Neonatal reflexes are involuntary responses present at birth that help assess infant development. There are several general body reflexes like the Moro reflex and plantar grasp reflex, as well as facial and oral reflexes. The presence, absence, strength, and timing of reflexes can indicate neurological abnormalities. Understanding neonatal reflexes aids in evaluating whether development is normal or if further assessment is needed.

1. NEONATAL REFLEX
:- ABHISHEK KUMAR

2. CONTENTS
• INTRODUCTION
• REFLEX ARC
• CLASSIFICATION OF REFLEXES
• SIGNIFICANCE OF REFLEXES
• TYPES OF REFLEXES
• CONCLUSION

3. Introduction
A reflex is an involuntary or autonomic action that your body does in
response to something without even having to think about it.
Neonatal reflexes – inborn reflexes present at birth and occur in a
predictable fashion.
Normally developing newborn should respond to certain stimuli with
these reflexes.

4. REFLEX ARC
• Anatomical pathway for a reflex is called reflex arc.
• It has 5 components:-
Receptor
Afferent nerve
Center
Efferent nerve
Effector organ

5. Significance of reflexes
• Helps to identify whether the child is developing normally or not.
• Tells about what abnormalities the child may be having if all reflexes
are not proper.
• Knowledge of development of motor skills – helps to identify whether
development is going on at a proper rate or not.

6. TYPES OF REFLEXES

7. GENERAL BODY REFLEXES:
 MORO REFLEX/STARTLE REFLEX
 PALMAR REFLEX/GRASP REFLEX
 PLANTAR GRASP REFLEX
 WALKING/STEPPING REFLEX
 LIMB PLACEMENT REFLEX
 ASYMMETRIC TONIC NECK REFLEX
 SYMMETRIC TONIC NECK REFLEX
 BABKIN REFLEX
 PARACHUTE REFLEX
 LANDAU REFLEX
 WITHDRAWAL REFLEX
 TRUNK INCURVATION REFLEX
 TENDON REFLEX
 GALLANT’S REFLEX
 TONIC LABYRINTHINE REFLEX

8. FACIAL REFLEXES:
NASAL REFLEX
BLINK REFLEX
DOLL’S EYE REFLEX
AUDITORY ORIENTING REFLEX
ORAL REFLEXES:
ROOTING REFLEX
SUCKING REFLEX
SWALLONING REFLEX
GAG REFLEX
CRY REFLEX

9. GENERAL BODY REFLEXES
• Moro reflex/Startle reflex
Begins at 28 weeks of gestation
Initiated by any sudden movement of the neck
ELICITED BY:- Pulling the baby halfway to sitting position
from supine and suddenly let the head fall back
 Consists of rapid abduction and extension of arms with the opening of hands , testing of the back
Muscles , flexion of the legs and crying
Within moments ,the arms come together again and again

10. CLINICAL SIGNIFICANCE:
• Its nature gives an indication of muscles tone.
• Failure of the arms to move freely or the hands to open fully indicates hypotonia.
• Its fades rapidly and is not normally elicited after 6 months of age.

11. • Palmar /grasp reflex
Begins at 32 weeks of gestation
Light touch of the palm produces reflex flexion of the
fingers
Most effective way – slide the stimulating object , such
as a finger or pencil , across the palm from the lateral
border
Disappears at 3-4 months
Replaced by voluntary grasp at 45 months

12. CLINICAL SIGNIFICANCE:
• Exceptionally strong grasp reflex– spastic form of cerebral palsy and
kernicterus.
• May be asymmetrical in hemiplegia and in cases of cerebral damage.
• Persistence beyond 3-4 months indicate spastic form of palsy.

13. • Plantar/Grasp reflex
 Placing object or finger beneath the toes causes curling of toes around the
object.
 Present at 32 weeks of gestation
 Disappears at 9-12 months
CLINICAL SIGNIFICANCE:
• This reflex is referred to as the “readiness tester”.
• Integrates at the same time that independent gait first becomes possible.

