Neonatal reflexes by baneet

Inborn behavioral ......

1. Presentation By DR. BANEET SHARMA ( p.t )

2. Contents Introduction Defination Why it iz necessory Reflexes Sucking reflex Rooting reflex Moro reflex Asymmetrical tonic neck reflex Symmetric tonic reflex Palmar grasp reflex Landaus reflex Plantar reflex Gallant reflex Stepping reflex Parachute reflex Pupillary reflex Acoustic reflex

3. Primitive REFLEXES

4. Also known as Infantile Infant Newborn reflexes

5. Introduction

6. Period of growth Prenatal period Ovum Embryo fetus 0 to 14 days 14 days to 9 weeks 9 weeks to birth Perinatal period 22 weeks of gestation to 7 days after birth Postnatal period New born Infancy Toddler Preschool child First 4 weeks after birth First year 1 to 3 years 3 to 6 years School age child 6 to 10 years {girls} 6 to 12 years{boys} Adolescence 10 to 19 years

7. Defination

8. Neonatal reflexes or primitive reflexes are the inborn behavioral patterns that develop during uterine life. They should be fully present at birth and are gradually inhibited by higher centers in the brain during the first 3 to 12 months of postnatal life.

9. Reflexes which are essential for a newborn’s survival immediately after birth

10. Under normal developmental conditions, these neonatal reflexes represent important reactions of the nervous system and are only observable within a specific period of time over the first few months of life. The following reflexes are normally present from birth and are part of a normal newborn evaluation A normally developing newborn should respond to certain stimuli with these reflexes, which eventually become inhibited as the child matures

11. Why neonatal reflexes are necessary to asses Most primitive reflexes begin to occur in utero through the early months of the child’s postnatal life. •These reflexes are then replaced by voluntary motor skills. •When the reflexes are not inhibited, there is usually a neurological problem at hand. •In those individuals with cerebral palsy and neurogenic dysphagia, the presence of primitive reflexes is a characteristic

12. Classification of reflexes

13. Automatic reflexes

14. Moro Reflex (Automatic reflex) Onset - begins at 28 weeks gestation Integration - 5-6 months Testing position - child in supine with head in midline, support the child's head while pulling the child to a position halfway between supine and upright sitting Procedure - support the infant’s head and shoulders with one hand. Allow the neck to drop back to allow the anterior neck muscles to stretch Response observed - the shoulders abduct, the elbows, wrists and fingers extend. Subsequently, the shoulders adduct, and the elbows and fingers flex Functional significance - asymmetry during this reaction may indicate a brain lesion or injury or peripheral nerve problems to the upper extremity

15. Landau’s Reflex (A.R) Onset - 3 -4 months Integration - 12 - 24 months Testing position - prone, supported in air Procedure - wait for a reaction after placement Response observed - the head will extend and the back and hips will extend in sequence ("superman" appearance) Functional significance - breaks up the total flexion pattern seen at birth

16. Gallant Reflex (A.R) Onset - begins at 32 weeks gestation Integration - 2 months, though may persist in atypical children Testing position - infant placed prone in alignment Procedure - gently stimulate along the paravertebral area from the C7 area to the buttocks Response observed - infant will laterally flex toward the stimulated side Functional significance - often seen with children with athetoid CP

17. Parachute reflex(A.R) occurs in slightly older infants, when you hold the 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.

18. Spinal reflexes Flexor withdrawal reflex Extensor trust Cross extensor Palmar grasp Plantar reflex Sucking reflex Rooting reflex Primitive walking

19. Flexior withdrawal Position- supine head in neutral position and legs extended Stimulus- sole of foot response- uncontrolled flexion of stimulated extremity Present –since birth disappears- by 2 months

20. Extensor trust Position- supine head neutral one leg extended and the other flexed Stimulus- sole of flexed leg is given stroking Response – immediate extension ,adduction and internal rotation of flexed led with plantar flexion of foot Present at birth and integrated by 4 months

21. Sucking Reflex Onset - begins at 28 weeks gestation Integration - 2-5 months Testing position - infant supine with the head in midline Procedure - place a finger of nipple into the infant’s mouth Response observed - rhythmical sucking Functional significance - persistence of this reflex may inhibit voluntary sucking

22. Rooting reflex (Spinal ref) Onset - 28 weeks gestation Integration - 3 months Testing position - with the infant supine, the head in midline and hands on chest Procedure - gently stroke the infant from the lips to the cheek Normal response - the infant should turn his head toward the stimulated side with the mouth opening and a trial of sucking the finger. May not be present if the infant is not hungry. Functional significance - persistence can interfere with sucking. Absence of this is seen in neurologically impaired infants.

