Paedologic anatomy

1. PAEDOLOGIC ANATOMY
• Dr. Faizan Ansari
• PG 1st Year
• Dept. of Paediatric and Preventive
Dentistry

2. Contents
Introduction
Fetal Growth Changes
General Post-natal changes In Dimensions & Proportions
Oral Features Of Neonates
External Features Of Newly Born Child
Reflexes present at Birth
Conclusion
References

3. Introduction
PEDOLOGY (Children study)
•Pedology (paidology, paedology) is the study of children's behavior and
development (as distinct from pedagogy, the art or science of
teaching).
•G. Stanley Hall (1844-1924) fostered pedology as a separate study, and also
became instrumental in the development of modern educational psychology.
•An American researcher, Oscar Chrisman, proposed the term "pedology" in
1893.
Depaepe, M. (1992). "Experimental Research in Education 1890-1940: historical processes behind the development of a
discipline in western Europe and the United States." Aspects of Education, Journal of the Institute of Education,
University of Hull, 42, pp. 67-93.

4. •A child may appear as a MINIATURE ADULT to a LAYMAN
but the detailed anatomy reveals that he/she is completely different
from an adult.
•The growth and development seems MIRACLE in growing child.
•These changes vary progressively till puberty after which permanent
features are established.
•The comparative knowledge of adult and child is necessary to be
known so as to recognize or diagnose developing characteristics of a
child which may be mistaken for an Abnormality or Pathologic
condition.

5. NORMAL HUMAN
GROWTH
PRE NATAL PHASES:
The time from conception to birth is
described in 3 phase:
1.Period of ovum
2.Period of embryo
3.Period of fetes

6. PERIOD OF OVUM (CONCEPTION - 10 DAYS )
•This period is from fertilization to implantation (up to 10-14 days).
•Rapid internal development is seen.
•Implantation in the uterine wall occurs after about 10 days of fertilization.

7. PERIOD OF EMBRYO (2-8 WEEKS)
•Accessory apparatus like placenta,
umbilical cord and amniotic sac develop
during this period.
•External and internal features start to
develop and function.
•Sex can be identified.
•Growth in the head region is
proportionally much greater than the rest
of the body.
•By the end of this period the embryo
measures 1½ to 2 inch length.

8. PERIOD OF FETUS (8-40 WEEKS)
•Growth continues.
•Nerve cells that are present since the third week, increase rapidly in number
during the second, third and fourth months.
•Internal organs assume nearly adult positions by fifth lunar month.

9. Fetal Growth Changes

10. End of First Month
• Head is flexed with longer and clearly defined neck.
• Development of face begins with upper lip and nostrils.
• The palate is incompletely formed.
• Enamel organ is formed from dental lamina.
• The external ears and eyelids are developing and limbs are
forming.
•Skeletal and visceral tissues begins to form.
•Kidney begins to form with tubules.
•The back bone and vertebral canal form small buds that will
develop into inner and upper extremities.
•Heart develops and starts functioning whereas other body
system also begins to form.

11. End of Second Month
•Eyes are far apart with fused
eyelids and nose is flat.
•Ossification begins and limbs
becomes distinct as upper and
lower.
•Digits are well formed.
•Major blood vessels forms.
•Internal organs continue to
develop.

12. End of Third Month
•Eyes are fully developed but eyelids are
still fused.
•Bridge of nose develops and external ears
are formed.
•Ossification continues and nails develop.
•Head flexion increases and neck becomes
proportionately larger.
•The umbilical protrusion of the gut is
reduced with a proportionate abdominal
volume.
•Heart beat is detectable.

13. End of Fourth Month
•Head is large in proportion to rest of the body.
•Face takes on human features and hair appears on
head.
•The colour of the skin is bright pink.
•Many bones are ossified and joints begins to form
with continued development of the body systems.
•The eyes have moved forward to anterior position but
are still wide apart.
•The external ear is on the side of the head and no
longer on upper part of the neck.

14. End of Fifth Month
•Head is less disproportionate to the
rest of the body.
•Fine lanugo hair covers the body.
•Rapid development of body
systems takes place.
•Skin is bright pink and sebaceous
glands become active forming a
cheesy covering over the skin.
•Fetal movement called
“quickening” can be seen.

