Neonatal Reflex

Paediatric Dentistry
BDS level presentation

1. NEONATAL REFLEX Presented by M.Anela Roll no.47 BDS 3 rd year Dept. of Paedodontics & Preventive Dentistry

2. Contents Introduction Reflex arc Classification of refexes Significance of reflexes Types of reflexes Conclusion

3. Introduction A reflex is an involuntary or automatic action that your 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.

4. Reflex arc Anatomical pathway for a reflex is called as reflex arc It has 5 components: Receptor Afferent nerve Center Efferent nerve Effector organ

5. Classification of reflexes Depending upon whether inborn or acquired Unconditioned reflexes,inborn reflex Conditioned reflexes/acquired reflexes

6. Depending upon the situation of the center Cerebellar reflexes Cortical reflexes Midbrain reflex Bulbar or medullary reflexes Spinal reflexes

7. Depending upon the purpose Protective/flexor reflexes Antigravity/extensor reflexes Depending upon clinical basis Superficial Reflexes Mucus membrane Cutaneous reflex Deep reflexes Viceral reflexes Pathological reflexes

8. Significance of reflexes Helps a paedodontics 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

9. TYPES OF REFLEXES

10. General body reflexes: Moro reflexes/Startle reflexes Palmar / grasp reflex Plantar grasp reflex Walking / stepping reflex Limb placement reflex Asymmetric tonic neck reflex Symmetric tonic neck reflex Babinski`s reflex Babkin reflex Parachute reflex Landau reflex Withdrawal reflex Trunk incurvation reflex Gallant’s reflex Tonic labyrinthine reflex

11. Facial reflexes: Nasal reflex Blink reflex Doll’s eye reflex Auditory orienting reflex

12. NASAL REFLEX Stimulation of 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 area muscles & kidney decreases Flow to the heart & brain remains protected

13. BLINK REFLEX A Bright light suddenly shone into the eyes, a puff of air upon the sensitive cornea or a sudden loudnoise 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 neonates & continue to be present throuhout life.

14. DOLLS EYE REFLEX Passive turning of the head of the newborn leaves the eye “behind”. A distint time lag occurs before the eyes move to a new position in keeping with the head postion . Disappears at within a week. Failure of this reflex to appear indicates a cerebral lesion.

15. AUDITORY ORIENTING REFLEX A sudden loud and unpleasant noise May produce the blink reflex Seen first at about 4months of age Quieter sounds usually cause reflex eye and head turning to the sound,as if to locate it. Head turning towards sound stimuli occurs & the accuracy of localization increases rapidly by 9-10mnths

16. Oral reflexes: Rooting reflex Sucking reflex/Swallowing reflex Gag reflex Cry reflex

17. ROOTING REFLEX Onset-28 weeks of gestation Integration -3mnths Response of infants to tactile stimulation of the cheeks or lips; causes infant to turn toward the stimulus and open mouth. If rooting movements continue beyond the 7 th month, it may indicate some level of defective functioning in the cortical area , or damage to the CNS. If the rooting is absent in early infancy, it could indicate some level of damage to the brainstem.

18. 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 -28 week of gestation Well establised-32-34 weeks IU Disappears around 12 months.

19. 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.

20. CRY REFLEX Non conditioned relex accounts for its lack of its individual character Sporadic in nature Starts as early as 21-29 weeks of life.

21. General body reflex Moro reflex/ starlereflex Begins at 28week of gestation Initial 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, arms come together again

22. Clinical significance Its nature gives an indication of muscle tone Failure of the arm to move freely or the hands to open fully indicates hypotonia It fades rapidly and is not normally elicited after 6 months of age

23. Palmar or grasps 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 finger or pencil,across the palm from the lateral border Disappear at 3-4 months Replaced by voluntary grasp at 45 months

24. Clinical significance Exceptionally strong grasp reflex—spastic form of cerebral palsy and kernicterus May be asymmetrical in hemiplasia & in case of cerebral damage Persistence beyond 3-4 months indicate spastic form of palsy

25. Planter /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

26. Clinical Significnce : This reflex is referred to as the ‘readiness tester’’. Integrates at the same time that independent gait first becomes possible

27. Walking/ Stepping reflex When sole of foot is pressed against the couch,baby trie to walk Legs prance up & down as if baby is walking or dancing Presence at birth , disappears at approx 2-4 months With daily practice of reflex,infants may walk alone at 10 months

28. Clinical significance Premature infants will tend to walk in a toe heel fashion while more mature infants will walk in a heel-toe pattern

29. Withdrawal reflex Protect ive reflex Stimulus: a pinkprick or a sharp painful stimulus to sole of foot Response:flexion & withdrawal of stimuled leg Present at birth,persists throuhout life Clinical significance Absence

30. 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 limps over the edge Present at birth,fades away rapidly in early months of life

31. Clinical significance Reflex is ready demonstable in the new born and persistent failure to elicit it at its stage ,is thought to indicate neurological abnormality

32. Asymmetric tonic neck reflex Most evidence between 2-3 months of age Clinical Significance The reflex fades rapidly & is not normally seen after 6 months of age Persistence is the most frequently observed abnormality of the infantile reflexs in infants with neurological lesions Greatly disrupts development

33. Symmetric tonic neck reflex Extension of head causes extension of the forelimbs & flexion of the hindlimbs Evident between 2-3 months Clinical Significnce Not normally easily seen or elicited in normal infants May be seen in an exaggerated form in many children with cerebral palsy.

34. BABINSKI 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 & sometimes movement of the of the other toes Present at birth, disappears at approx 9 -10 months Present of reflex later may indicate disease

35. BABKIN REFLEX Deep pressure applied simultaneously to the palms of bothhands while the infants is in supine postion . Stimulus is followed by flexion or forward bowing of the head, opening of the mouth & closing of the eyes Fades rapidly & normally cannot be elicited after 4 months of age

36. 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 3months, disappears at 12-24 months

37. PARACHUTE REFLEX Occurs in slightly older infants, when you hold child upright and then rotate his body quickly face forward[as if falling ]. The baby will extend his arms forward as if to break a fall,even though this reflex appears long before the baby walks.

38. TONIC LABYRINTHINE REFLEX Labyrinths-most important organs concerned with development of anti- gravity postures & balance. Movement of the head in any dimension stimulates the labyrinths; & produces the appropriate response Arms & legs extend when head moves backwards ,& will curl in when the head moves forward Emerges in utero until approximately 4 months posnatally

39. TRUNK INCURVATION REFLEX Stroking one side of spinal column while baby is on his abdomen cause Crawling motion with legs. Lifting head from surface Present in utero , seen at approximately 3 rd or 4 th day Persists for 2-3 months

40. Galant reflex Elicited by: Holding the child in vertical suspension or placed in prone position & running finger down in paravertical area on one side Response : Swinging of pelvis towards stimulated side Appears at birth disappear by 1year Used for mapping sensory level of trunk

41. CONCLUSION Knowledge of neonatal reflexes is important for Understanding the human development as a whole. Application for all over all assessment of baby. Recognition of possible neurodevelopmental damage in prenatal & perinatal period. Establising of the prognosis for future. Predicting the childs future potential.

42. THANKS HAVE A NICE DAY