primitive reflex in newborn

1. Newborn Reflexes

2. What is a newborn reflex?
• Reflex actions originating in the central nervous system (brain) that are
exhibited by normal infants, in response to particular stimuli.
• Primitive reflexes provide information about the neonate’s brainstem and
cortical function.
• They develop in utero and are well-developed by term.
• As the central nervous system matures and cortical inhibition develops,
starting at around four to six months of age, the primitive reflexes begin to
diminish and are replaced by voluntary motor.

3. IN GENERAL
• Survival reflexes rooting and sucking reflexes.
• Protective reflexes include the palmer grasp, plantar grasp, Moro,
tonic neck, and gag.
• Absence of an expected reflex - indicate general depression of the
central or peripheral nervous system motor functions (i.e., lower
motor neuron, nerve, and muscle function).
• Asymmetry may indicate motor cortex lesions or trauma related
peripheral bone or nerve injury.

4. REFLEX ONSET
(WEEKS)
WELL
ESTABLISHED
(WEEKS)
DISAPPEARA
NCE
(MONTHS)
SUPPRESSED
SUCKING 28 32-34 12 SURVIVAL
REFLEX
ROOTING 28 32-34 3-4 SURVIVAL
REFLEX
PALMER
GRASP
28 32 2 ALLOWS FOR
VOLUNTARY
GRASPING
PLANTAR
GRASP
28 32 7-9 ALLOWS FOR
STANDING
AND
WALKING

5. REFLEX ONSET
(WEEKS)
WELL
ESTABLISHED
(WEEKS)
DISAPPEARA
NCE
(MONTHS)
SUPPRESSED
TONIC NECK
REFLEX
35 1 MONTHS 6 MONTHS ALLOWS FOR
ROLLING OVER
AND REACHING
AND GRASPING
MORO 28-32 37 6 MONTHS ALLOWS FOR
SITTING
STEPPING 35-36 WEEKS 37 3-4
TRUNCAL
INCURVATION
28 WEEKS 40 3-4
BABINSKI 34-36 WEEKS 38 12-14

6. REFLEX ONSET
(WEEKS)
WELL
ESTABLISHED
(WEEKS)
DISAPPEARA
NCE
(MONTHS)
SUPPRESSED
BABINSKI 34-36 WEEKS 38 12-14
SWALLOW 12 28 NEVER
DISAPPEAR
TONIC NECK
REFLEX
3 months 9 months HELPS THE CHILD
TO GET IN
KNEELING
POSITION
TONIC
LABYRINTHIN
E REFLEX
LANDAU
REFLEX
3 MONTHS 1 YEAR Postural reflex

7. Moro Reflex

8. MORO’S REFLEX
• ONSET – 28 WEEKS. DISAPPEARS – 6 MONTHS
• COMPONENTS : Suddenly allowing the neonate’s head and shoulders to drop a
few inches in relation to their trunk into the examiner’s hands.. The term
neonate responds by opening his hands and extending and abducting the arms.
This motion is followed by arm flexion back toward the body ( similar to a
hugging motion). A neonate will often cry when the Moro is stimulated.
• ABSENT MORO’S REFLEX- GENERALIZED DISTURBANCE OF CNS
• UNILATERALLY ABSENT RESPONSE- upper extremity injury, such as one of the
brachial plexus (e.g., Erb’s palsy), or fracture of the humerus or clavicle.
• Persistence of the Moro reflex : B/L INTRAUTERINE CEREBRAL DISTURBANCE

9. STARTLE REFLEX
• CONFUSED WITH MORO’S REFLEX
• SUDDEN LOUD NOISE OR BY TAPING THE STERNUM
• Flexion of the upper limb.

10. ASYMMETRIC TONIC NECK REFLEX

11. Asymmetrical tonic neck reflex
• APPEARS- 35 WEEKS. DISAPPEARS- 6 MONTHS OF AGE
• COMPONENTS: The tonic neck reflex is elicited when with the
neonate in the supine position, the head is turned to one side,
resulting in extension of the upper extremity on the side to which the
face is rotated and flexion of the upper extremity on their occiput
side.. FENCING POSITION.
• The tonic neck reflex is inhibited as head control develops and the
cerebral cortex matures.
• Persistence of the reflex – Common in extrapyramidal d/o like
kernicterus.