15. End of Six Month
•Head becomes smaller but still less
disproportionate to the rest of the body.
•Eyelids separates and eyelashes form.
•Skin is wrinkled and pink.
•Increase in growth of sebaceous and
cutaneous tissue occurs.

16. End of Seven Month
•Head and body becomes more
proportionate.
•Skin is wrinkled and pink.
•Eyebrow hair and eyelashes are
developed.
•Eyelid and the papillary membrane
separates.
•Body is more plump.

17. End of Eight Month
•Sub-cutaneous fat deposition takes place.
•Skin is less wrinkled.
•Testes descends to scrotum.
•Bones of head are soft.
•There is progressive loss of lanugo, except
of eyelid eyebrows and scalp.
•The shape of body is more infantile.
•The thorax and abdomen broaden relative
to head.
•The umbilicus is gradually centrally
located.
•Chances of survival is much greater at this
period.

18. End of Nine Month
•Additional subcutaneous fat
accumulates.
•Lanugo sheds.
•Nails extend to tip of finger and
even beyond.

19. General Post Natal changes
in Dimensions and
Proportions

20. Neonatal Skeleton
•The neonates has 270 bones as compared to
adult (206).
•Skull bones in neonates are 45 due to
incomplete ossification which is 22 in adult.
•The frontal bone at birth is in two halves
which fuses at 2 years.

21. •There are two parietal bones. The occipital bone at birth consists of four pieces,
which fuse by 3-4 years of life.
•The sphenoid bone is made up of three parts at birth, which fuse during the first
year. Sinuses do not develop in the sphenoid bone till the 5th year.
i. the body,
ii. the lesser and
iii. the greater wings
•Mastoid process is absent in the neonates thus the stylomastoid foramen lies
superficial.

22. Body Proportions
•The body proportions are a result of the differential rates of growth of the
cephalic and caudal ends.
•Massive changes in the body proportion occurs from the fetal life to adulthood.
•Mid point: The mid point of the stature of a two month old embryo is at chest,
close to chin.
At Birth: This may shift to just above the umbilicus.
In Adult: It is at the pubic-symphysis region.

24. CEPHALO-CAUDAL GRADIENT
•Cephalocaudal gradient of growth simply means that there is an axis of increased
growth extending from head towards the feet.
•The head takes up about 50% of the total body length around the third month of
intra uterine life.
•At the time of birth, the trunk and the limbs have grown more than the head,
thereby reducing the head to about 30% of body length.

25. •The overall pattern of growth continues with a progressive reduction in the relative
size of the head to about 12% in the adult.
•The lower limbs are rudimentary around the 2nd month of intrauterine life. They later
grow and represent almost 50% of the body length at adulthood.
•There is increased gradient of growth evidence even within the head and face.
•At birth, cranium is proportionally larger than face, post natally the face grows more
than cranium.
•Mandible shows more growth than maxilla post natally.
•In a new born child the height is measured using measuring tape in a laying position
and referred as LENGTH. [40-45 cm]

26. POSTURE OF NEWBORN BABY
•The new born is usually kept in supine
posture but can be literally folded to its
most comfortable position i.e. the
posture simulating the fetal posture of
partial flexion.
•Mild lordosis and protuberance of the
abdomen is a common finding at 2-3
years of age but disappears by 4 years.

27. THE NECK
•The neck is relatively short at birth and its
muscles are not developed for supporting
the head.
•Functional development of the muscles
begins after 2 months.

28. THE CHEST
•The girth of the chest at birth is
smaller then the head circumference.
•It becomes equal by 2 years and by 15
years its ratio becomes 3 : 2.
•The final ratio is 5 : 3.
•The chest is rounded in newborn.

29. ABDOMEN
•The umbilicus of new born is shed
off around 12- 15 day.
•The umbilicus is everted and in some
cases umbilical hernia may be
present.
•At this stage abdomen is quite
protuberant but soft.
•Circumference of abdomen is equal
to the chest until two years BUT after
2 years abdominal circumference is
less than the chest.

