This document discusses newborn reflexes. It defines a reflex as an involuntary action in response to stimulation without awareness. Neonatal or primitive reflexes are inborn patterns that develop in newborns and should be fully present at birth. The document describes several important reflexes like Moro, palmar, plantar, stepping, tonic neck, and oral reflexes. It provides details on when each reflex typically appears and disappears during development. The clinical significance of these reflexes is also explained, such as what abnormalities in the reflexes may indicate.

1. NEWBORN
REFLEXES
BY :- DR. KRISHNA SHARMA
INTERN
GUIDED BY :- DR. BHARAT SHAH
DR. HETAL GOHIL

2. WHAT IS A REFLEX ?
A reflex is a involuntary action that the body does in response to stimulation
without awareness.
Neonatal reflexes or primitive reflexes are the inborn behavioural pattern that
develop in newborn.
They should be fully present at birth and are gradually inhibited by higher
center in the brain.

3. TYPES OF REFLEXES
• GENERAL BODY REFLEX
• FACIAL REFLEX
• ORAL REFLEX
Brainstem mediated Midbrain & cortex Spinal cord
Moro’s reflex Parachute reflex Galant reflex
Sucking reflex Perez reflex

4. GENERAL BODY REFLEXES
Moro reflex/ Startle reflex
Palmar /Grasp reflex
Planter grasp reflex
Walking /stepping reflex
Asymmetric tonic neck reflex
Symmetric tonic neck reflex
Babinski’s reflex
Babkin reflex
Parachute reflex
Galant’s reflex

5. MORO REFLEX
 Begins :- 28 weeks of gestation
 Disappear :- 3- 6 month
 Method – sudden drop of baby’s head in
relation to trunk
 Response :- abduction & extension of upper limb
with the opening of hands, followed by
adduction and flexions followed by
crying.
Development :- by 28 wks IU = hand opening
by 32 wks IU = extension and abduction
by 37 wks IU = anterior flexion

6. MORO REFLEX
• CLINICAL SIGNIFICANCE
Its nature gives an indication of muscle tone
Failure of the arms to move freely or the hands to open fully indicates hypotonia.
Depressed / absent more reflex:
 cerebral depression (eg, birth asphyxia )
Exaggerated moro reflex:
Cerebral irritability
Asymmetric moro reflex:
Brachial palsy, fracture of clavicle or humerus, and hemiplegia

7. MORO REFLEX

8. PALMAR/ GRASP REFLEX
Begins :- 32 weeks of gestation
Disappears:- 3-4 months
Light touch of the palmar surface produces reflex flexion of the fingers
Most effective way –slid the stimulating object, such as a finger or pencil, across
the palm from the lateral border
Replaced by voluntary grasp at 4-5 months

9. PALMAR/ GRASP REFLEX
• CLINICAL SIGNIFICANCE
Persistence beyond 3-4 months indicate spastic form of cerebral palsy &
kernicterus
May be asymmetrical in hemiplegia & in case of cerebral damage

10. PLANTAR/ GRASP REFLEX
Present :- 32 weeks of gestation
Disappears :- 6-8months
Placing finger in the sole causes
flexion of toes.
o Clinical significance:
The reflex is referred to as the “readiness tester”.

11. PALMAR AND PLANTAR RELEXES

12. WALKING/ STEPPING REFLEX
 Present in full term babies > 1.8 kg weight
 Disappears at approx 5-6 weeks.
 When sole of foot is pressed against the
couch edge, baby tries to walk
 Legs prance up & down as if baby is
walking or dancing
 Reflex reappear at 10 months . that’s how baby learn how to walk
o Clinical significance
 Premature infants will tend to walk in a toe-heel fashion while more mature infants
will walk in heel-toe pattern.

