Revised June 2011
American College of Emergency Physicians Section of Pediatric Emergency Medicine
1. d. Frequently, children will have an upgoing plantar reflex until they are walking, around 12 months. However, they also have a grasp reflex of both their hands and feet, so if you stroke the middle of the foot instead of the side, they may have a plantar grasp, with the toes going down instead.
2. b. Generally by age 5 years, kids can do a tandem gait. Around 1 year they should walk, by 2 years, they should be able to stand briefly on one foot, and by 3 years, hop 2-3 times, so these can be used in younger children to test balance.
3. Scissoring and truncal hypertonicity. Babies who are trying to kick you away can seem surprisingly strong. While they are resting, holding their legs crossed in a "scissors position" is frequently abnormal. Also, when you turn the baby from back to front by pulling on one arm, he/she should move in sections- chest first, then abdomen, then diaper area. If they roll over all at once, like a log, this is abnormal.
4. Yes. Deaf children tend to vocalize normally until 6-8 months, then fail to progress.
5. Not necessarily. Clearly a question for their general pediatrician, but you can reassure them that 5-15% of normal toddlers head bang. Other signs of autism include delayed language, echoing what is said rather than reciprocal language, and lack of pretend play or play with other children.
6. It is very difficult. One orthopedic text suggests that if the child is able to sweat, then sensation also should be intact.
7. c. Although it is recommended to try vision screening at age 3 years old, children generally can read a standard eye chart by 4 years old (in a developmentally average child). However, if they do not know all the letters, a picture or tumbling E chart may be helpful. They should be able to identify pictures by 18 months if just held up to them.
8. No. By birth in a term infant, despite a visual acuity of 20/400, they should be able to fix on mom's face and blink in response to light. However, blinking to threat doesn't develop until 5 months.
9. This is a description of the classic Moro reflex, which can be elicited by slightly dropping the supported head of the baby, pulling on their arms then releasing, and sometimes just by startling them. It begins at birth and continues until 3-6 months. Parents may present to the ED thinking that their newborn is having seizures.
10. None. This is normal in the newborn and can continue for up to a year. If the child has no other signs of jitteriness, developmental delay, or hypertonicity, this can be a normal physical examination finding.
11. At birth, there is a palmar grasp of both the hand and foot, which is generally gone by 4 months.
Copyright 2004 American College of Emergency Physicians. Pediatric Emergency Medicine Section quizzes may be reproduced for educational purposes only. To obtain permission to reprint for any other purpose, please submit your written request to: Deputy Executive Director, American College of Emergency Physicians, PO Box 619911, Dallas, TX 75261.