30. Extremities
•At Birth: Legs are short and arms are long.
Arms:
Birth-2 years: Length increases by 6.75%.
At 8 years: 50% longer than at 2 years.
By 16-18 years: Slow growth and increase development takes place.

31. Legs:
At birth: Short and curved.
Birth-2 years: Length increases by 40% [ a lot of fat deposits on medial
aspect of foot giving flat foot appearance.]
6 years: Straight with presence of knock knee and the flat foot gets corrected.
8 years: 50% longer than at 2 years.
Adolescence: Four times longer than birth.
Early maturer: Shorter legs than the late maturer.

32. Changes in Craniofacial Complex
•The skeletal portion of craniofacial complex
develops as a blend of morphogenesis of primary
skull components.
The Neurocranium : it consists of two parts:
a. The Desmocranium: comprise the vault of
skull or calvarium. It protects the brain and is
formed of intramembranous bone.
b. The Chondrocranium: forms the base of
skull which ossifies as an endochondral bone.
The viscerocranium : formed by the bones of
facial skeleton which develop by
intramembraneous ossification which is derived
from brachial arches.

33. •At birth, craniofacial skeleton undergoes changes between 30%-60% of its total
growth.
• Head makes up about a greater part of total body length whereas in adult accounts
for about one-eighth of total body height.
•These dimensional changes can be appreciated even in intrauterine life.
• From third month to birth, the entire cranium becomes longer and wider in its
relation to height .
•This change reflects the early development and attainment of the final size of the
head compared with the rest of the body.

34. After birth:
•Size of cerebral cranium increase by about 50% while the facial skeleton will
grow more than twice the original size.
By 4 years:
•This growth is completed. Cranial circumference increase from about 33cm
[ birth] - 50cm [at 3 years]. After which it only increases by 6cm.
After 4yrs +:
•Facial skeleton increases in all direction.

35. Head
•At Birth: The head circumference is
around 35 cm.
•6 months: It increases by 44 cm.
•At 1 year: Head circumference may be
more than chest circumference. A total 4
inches increase takes place.
•1year onwards: 4 inches increment
occurs between 1-2 years.
•At 10 years: 95% of total head growth
completes with the width of head
completed by 3 years while the length of
head completes by 17-18 years.

36. Fontanelles
•Fontanelles are a regular feature of infant development in which two segments of bone
remain separated, leaving an area of fibrous membrane or a “soft spot” that acts to
accommodate growth of the brain without compression by the skull.
•Of the six fontanelles in the human skull, the anterior fontanelle, located between the
frontal and parietal bones, serves as an important anatomical diagnostic tool in the
assessment of impairments of the skull and brain and allows access to the brain and
ventricles in the infant.
•They are made up of :-
Duramater.
Primitive periosteum.
Aponeurosis from inside.
D’Antoni AV, Donaldson OI, Schmidt C, Macchi V, De Caro R, Oskouian RJ, Loukas M, Tubbs RS. A comprehensive review of the anterior
fontanelle: embryology, anatomy, and clinical considerations. Child's Nervous System. 2017 Jun 1;33(6):909-14.

37. Fontanelles present at Birth:
1. Anterior Fontanelle : between two parietal bone and the frontal bone.
2. Posterior Fontanelle : between two parietal bone and the occipital bone
3. Sphenoid Fontanelle : between the frontal, parietal, temporal, sphenoid bone.
4. Mastoid Fontanelle : between parietal, occipital and the temporal bone.

38. Clinical Importance of Fontanelle:
•Enables the fetal skull to modify its size and shape as it passes through the
birth canal and permits rapid growth of brain during infancy.
•Helps the physician to gauze degree of brain development by their state of
closure.
•Anterior Fontanelle serves as landmark for withdrawal of blood for analysis
from superior sagital sinus.
•Depressed levels of Fontanelle suggests dehydration and increased level
indicate increase in Intra-cranial pressure.

39. Closure of Fontanelle:
a. Anterior Fontanelle [frontal]: 18-24 months after birth.
b. Posterior Fontanelle [occipital]: 2 months after birth.
c. Antero-lateral Fontanelle [sphenoid]: 3 months after birth (paired).
d. Postero-lateral Fontanelle [mastoid]: Begins to close 1-2 months after
birth, closed completely by 12 months (paired).

