Friday, July 10, 2015

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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