The Pediatric Neurological History

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Establishing rapport

  • Parents and guardians are often very worried about the seriousness of their child’s illness.
  • It is important to put the child and caregiver at ease and present an empathetic demeanor.
  • Establish expectations, understanding and fears regarding the child’s presentation.

General pointers

  • History is crucial for evaluation of a child with a suspected neurologic problem.
  • Children 3 or older should be encouraged to participate in providing the history.
  • History in children is always a composite of the parent/guardian and the child’s input.
  • Be sure to confirm and clarify symptoms ie. dizziness could be lightheadedness, confusion, vertigo, weakness, etc.

Chief complaint

  • Elicit a succinct reason that prompted the parents and child to seek medical attention
History of presenting illness

  • detail the onset, duration, frequency, character, palliating and provoking factors, and associated symptoms
  • Focused review of systems relevant to chief complaint
    • Hypotonia
      • Infection: fever, nuchal rigidity, rash, seizures
      • Family history of muscular disorders, consanguinity
      • Progressive hypotonia?
      • Limbs affected
      • Developmental milestones
      • Seizures
        • Duration, frequency
        • Infection: Fever, rash, diarrhea, vomiting, sore throat, nasal discharge, cough
        • Changes in consciousness, focal vs generalized
        • Underlying medical conditions
        • Timing of seizure relative to fever (if present)
        • Presence of a postictal phase?
          • Paralysis
          • Breathing difficulties
          • Cyanosis
          • Aspiration
      • Headache
        • Infection: fever, nuchal rigidity, rash, nausea, vomiting, diarrhea
        • Severity and impact on function (absence from school?)
        • Worst headache ever experienced?
        • Migraine symptoms
          • Presence of an aura
          • Triggers
        • Changes in consciousness
        • Personality changes, visual disturbances,
  • If seizure lasts > 30 minutes without child regaining consciousness = status epilepticus and should be managed accordingly
  • Benign febrile seizures < 15 minutes

  • try to obtain history of headache (especially pain) directly from child
  • progressively worse headache may suggest increasing intracranial pressure/space-occupying mass


General review of systems

  • The review must include all of the organ systems because neurological function is adversely affected by dysfunction of many systems, including the liver, kidney, gastrointestinal tract, heart, and blood vessels
  • Include sleep habits, diet, bowel and bladder habits, activity level, personality, and mood


Alarm symptoms

  • Failure to thrive
  • Altered/decreased level of consciousness
  • Seizures
  • Weight loss
  • Persistent vomiting
  • Severe headache
  • Muscular weakness
  • Any focal neurological deficit
Past medical history

  • General medical conditions
  • Past surgeries, emergency visits, hospitalizations

Review of pregnancy, labor and delivery

  • Important – especially if congenital disorder is suspected
  • Prenatal history
    • Infections (rubella, HIV, syphilis)
    • Comorbidities + complications (pregnancy-induced HTN, gestational diabetes)
    • Screening test results (ultrasound, amniocentesis, etc)
    • Toxin, alcohol, cigarette, illicit drug use, medication exposure
    • Delivery and birth history
      • Birth weight, length, head circumference, Apgar score, NICU stay, ventilator assistance, neonatal seizures, jaundice

Developmental History (see table)

  • Assess presence of developmental delay
    • Global or specific (ie. isolated motor delay)
    • Onset, timing, progression of developmental delay
      • Delay at birth or early in development
      • Delay in infancy and childhood
      • Personality before and after onset of symptoms
      • Academic performance before and after onset of symptoms
  • Loss of skills (regression) over time suggests an underlying degenerative disease
  • Information from teachers or kindergarten staff may be helpful regarding academic performance and social skills
Medications – dose, frequency, indication, response, side effectsAllergies – document nature of reaction

  • Food
  • Environmental
  • Medications
Family History

  • Extremely important
  • Parents may be unwilling to discuss neurological disorders that run in the family openly


  • Neuromuscular diseases often have a strong familial component
Social history

  • Living conditions (caregivers, neighborhood)
  • Support system
  • Exercise habits
  • Diet

TABLE Screening Scheme for Developmental Delay: Upper Range





Supports weight on forearms Opens hands spontaneously Smiles appropriately Coos, laughs


Sits momentarily Transfers objects Shows likes and dislikes Babbles


Pulls to stand Pincer grasp Plays pat-a-cake, peek-a-boo Imitates sounds


Walks with one hand held Releases an object on command Comes when called 1–2 meaningful words


Walks upstairs with assistance Feeds from a spoon Mimics actions of others At least 6 words


Runs Builds a tower of 6 blocks Plays with others 2–3 word sentences


  1. Berstein D, Shelov SP, editors. Pediatrics. Baltimore: Williams and Wilkins;1996.
  2. Behrman RE, Jenson HB, Kliegman RM, Stanton BF. Nelson Textbook of Pediatrics. 18th ed. Elsevier; 2007.
  3. Bradley WG, Daroff RB, Fenichel G, Jankovic J. Neurology in Clinical Practice. 5th ed. Butterworth-Heinemann; 2008.


Written by: Bing Wei Wang

Edited by: Katherine Muir

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