41. Sutures of cranium
•Cranial vault sutures, the fibrous tissues uniting the bones of the skull, are the
major sites of bone growth along the leading margins of the cranial bones during
craniofacial development, especially during rapid expansion of the neurocranium
(Baer, 1954).
•The cranial sutures are fibrous joints connecting the bones of the skull.
•The dense fibrous tissue that connects the sutures is made mostly out of collagen.
•These joints are fixed, immovable, and they have no cavity.
•They are also referred to as the synarthroses.
•In fetal skull the sutures are wide and allow slight movement during birth, but
later they become rigid and fixed just like in the adults.

42. 1. Coronal Suture: Between the frontal and parietal bone. Closes by 24-
35 years
2. Sagittal suture: Between two parietal bone. Closes by 22-30 years of
age.
3. Lambdoidal Suture: Between two parietal and occipital bone.
Closes by 29 years of age.
4. Squamous Sutures and Lateral antero-posterior Sutures: Between
the squamous portion of the temporal and parietal bone. The squamous suture
closes late in life.

43. Face
• At birth, lower third and the middle third of the face are
underdeveloped due to the absence of the teeth.
• The fore-head is high and bulging.
• The face of the newly born baby is round and flat.
• The eye dominate and owing to the absence of the root of the nose,
appear to be widely separated.
• After the onset of the puberty the forehead flattens and widens, lips
thicken and face acquires an oval shape, mainly due to growth of
jaws.
• The child convex profile is straightened out, owing to the more
anterior position of the jaws.

44. Naso-Maxillary Complex
•The maxilla develops in the
membranous tissue at the end of the sixth
fetal week.
•The maxilla is attached to the
neurocranium directly with the
frontomaxillary sutures and indirectly by
means of various other facial structures
such as the nasal, lacrimal and ethmoid
bones, nasal septum including vomer,
palatine bones and zygomatic arch.

45. •Most of the structures mentioned above are joined together in an edged – edge fashion.
•During the early phase of fetal development the sagittal interrelation of the jaws is
characterised by Mandibular protrusion, which is gradually reversed.
•At birth the maxilla is placed more anteriorly giving Class II relationship of the jaws.
•Later in course of post-natal development, both maxilla and mandible with their
associated soft tissues grow forward and downward and establish a normal Class I
relationship.
•Maxillary sinus at birth are not well developed and are present like slits.
•Development of orbital cavities is practically complete at birth.
•Nasal cavity is located between the two orbits of the eyes and its floor is roughly at level
with their bottoms.
•The alveolar process can only be faintly discerned and the palate has a weak transversal
curvature.
•The maxillary body is almost entirely filled with the developing teeth.

46. Mandible
•Although still separated by
symphisis in the mid-line, the two
halves of the mandible fuse into a
single bone by the age of 1-2 years.
AT BIRTH :
•The two rami are short.
•Condylar development is minimal.
•A thin line of fibrocartilage and
connective tissue exists at the
midline of the symphisis to separate
the right and left mandibular
bodies.

47. •The symphysial cartilage is replaced by bone [between 4 months of
age–end of the 1 year].
•Growth is quite general, with all surface showing bone apposition,
esp. at the alveolar border, distal and superior surface of the ramus,
condyle, lower border and lateral surface of the mandible.
•The alveolar process and the muscles are poorly developed at this
age, so that its basal arch mainly determines the shape of the mandible
in the neonate.
•At birth the structure of mandible is shell like with 10 alveolar sockets
for developing tooth gum.

48. •Of all the facial bones, the mandible shows not only the largest amount of
post-natal growth, but also the largest individual variation in morphology.
•The position of the mandibular foramen changes by remodelling, to a more
superior position from the occlusal plane as the child matures into the adult.
•The foramen is below the occlusal plane in a very young child, slightly at
occlusal plane at the period of primary dentition. It averages 7mm above the
occlusal plane in an adult.
•Angle of mandible is more obtuse in young children.
•Mental foramen is placed very close to the border of the mandible in young
children.

