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- Cranial Nerves
- I—Olfactory Nerve
- Olfactory mucosa of nasal cavity (Smell)
- With eyes closed, have child identify odors, such as coffee, alcohol from a swab, or other smells; test each nostril separately.
- Olfactory mucosa of nasal cavity (Smell)
- II—Optic Nerve
- Rods and cones of retina, optic nerve (Vision)
- Check for perception of light, visual acuity, peripheral vision, color vision, and normal optic disc.
- Rods and cones of retina, optic nerve (Vision)
- III—Oculomotor Nerve
- Extraocular muscles of eye:
- Superior rectus: moves eyeball up and in
- Inferior rectus: moves eyeball down and in
- Medial rectus: moves eyeball nasally
- Inferior oblique: moves eyeball up and out
- Have child follow an object (toy) or light in six cardinal positions of gaze
- Pupil constriction and accommodation
- Perform PERRLA (Pupils Equal, Round, React to Light, and Accommodation).
- Eyelid closing Check for proper placement of eyelid.
- Extraocular muscles of eye:
- IV—Trochlear Nerve
- Superior oblique (SO) muscle: moves eye down and out
- Have child look down and in
- Superior oblique (SO) muscle: moves eye down and out
- V—Trigeminal Nerve
- Muscles of mastication
- Have child bite down hard and open jaw; test symmetry and strength.
- Sensory: face, scalp, nasal and buccal mucosa
- With child’s eyes closed, see if child can detect light touch in mandibular and maxillary regions.
- Test corneal and blink reflex by touching cornea lightly with a whisk of cotton ball twisted into a point (approach from side so the child does not blink before cornea is touched).
- Muscles of mastication
- VI—Abducens Nerve
- Lateral rectus (LR) muscle: moves eye temporally
- Have child look toward temporal side
- Lateral rectus (LR) muscle: moves eye temporally
- VII—Facial Nerve
- Muscles for facial expression
- Have child smile, make funny face, or show teeth to see symmetry of expression.
- Anterior two-thirds of tongue (sensory)
- Have child identify sweet or salty solution; place each taste on anterior section and sides of protruding tongue; if child retracts tongue, solution will dissolve toward posterior part of tongue.
- Muscles for facial expression
- VIII—Auditory, Acoustic, or Vestibulocochlear Nerve
- Internal ear
- Hearing and balance
- Test hearing; note any loss of equilibrium or presence of vertigo.
- IX—Glossopharyngeal Nerve
- Pharynx, tongue
- Stimulate posterior pharynx with a tongue blade; child should gag.
- Posterior third of tongue (Sensory)
- Test sense of sour or bitter taste on posterior segment of tongue.
- Pharynx, tongue
- X—Vagus Nerve
- Muscles of larynx, pharynx, some organs of gastrointestinal system, sensory fibers of root of tongue, heart, and lung
- Note hoarseness of voice, gag reflex, and ability to swallow.
- Check that uvula is in midline; when stimulated with tongue blade, it should deviate upward and to stimulated side.
- Muscles of larynx, pharynx, some organs of gastrointestinal system, sensory fibers of root of tongue, heart, and lung
- XI—Accessory Nerve
- Sternocleidomastoid and trapezius muscles of shoulder
- Have child shrug shoulders while applying mild pressure; with examiner’s palms placed laterally on child’s cheeks, have child turn head against opposing pressure on either side; note symmetry and strength.
- Sternocleidomastoid and trapezius muscles of shoulder
- XII—Hypoglossal Nerve
- Muscles of tongue
- Have child move tongue in all directions; have child protrude tongue as far as possible; note any midline deviation.
- Test strength by placing tongue blade on one side of tongue and having child move it away.
- Muscles of tongue
- I—Olfactory Nerve
- Expected findings
- Cranial Nerves
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| Infants | Children and Adolescents | |
| I Olfactory |
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| II Optic |
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| III Oculomotor |
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| IV Trochlear |
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| V Trigeminal |
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| VI Abducens |
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| VII Facial |
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| VIII Acoustic |
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| IX Glossopharyngeal |
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| X Vagus |
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| XI Spinal Accessory |
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| XII Hypoglossal |
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- Deep tendon reflexes
- Deep tendon reflexes should demonstrate the following
- Partial flexion of the lower arm at the bicep tendon
- Partial extension of the lower arm at the triceps tendon
- Partial extension of the lower leg at the patellar tendon
- Plantar flexion of the foot at the Achilles tendon
- Deep tendon reflexes should demonstrate the following
- Deep tendon reflexes
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