identify familiar odors such as peanut butter, orange, and peppermint. Test each nostril separately
II Optic (S)
Optic nerve, retinal rods and cones	Check visual acuity, peripheral vision, color vision, perception of light in infants, fundoscopic examination for normal optic disk
III Oculomotor (M)
Muscles of the eyes (superior rectus, inferior rectus, medial rectus, inferior oblique)	Have child follow an object or light with the eyes (EOM) while head remains stationary. Check symmetry of corneal light reflex. Check for nystagamus (direction elicited, vertical, horizontal, rotary). Check cover-uncover test.
Muscles of iris and ciliary body	Reaction of pupils so light, both direct and consensual, accommodation
Levator palpebral muscle	Check for symmetric movement of upper eyelids. Note ptosis
IV Trochlear (M)
Muscles of eye (superior oblique)	Check the range of motion of the eyes downward (EOM). Check for nystagmus
V Trigeminal (M, S)
Muscles of mastication (M)	Palpate the child’s jaws, jaw muscles, and temporal muscles for strength and symmetry. Ask child to move lower jaw from side to side against resistance of the examiner’s hand
Sensory innervation of face (S)	Test child for sensation using a wisp of cotton, warm and cold water in test tubes, and a sharp object on the forehead, cheeks, and jaw. Check corneal reflex by touching a wisp of cotton to each cornea. The normal response is blink
VI Abducens (M)
Muscles of eye (lateral rectus)	Have child look to each side (EOM)
VII Facial (M, S)
Muscles for facial expression	Have child make faces: look at the ceiling, frown, wrinkle forehead, blow out cheeks, smile. Check for strength, asymmetry, paralysis
Sense of taste on anterior two-thirds of tongue. Sensation of external ear canal, lachrymal, submaxillary, and sublingual glands	Have a child identify salt, sugar, bitter (flavoring extract), and sour substances by placing substance on anterior sides of tongue. Keep tongue out until substance is identified. Rinse mouth between substances
VIII Acoustic (S)
Equilibrium (vestibular nerve)	Note equilibrium or presence of vertigo (Romberg sign)
Auditory acuity (cochlear nerve)	Test hearing. Use a tuning fork for the Weber and Rinne tests. Test by whispering and use of a watch
IX Glossopharyngeal (M, S)
Pharynx, tongue (M)	Check elevation of palate with “ah” or crying. Check for movement and symmetry. Stimulate posterior pharynx for gag reflex
Sense of taste posterior third of the tongue	Test sense of taste on posterior portion of tongue
X Vagus (M, S)
Mucous membrane of pharynx, larynx, bronchi, lungs, heart, esophagus, stomach, and kidneys Posterior surface of external ear and external auditory meatus	Note same as for glossopharyngeal. Note any hoarseness or stridor. Check uvula for midline position and movement with phonation. Stimulate uvula on each side with tongue depressor – should rise and deviate to stimulated side. Check gag reflex. Observe ability to swallow
XI Accessory (M)
Sternocleidomastoid and upper trapezius muscles	Have child shrug shoulders against mild resistance. Have child turn head to one side against resistance of examiner’s hand. Repeat on the other side. Inspect and palpate muscle strength, symmetry for both maneuvers
XII Hypoglossal (M)
Muscle of tongue	Have child move the tongue in all directions, then stick out tongue as far as possible: check for tremors or deviations. Test strength by having child push tongue against inside cheek against resistance on outer cheek. Note strength, movement, symmetry

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Modified Glasgow Coma Scale For Infants And Children

Modified Glasgow Coma Scale for infants and children. Coma scoring system appropriate for pediatric patients.
Obtained from Marcoux (2005) [24]

Activity	Score	Infant/non-verbal child (<2 years)	Verbal child/adult (>2 years)
Eye Opening	4	Spontaneous	Spontaneous
	3	To Speech	To verbal stimuli
	2	To Pain Only	To Pain Only
	1	No Response	No Response
Motor Response	6	Normal/ spontaneous movement	Obeys commands
	5	Withdraws to touch	Localizes pain
	4	Withdraws to pain	Flexion withdrawal
	3	Abnormal flexion (decorticate)	Abnormal flexion
	2	Extension (decerebrate)	Extension (decerebrate)
	1	No response	No response
			2–5 years	> 5 years
Verbal Response	5	Cries appropriately, coos	Appropriate words	Oriented
	4	Irritable crying	Inappropriate words	Confused
	3	Inappropriate screaming / crying	Screams	Inappropriate
	2	Grunts	Grunts	Incomprehensible
	1	No Response	No Response	No Response

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Developmental Screening Tools Commonly Used To Assess Child Development

Developmental screening tools commonly used to assess child development. Data from references: Behrman et al. (2004) [4] and Wong et al. (2000) [35]

Tool name	Revised Denver developmental screening test (Denver II)	Prescreening developmental questionnaire R-PDQ)	Developmental profile II	Draw a person (DAP) test
Author	Frankenburg [13]	Frankenburg et al. [14]	Alpern et al. [1]	Goodenough [15]
Items scored	Gross motor Fine motor Language Personal-social	Parent answered prescreen of items on Denver II	Physical Self-help Social Academic Communication	Score for body parts
Age range	Birth–6 years	Birth–6 years	Birth–7 years	5–17 years
Interview	Parent/child	Parent only	Parent/child	Child only
Testing time	30–40 minutes	15–20 min	20–40 min	As needed
Training/certified	Yes	Self-instruction	Self-instruction	Self-instruction
Pros/cons	Range of items Identify child’s strengths/weakness Validity tested Cultural bias Teaching tool	Parent report Can rescreen If delays administer Denver II	Range of items Low rate of sensitivity	Nonverbal Nonthreatening Cultural unbias Few items to score Gives IQ score

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