12. SYMMETRICAL TONIC NECK REFLEX
• COMPONENTS –
• FLEXION NECK- HANDS FLEX/ LEGS EXTEND
• EXTENSION OF NECK – HANDS EXTEND AND FLEXION OF
LEGS

13. Palmer Grasp
• Appear – 28 weeks disappear – 2 month
• Components – introducing a finger into the palm
from the ulnar side. Baby responses by flexing the
fingers and gripping the object.
• Afferent- ulnar and median nerve that supplies the
palmer surface of the hand
• Efferent – ulnar nerve and median nerve
• Efferent- ulnar and median nerve
• Persistence grasp reflex- kernicterus , athetoid
form of cerebral palsy.
• Absent asymmetric – peripheral nerve root injury

15. • Ulnar nerve- C8 , T1
• RADIAL NERVE- C5 , C6,C7,C8 T1
• MEDIAN NERVE – C5 C6 C7 C8 T1

16. Plantar grasp
• Appear : 28 weeks. Disappear: 7-9
months
• Components: gently stroking the foot
behind the toes. This causes the toes of
the foot to curl up.
• Importance- so that the normal voluntary
walking can develop

17. BANINSKI reflex
• Stimulus applied to the distal half of the outer side of the foot.
• Often confused with the Plantar GRASP, the Babinski reflex is also
present at birth and fades around the first year.
• This reflex appears when the side of the foot is stroked, causing the toes
to fan out and the hallux to extend.
• Caused by a lack of myelination in the corticospinal tract in young
children

19. Rooting Reflex
• Appear- 28 weeks
• Disappear-3-4 months
• Component- stroke the cheek and
corner of infants mouth. Head turns
towards the stimulus and mouth
opens.
• Persistence after 6 months – congenital
cerebral palsy
• Absent- congenital trigeminal
anaesthesia.

20. Sucking Reflex
• Ensures that the baby will nurse on a
breast or bottle to be fed and occurs
when something is placed in the baby's
mouth
• Sucking is made possible by the thorax
when the infant breathes in and by
fixing the jaw between breaths
• Swallowing and breathing must be
coordinated, and the depth and rate of
breathing are handled differently when
the baby is engaged in nutritive and
non-nutritive (such as on fingers or a
pacifier) sucking
• Slowly replaced by voluntary sucking
around 2 months of age

21. STEPPING
• APPEAR- 35-36 WEEKS
• DIAPPEAR – 3-4 MONTHS
• When the neonate is held upright and the feet is allowed to touch a
flat surface – alternate stepping movements can be elicited

22. PLACING
• Elicited by touching the dorsum of foot under a table- the child lifts
up the legs onto the table
• Appear – birth in FT babies (weight >1800 gm) /After 24 hrs in PT
BABIES ( WEIGHING OVER 1700)
• DISAPPEAR- 5-6 WEEKS AFTER BIRTH

23. Withdrawal Reflex
•An attempt to avoid pain
•Babies receive a whole slew
of tests as newborns and, if
you will notice when the
heel of the foot is pricked
for a blood test, the leg and
foot will jerk backwards and
the opposite leg and foot
push forward

24. Parachute reflex
• Appear – 6 months. Disappear: never
• ELICIT – ELICIT – VENTRAL SUSPENSION AND SUDDENLY LOWERING
HIM TOWARDS COUCH – ARMS EXTEND
• ABSENT - CHILDREN WITH CP

25. Landau Reflex
• Appear – 3 months
• Disappear– 1 year
• ABSENT – MOTOR WEAKNESS , CEREBRAL PALSY , ID

27. References
• Illingworth’s THE DEVELOPMENT OF INFANT AND YOUNG CHILD
• VOLPE’S Neurology of the Newborn
• ELLEN P TAPPERO , MARY ELLEN HONEYFIELD