1. LOC Level of arousal, emotional state, social orientation Assess changes in baseline: easy/ difficult/ unable to arouse response to parents degree of irritability/ consolability In addition to infant assessment: –attention span, orientation in terms of memory: (name of favorite stuffed animal,pet, best friend,school routine, holidays.) degree of agitation/ restlessness, discerns night-time from daytime In addition to infant and child assessment: assess orientation to person, place time, increase in confusion, anxiety or combativeness CN 1- Smell OLFACTORY I difficult to assess in ICU setting CN 2/3- muscles of eyes and optic nerve OPTIC II OCULOMOTOR III grimaces to light “blinks to threat” tracts or follows objects across visual fields Assess visual acuity “how many fingers?Same as child CN 3/4/6 -muscles of eyes OCULMOTOR III TROCHLEAR IV ABDUCENS VI PERRL, Visually follows object, no abnormal eye movements Intact Extra ocular movements In addition Can identify objects in peripheral visual field, no complaints of double vision CN 5 –nerves of the jaw TRIGEMINAL V difficult to assessClenches teeth In addition Can move jaw side to side against resistance CN 7- muscles of facial expression FACIAL VII Symmetrical facial movements when smiling or crying In addition : Makes faces, smiles, wrinkles forehead, looks at ceiling, blows out cheeks Same as child assessment CN 8- nerves of acoustic and equilibrium ACOUSTIC VIIIAwakens to verbal stimuliSame as infant assessment In addition no complaints of dizziness CN 9/10- Mouth and throat muscles VAGUS X.Cry/Voice does not become hoarse or high pitch, intact gag reflex Same as infant assessment In addition; When saying “aahhh” uvula mid line CN 11 Shoulder muscles ACCESSORY XIDifficult to assess Symmetrical shoulder shrug In addition -Shoulder shrug against resistance CN 12- Muscles of Tongue HYPOGLOSSAL XII Sucking swallowing gag No deviations when sticking out tongue In addition Punches tongue inside cheek against resistance Infant or Severe Developmental Delay ChildAdolescent PICU Quick Reference Pediatric Neurological Assessment

2. Goal : Recognize/Report subtle changes in baseline neurological status before deterioration. Most Important: Be systematic! Repeat assessment same order each time: 1.Appearance and Observation 2.Level of consciousness 3.Cranial Nerve Assessment 4.Motor Sensory Function 5.Vital Signs 6.External Monitoring Devices Exam - Infant/Toddler- determine eye opening, arousability, level or irritability/consolability, symmetry of facial expressions and movement of upper and lower extremities, listen for increase weakness or pitch in cry/vocalizations, assess anterior fontanel, check each pupil separately for size, shape, equality of reaction to light, check ability to track object, note muscle tone for rigid extension or flexion of extremities, flaccidity and/or unusual posturing. Child- (In addition )- note c/o headache, assess social orientation attention span, orientation in terms of memory (name of favorite stuffed animal etc.) degree of agitation/ restlessness, clarity of speech, EOMs, visual acuity, blow fish cheeks, tongue deviation, symmetrical shoulder shrug, high five, drift assessment*, grip strength, ability to lift legs against resistance. Adolescent- (In addition)-note complaints of double vision, dizziness, anxiety, fearfulness Score patient using Glascow Coma scale: ActivityScoreInfant/Non verbal child <2years Verbal child/ adolescent >2years >5year Eye Opening 43214321 Spontaneous To Speech To Pain Only No Response Spontaneous To verbal stimuli To Pain Only No Response Motor Response 654321654321 Normal/Spontaneous Withdraws to touch Withdraws to pain Abnormal flexion-decorticate Extension- decerebrate No response Obeys commands Localizes Pain Flexion withdrawal Abnormal flexion Abnormal extension No response Verbal Response 5432154321 Cries appropriately, coos Irritable crying Inappropriate screaming/cry Grunts No response Appropriate words Inappropriate words Screams Grunts No response Oriented Confused Inappropriate Incomprehensible No response