NEUROLOGICAL EXAMINATION
The neurological examination in children will depend on the child’s age and willingness but it can usually be carried out in the normal way in older children. The most common neurological examination may include:
- Mental status
- Motor function and balance
- Reflexes
- Sensory perception
EYE
The eye should be checked and inspected for conjunctivitis, cataracts, or congenital defects
The pupil responses are checked. This is done by examining whether the eye’s pupil opens and closes appropriately in the presence of light. Pupils are measured for size and symmetry in both light and darkness
Ocular fixation is evaluated. Here, the doctor will note if the child fixates on things such as light and follow as it moves.
Ocular alignment should be assessed to identify abnormal eye alignment such as in the case of strabismus
It is essential to check for squint
The external portion of the eye, including eyelids, orbits, conjunctiva, sclera, cornea, and iris should be examined. Using a light, the examiner should inspect for excessive tearing, watery discharge, and gross structural abnormalities.
Red reflex examination is carried out. Red reflex should be equal in both eyes when viewed simultaneously. If it is absent, it could be indicative of corneal, lens, or vitreous opacity such as retinoblastoma.
When both visual acuity and ocular alignment are accessed, the doctor should note of the possibility of lazy eyes (amblyopia)
ABDOMEN
The examination should follow the three essential components of observation, palpitation (feeling), and auscultation (listening).
The doctor should start by observing the abdomen for signs of swelling and movement
The doctor should watch the child’s face he/she gently and lightly palpates the stomach and ask if the tummy hurts anywhere. The four quadrants should be palpated to determine the position and size of the liver, spleen, kidneys, and bladder.
The position, size, surface, and texture of any enlarged organ should be noted. The character of the edge if there is one and whether it is tender should also be noted.
THE NOSE, EARS, MOUTH, AND THROAT
The nose is examined superficially. The doctor looks at the nose from the front and side and note:
- Size and shape
- Obvious bend or deformity
- Swelling
- Scars or crease
- Inflammation, the position of the septum and the presence of polyps
- Redness
- Discharge and any offensive smell
The examination of the ear includes an assessment of hearing as well as the appearance of the ear.
The external ear should be checked for size and shape, signs of trauma to the pinna, skin condition of the pinna, and inflammation of the external ear canal, with discharge
Note the condition of the ear canal skin, and the presence of wax, foreign tissue or discharge
A detailed hearing test is performed
To view the throat of a defiant child, a tongue depressor may be inserted into the gap between clamped teeth and cheek and the teeth.
The mouth is examined and the condition of the tongue is noted
The back of the tongue may be pressed down with a tongue depressor. This is done to examine the back of the tongue and the tonsils
The floor of the mouth should be examined.
The uvula and soft palate should be inspected
Also, inspect the hard palate
GENITALIA, GROIN, AND ANUS
If it necessary to examine the child, nappy or underpants can be removed.
In small babies, the testes should be present in the scrotum
In girls, the vulva should be checked for redness, soreness, or discharge
Check that the labia separate normally
The anal orifice should be checked for fissures which are associated with constipation