NEWBORN REFLEXES/ PRIMITIVE REFLEXES BY. MR. DINABANDHU BARAD

1. NEWBORN REFLEXES
BY:
Mr. Dinabandhu Barad
MSC TUTOR, SNC,SOA,DTU

2. WHAT IS A REFLEX ?
• A reflex is an involuntary, or automatic, action that the body does in
response to stimulation, without awareness.
• Neonatal reflexes or primitive reflexes are the inborn behavioral
patterns that develop during uterinelife.
• They should be fully present at birth and are gradually inhibited by
higher centers in the brain during postnatallife.

3. TYPES OF REFLEXES

4. TYPES OF REFLEXES
1. GENERAL BODY REFLEX
2. FACIAL REFLEX
3. ORAL REFLEX

5.  Moro reflex/Startle reflex
 Palmar/grasp reflex
 Plantar graspreflex
 Walking/stepping reflex
 Asymmetric tonic neck reflex
 Symmetric tonic neck reflex
 Babinski’s reflex
GENERAL BODY REFLEXES
 Babkin reflex
 Parachute reflex
 Gallant’s reflex

6.  Blink reflex
 Doll’s eye reflex
 Auditory orienting reflex
FACIAL REFLEXES

7.  Rooting reflex
 Sucking reflex
 Swallowing reflex
 Gag reflex
 Cry reflex
ORAL REFLEXES

8. MORO REFLEX
 Begins at 28weeks of gestation
 Initiated by any sudden movementof the neck
 Elicited by -- pulling the baby halfway to sitting
position from supine & suddenly let the head fall back
 Consists of rapid abduction & extension of arms with
the opening of hands, tensing of the back muscles,
flexion of the legs and crying

9. Clinical significance
Its nature gives an indication of muscle tone
Failure of the arms to move freely or the hands toopen fully indicates
hypotonia.
It fades rapidly and is not normally elicited after 6 months of age.
MORO REFLEX

10. PALMAR/GRASP REFLEX
 Begins at 32weeks ofgestation
 Light touch of the palmproduces reflex flexion of the
fingers
 Most effective way -- slide the stimulating object, such as
afinger or pencil, across the palm fromthe lateral border
 Disappears at 3-4months
 Replaced by voluntary grasp at45 months

11. Clinical significance
Exceptionally strong grasp reflex -- spastic form of cerebral palsy &
Kernicterus
May be asymmetrical in hemiplagia & in cases of cerebral damage
Persistence beyond 3-4 months indicate spastic form of palsy
PALMAR/GRASP REFLEX

12. PLANTAR/GRASP REFLEX
 Placing object or finger beneath the
toes causes curling of toes around the
object
Present at 32weeks ofgestation
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.

13. WALKING/STEPPING REFLEX
When sole of foot is pressed against the
couch, baby tries to walk
Legs prance up & down as if baby
is walking or dancing
Present at birth, disappearsat approx 2-4
months
With daily practice of reflex, infants
may walk alone at 10 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.

14. ASYMMETRIC TONIC NECK REFLEX
Most evident between 2-3months ofage
• 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

15. SYMMETRIC TONIC NECK REFLEX
 Extension of the head causes
extension of the fore limbs and
flexion of the hind limbs
Evident between 2-3months ofage
Clinical significance
Not normally easily seen or elicitedin
normal infants
 May be seen in an exaggerated form
in many children with cerebral palsy.

16. 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
othertoes
Present at birth, disappears at approx9-
10 months
Presence of reflex later may indicate
disease

17. 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.

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

19. PARACHUTE REFLEX
Reflex appears at about 6-9 months &
persists thereafter
Elicited by holding the child in ventral
suspension & suddenly lowering him to
the couch
Arms extend as a defensivereaction
• Clinical significance
Absent or abnormal in childrenwith
cerebral palsy
Would be asymmetrical in spastic
hemiplagia

20. 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.

21. FACIAL
REFLEXES

22. BLINK REFLEX
 A bright light suddenly shown into the eyes, a puff ofair 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 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

23. CLINICAL SIGNIFICANCE
Examination is a part of some neurological exams, particularly
when evaluatingcoma
Satisfactory demonstration of these reflexes indicate–
 No cerebral depression
 Contraction of appropriate muscles in response
BLINK REFLEX

24. 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 weekor two
of birth
Failure of this reflex to appear
indicates a cerebral lesion

25. 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 tothe 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

26. 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
AUDITORY ORIENTING REFLEX

27. ORAL REFLEXES

28. Baby’s cheek is stroked :
 They 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
ROOTING REFLEX

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

30. SUCKING / SWALLOWING REFLEX
Touching lips or placing something in
baby’s mouth causes baby to draw
liquid into mouth by creating vacuum
with lips, cheeks & tongue
Onset – 28weeks IU
Well established – 32-34weeks IU
Disappears around 12 months

31. GAG REFLEX
(PHARYNGEAL REFLEX)
Seen in 19weeks 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

32. Functional significance
 It, along with reflexive pharyngeal swallowing, prevents
something from entering the throat except as part of normal
swallowing and helps prevent choking
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.
GAG REFLEX
(PHARYNGEAL REFLEX)

33. CRY REFLEX
 Non conditioned reflex which
accounts for its lack of its individual
character
 Sporadic in nature
 Starts as early as 21-29weeks of IU life