The document discusses neonatal reflexes in newborns. It defines reflexes as involuntary responses to stimuli that do not require conscious thought. It describes 17 different reflexes that are present in newborns, including rooting, sucking, Moro/startle, tonic neck, palmer grasp, stepping/dance, cough, withdrawal, parachute, tendon, and blink reflexes. The reflexes are categorized as either temporary reflexes that disappear during the first year or permanent reflexes that remain throughout life. The document provides details on the stimulus and response for each reflex and their implications for development.

1. NEONATAL REFLEXES
BY,
SYEDA AFNAAN BANU

2. CONTENTS
DEFINITION AND MEANING OF REFLEXES
TYPES OF REFLEXES
TEMPORARY REFLEXES
PERMANENT REFLEXES
REVIEW ARTICLE
CONCLUSION
REFERENCES
THANKYOU

3. DEFINITION AND MEANING OF REFLEX
Neonatal reflexes or primitive reflexes are the inborn behavioural
patterns that develop during uterine life. They should be fully present at
birth and are gradually inhibited by higher centres in the brain during
the first three to 12 months of postnatal life
A reflex, or reflex action, is an involuntary and nearly instantaneous
movement in response to a stimulus. A reflex is made possible by neural
pathways called reflex arcs which can act on an impulse before that
impulse reaches the brain. The reflex is then an automatic response to a
stimulus that does not receive or need conscious thought.

4. TYPES OF REFLEXES
SL.NO TYPES OF REFLEXES STIMULUS RESPONSE TEMP/PERMANENT
1. ROOTING REFLEX WHEN THE CORNER OF THE
BABY'S MOUTH IS STROKED
OPENS ITS MOUTH TEMPORARY REFLEX
2. SUCKING REFLEX WHEN ROOF OF THE BABY'S
MOUTH IS TOUCHED
WILL START TO SUCK TEMPORARY REFLEX
3. MORO/STARTLE REFLEX WHEN LOUD SOUNDS OR
MOVEMENT ARE MADE
EXTENDS ARMS
AND LEGS,CRIES THEN
PULLS THE LEGS AND ARMS
BACK IN
TEMPORARY REFLEX
4. TONIC NECK REFLEX WHEN THE BABY'S HEAD IS
TURNED TO ONE SIDE
THE ARM ON THAT SIDE
STRETCHES OUT AND THE
OPPOSITE ARM BENDS UP
THE ELBOW
TEMPORARY REFLEX
5. PALMER GRASP REFLEX STROKING THE PALM OF THE
BABY'S HAND OR TOES
CLOSES HIS FINGERS IN A
GRASP
TEMPORARY REFLEX
6. STEPPING/DANCE REFLEX WHEN THE FEET TOUCHES THE
SOLID GROUND
APPEARS TO TAKE STEPS
OR DANCES
TEMPORARY REFLEX
7. COUGH REFLEX WHEN DUST OR FOREIGN
PARTICLES IRRITATE THE COUGH
RECEPTORS
PRODUCES A COUGH FROM
THE RESPIRATORY TRACT
PERMANENT REFLEX

5. SL.NO TYPES OF REFLEX STIMULUS RESPONSE TEMP/PERMANANT
8. SPINAL PEREZ REFLEX HOLDING THE CHILD IN
PRONE POSITION AND
PRESSURE APPLIED UPWORD
ALONG SPINE
FLEXION WITH ARMS AND LEGS
WITH EXTENSION OF NECK AND
CRIES
TEMPORARY REFLEX
9. BABINSKI REFLEX STROKING THE BABY'S FOOT
FROM SOLE TO HEEL
BABY'S TOE WILL FAN OUT AND
BIG TOE WILL MOVE UPWARD
TEMPORARY REFLEX
10. TRACTION REFLEX GRASP THE BABY'S HAND AND
FINGERS TO PULL TO SIT
HEAD IS BROUGHT FORWARD
ACTIVELY
PERMANENT REFLEX
11. PALMOMENTAL/BABKIN
REFLEX
PRESSING THE PALM OPENING OF THE MOUTH TEMPORARY REFLEX
12. WITHDRAWAL REFLEX SHARP PAINFUL PRICK TO
THE SOLE OF THE FOOT
WITHDRAWAL OF STIMULATED
LEG
PERMANENT REFLEX
13. PARACHUTE REFLEX HOLDING THE CHILD IN
LOWERING POSITION
ARMS EXTEND AS A DEFENSIVE
REACTION
PERMANENT REFLEX
14. TENDON REFLEX OCCURS WHEN THE TENDON
IS TAPPED
SUDDEN STRETCH OF A MUSCLE
TENDON
PERMANENT REFLEX
15. BLINK REFLEX BRIGHT LIGHT,PUFF OF AIR
OR LOUD NOISE
IMMEDIATE BLINKING OF EYES PERMANENT REFLEX

