ASSESSMENT OF NEWBORN REFLEXES

1. MRS.JEBAKUMARI SUTHA.A
ASSOCIATE PROFESSOR
HOD,PAEDIATRIC DEPARTMENT
GANGA COLLEGE OF NURSING
COIMBATORE-22

2. ASSESSMENTOF
NEWBORN
REFLEXES

3. INTRODUCTION
• A newborn should have a thorough evaluation
performed within 24 hours of birth to identify any
abnormality

4. • All the new born
should be examine at
• Birth
• 24 hours
• Before discharge
• Follow up
A systematic approach consisting of ask,
check,look,listen and feel should be followed at
each assessment

5. NEWBORN PERIOD
• Newborn usually
refers to a baby from
birth to 28 days period
• Infants can be
considered children
anywhere from one
month to 1 year old.

6. ASSESSMENT
• Examination of
the child during
new-born
period

7. TYPES OF ASSESSMENT
1. Initial Assessment
2. Transitional Assessment
3. Behavioural assessment
4. Assessment of
gestational age
5. Systemic physical
examination

8. INITIAL ASSESSMENT
APGAR Score
APGAR score: It is a method use to assess the newborn’s
immediate adjustment to extra uterine life
• The score based on five signs
• 1. Appearance (color)
• 2. Pulse ( Heart rate)
• 3. Grimace (Reflex irritability)
• 4. Activity(Muscle tone)
• 5. Respiratory rate

9. SCORING OF APGAR
INDICATORS 2 1 0
Activity Active,
spontaneous
Some flexion
of extremities
No movement
(flaccid, limp)
Pulse >100 bpm < 100 bpm Absent
Grimace Pulls away,
sneezes, coughs
Facial grimace
only
No response
with stimulation
Appearance Completely pink Acrocyanosis Bluish-gray or
pale all over
Respiration Good vigorous
cry
Slow, irregular
Weak cry
Absent

10. INTERPRETATION OF APGAR
• Each item is given a score 0, 1, or 2
• 0-3 severe distress
• 4-6 moderate difficulty
• 7-10 no difficulty adjusting to life
• Evaluation of all five categories are made on 1- 5
min after birth.

11. OTHER INITIAL ASSESSMENTS ARE…..
• Stabilization
• Measuring weight.

12. TRANSITIONAL ASSESSMENT
• Transitional Assessment during the period of
reactivity: First period of reactivity (6- 8 hours
after birth)

13. BEHAVIOURAL ASSESSMENT
• While babies may not speak their first word for a
year, they are born ready to communicate with a
rich vocabulary of body movements, cries and
visual responses: all part of the complex language
of infant behavior.

14. ASSESSMENT OF GESTATIONAL AGE
An accurate assessment of age is important for 2
reasons
• Identifying neonatal risks
• Developing management plans

15. ASSESSMENT OF GESTATIONAL AGE
• Gestational age can measure by weight for
gestational age chart.

16. 19
PHYSICAL MATURITY- BALLARD SCORE

17. 17
NEUROMUSCULAR MATURITY-BALLARD SCORE

18. NEUROMUSCULAR MATURITY
POSTURE SQUARE WINDOW

19. ARM RECOIL SCARF SIGN

20. POPLITEAL ANGLE HEAL TO EAR

21. Scoring
19+17=36
36 39

22. SYSTEMIC, PHYSICAL EXAMINATION

23. REFLEXES

24. • Primitive reflexes
are automatisms
that are usually
triggered by an
external stimulus
STARTS IN THE WOMB ITSELF

25. FACIAL REFLEXES
• BLINKING REFLEX
Blinking the eyes when
they are touched or
when a sudden bright
light appears
PERMANENT REFLEX

26. PUPILLARY REFLEX
• Pupil constrict when
the bright light shine
PERMANENT REFLEX

27. GLABELLAR REFLEX
• The glabellar reflex,
also known as the
"glabellar tap sign", is a
primitive reflex elicited
by repetitive tapping
on the forehead.
Subjects blink in
response to the first
several taps.
APPERARS AT BIRTH, PERMANENT

28. NASAL REFLEX
• Sneezing occurs
when the nasal
passages are
irritated.
PERMANENT REFLEX

29. DOLLS EYE REFLEX
• Doll's eye reflex can be
noted with the baby
supine (lying on the
back) and slowly
turning the head to
either side.
APPEARS AT BIRTH,DISAPPEARS WHEN THE FIXATION
DEVELOPS

30. AUDITORY ORIENTING REFLEX
• Response of the
body to
auditory
stimulus
PERMANENT REFLEX

31. ORAL REFLEX
• ROOTING REFLEX
This reflex begins when the
corner of the baby's mouth is
stroked or touched. The baby
will turn his/her head and open
his/her mouth to follow and
"root" in the direction of the
stroking. This helps the baby
find the breast to begin feeding.
APPEARS AT BIRTH,DISAPPEARS AT 6-8 MONTHS

32. SUCKING REFLEX
• Rooting helps the baby
become ready to suck.
When the roof of the
baby's mouth is touched,
the baby will begin to
suck.
APPEARS AT BIRTH,DISAPPEARS AT 6 MONTHS

33. SWALLOWING REFLEX
• SWALLOWING
When an infant's lips and
mouth area are touched,
the mouth opens and
suckling or sucking
movements begin. As
liquid moves into the
mouth, the tongue
immediately moves it to
the back of the mouth for
swallowing.
PERMANENT REFLEX

