This is one of the few feared ares in medicine. It is easier to remember if you make sure you write this below format repeatedly and use it every time you examine a patient

Below is a brief note of headings for easy revision in exams. For detailed examination, look into individual articles.

Look around the room to see if any accessories/ instruments like

  • Wheelchairs
  • Hearing aids
  • Vision aids
  • Feeding pumps
  • Braces
  • Head support

Observe every action of the child when the child is walking and sitting.

  • If the child is on a wheelchair, then look at comorbidities
  • Position of limbs- flexed, contractures, atrophy

General examination

  • Level of consciousness- Alert/ Oriented/ cooperative
  • Gait and Decubitus (position in bed)
  • Asymmetry in the body parts
  • Any obvious dysmorphism


Size of head

  • Microcephaly
  • Macrocephaly

Shape of head

  • Plagiocephaly- commonly seen in preterm
  • Brachycephaly- commonly seen in ‘Down’s syndrome’ and ‘Crouzon syndrome’
  • Scaphocephaly- can be seen in ‘Craniosynostosis’


  • Dysmorphism- Head size, ports, stoma, nasogastric tube, tracheostomy
  • Neck lines, scars over the head


  • Webbing
  • Torticollis


  • Squint
  • Visual aids
  • Palpebral fissures
  • Antimongoloid slant
  • Drooping eyelids


  • Hearing aids
  • Ear tags
  • Low lying ears


  • Dentition
  • Tongue- fasciculations, deviation , macroglossia
  • Speech, stuttering, articulation
  • Drooling

Now focus on the nervous system and look for the following

  1. Higher function
    1. Consciousness level
    2. Behaviour
    3. Walk
  1. Cranial nerves
    1. Olfactory- sensation of amell
    2. Optic- vision abnormality
    3. Oculomotor/ Trochlear/  Abducens/ – eye movements
    4. Trigeminal- Sensation over face
    5. Vestibulocochlear- hearing
    6. Facial- features of facial palsy
    7. Glossopharyngeal- Uvula deviation when saying ‘Ahh’
    8. Vagus- hoarseness of voice
    9. Accessory- shrugging of shoulders
    10. Hypoglossal- Deviation of tongue
  1. Motor system
    1. Power or weakness in muscles
    2. Wasting of muscles
    3. Fasciculations
    4. Involuntary movements
    5. Pain in muscles
    6. Gait abnormalities
  1. Sensory system
    1. Altered sensation
    2. Paresthesia
    3. Tingling sensation
    4. Hyperesthesia/ hypoesthesia
  1. Cerebellar system
    1. Ataxia
    2. Hypotonia
    3. Incoordination
    4. Proprioception
  1. Autonomic nervous system
    1. Bowel/ bladder abnormalities
    2. Abnormal sweating/ flushing
  1. Others
    1. Fever
    2. Neck pain
    3. Seizures
    4. Psychological changes

Read further articles for detailed explanation of sections

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