2. Primitive Reflexes
Reflex Stimulus Expected Response Duration Abnormal Indications
Cephalic:
1. Blinking/ Dazzle shine bright light in eyes eyelids close birth-1 yr absence indicates poor light perception or blindness
2. Acoustic blink create a loud noise about 12
inches from baby's ear
both eyes will blink birth-6 months absence indicates decreased hearing or congenital deafness
3. Rooting stroke baby's cheek near corner
of mouth
head moves toward side of stimulus and
mouth opens
birth-4 months asymmetric response indicates lesion of brain stem or trigeminal nerve;
absence may be CNS disease; expect minimal or no response if baby
was just fed
4. Suckling place finger in baby's mouth tongue should push finger up against hard
palate with good strength, note pressure,
strength and pattern
disappearance
variable
abnormal function of CN IX, X, and/or XII
5. Rotation Test/ Doll's
Eye
hold baby under axilla in an
upright position, head held
steady, facing examiner, rotate
baby one way, then the other
eyes should turn in direction of rotation,
then opposite direction once rotation stops
disappearance
variable
if eyes do not move in expected direction suspect vestibular problem or
eye muscle paralysis
Neck:
1. Moro/ Startle create a loud noise total extension then flexion birth-6 months beyond 6 mo =neurological disease; asymmetrical response of UE=
brachial plexus injury or fx of clavicle or humerus, LE= low spinal injury or
congenital hip dislocation
2. Tonic neck/ Fencer baby supine, turn head
to one side
extension of arm and leg on side head is
turned to, flexion of other arm and leg
present at birth,
dominant 3 months,
gone by 6 months
persistance= major cerebral damage
3. Reverse Fencer suspend baby upside
down by the feet, relax
weight off one extremity,
then the other; place
baby supine apply firm
pressure of femurs into
acetabulum bilaterally
look for arching upon initial suspension;
head should rotate away from the weight
bearing side smoothly; acetabular
resistance should be equal
birth-6 months arching could indicate meningeal pull; inability to turn head to opposite
side of extension (or twitching) indicates C0, or C1 subluxation on that
side; softer acetabular pump indicates C1 laterality to that side; equal
acetabular pump indicates C0
Trunk:
1.Galant/Trunk
Incurvation
baby is face down with trunk
supported on examiner's lower
arm, run finger 3 cm
paravertebrally from occiput to
buttock
curvature of trunk towards side stroked birth-2 months absence indicates presence of spinal cord lesion or possibly paralysis
2.Perez baby is positioned same as
above, run finger over spinous
from sacrum to occiput
extension of head and spine with flexion of
knees on chest; most likely elicits urination
as well
birth -3 months absence indicates severe cerebral insult, injury to upper cervical cord,
advanced anterior horn cell disease, severe myopathy
3. Landau baby positioned same as above baby should be able to lift head above
horizontal with extension of arms, legs and
trunk
3 mo-18 months brain stem dysfunction
3. Reflex Stimulus Expected Response Duration Abnormal Indications
Upper Extremity:
1. Palmer Grasp place finger from ulnar side into baby's
hand
fingers curl to stimulus birth- 3 months persistence indicates cerebral dysfunction
Lower Extremity:
1. Plantar Grasp touch plantar surface of baby's foot at the
base of the toes
toes should curl downward birth- 3 months absence correlates with development of
spastic cerebral palsy
2. Babinski stroke lateral plantar surface of foot from
heel to base of toes, then across ball of
foot towards first digit
normal (negative) response= toes curl
down and foot moves away; abnormal
(positive) response= toes spread with
dorsiflexion of foot and digit 1
positive response normal until age 2 persistance beyond 2 yoa indicates upper
motor neuron lesion; unilateral persistance
may indicate cerebral palsy
3. Clonus press thumb over ball of foot and abruptly
dorsiflex it
rapid, rhythmic plantar flexion of foot
which is unsustained
sustained clonus is indicative of severe
CNS disease
Suspension & Stepping:
1. Vertical suspension suspend baby with your hands under their
axillae
head midline, legs flexed at hips and
knees
birth-4 months scissoring of legs, fixed extension &
adduction of legs= spastic paraplegia or
diplegia
2. Placing baby held upright with back and head
support, allow dorsum of foot to touch
undersurface of table top
flexes hip and knee, places stimulated
foot on table top
birth- 11 months absence could indicate paresis or breech
presentation at birth
3. Steppage baby held upright under axillae, allow
soles of feet to touch surface of table,
baby's body is inclined slightly forward
alternate flexion and extension of legs
simulating walking
birth- 11 months absence could indicate paresis or breech
presentation at birth
4. Parachute Response baby held upright under axillae,
slowly lower baby's head toward
surface (prone)
baby extends it's arms and legs forward as
if to protect itself
6 months - adulthood Upper extremity pyramidal tract
dysfunction; asymmetrical response may
be a sign of hemiparesis
