Neonatal reflexes

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