Neurological exam for a newborn and infant

• Babies born prematurely or with low birth weight, or who spent time in intensive care — scheduled follow-up
• A difficult delivery, lack of oxygen at birth, a low Apgar score, severe jaundice
• Signs that worry parents: unusual floppiness or stiffness, poor sucking, constant irritability, unusual movements, trembling, rapid growth of head circumference
• A preventive check at the request of the pediatrician or the parents, even without complaints

Head and fontanelle

Head circumference is measured and followed on a growth chart — the trend matters, not a single measurement. The size, tension and bulging of the anterior fontanelle are assessed; the fontanelle usually closes at 9–18 months.

Posture and muscle tone

The baby's position on the back and on the tummy, the flexion of arms and legs, the body's resistance when you pick them up (too floppy, too stiff, or normal), and head control. In the first months, bent arms and legs are normal; it is important that the tone is the same on both sides.

Reflexes

Age-appropriate primitive reflexes: the Moro reflex (the arms opening and closing in response to a sudden sound or head movement), grasp (the fingers closing around a finger placed in the palm), sucking and rooting, stepping, and the asymmetric tonic neck reflex. Their presence, symmetry and fading on time (most by 4–6 months) are assessed. A reflex that fades late needs attention.

Spontaneous movements

The quality of the movements a baby makes without any prompting: at 3–5 months, small, continuous “fidgety” movements in varied directions are a strong sign of healthy motor development; their absence has high predictive value for later cerebral palsy.

Vision, hearing, social response

Looking at faces and following (1–2 months), reacting to sound, a social smile from 6–8 weeks.

Standard scored systems exist for the newborn exam (for example, the Dubowitz and Hammersmith exams). Even in healthy full-term babies, isolated “out-of-range” findings are common: in a study of 224 healthy babies, one in three had one or two findings outside the norm, but 4 or more out-of-range findings were seen in fewer than 10%. In other words, a single finding has little diagnostic value; the doctor looks at the overall picture, symmetry and change over time. A worrying result is clarified with a repeat exam, a brain ultrasound when indicated, or other tests.

Brief, symmetric twitches during sleep (benign sleep myoclonus), the body shaking for a few seconds when excited (shuddering attacks), a quivering chin, the Moro response to a sudden sound — these are usually the movements of a healthy baby. What sets a seizure apart: rhythmic movement while awake, eyes rolling, a change in color, limpness afterward. If in doubt — video and an exam.