Neurological assessment in children and young people

• Understand the importance of accurate neurological assessment and the need to involve parents/carers
• Recognise that the age and developmental stage of a child affects their responses
• Develop an understanding of the neurological observations that should influence your assessment

Nurses completing a structured assessment will consider the neurological status of their patient. This is the ‘D’ for ‘disability’ in the ABCDE algorithm taught in professional health settings. That is, issues related to neurological function, which in turn disable the individual in some manner. Generally, this relates to consciousness, which is the earliest and most sensitive indicator of change in neurological status (Hickey, 2013). If concerns are raised, assessment will include observations that indicate the function and status of an individual's nervous system.

Neurological observations should only be performed by appropriately competent staff and must be recorded accurately (National Institute for Health and Care Excellence (NICE), 2017). The frequency of neurological observations will be informed by the condition of the patient and reviewed regularly by a registered practitioner (NICE, 2017). Professional knowledge, judgement and policy, will influence the frequency of this assessment, which can be as regular as every 15

Box 1. Possible reasons for neurological assessment

1. Increased brain volume caused by: brain lesions, brain tumours, brain abscess, intracranial haematoma, cerebral oedema, encephalitis, meningitis, traumatic brain injury (head injury), stroke
2. Increase in cerebrospinal fluid volume caused by hydrocephalus
3. Increased blood volume caused by: vascular malformations, cerebral thrombosis, meningitis, encephalitis
4. Increased or decreased brain activity caused by: epilepsy, intoxication (Great Ormond Street Hospital, 2015)

NICE recently published a guideline on suspected neurological conditions (NICE, 2019), which goes into more detail on signs and symptoms that may raise concerns and prompt a referral for assessment.

Neurological structure and function

To understand the elements of a nursing neurological assessment it is necessary to first understand the structure and function of the nervous system. If there is clear understanding of how a system is formed and how it behaves normally, we are able to assess and identify change from this. The structure of the

References

British Paediatric Neurological Association. Child's Glasgow Coma Scale. 2001. https://tinyurl.com/yyh8hoca (accessed 6 August 2019) 

Derbyshire J, Hill B. Performing neurological observations. Br J Nurs. 2018; 27(19): 1110-1114. https://doi.org/10.12968/bjon.2018.27.19.1110 

Dougherty DLister S. The Royal Marsden Hospital manual of clinical nursing procedures. (9th edn). Oxford: Wiley-Blackwell; 2015

Great Ormond Street Hospital. Head injuries. 2015. https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/head-injuries/ (accessed 16 December 2022) 

Hickey JV. The clinical practice of neurological and neurosurgical nursing. (7th edn). Philadelphia (PA): Lippincott; 2013 

Iggulden H. Care of the neurological patient. Oxford: Blackwell; 2006

National Institute for Health and Care Excellence. Head injury: assessment and early management. Clinical guideline CG176. 2017 (updated version of guideline first published in 2014). https://www.nice.org.uk/guidance/cg176 (accessed 16 December 2022) 

National Institute for Health and Care Excellence. Suspected neurological conditions: recognition and referral. NICE guideline NG127. 2019. https://www.nice.org.uk/guidance/ng127/chapter/Recommendations-for-children-aged-under-16 (accessed 16 December 2022) 

Nuttall AGL, Paton KM, Kemp AM. To what extent are GCS and AVPU equivalent to each other when assessing the level of consciousness of children with head injury? A cross-sectional study of UK hospital admissions. BMJ Open. 2018; 8(11): e023216.