What are the primitive reflexes?
Asymmetric tonic neck reflex
Babinski (extensor plantar) reflex
Galant reflex
Grasp reflex
Moro reflex
Sucking (rooting) reflex
Walking (stepping) reflex
What is the walking/stepping reflex?
Supporting infant upright with soles touching surface causes each foot in turn to lift as if walking
Disappears at 2 months
What is the sucking/rooting reflex?
Coordinated suck and swallow and turning towards the breast. Rooting - stimulation of corner of mouth/cheek prompts baby to turn towards the source and open mouth
May not develop until 32-36 weeks gestation
Disappears at 4 months
What is the galant reflex?
Stroking to the side of the spine causes body to curve towards the stimulus (lateral curvature of spine)
Disappears at 4-6 months
What is the grasp reflex?
Fist clenches when palm stimulated
Disappears at 5-6 months
What is the moro reflex?
Throws head back
Extends then contracts limbs and clenches fists
Disappears at 5-6 months
What is the Asymmetric tonic neck reflex?
Extension of ipsilateral arm and contraction of contralateral elbow upon head turning (fencer’s posture)
Disappears at 6-7 months
What is the Babinski reflex?
Extension of toes upon stroking lateral surface of foot
Disappears at 2 years
What is congenital anosmia?
About 1% of total cases of anosmia
Most common cause is Kallman syndrome (associated with absent or incomplete puberty)
What is visual acuity?
Minimal distance that 2 targets need to be separated in order to be seen as distinct
An individual with ‘perfect’ vision can resolve 2 targets serparated by one minute of an arc (1/60th of a degree) i.e. 6/6 Snellen (or 20/20 by US measures)
How are the numbers on Snellen chart calculated?
Numerator - distance from chart, usually 6 meters (20 yards).
Denominator - number beneath smallest line patient can read
A child with 6/36 vision is reading print at 6 meters that an individual with ‘normal’ vision would be able to read at 36 meters
What is expected mean visual acuity for a newborn?
Visual acuity test for a newborn?
Visual field test for a newborn?
<6/60
Acuity test = fixation to lights
Field tests are not possible
What is expected mean visual acuity at 0-3 months?
Visual acuity test for 0-3 months?
Visual field test for 0-3 months?
6/60 - 6/38
Acuity: fixation to faces/large toys
Fields: visually elicited eye movements
What is expected mean visual acuity at 3-24 months?
Visual acuity test for 3-24 months?
Visual field test for 3-24 months?
6/38 improving to 6/12
Acuity: preferential looking cards (Teller/Cardiff) - preference to look towards more interesting stimulus
Fields: confrontation techniques
What is expected mean visual acuity at 2-4 years?
Visual acuity test for 2-4 years?
Visual field test for 2-4 years?
6/12 - 6/9
Acuity: picture optotype charts
Fields: ?confrontation techniques
What is expected mean visual acuity at 5+ years?
Visual acuity test for 5+ years?
Visual field test for 5+ years?
6/9 - 6/6
Acuity: letter optotype charts
Fields: Goldmann perimetry / automated perimetry
(Humphrey/Octopus sometimes possible)
Fields are notoriously difficult to test in children but by 5 years expected 150 degrees horizontal and 130 degrees vertical
What is logMAR?
Logarithmic minimal angle of resolution
Replacing Snellen charts in eye departments
Uniform 5 letters per line
Score 0.00 equivalent to 6/6, higher number = worse acuity
What is VEP?
Visual evoked potentials
VEP pattern reversal test
= way of objectively assesing acuity, skin electrodes measure cortical activity stimulated from reversing white/black chequerboard pattern
Acuity is quantified by the smallest check size to elicit a cortical reaction
Can be esp. useful in non-organic visual loss
What is variable angle squint?
Ocular misalignment
Common in neonates, reflects poor visual acuity at that stage of development. By 3 months, visual acuity should be sufficient to stimulate ocular alignment.
Squint after 3 months suggests vision is poor or squint is pathological
Ocular and cortical immaturity causes pursuit and saccadic eye movements to be jerky and inaccurate until what age?
3-4 months
When is vision routinely assessed in children?
Red reflex at birth
Orthoptist led service 4-5 years
