The Newborn and Infant Neuro Exam

Performing a neurologic examination on pre-verbal children in the emergency department relies heavily on keen observation and context-driven assessment. Rather than relying solely on traditional deep tendon reflexes, clinicians should evaluate developmental milestones, such as the Moro, palmar grasp, and fencing reflexes, noting their expected presence at birth and subsequent extinction by four to six months. Abnormalities, particularly asymmetries or persistent reflexes beyond typical developmental windows, serve as critical indicators for further investigation. Cranial nerve function can be effectively assessed through modified techniques, including pupillary response to light, auditory startle responses, and observing feeding behaviors. Integrating these findings with a thorough assessment of muscle tone, posture, and head circumference provides a comprehensive neurologic picture, allowing for the timely identification of potential pathologies such as increased intracranial pressure or developmental disorders.