14. • Walking/stepping reflex:
 When sole of foot is pressed against the couch , baby tries to walk
 Leg prance up and down as if baby is walking or dancing
 Present at birth, disappears at approx 2-4 months
 With daily practice of reflex, infants may walk alone at months
CLINICAL SIGNIFICANCE
• Premature infants will tend to walk in a toe – heel fashion while more mature
infants will walk in a heel – toe pattern.

15. • Limb placement reflex
 When the front of the leg below the knee or the arm below the elbow is brought into
contact with the edge of a table , child lifts the limbs over the edge
 Present at birth , fades away rapidly in early months of life
CLINICAL SIGNIFICANCE
• Reflex is readily demonstrable in the newborn and persistent failure to elicit it at this
stage , is thought to indicate neurological abnormality.

16. • Withdrawal reflex
 Protective reflex
 Stimulus: a pinprick or a sharp painful stimulus to sole of foot
 Response: flexion and withdrawal of stimulated leg
 Present at the birth , persist throughout life
CLINCICAL SIGNIFICANCE
• Absence of this seen in neurologically impaired infants.

17. • Asymmetric tonic neck reflex
 Most evident between 2-3 months of age
CLINICAL SIGNIFICANCE
• The reflex fades rapidly and is not normally seen after 6 months of age.
• Persistence is the most frequently observed abnormality of the infantile
reflexes in infants with neurological lesions
• Greatly disrupts development

18. • Symmetric tonic neck reflex
 Extension of the head causes extension of the fore limbs and flexion of the hind
limbs
 Evident between 2-3 months of age
CLINICAL SIGNIFICANCE
• Not normally easily seen or elicited in normal infants
• May be seen in an exaggerated form in many children with cerebral palsy

19. • Babinski’s reflex
 Stimulus consists of a firm painful stroke along the lateral border of the sole from heel to toe
 Response consists of movement ( flexion or extension ) of the big toe and sometimes
movement (fanning) of the other toes
 Present at birth , disappears at approx. 9-10 months
 Presence of reflex later may indicate disease

20. • Babkin reflex
Deep pressure applied simultaneously to the palms of both
hands while the infants is in supine position
Stimulus is followed by flexion or forward bowing of the head,
opening of mouth and closing of the eyes
Fades rapidly and normally cannot be elicited after 4 months of
age

21. CLINICAL SIGNIFICANCE
• Reflex can be demonstrated in the newborn , thus showing a hand-
mouth neurological link , even at the early stage.

22. • Parachute reflex
 Reflex appears at about 6-9 months and persists thereafter
 Elicited by – holding the child in ventral suspension and suddenly lowering
him to the couch
 Arms extended as a defensive reaction
CLINICAL SIGNIFICANCE
• Absent or abnormal in children with cerebral palsy
• Would be asymmetrical in spastic hemiplegia

23. • Landau reflex
 Seen in horizontal suspension with the head , legs , and spine extended
 If the head is flexed , hip knees and elbows also flex
 Appears at approximately 3 months , disappears at 12-24 months
CLINICAL SIGNIFICANCE
• Absence of reflex occurs in hypotonia, hypertonia or mental
abnormality

24. • Trunk incurvation reflex
 Stroking one side of spinal column while baby is on his abdomen
causes
 Crawling motions with the legs
 Lifting head from the surfaces
 Present in utero , seen at approx. 3 or 4 day
 Persists for 2-3 months

25. • Gallant’s reflex
 Firm sharp stimulation along sides of the spine with
the fingernails or a pin produces contraction of the
underlying muscles and curving of the back
 Response is easily seen when the infant is held
upright and the trunk movement is unrestricted
 Best seen in the neonatal period and thereafter
gradually fades

26. • Tendon reflexes
Simple monosynaptic reflexes , which are elicited by a sudden stretch
of a muscle tendon
Occurs when the tendon is tapped
Present throughout life

28. CLINICAL SIGNIFICANCE
Useful diagnostically for:
Detection of upper motor neuron lesions (exaggerated response)
Myopathic conditions (depressed or absent response)
Localization of the segmental lesions of the cord

29. • Tonic labyrinthine reflex
Labyrinths – most important organs concerned with
the development of anti-gravity postures and balance
Movement of the head in any dimension stimulates
the labyrinths; and produces the appropriate
responses
Arms and legs extend when head moves backwards
and will curl in when the head moves forward
Emerges in utero until approximately 4 months
postnatally