49. •The temporomandibular joints (TMJ) are the two
joints connecting the jawbone to the skull.
•It is a bilateral synovial articulation between the
temporal bone of the skull above and the mandible
below.
STRUCTURE
•The main components are the joint capsule,
articular disc, mandibular condyles, articular
surface of the temporal bone, temporomandibular
ligament, stylomandibular ligament,
sphenomandibular ligament, and lateral pterygoid
muscle.
TemporoMandibular Joint
[TMJ]

50. •Three phases of development are seen in the intrauterine life period.(Valasco
Merida et all. 1999)
•Blastemic Stage:
7-8 weeks of development coresponding to the organization of condyle, articular
disc and capsule.

51. •Cavitation stage:
9-11 weeks of development corresponding to the initial formation of inferior
joint cavity and then start of condylar chondrogenesis.
•Maturation stage:
After 12 weeks of development.

52. Post -natal Changes in TMJ
•At birth the articular disc is flat and develops an accentuated S-shaped profile as
the articular tubercle develops.
•Condylar cartilage is approx. 1.5 mm thick at birth, but soon thins down to 0.5
mm. By 20-30 years of life it is completely replaced by endo-chondral
ossification.
•Mandibular condyle grows in a constant posterior, superior and lateral direction
and attains a mature contour by late mixed dentition period.

53. Oral features of the Neonate
•The edentulous arches of a child varies from an edentulous adults.
•The alveolar process of an infant are called gumpads, which are firm and pink
structures with a definite form.

54. Gumpads
•Each gumpad is divided into 10 segments by a transverse grooves.
•The groves between the deciduous first molar and canine are prominent and
called lateral sulci.

55. Upper Gumpad
•HORSESHOE SHAPED
•Gingival Groove: separates gum pad
from palate.
•Dental Groove: originates in incisive
papillae region and extends backwards to
touch the gingival groove in the canine
region and then laterally to end in the
molar region.
•Lateral Sulcus: is a deepened groove
separating canine and deciduous first
molar segments.

56. LOWER GUMPAD
•“U” shaped, with its anterior portion everted
labially.
•Gingival groove- that demarcates the lingual
extent of gum pads.
•Dental groove- running from the mandible
backwards, laterally to join the gingival
groove in the canine region.
•Lateral sulcus- deepened groove separating
the canine and deciduous first molar
segments.

57. Relationship of Gumpads
•At rest gumpads are separated by the tongue lying over the lower gumpad.
•There is no definite antero-posterior relationship of the gumpads on occlusion, but
lower gumpad being smaller, the lateral sulcus of the lower gumpads lies distal to
that of the upper.
•There is no variable overjet with contact only in the first molar segments.

58. •During function the mandibular movements at this stage are mainly vertical and
to a very small extent in the antero-posterior direction.
•Lateral movement are absent.
•During the early phase of fetal development the sagittal interrelationship of the
jaws is characterized by mandibular protusion which is gradually reversed.
•At birth lower jaw is situated posteriorly. This relationship has some
significances i.e. disturbed post-natal forward growth of the mandible may result
in malocclusion.

59. Growth of Gumpads
•At birth the width of gumpads are inadequate to accommodate all the incisors.
•The growth is rapid in first year after birth.
•Growth is more in transverse direction and in the labio-lingual direction.
•Due to the growth the segments of each gumpads becomes prominent.
•Eruption of deciduous teeth commence at 6 months of age.

60. Tongue
• It is comparatively large in relation to the small mouth.
• The tongue is flat, thin and blunt tipped, probably due to short frenum.
• The tongue at this stage performs only one function, i.e. acts as a piston while
sucking.
Carlo WA. The newborn infant. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed.
Philadelphia, PA: Elsevier; 2016:chap 94.

61. Tonsils & Adenoids
•At birth:
•Tonsils and adenoids are small in size. Clusters of yellow and white follicles with
erythematous border may appear initially. A few days after birth these may regress.
•First few months:
•The growth of tonsils and adenoids takes place as lymphoid tissue starts
proliferating and establishing function. This growth is more in presence of infection.

