Pediatric sensations,gait and meningeal signs

Even in small children, the sense of touch and pain can be tested. We observe the child's reaction. Sensation deficits are very rare in children. A child's walking posture is examined as in adults. We note whether the child limps and whether its movements are coordinated. If some pathology is suspected, the child may also be asked to run. Walking on the heels and on tiptoe are also tested. During assessment, the child's age and stage of development must also be borne in mind. This one-year-old child is still unsure and his walk is broad-based.

Standing on one leg is not possible for a child until age five. Because of the seriousness of meningitis, we shall also cover the meningial signs. The signs of meningitis comprise Nucle-rigidity, a positive laseg, a positive kerning, and a positive Brudzinski sign. When testing for Nucle-rigidity, the examiner tries to flex the child's chin down to the sternum, which is normally readily accomplished. As our little actress shows, the flexion can be carried out only incompletely, or not at all in meningitis because of the pain. For the laseg sign, the examiner takes the stretched leg of the supine child

and flexes it at the hip joint. Normally a flexion of 70 to 90 degrees is quite possible. The laseg sign is positive if the hip flexion is restricted and painful. In order to exclude compensatory movements, the pelvis should be held down. The kerning sign is based on a similar mechanism. The leg is first flexed 90 degrees at the hip, then is stretched at the knee. If there is meningitis, the leg can no longer be straightened. A further indication of meningitis is the Brudzinski sign. If the meninges are stimulated, raising the head will cause the legs to flex.

Another indication is seen if the child has to support itself in a sitting position by placing its hands behind it and by drawing up its legs.