30. FACIAL REFLEXES
• Nasal reflex
Stimulation of the face or nasal cavity with water or local irritants produces
apnoea in neonates
Breathing stops in expiration with laryngeal closure in infants – bradycardia and
lowering of cardiac output
Blood flow to skin , splanchnic areas muscles and kidney decreases
Flow to the heart and brain remains proctected

31. • Blink reflex
A bright light suddenly shown into the eyes, a puff of air upon the
sensitive cornea or a sudden loud noise will produce immediate
blinking of the eyes
Purpose – to protect the eyes from foreign bodies and bright light
May be associated tensing of neck muscles, turning of the head away
from the stimulus , frowning and crying
Reflexes are easily seen in the neonate and continue to be present
throughout life

32. CLINICAL SIGNIFICANCE
Examination is a part of some neurological exams , particularly when
evaluating coma
Satisfactory demonstration of these reflexes indicate –
 no cerebral depression
 contraction of appropriate muscles in response

33. • Doll’s eye reflex
Passive turning of head of the new-born leaves the eye
“behind”
A distinct time lag occurs before the eyes move to a new
position in keeping with the head position
Disappears at within a week or two of birth
Failure of this reflex to appear indicates a cerebral lesion

34. • Auditory orienting reflex
A sudden loud and unpleasant noise:
May produce the blink reflex
Infant may remain still and show increased alertness
Quieter sounds usually cause reflex eye and head turning to the side
of the sound , as if to locate it
Seen first at about 4 months of age
Thereafter , head turning towards sound stimuli occurs and the
accuracy of localization increases rapidly by 9-10 months

35. CLINICAL SIGNIFICANCE
• Reflex responses are made use of in tests of infants for
hearing loss
• Pattern of the localization responses indicates the level of
neurological maturity

36. ORAL REFLEXES
• Rooting reflex
 Baby’s cheek is stroked:
 The respond by turning their head towards the stimulus
 They start sucking , thus allowing for breast feeding
When corner of mouth is touched, lower lip is lowered
,tongue moves towards the point stimulated
When finger slides away, head turns to follow it
When center of lip is stimulated , lip elevates

37.  Onset – 28 weeks IU
 Well established – 32-34 weeks IU
 Disappears – 3-4 months
CLINICAL SIGNIFICANCE
• Persistence can interfere with sucking
• Absence of this is seen in neurologically impaired infants

38. • Sucking/Swallowing reflex
 Touching lips or placing something in baby’s mouth causes
baby to draw liquid into mouth by creating vaccum with
lips , cheeks and tongue
 Onset – 28 weeks IU
 Well established – 32-34 weeks IU
 Disappears around 12 months

39. CLINICAL SIGNIFICANCE
• Persistence may inhibit voluntary sucking
• SIGMUND FREUD – Any kind of deprivation of the activity will lead to
fixation resulting in oral habits

40. • Gag reflex (pharyngeal reflex)
 Seen in 19 weeks of IU life
 Reflex contraction of the back of the throat
 Evoked by touching the roof of the mouth , the back of the
tongue , the area around the tonsils and the back of the throat
• FUNCTIONAL SIGNIFICANCE
 It , along the reflexive pharyngeal swallowing , prevents
something from entering the throat except as a part of normal
swallowing and helps prevent choking

41. CLINICAL SIGNIFICANCE
• Absence of the gag reflex – symptom of a number of severe medical
conditions:
Damage to the glossopharyngeal nerve, the vagus nerve
Brain death

42. • Cry reflex
 Non conditioned reflex which accounts for its individual
character
Sporadic in nature
Starts as early as 21-29 weeks of IU life

43. • Importance of cry
It is infant’s first verbal communication
Can be interpreted as a message of urgency or distress
Indicates :-
Hunger
Pain
Discomfort

44. CONCLUSION
Appropriate knowledge of reflexes enables
 To identify whether the child is developing normally or not
 To identify whether development is going on at a proper rate or not
 Knowledge of abnormalities if all reflexes are not proper