62. •6 months – 2 years:
Maximum growth occurs as the primary physiological enlargement.
•At 6 years:
The next hypertrophy, after a period of quiescence, occurs especially when
the child is exposed to infection at school. This is secondary physiological
enlargement.
•At puberty:
The regression and atrophy of naso-pharyngeal lymphoid tissue finally
occurs by the time child attains puberty.
Carlo WA. The newborn infant. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds.
Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 94.

63. •It is a child reserve of energy. It is
nothing but the child cheek prominence
giving a chubby appearance. It is formed
of a firm encapsulated mass of fat lying
between the subcutaneous fat and the
muscle of the cheek.
•Its exact role in suckling is not known.
It probably plays no role in suckling, but
it has been found to regress once
suckling has ceased .
Buccal pad of fat (Corpus
Adiposum/Bichat’s Fat Pad)
Carlo WA. The newborn infant. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds.
Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 94.

64. Reflexes present at
the time of birth

65. •Reflex is an involuntary, or an automatic, action that your body does in response
to something, without even having to think about it.
•The various reflexes are:
i. General Body Reflexes
ii. Facial Reflexes
iii. Oral Reflexes
Reflexes present at the time of
birth

66. •Anatomical pathway for
a reflex is called as reflex
arc.
It has 5 components :
i. Receptor
ii. Afferent nerve
iii. Center
iv. Efferent nerve
v. Effector organ
Reflex Arc

67. 1. Moro Reflex
2. Startle reflex
3. Palmar reflex/ Grasp Reflex
4. Walking/ stepping Reflex
5. Limb placement reflex
6. Asymmetric Tonic Reflex
7. Babinski’s Reflex
8. Parachute Reflex
9. Landau Reflex
10. Tendon Reflex
11. Abdominal Reflex
General Body Reflexes in infants

68. •Any sudden movement of the neck
initiates this reflex. A satisfactory way
of eliciting the reflex is to pull the
baby half way to a sitting position
from the supine and suddenly let the
head fall back to a short distance.
•This reflex consists of a rapid
abduction and extension of the arms
with the opening of hands. The arms
come together as in an embrace.
Moro Reflex

69. Clinical Importance:
•This reflex gives an indication of muscles tone.
•The response may be asymmetrical if muscle tone is unequal on the two sides, or
if there is a weakness of arm or an injury to the humerus or clavicle.
•This reflex usually disappear in 2-3 months.

70. •It is similar to Moro reflex, but it is initiated by a sudden noise or any stimulus. In
this reflex, the elbows are flexed and the hands are remained closed, there is less of
embrace, outward and inward movement of arms.
•His startle reflex will decrease and ultimately disappear around the 4-month
mark.
Startle Reflex
Feldman HM, Chaves-Gnecco D. Developmental/behavioral pediatrics. In: Zitelli BJ, McIntire
SC, Nowalk AJ, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 7th ed. Philadelphia,
PA: Elsevier; 2018:chap 3

71. Palmar / Grasp Reflex
•Elicited By: Placing finger or object in open palm of each hand.
•Response: Infant grasp the object and with attempted removal grip reinforced.
•Appears at 28 weeks of gestation and Disappears at 2-3 months of life.

72. Clinical Significance:
•An exceptionally strong grasp reflex may be found in the spastic form of
cerebral palsy and in Kernicterus.
•It may be asymmetrical in hemiplegia and in cases of cerebral damage.
•It should have disappeared in 2- 3 months and persistence may indicate
the spastic form of cerebral palsy.
Surveillance of Cerebral Palsy in Europe (SCPE) Collaborative Group. Surveillance of cerebral palsy in Europe: a collaboration of
cerebral palsy surveys and registers. Dev Med Child Neurol. 2000;42:816–24

73. Walking / Stepping Reflex
•When the sole of the foot is pressed
against the couch, the baby tries to
walk.
•It persists as voluntary standing.

74. Clinical significance:
•Premature infants will tend to walk in a toe-heel fashion while more mature
infants will walk in a heel-toe pattern.
Feldman HM, Chaves-Gnecco D. Developmental/behavioral pediatrics. In: Zitelli BJ, McIntire SC, Nowalk AJ, eds. Zitelli and
Davis' Atlas of Pediatric Physical Diagnosis. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 3

75. Limb Placement Reflex
•When the front of the leg below the knee, or the arm below the elbow is
brought in contact with the edge of table, the child lifts the limb over the
edge.
•Disappears by 24 months.