13. WALKING/ STEPPING REFLEX

14. ASYMMETRIC TONIC NECK REFLEX
When the child’s head is turned to the one side, the arm
on that side will extended and the opposite limb flexed.
Most evident between 2-3 months of age
Disappers :- 6 months of age.
o Clinical significance
Persistence of most frequently observed
abnormality of the infantile reflexes in infants
with neurological lesions.
Greatly disrupts development

15. ASYMMETRIC TONIC NECK REFLEX

16. 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
o Clinical significance:
Not normally easily seen or elicited in
normal infants
May be seen in an exaggerated form
in many children with cerebral palsy.

17. SYMMETRIC TONIC NECK REFLEX

18. BABINSKI’S REFLEX
Stimulus consists of a firm painful stroke
along the lateral border of the from heel to toe.
Response consists of movement (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.

19. BABINSKI’S REFLEX

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

21. BABKIN REFLEX
o Clinical significance
Reflex can be demonstrated in the newborn, thus showing a hand- mouth
neurological link, even at that early stage.

22. BABKIN REFLEX

23. PARACHUTE REFLEX
Appears:- 6-9 months &
persists there after.
Method :- by holding the child in ventral
suspension & suddenly lowering him to
the couch.
Arms extend as a defensive reaction.
o Clinical significance
Absent or abnormal in children with
cerebral palsy.
Would be asymmetrical in spastic hemiplegia

24. PARACHUTE REFLEX

25. GALANT’S REFLEX
Firm sharp stimulation along sides of
the spine produces contraction of the underlying
muscle 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. GALANT’S REFLEX

27. FACIAL REFLEXES

28. FACIAL REFLEXES
Blink reflex
Doll’s eye reflex
Auditory orienting reflex

29. 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 & bright light
May be associated tensing of the neck muscle,
Turning of the head away from the stimulus,
frowning and crying

30. BLINK REFLEX
Reflexes are easily seen in the neonate and continue to be present throughout
life.
o Clinical significance
Examination is part of some neurological exams, particularly when evaluating
coma.
Satisfactory demonstration of these reflexes indicate-
No cerebral depression
Contraction of appropriate muscles in response.

31. BLINK REFLEX

32. DOLL’S EYE REFLEX
(OCULOCEPHALIC REFLEX)
Passive turning of the head of the newborn
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

33. DOLL’S EYE REFLEX

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. AUDITORY ORIENTING REFLEX
o 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

37. ORAL REFLEXES
Rooting reflex
Sucking reflex
Swallowing reflex
Gag reflex

38. ROOTING REFLEX
• Baby’s cheek is stroked:
They respond by turning their head
towards the stimulus.
They start try to find breast, thus allowing for
breast feeding
When finger slides away , head turns to follow it.

39. ROOTING REFLEX
Onset – 28 weeks IU
Well established – 32-34 weeks IU
Disappears at 3- 4 months
o Clinical significance
Persistence can interfere with sucking
Absence of this is seen in neurological impaired infants.

40. ROOTING REFLEX

41. SUCKING/ SWALLOWING REFLEX
Touching lips or placing finger in
baby’s hard palate causes baby to start
sucking the finger.
Onset – 28 weeks IU
Well established at 32- 34 weeks IU
Disappears around 12 months

42. SUCKING/ SWALLOWING REFLEX

43. GAG REFLEX
(PHARYNGEAL REFLEX)
Seen in 19 weeks of IU life
Reflex contraction of the back of
the throat
Evoked by touching uvula.

44. GAG REFLEX
(PHARYNGEAL REFLEX
o Functional significance
It, along with reflexive pharyngeal swallowing, prevent something from entering
the throat except as part of normal swallowing and helps prevent choking.
o Clinical significance
Absence of the gag reflex – symptom of a number of severe medical condition
Damage to the glossopharyngeal nerve, the vagus nerve,
braindeath

45. NORMAL DEVELOPMENT OF NEONATAL
REFLEXES
NEONATAL REFLEXES APPEARANCE( IN WKS) DISAPPEARANCE (MONTH)
MORO REFLEX 28-32 3-4
PALMAR REFLEX 28 3-4
PLANTER REFLEX 32 6-8
ROOTING 32 4
TONIC NECK REFLEX 35 6