neonatal reflex.pptx

Newborn reflex

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 . 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 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. 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 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 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. 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. 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 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 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 Functional significance It, along with reflexive pharyngeal swallowing, prevent 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 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