2.

NEW BORN REFLEXES

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

It has 5 components :

1. Receptor

2. Afferent nerve

3. Center

4. Efferent nerve

5. Effector organ

CLASSIFICATION OF REFLEXES
a) Depending upon whether inborn or acquired

1) Unconditioned reflexes, inborn reflex

2) Conditioned reflexes/acquired reflexes

b) Depending upon the situation of the center

1) Cerebellar reflexes

2) Cortical reflex

3) Midbrain reflex

4) Bulbar or medullary reflexes

5) Spinal reflexes

c) Depending upon the purpose

1) Protective/flexor reflexes

2) Antigravity/extensor reflexes

d) Depending upon clinical basis

 Superficial reflexes

1) Mucus membrane

2) Cutaneous reflex

Deep reflexes

Visceral reflexes

Pathological reflexes

SIGNIFICANCE OF REFLEXES
Helps a paedodontist 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

TYPES OF REFLEXES

General body reflexes :

Moro reflex/Startle reflex

Palmar/grasp reflex

Plantar grasp reflex

Walking/stepping reflex

Limb placement reflex

Asymmetric tonic neck reflex

Symmetric tonic neck reflex

Babinskis reflex

Babkin reflex

Parachute reflex

Landau reflex

Withdrawal reflex

Trunk incurvation reflex

Tendon reflexes
 Gallants reflex

Tonic labyrinthine reflex

Facial reflexes :
Nasal reflex

Blink reflex

Dolls eye reflex

Auditory orienting reflex

Oral reflexes :
Rooting reflex

Sucking reflex

Swallowing reflex

Gag reflex

Cry reflex

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 &
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

Within moments, the arms come together again

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.

It fades rapidly and is not normally elicited after 6 months of age.

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

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

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.

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, disappears at 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.
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

Withdrawal reflex
Protective reflex

Stimulus : a pinprick or a sharp painful stimulus to sole of foot

Response : flexion & withdrawal of stimulated leg

Present at birth, persists throughout life

Clinical significance

Absence of this is seen in neurologically impaired infants.

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

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.

Babinskis 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

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.

Clinical significance

Reflex can be demonstrated in the newborn, thus showing a hand-mouth

neurological link, even at that early stage

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 defensive reaction

Clinical significance

Absent or abnormal in children with cerebral palsy

Would be asymmetrical in spastic hemiplagia

Landau reflex
Seen in horizontal suspension with the head, legs & spine extended

If the head is flexed, hip knees & 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

Trunk incurvation reflex

Stroking one side of spinal column while baby is on his abdomen causes

Crawling motion with legs

Lifting head from surface

Present in utero, seen at approximately 3rd or 4th day

Persists for 2-3 months

Gallants 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.

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

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.

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 & legs extend when head moves backwards, & will curl in when the head
moves forward

Emerges in utero until approximately 4 months postnatally

Facial reflexes

Nasal reflex
Stimulation of the face or nasal cavity with water or local irritants produces
apnea in neonates

Breathing stops in expiration with laryngeal closure in infants bradycardia&

lowering of cardiac output

Blood flow to skin, splanchnic areas muscles & kidney decreases

Flow to the heart & brain remains protected

Blink reflex
A bright light suddenly shone 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 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

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

Dolls 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

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

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

Oral reflexes

Rooting reflex
Babys 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

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.

Sucking / Swallowing reflex

Touching lips or placing something in babys mouth causes baby to draw liquid
into mouth by creating vacuum with lips, cheeks & tongue

Onset 28 weeks IU

Well established 32-34weeks IU

Disappears around 12 months

Clinical significance :

Persistence may inhibit voluntary sucking

Sigmund Freud - Any kind of deprivation of the activity will lead to fixation
resulting in oral habits

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 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.

Cry reflex
Non conditioned reflex which accounts for its lack of its individual character
 Sporadic in nature

Starts as early as 21-29 weeks of IU life

Importance of cry

It is infants first verbal communication

Can be interpreted as a message of urgency or distress

Indicates:

Hunger

Pain

Discomfort

Bibliography :

1. Potter and Perry; Fundamentals of Nursing; 3rd edition; p:1251

2. Dr.B.T.Basvantthapa,CHILD HEALTH NUSRING, first edition ,published by
Ahuja publishing house,New delhi,India

3. Wongs and all,ESSENTIAL OF PEDIATRIC NURSING,8th edition ,Published by

Elsevier,Noida,India