NEWBORN REFLEXES/ PRIMITIVE REFLEXES

NEWBORN REFLEXES/ PRIMITIVE REFLEXES BY. MR. DINABANDHU BARAD

1. NEWBORN REFLEXES BY: Mr. Dinabandhu Barad MSC TUTOR, SNC,SOA,DTU

2. WHAT IS A REFLEX ? A reflex is an involuntary, or automatic, action that the body does in response to stimulation, without awareness . 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 postnatal life.

3. TYPES OF REFLEXES

4. TYPES OF REFLEXES GENERAL BODY REFLEX FACIAL REFLEX ORAL REFLEX

5. Moro reflex/Startle reflex Palmar/grasp reflex Plantar grasp reflex Walking/stepping reflex Asymmetric tonic neck reflex Symmetric tonic neck reflex Babinski’s reflex GENERAL BODY REFLEXES Babkin reflex Parachute reflex Gallant’s reflex

6. Blink reflex Doll’s eye reflex Auditory orienting reflex FACIAL REFLEXES

7. Rooting reflex Sucking reflex Swallowing reflex Gag reflex Cry reflex ORAL REFLEXES

8. MORO 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

9.  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. MORO REFLEX

10. 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

11.  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 PALMAR/GRASP REFLEX

12. 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.

13. 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.

14. 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

15. 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.

16. BABINSKI’S 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

17. 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.

18. Clinical significance Reflex can be demonstrated in the newborn, thus showing a hand-mouth neurological link, even at that early stage BABKIN REFLEX

19. 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

20. GALLANT’S 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.

21. FACIAL REFLEXES

22. BLINK REFLEX A bright light suddenly sho wn 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

23. 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 BLINK REFLEX

24. 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

25. 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

26. 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 AUDITORY ORIENTING REFLEX

27. ORAL REFLEXES

28. Baby’s 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 ROOTING REFLEX

29. 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. ROOTING REFLEX

30. 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 weeks IU Well established – 32-34weeks IU Disappears around 12 months

31. 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

32. 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. GAG REFLEX (PHARYNGEAL REFLEX)

33. 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