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Discussion

Neuro Checks

I've been working in an unit that gets many post op neuro patients that require q4h neuro checks. I find it so hard to perform neuro checks on the smaller kiddos and am so scared I'm gonna miss something some time. Little kids rarely let me check there pupils, don't want to talk, follow commands, etc. Any ideas on easy, kid-friendly ways to do neuro checks? Thanks!!:nuke:

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We try and get them to do high 5's and to squeeze our hands as hard as they can.

We get to look into their eyes with a little light.

It helps to let them play with the light for a few minutes too :) Or to check my eyes, or moms/dads

I do admit, neuro checks are very hard on little kids. Infants its really only pupils, are they acting appropriately, moving all extremities, etc. Toddlers are the worst! :)

  • Experts

Try to engage them in play. See how they respond to their parents. Watch them when they do things. Are they moving normally? Are they looking at things that move into their field of vision? If they still have a fontanelle, what are its characteristics? Soft, flat, full, tense, bulging? Do they react to noises? So much can be assessed by simply observing.

In our unit we are still using the Glascow Coma Scale to assess neurological function in our kids, but the one we're forced to use isn't modified for babies or small children so it's all but useless. I'm going to try introducing the FOUR Score to our unit and see if I can convince them we should use it either instead or in addition.

http://medicineworld.org/cancer/lead/9-2005/new-coma-measurement-system.html

http://www.mayoclinicproceedings.com/pdf%2F8204%2F8204a5.pdf

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