76. Asymmetric Tonic Reflex
•When the baby is at rest and not crying, he lies at intervals with his head on
one side, the arm extended to the same side, and often flexion of the
contralateral knee. This reflex normally disappears after 2 to 3 months, but
may persists in spastic children.

77. Babiniski’ Reflex
•Emerges at 18 weeks in utero
and disappears by 6 months after
birth.
•The Babinski reflex (plantar reflex) was
described by the neurologist Joseph
Babinski in 1899.
•Stroking of lateral surface of planter
surface of the foot from the heel to the toe
results in flexion of the toe.

78. Clinical Significance:
•The presence of the Babinski reflex is indicative of dysfunction of the CST.
•Oftentimes, the presence of the reflex is the first indication of spinal cord
injury after acute trauma.
•In comatose patients, one may witness a triple flexion response. In this case,
one observes dorsiflexion of the big toe, the fanning of the other toes,
dorsiflexion of the foot, as well as knee flexion.
•The triple flexion response represents profound dysfunction of the CST, with a
spread of the reflex to the L3 and L2 myotomes.

79. Parachute Reflex
•It appears at about 6-9 months and
persists there after. This reflex is
elicited by holding the child in ventro
suspension and suddenly lowering
him in the couch. The arms extended
as a defensive reaction.
•In children with cerebral palsy, the
reflex may be absent or abnormal.
•It would be asymmetrical in spastic
hemipalgia

80. •It is seen in vertical suspension, with the head, spine and legs
extended. If the head is flexed, the hips, knees and the elbows
also flex.
•It is normally present from 3 months and is difficult to elicit
after 1 year.
•Absence of reflex occurs in Hypotonia, hypertonia, or severe
mental abnormality.
Landau Reflex

81. Tendon Reflex
•They are present in neonate. They are of great value for the diagnosis of
cerebral palsy.
•In spastic children the tendon reflex are exaggerated.
Surveillance of Cerebral Palsy in Europe (SCPE) Collaborative Group. Surveillance of cerebral palsy in
Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol. 2000;42:816–24

82. Facial Reflexes

83. Nasal Reflex
•Stimulation of the face or nasal cavity with water or local irritants produce
apnea in neonates.
•Breathing stops in expiration with laryngeal closure and infants exhibit
bradycardia and lowering the cardiac output.
•Blood flow to the skin splanchnic areas, muscles and kidney decrease, whereas
flow to the heart and brain is protected.
•Midwives have for many years blows on the face of neonates to induce the first
breathe.

84. Blink Reflex
•Various stimuli provoke blinking. Where the child is awake or
asleep, pupils of the eye react to change in intensity of light.
•This reflex should disappear between three to four months of age.
.

85. Corneal Reflex
•It consists of blinking when the cornea is touched.
•The satisfactory demonstration of these reflex shows that the stimulus,
whether sound light or touch has been received, that cerebral depression is
unlikely, and that appropriate muscles can contract in response.

86. •Through a complex mechanism, infants
hold fixation of faces, movements or
changing intensity of light within their
visual fields.
•When the infants head is slowly turned,
the infant’s eye will remain stationary.
•During the first week , they are able to
maintain these fixations against passive
movement of their bodies.
•This reflex will disappear at
approximately two months of age.
Doll’s Eye Reflex

87. Pupil’s Reflex
•The pupil reacts to the light but in the preterm baby and some full term babies the
duration of exposure to the light may have to be prolonged to elicit the reflex.
•The light used should not be bright, for a bright light will cause closure of the
eyes.
•This reflex will disappear at approximately two months of age.

88. ORAL REFLEXES
•Rooting Reflex
•Sucking Swallowing
•Gag Reflex
•Cry
•Mastication

89. •When the infants cheek contact the
mother’s breast, the baby mouth results in
vigorous sucking movements resulting
the baby rooting for milk.
•When corner of the mouth is touched,
the lower lip is lowered, the tongue
moves toward the point stimulated.
•When the finger slides away, the head
turns to follow it.
•When the center of the upper lip is
stimulated, the lips elevates.
Rooting Reflex

90. •Onset: 28 weeks IUL
•Well established: 32- 34 weeks IUL
•Disappear: 3-4 months
•The “rooting” or “search” reflex is present in normal full term babies.
Clinical significance
•Persistence can interfere with sucking.
•Absence of this is seen in neurologically impaired infants.

