II. Exam: General
-
Newborn Reflexes
- Primitive Stepping Reflex
- Rooting Reflex
- Moro Reflex (Startle Reflex)
-
Babinski Reflex
- Upgoing toe until after 6 months of age
-
Seizures
- See Neonatal Seizures
- Typically subtle in infants (e.g. lip smacking, repetitive movements)
-
Posture
- Normally in Fetal Position with hands closed
- Hold infant in vertical suspension
- Hypotonia is this position is abnormal
- Alertness
- Awakened by uncovering or stimulating foot or cheek
- Level of activity
- Jitteriness
- Normal fine Tremor provoked when startled
- Consider Electrolyte abnormality if severe (obtain Serum Glucose, Serum Magnesium, Calcium)
- Consider Drug Withdrawal for infants of mothers on longterm medications of drugs (e.g. Methadone, SSRI)
- Benign neonatal sleep Myoclonus
- Myoclonic Jerks while sleeping (resolves when infants are awake)
- Presents at 2-4 weeks of life, and resolves by age 6 months
- Saccadic Intrusions
- When infants are tracking with their eyes, their eyes may make corrective jumps
- Small amplitude conjugate interruptions (not Nystagmus)
- Resolve over the first few months of life
- Differentiate from randomly wandering eye movements (may be a sign of blindness)
- When infants are tracking with their eyes, their eyes may make corrective jumps
- Periodic breathing
- Common and normal in children
- Pauses in breathing up to 20 seconds are normal (unless associated bradycardi, mental status change, Skin Color change)
III. Exam: Cranial Nerve Exam
- Pupil reflex
- Doll's Eyes
- Corneal, sucking, and Rooting Reflexes
- Response to noise
- Gag Reflex