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You can only test for sensory function of the newborn in a limited way. Test for pain sensation by flicking the infant's palm or sole with your finger. Observe for withdrawal, arousal, and change in facial expression. Do not use a pin to test for pain.

The cranial nerves of the newborn or infant can be tested, although you will have to open your bag of tricks for special methods that differ from those used for the older child or adult. The table on the next page provides some useful strategies.

The deep tendon reflexes are variable in newborns and infants because the corticospinal pathways are not fully developed. Thus, their exaggerated presence or their absence has little diagnostic significance unless this response is different from results of previous testing, or extreme responses are observed.

Persistent effects of anesthesia may limit a newborn's response to pain. If changes in facial expression or cry follow a painful stimulus but no withdrawal occurs, paralysis may be present.

A progressive increase in deep tendon reflexes during the first year of life may indicate central nervous system disease such as cerebral palsy, especially if it is coupled with increased tone.

Strategies to Assess Cranial Nerves in Newborns and Infants

Cranial Nerve

Strategy

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