Pediatrics : Musculoskeletal system / Neurological system

- Musculoskeletal system
  - Length, position, and size of extremities are symmetric
  - Joints
    - Stable and symmetric with full range of motion and no crepitus or redness
  - Spine
    - Infants
      - Spines should be without dimples or tufts of hair.
      - They should be midline with an overall C-shaped lateral curve
    - Toddlers
      - Appears squat with short legs and protuberant abdomen
    - Preschoolers
      - Appear more erect than toddlers
    - Children
      - Should develop the cervical, thoracic, and lumbar curvatures like that of adults
    - Adolescents
      - Should remain midline (no scoliosis noted)
  - Gait
    - Toddlers and younger children
      - A bowlegged or knock-knee appearance is a common finding
      - Feet should face forward while walking
    - Older children and adolescents
      - A steady gait should be noted with even war on the soles of shoes
- Neurological system
  - Tests for cerebellar function
    - Finger-to-nose test:
      - With the child’s arm extended, ask the child to touch the nose with the index finger with the eyes open and then closed.
    - Heel-to-shin test:
      - Have the child stand and run the heel of one foot down the shin or anterior aspect of the tibia of the other leg, both with the eyes opened and then closed.
    - Romberg test:
      - Have the child stand with the eyes closed and heels together; falling or leaning to one side is abnormal and is called the Romberg sign.
  - Infant reflexes

	Expected Finding	Expected Age
Sucking and rooting reflexes	Elicited by stroking an infant’s cheek or the edge of an infant’s mouth The infant turns their head towards the side that is touched and starts to suck	Birth to 4 months
Palmar Grasp	Elicited by placing an object in an infant’s palm The infant grasps the object	Birth to 4 months
Plantar Grasp	Elicited by touching the sole of an infant’s foot The infant’s toes curl downward	Birth to 8 months
Moro Reflex	Elicited by allowing the head and truck of an infant in a semi-sitting position to fall backward to an angle of at least 30° The infant’s arms and legs symmetrically extend, then abduct while fingers spread to form C shape	Birth to 6 months
Tonic Neck Reflex (Fencer Position)	Elicited by turning an infant’s head to one side The infant extends the arm and leg on that side and flexes the arm and leg on the opposite side	Birth to 3 to 4 months
Babinski Reflex	Elicited by stroking the outer edge of the sole of an infant’s foot up toward the toes The infant’s toes fan upward and out	Birth to 1 year
Stepping	Elicited by holding an infant upright with his feet touching a flat surface The infant makes stepping movement	Birth to 4 weeks

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