34. GAG REFLEX
• Stimulation of
posterior pharynx by
suction or passing of
tube cause the infant
to gag
PERMANENT REFLEX

35. COUGHING REFLEX
• Irritation of mucus
membrane of larynx
and tracheobronchial
tree causes coughing
PERMANENT REFLEX

36. YAWNING REFLEX
• It is a spontaneous
response to decreased
oxygen by increasing
inspired o2
PERMANENT REFLEX

37. EXTRUSION REFLEX
• An extrusion reflex or
tongue-thrust reflex is
the reflex motion that
causes your baby's
tongue to move
forward as soon as his
lips are touched
APPEARS AT BIRTH,DISAPPEARS AT 4 to 6 MONTHS

38. GENERAL BODY REFLEX
• MORO/STARTLE REFLEX
It is a response to a
sudden loss of support
and involves TWO distinct
components: spreading
out the arms (abduction)
pulling the arms in
(adduction)
APPEARS AT BIRTH,DISAPPEARS AT 6-8 MONTHS

39. ASYMMETRICAL TONIC NECK REFLEX
It is characterized by
extension of the upper
and lower extremities
on the side to which
the head and neck is
turned with flexion of
the contralateral
upper extremity
(fencing posture).
APPEARS AT 1 MONTH,DISAPPEARS AROUND 4 MONTHS

40. SYMMETRICAL TONIC NECK REFLEX
• Placing the child in
quadruped position on
the floor and passively
flexing the head
forward and then
extend it backwards.
• Head extension causes
arm extension and leg
flexes
APPEARS AT 1 MONTH,DISAPPEARS AROUND 6-8 MONTHS

41. TONIC LABYRINTHINE REFLEX
• Movement of the head
any dimensions,
stimulate the labyrinth
to produce the
appropriate responses
• Arms &legs extend
when head moves back
ward, will curl in when
the head moves
forward
APPEARS AT 1 MONTH,DISAPPEARS AROUND 4 to 6 MONTHS

42. NECK RIGHTING REFLEX
• Neck Righting Reflex:
With the infant supine,
turning the head to
one side causes the
infant to turn his
shoulders and trunk to
the same side. It
appears when the tonic
neck reflex disappears

43. TRUNK INCURVATION/GALANT REFLEX
• Stroking one side of
the spinal column
when baby is on
abdomen causes
 Crawling motion with
legs
 Lift the head from
surface

44. LIMP PLACEMENT
• ALSO CALLED AS
STEPPING REFLEX
APPEARS AT BIRTH , DISAPPEARS WHEN CHILD STARTS

45. STEPPING REFLEX
• The stepping reflex in
new-borns is also
known as the
"walking" or "dancing
reflex". This reflex can
be seen when a baby is
held upright or when
the baby's feet are
touching the ground.
APPEARS AT BIRTH , DISAPPEARS AROUND 12 MONTHS

46. WITHDRAWAL REFLEX
• When your baby is
sitting, suddenly move
your face close to his,
you will notice that the
baby will turn his head
away. He would do the
same if an object
suddenly moves closer
to him.
APPEARS AT BIRTH ,DISAPPEARS AROUND 4 – 6 MONTHS

47. BABINSKI’S REFLEX
• The Babinski reflex
occurs after the sole of
the foot has been
firmly stroked. The big
toe then moves upward
or toward the top
surface of the foot. The
other toes fan out.
APPEARS AT BIRTH ,DISAPPEARS AROUND 1 to 2 Years

48. PLANTAR REFLEX
• The plantar reflex is a
reflex elicited when the
sole of the foot is
stimulated with a blunt
instrument. In normal
adults the plantar
reflex causes a
downward response
APPEARS AT 1 to 2 YEARS ,PERMANENT REFLEX

49. BABKIN REFLEX
• The hand-mouth
reflex of Babkin
consisting of head
flexion and rotation
with opening of the
mouth in response to
pressure on the palms
of both hands
APPEARS AT 1 MONTH,DISAPPEARS AROUND 4-6 MONTHS

50. GRASPING REFLEX
PALMAR GRASPING
• When an object is
placed in an infant's
hand and the palm of
the child is stroked,
the fingers will close
reflexively, as the
object is grasped via
palmar grasp
APPEARS AT 1 BIRTH,DISAPPEARS AROUND 3-4 MONTHS

51. PINCER GRASPING
• Child will be able to
pick up smaller objects
between their thumb
and forefinger once
they develop little
strength
APPEARS AT 4-6 MONTHS, PERMANENT REFLEX

52. LANDOU REFLEX
• A normal response in
infants when held in a
horizontal, face-down
position to maintain a
convex arc with the
head raised and legs
slightly flexed;
APPEARS AT 2-3 MONTH,DISAPPEARS AROUND 12

53. PARACHUTE REFLEX
• This reflex occurs in
slightly older infants
when the child is held
upright and the baby's
body is rotated quickly
to face forward (as in
falling). The baby will
extend his arms
forward as if to break
a fall
APPEARS AT 6-7 MONTHS,DISAPPEARS AROUND 12 MONTHS

54. PEREZ REFLEX
• Running a finger down
the spine of an infant
held supported in a
prone position will
normally cause the
whole body to become
extended
APPEARS AT 6-7 MONTHS,DISAPPEARS AROUND 12 MONTHS

55. CONCLUSION
• Neonatal examination especially assessment of
reflexes is important for understanding the baby's
development as a whole and recognition of neuro
developmental damage in prenatal and perinatal
period.With this impression we can predict the
Childs future potential

56. Children's are our future asset…..
• Every child has……..
..the right to be respected
..the right to dream
..the right to be loved and care
..the right to achieve their god given potential
At last
They need unconditional love