23. Palmar Grasp spinal reflex Onset - 10 weeks gestation Integration - 4-6 months Testing position - supine, head midline, arms and hands free Procedure - place a finger in infant’s hand from the ulnar to the palmar surface Response observed - infant’s fingers will flex around the finger Functional significance -following the development of grasp, the infant begins to reach for objects and utilizes a crude palmer grasp to hold them

24. Plantar Reflex spinal reflex Onset -18 weeks in utero Integration – 6 months after birth Stimulated by stroking the sole of the foot: – toes of the foot should fanning out – the foot itself should curl in.

25. Stepping reflex Onset - begins at 37 weeks gestation Integration - 2 months Testing position supported in the vertical position Procedure - support the infant upright with the feet touching a hard surface. Incline the infant forward and gently move the infant forward to accompany any stepping Response observed - alternating, rhythmical, and coordinated steps Functional significance - premature infants will tend to walk in a roe-heel fashion while more mature infants will walk in a heel-toe pattern.

26. Brainstem level reflex Symmetrical tonic neck reflex Asymmetrical tonic neck reflex Tonic labyrinthine reflex Positive supporting reaction

27. Symmetrical tonic reflex Onset – 0,4-6 months Integration - 8 - 12 months Testing position - child in quadruped position on the floor or either in supine position Procedure - passively flex the head forward and then extend it backwards Response observed - forward head flexion will produce flexion of the upper extremities and extension of the lower extremities; extension of the head will produce extension of the upper extremities and flexion of the lower extremities Functional significance - necessary to achieve quadruped crawling

28. Asymmetrical tonic reflex Brain stem reflex Onset - 0-2 months Integration - 4-6 months Testing position - supine Procedure - gently turn the infant’s head to one side Response observed – UL and UL of opposite side goes into flexion and on the same side ,limbs are extended. Functional significance - persistence of this reflex may indicate CNS damage

29. Tonic labyrinthine reflex Position either supine or prone Response: in supine extensor tone is present ,in prone flexion tone is increased Present from birth Integrated by 3 to 4 months

30. Positive supporting reaction Stimulus : hold child in eract position ,lift him up and bounce up and down on plinth till sole of foot touches the plinth Responce : exaggerated extension of the lower limbs This is present at birth and disappears within 3 to 4 months

31. Negative supporting reaction It can be checked by holding the child in weight bearing position and suddenly lift him up The response is sudden flexion of the lower limb Present at birth and integrated by 4 months

32. Midbrain reflex Optical righting reflex Neck righting

33. Optical righting reflex Optical righting reflex Position – hold child from armpit in a suspended position then change position of his head from side to side response: eyes will always move to same side as head Appears by 1 to 2 year and remains throughout ones life

34. Neck righting Position : supine blind folded ,rotate head to one side Response:body rotates to that side as a whole . Generally present at birth but a time may appear as late as 3 months

35. Cortical level reflex This consists of all the equlibrium reactions Usually checked on tilt board or rocking board

36. Other reflex

37. ACOUSTIC REFLEX ALSO CALLED . STAPEDIUS REFLEX It is an involantary muscle contraction that occurs in the middle ear of mammals in responce to high intensity sound stimuli. Response in neonate ,in response of loud sound upper limb goes in to extension ,abduction followed by adduction and flexion. Functional significance –to locate injury to facial nerve. as the stapedius muscle is innervated by the facial nerve

38. Pupillary reflex reflex occurs with darkening the room and shining a penlight directly into the neonate's eye for several seconds. The pupils should both constrict equally; this reflex should not disappear.

39. Reflex Stimulation Response Duration Babinski Sole of foot stroked Fans out toes and twists foot in Disappears at nine months to a year Blinking Flash of light or puff of air Closes eyes Permanent Grasping Palms touched Grasps tightly Weakens at three months; disappears at a year Moro Sudden move; loud noise Startles; throws out arms and legs and then pulls them toward body Disappears at three to four months Summary

40. Rooting Cheek stroked or side of mouth touched Turns toward source, opens mouth and sucks Disappears at three to four months Stepping Infant held upright with feet touching ground Moves feet as if to walk Disappears at three to four months Sucking Mouth touched by object Sucks on object Disappears at three to four months tonic neck Placed on back Makes fists and turns head to the right Disappears at two months

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