What happens at a baby’s neurological exam

How the pregnancy went, at what week and how the birth happened, birth weight and Apgar score, jaundice in the first days, resuscitation, feeding, sleep, and any neurological conditions in the family. If there is a specific movement that worries you, a video helps. This background determines what the findings in the exam mean.

Is the baby awake, responding to the surroundings, and crying normally? The head circumference is measured and compared with earlier measurements. What matters is not a single number but the trend along the growth curve. The size, tension and level of the large fontanelle are assessed: a bulging, tense fontanelle or a rapidly growing head needs attention. The skin (spots, vascular marks), facial structure and eye movements are part of the exam as well.

A 1.5-month-old lying on their back keeps their arms and legs bent, which is normal. The doctor gently extends and flexes the arms and legs, picks the baby up to feel the body’s resistance, pulls the baby by the hands toward sitting (checking how far the head lags behind), places the baby on the tummy (watching for head-lifting attempts), and lifts the baby under the arms to see how the feet touch the surface. What is assessed: whether the tone is too loose or too stiff, whether both sides are the same, and whether head control fits the age.

Age-appropriate primitive reflexes are checked in turn: the Moro reflex (the arms open and then close as if hugging when the head position changes suddenly), the grasp reflex (the baby squeezes a finger placed in the palm), the sucking and rooting reflexes, the stepping reflex, and the asymmetric tonic neck reflex. What matters is that the reflexes are present, symmetrical and fade on time: most go away by 4–6 months, and a Moro or tonic neck reflex that persists after 6 months needs attention. Tendon reflexes are checked too.

The doctor spends some time simply watching the baby’s own movements. At 3–5 months, small, continuous “fidgety” movements in different directions throughout the body are a strong sign of healthy motor development. Their absence has a high predictive value for later cerebral palsy risk (sensitivity of 97% in a systematic review). In babies at risk, this is done as a standard video assessment.

Following a face, looking at a bright object, reacting to sound, and a social smile from 6–8 weeks. In a 1.5-month-old, a social smile that is just starting to appear is what we expect.

At the end of the exam, the doctor interprets the findings against the baby’s age. Even healthy babies often show an isolated “out-of-range” sign: among 224 healthy full-term babies, one-third had one or two such signs, but fewer than 10% had four or more. So a single sign carries little weight; the doctor looks at the overall picture, symmetry and trend. The results are explained to you in plain language, along with when the next exam is due and what to watch for at home. For this baby, development matched their age, and the next visit was planned for 3–4 months.

The exam is more informative when the baby is fed and awake (30–60 minutes after a feeding). Dress your baby in clothes that are easy to take off. Bring the birth discharge summary, the vaccination card, a brain ultrasound result if you have one, and a video of the movement that worries you. The exam is painless, takes place with you beside your baby, and lasts 20–30 minutes. More detail: newborn neurological exam.