6. SL.NO TYPE OF REFLEX STIMULUS RESPONSE TEMP/PERMANANT
16. DOLL'S EYE REFLEX WHEN THE BABY'S HEAD IS
TURNED
THE INFANTS EYE WILL
REMAIN STATIONARY
TEMPORARY REFLEX
17. STRETCH REFLEX WHEN THE SKELETAL
MUSCLE IS STRETCHED
THE MUSCLE CONTRACTS PERMAMNENT REFLEX

8. TEMPORARY
REFLEXES
1. ROOTING REFLEX
• This reflex starts when the corner of the
baby's mouth is stroked or touched.
• The baby will turn his or her head and open
his or her mouth to follow and root in the
direction of the stroking.
• This helps the baby find the breast or bottle
to start feeding. This reflex lasts about 4
months.
-In an infant with an intact CN 5, stroking or
touching the corner of his or her mouth will
initiate the rooting reflex. If the infant has CN 5
dysfunction, it may result in the absence of
the rooting reflex.

9. 2. SUCKING REFLEX
• Rooting helps the baby get ready to suck.
When the roof of the baby's mouth is touched,
the baby will start to suck.
• This reflex doesn't start until about the 32nd
week of pregnancy and is not fully developed
until about 36 weeks.
• Premature babies may have a weak or
immature sucking ability because of this.
• Because babies also have a hand-to-mouth
reflex that goes with rooting and sucking, they
may suck on their fingers or hands.
- infants with poor or absent suck reflex usually
have moderate or lack of oxygen around the time
of birth.

10. 3.STARTLE RELFEX
• The Moro reflex is often called a startle
reflex.
• That’s because it usually occurs when a
baby is startled by a loud sound or
movement. In response to the sound, the
baby throws back his or her head,
extends out his or her arms and legs,
cries, then pulls the arms and legs back
in.
• A baby's own cry can startle him or her
and trigger this reflex. This reflex lasts
until the baby is about 2 months old.
-Absence on both sides suggests damage
to the brain or spinal cord. Absence on only
one side suggests either a broken shoulder
bone or an injury to the group of nerves
that run from the lower neck and upper
shoulder area into the arm may be present

11. 4.TONIC NECK REFLEX
• When a baby's head is turned to
one side, the arm on that side
stretches out and the opposite arm
bends up at the elbow.
• This is often called the fencing
position. This reflex lasts until the
baby is about 5 to 7 months old.
-Absence of this reflex in the neonate
is a threatening implication of
underlying neurological damage.
Asymmetrical tonic neck
reflex (sometimes called the tonic
labyrinthine reflex) is activated as a
result of turning the head to one side.

12. 5. PALMER GRASP REFLEX
• Stroking the palm of a baby's hand
causes the baby to close his or her
fingers in a grasp.
• The grasp reflex lasts until the
baby is about 5 to 6 months old.
• A similar reflex in the toes lasts
until 9 to 12 months.
-The absence or a weak response of this
reflex during early infancy may reflect
peripheral nerve or spinal cord involvement
resulting in hyperactivity in children with
spasticity in their upper limbs.

13. 6. STEPPING / DANCE REFLEX
• This reflex is also called the walking or dance
reflex because a baby appears to take steps or
dance when held upright with his or her feet
touching a solid surface.
• This reflex lasts about 2 months.
-The total absence of the stepping reflex as well as it's
continuance after 4 months of age in babies could be
due to a number of reasons like motor nerve injury,
severe neurological deficit during birth.
However, babies with cerebral palsy or a condition
known as the neonatal abstinence syndrome will have
an absence of stepping reflex. This could be due to
drugs which are taken by the mother like opiates and
methadone during the time of pregnancy.

14. 7. SPINAL PEREZ REFLEX
• Perez reflex consists on the normal
response of an infant when held in a prone
position and pressed with a finger along
the spine from the sacrum to the neck.
• The response is described as crying,
flexion of the limbs and head elevation and
pelvis.
• It can also trigger urination and defecation.
-When reflex responses are absent this could
be a clue that the spinal cord, nerve root,
peripheral nerve, or muscle has been
damaged. When reflex response is abnormal,
it may be due to the disruption of the sensory
(feeling) or motor (movement) nerves or both.

15. 8. BABKIN REFLEX
• The Babkin reflex occurs in new born babies, and describes varying
responses to the application of pressure to both palms.
• Infants may display head flexion, head rotation, opening of the mouth, or
a combination of these responses.
-same as moro relex

16. 9. DOLL'S EYE REFLEX
WHEN THE INFANTS
HEAD IS SLOWLY
TURNED,THE INFANTS
EYE WILL REMAIN
STATIONARY

17. 10. BABINSKI REFLEX
• Babinski reflex is one of the normal
reflexes in infants.
• Babinski reflex occurs after the sole
of the foot has been firmly stroked.
• The big toe then moves upward or
toward the top surface of the foot.
The other toes fan out.
• This reflex is normal in children up to
2 years old.
• It disappears as the child gets older. It
may disappear as early as 12 months.

