What to expect during a neurological evaluation

When your child isn’t feeling well, you’re not always sure where to turn or what to do next. At Advocate Children’s Hospital, our neuroscience center is here to help when a possible neurological issue is suspected. We’re ready to determine exactly what’s affecting your child and provide the answers your family needs.

Learn more about our team:

• Neurology program
• Neurosurgery program

Neurological evaluations at Advocate Children’s Hospital

We always spend as much time with your family as needed to understand what your child is experiencing. We’re ready to answer all your questions and help make sense of what’s going on.

The particular details of each tailored evaluation vary by a child’s age, symptoms and overall health. Generally, though, you can expect certain steps.

Medical history and physical exam

We ask your child about how they’ve felt recently and also ask you about any symptoms you’ve noticed. We also want to know about your child’s personal and family medical history. We discuss any previous care your child has had, such as a visit to your pediatrician. The more details you can provide, the better, so bring notes and any previous test results. We perform a physical exam based on your child's symptoms and other information you've provided.

Neurological exam

Next, a neurologist conducts a detailed examination to assess your child’s neurological functions in several areas. A neurological exam is a series of painless tests that help us find underlying causes for the symptoms your child is experiencing. The information we gather helps us identify any medical conditions that may affect your child’s nervous system.

In a neurological exam, we test seven areas of function:

1. Mental status: We assess your child’s level of alertness and interaction with their surroundings. Issues we observe include speech, language, memory, mood, general knowledge, and awareness of time and place.
2. Cranial nerves: These nerves connect the brain with the rest of the body to coordinate movement and the five senses. We choose areas to test depending on your child’s symptoms to assess their abilities in:
   • Sight: Identifying letters, numbers and shapes; following movements with eyes; and undergoing an eye exam
   • Hearing: Detecting position and intensity of certain sounds
   • Smell: Identifying various smells
   • Touch: Identifying various sensations such as pain, temperature, pressure and vibration
   • Taste: Identifying various tastes such as sweet, sour or bitter
   • Movement: Moving the shoulders, neck, face and tongue in specific ways, including smiling, speaking, chewing and swallowing
3. Motor system: We test your child’s arms and legs for strength, mobility, stiffness and dexterity.
4. Reflexes: We test muscle stretch reflexes, such as knee jerks, by tapping various areas with a reflex hammer. We also test superficial reflexes by lightly touching areas such as the soles of the feet. We tweak our approach for newborns and infants, since they have different reflexes.
5. Sensations: We assess sensations, including touch, pain, position, vibration, heat and cold in various areas of the body. We look for differences between the two sides of your child’s body.
6. Balance and coordination: We look for stability as your child sits or stands. We also do tests such as touching the nose with the index finger with eyes closed.
7. Station and gait: We may ask your child to stand up, walk heel to toe, turn, sit down and complete other movements.

Working diagnosis

Based on the information we’ve gathered with the medical history, physical exam and neurological exam, we develop a working, or initial, diagnosis. We may arrange additional tests to confirm our suspicions or start developing treatment recommendations. Sometimes, we begin care while testing is not yet complete, if timing is critical.

Learn more about the neurological conditions we diagnose most frequently and the additional tests we might perform.