Key Concepts
Introduction
Neurological assessment in children presents unique challenges because the developing nervous system does not look the same as a mature adult nervous system. Reflexes that are pathological in adults are normal in infants. Verbal responses that indicate full consciousness in a 3-year-old are impossible in a 6-month-old. A fontanel that is flat at rest may become bulging with crying โ but persistent bulging at rest is a significant sign of elevated intracranial pressure. The RPN performing neurological assessment in pediatric settings must know not only what to assess, but what is developmentally expected at each age, and what constitutes a deviation from that expectation. A 15-month-old who does not walk yet may be within normal limits or may represent a neurological concern โ context and trend matter as much as the finding itself. This lesson covers the core components of the pediatric neurological examination relevant to RPN practice: level of consciousness using GCS and AVPU, pupillary responses, primitive and postural reflexes, deep tendon reflexes, meningeal signs, and signs of increased intracranial pressure including Cushing's Triad and the sunset sign. These...