91. •Onset: 28 weeks IU
•Well established: 32-34 weeks IU
•Disappears: starting around 12 months
•Elicited by:
It is tested by introducing a finger or teat into the mouth, when
vigorous sucking will occur.
Sucking

92. Suckling vs Sucking:
•The suckling reflex involves a
front to back movement of the
tongue. The tongue is deeply
cupped and this allows the infant to
extract liquid from a breast or
bottle.
•The main difference between
suckling and sucking is
that suckling is a primitive reflex
and sucking is a more mature
pattern.

93. •Onset: begins around 12 ½ weeks IU life. Full swallowing and sucking
established by 32- 36 weeks of IUL.
•Sucking & swallowing reflexes are present in full term babies.
•Their absence in a full term baby would suggest a developmental defect.
Swallowing

94. Infantile Swallow:
•Infantile swallowing is that which exists at birth and is also termed
Visceral swallowing'.
•It is characterized by a forward movement of the tongue tip. A visceral
type of swallow can persist well after the fourth year of life.
•Until the primary molars erupt, infants swallow with the jaws separated
and tongue thrust forward using facial muscles (Orbiculars oris &
Buccinator). This is non-conditional congenital reflex.
Acquired Congenital Reflex:
•After eruption of the posterior primary teeth, from the 18 months of age
onwards the child tends to swallow with the teeth brought together by the
masticatory muscles action, without a tongue thrust.

95. Gag Reflex (Pharyngeal
reflex)
•It is seen in 18 ½ weeks. IU life.
•In the buccal cavity and pharynx, the ectoderm / endoderm zone is
towards the posterior third if the tongue.
•Touching here elicits a gag reflex, a protective reflex

96. Functional significance:
•It along with reflexive pharyngeal swallowing, prevents something from
entering the throat except as part of normal swallowing and helps prevent
choking.
Clinical significance:
•Absence of the gag reflex -- symptom of a number of severe medical
conditions:
i. Damage to the glossopharyngeal nerve, the vagus nerve,
ii. Brain death.

97. •It is a non conditional reflex which accounts for its lack of individual
character and is of sporadic nature. It starts as early as 21- 29 weeks IU
life.
Cry

98. Importance of cry:
•It is infant’s first verbal communication.
•Can be interpreted as a message of urgency or distress.
Indicates:
i. Hunger
ii. Pain
iii. Discomfort

99. Mastication
•It is a conditioned reflex, learned initially by
irregular and poorly coordinated, chewing
movements.
•The proprioceptive response of the TMJ and the
periodontal ligament of the erupting dentition
establishes a stabilized chewing pattern, aligned
to the individual dental intercuspation.

100. IMPORTANCE OF NEONATAL
REFLEXES:
•Understanding the human development as a whole.
•Application for over all assessment of baby.
•Recognition of possible neuro developmental damage in prenatal and
perinatal period.
•Establishment of the prognosis for future.
•Predicting the Childs future potential.

101. •Knowledge of PEDOLOGIC ANATOMY is very helpful to PEDODONTIST as
it not only serves as an adjunct in DIAGNOSIS but also aids in TREATMENT
PLANNING.
•The knowledge of different growth spurts helps in planning treatment especially
in Interceptive Orthodontics where growth can be modified or surgery is
indicated [ e.g. Cleft lip & Palate]
•The knowledge of development of motor skills and language helps to know
whether development is going on at a proper rate or not.
•The knowledge of reflexes helps to identify whether child is developing
normally or not. It also helps to know what abnormalities child may be having if
reflexes are not proper.
Conclusion

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104. •Rennie JM. Rennie & Roberton's Textbook of Neonatology E-Book: Expert
Consult: Online and Print. Elsevier Health Sciences; 2012 Sep 3.
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105. Thank You