18. PERMANENT
REFLEXES
1.COUGH REFLEX
 Cough, an expulsive reflex initiated
when the respiratory tract is
irritated by infection, noxious
fumes, dust, or other types of
foreign bodies. The reflex results in
a sudden expulsion of air from the
lungs that carries with it excessive
secretions or foreign material from
the respiratory tract.

19. 2. TRACTION REFLEX
When a new born is pulled by
the arms from a lying to a
sitting position, the head lags
at first. The baby then flexes,
lifting the head to the midline
to the rest of the body before it
falls forward.

20. 3. WITHDRAWAL REFLEX
Withdrawal reflex is another
precautionary reflex and is
a natural way for the baby
to avoid colliding with any
object.
How to Check
When your baby is sitting,
suddenly move your face close
to his, you will notice that the
baby will turn his head away.
He would do the same if an
object suddenly moves closer
to him.

21. 4. PARACHUTE REFLEX
This reflex occurs in slightly older
infants (starts between 6 and 7
months and become fully mature by
1 year of age) when the child is held
upright and the baby's body is
rotated quickly to face forward (as
in falling).
The baby will extend their arms
forward as if to break a fall, even
though this reflex appears long
before the baby walks

22. 5.TENDON REFLEX

23. 6. BLINK REFLEX
Blink reflex is stimulated by
momentarily shining a
bright light directly into the
neonate's eyes causing him
or her to blink.
This reflex should not
become inhibited.

24. 7. STRETCH REFLEX
Dev Med Child Neurol. 1986 Aug;28(4):440-9. doi:
10.1111/j.1469-8749.1986.tb14281.x.
Stretch reflexes of the normal infant
B M Myklebust, G L Gottlieb, G C Agarwal
PMID: 2944785 DOI: 10.1111/j.1469-8749.1986.tb14281.x
Abstract
Tendon-jerk reflexes were tested in normal, full term infants
aged one to four days. EMGs were recorded from
gastrocnemius-soleus and tibialis anterior muscles. Reflex-
like EMGs were evoked when tapping sites which should
not excite the muscles from which that activity is recorded--
this included the simultaneous activation of antagonistic
muscles by a tendon tap. The possible mechanisms which
could produce these results are discussed, as are the
possible relationships between the proposed pathways and
the reciprocally excitatory paths in cerebral palsy.

25. Review Article
BARTLETT, DOREEN June 1997 Primitive Reflexes and Early Motor Development Journal
of Developmental & Behavorial Paediatrics Vol 18-issue 3-p 151-157
To investigate the relationship between primitive reflexes and typical early motor development,
156 full-term infants with normal 18-month developmental outcomes were assessed using a
modified Primitive Reflex Profile (PRP) and the Alberta Infant Motor Scale (AIMS) at 6 weeks
and 3 and 5 months. No significant positive or negative correlations were obtained between
the scores of the PRP and the AIMS at any of the ages assessed. Similarly, PRP scores did not
differ between infants scoring above and below the 50th percentile on the AIMS. Primitive
reflexes were unrelated to motor development. If this finding is maintained among infants at
risk for motor disability, observational assessment of spontaneously generated movement,
rather than isolated testing of primitive reflexes, might yield more valuable information on the
child's overall level of maturation. Intervention for children with identified motor delays or
neurological impairments might not need to be focused on either suppression or enhancement
of these motor functions.

26. CONCLUSION
An indepth information on neonatal reflexes covered the different types of
reflexes that are present in newborns which are also temporary and over a
period of time become permanent reflexes.
When the question of implications of a missing reflexe arises then, a reflex
can be decreased or absent if there is a problem with the nerve supply. If a
certain reflex is decreased or absent, it will show that the nerve might be
compressed. Not all nerve roots have a reflex associated to them.
This presentation also gave details of which particular reflex is present at
what time in a newborns life,whether the child is developing normally or not,
whether development is taking place at a normal rate or not and to gain
knowledge of abnormalities if all reflexes are not proper

27. REFERENCES
 http://www.slideshare.net/drajayagale/neonatal-reflexes
 http://www.slideshare.net/koilonychai/reflexes-present-in-infants
 http://www.Medlineplus.gov/ency/article/003294.htm
 http://www.wikiepedia.com
 http://www.khanacademy.org/science/healthcare-and-medicine
 https://journals.lww.com/jrnldbp/Abstract/1997/06000/Primitive_Ref
lexes_and_Early_Motor_Development.2.aspx