reflex-210317162019.pptxjy5i767i6i67i67i67i76

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1.       NEONATAL REFLEXES BY, SYEDA AFNAAN BANU

2. CONTENTS

3. DEFINITION AND MEANING OF REFLEX Neonatal reflexes or primitive reflexes are the inborn behavioural patterns that develop during uterine life. They should be fully present at birth and are gradually inhibited by higher centres in the brain during the first three to 12 months of postnatal life A reflex, or reflex action, is an involuntary and nearly instantaneous movement in response to a stimulus. A reflex is made possible by neural pathways called reflex arcs which can act on an impulse before that impulse reaches the brain. The reflex is then an automatic response to a stimulus that does not receive or need conscious thought.

4. TYPES OF REFLEXES SL.NO TYPES OF REFLEXES STIMULUS RESPONSE TEMP/PERMANENT 1. ROOTING REFLEX WHEN THE CORNER OF THE BABY'S MOUTH IS STROKED OPENS ITS MOUTH TEMPORARY REFLEX 2. SUCKING REFLEX WHEN ROOF OF THE BABY'S MOUTH IS TOUCHED WILL START TO SUCK TEMPORARY REFLEX 3. MORO/STARTLE REFLEX WHEN LOUD SOUNDS OR MOVEMENT ARE MADE EXTENDS ARMS AND LEGS,CRIES THEN PULLS THE LEGS AND ARMS BACK IN  TEMPORARY REFLEX 4. TONIC NECK REFLEX WHEN THE BABY'S HEAD IS TURNED TO ONE SIDE THE ARM ON THAT SIDE STRETCHES OUT AND THE OPPOSITE ARM BENDS UP THE ELBOW TEMPORARY REFLEX 5. PALMER GRASP REFLEX STROKING THE PALM OF THE BABY'S HAND OR TOES CLOSES HIS FINGERS IN A GRASP TEMPORARY REFLEX 6. STEPPING/DANCE REFLEX WHEN THE FEET TOUCHES THE SOLID GROUND APPEARS TO TAKE  STEPS OR DANCES TEMPORARY REFLEX 7. COUGH REFLEX WHEN DUST OR FOREIGN PARTICLES IRRITATE THE COUGH RECEPTORS PRODUCES A COUGH FROM THE RESPIRATORY TRACT PERMANENT REFLEX 

5. SL.NO TYPES OF REFLEX STIMULUS RESPONSE TEMP/PERMANANT 8. SPINAL PEREZ REFLEX HOLDING THE CHILD IN PRONE POSITION AND PRESSURE APPLIED UPWORD ALONG SPINE FLEXION WITH ARMS AND LEGS WITH EXTENSION OF NECK AND CRIES TEMPORARY REFLEX 9. BABINSKI REFLEX STROKING THE BABY'S FOOT FROM SOLE TO HEEL BABY'S TOE WILL FAN OUT AND BIG TOE WILL MOVE UPWARD TEMPORARY REFLEX 10. TRACTION REFLEX GRASP THE BABY'S HAND AND FINGERS TO PULL TO SIT HEAD IS BROUGHT FORWARD ACTIVELY PERMANENT REFLEX 11. PALMOMENTAL/BABKIN REFLEX PRESSING THE PALM OPENING OF THE MOUTH TEMPORARY REFLEX 12. WITHDRAWAL REFLEX SHARP PAINFUL PRICK TO THE SOLE OF THE FOOT WITHDRAWAL OF STIMULATED LEG PERMANENT REFLEX 13. PARACHUTE REFLEX HOLDING THE CHILD IN LOWERING POSITION ARMS EXTEND AS A DEFENSIVE REACTION PERMANENT REFLEX 14. TENDON REFLEX OCCURS WHEN THE TENDON IS TAPPED SUDDEN STRETCH OF A MUSCLE TENDON PERMANENT REFLEX 15. BLINK REFLEX BRIGHT LIGHT,PUFF OF AIR OR LOUD NOISE IMMEDIATE BLINKING OF EYES PERMANENT REFLEX

6. SL.NO TYPE OF REFLEX STIMULUS RESPONSE TEMP/PERMANANT 16. DOLL'S EYE REFLEX WHEN THE BABY'S HEAD IS TURNED THE INFANTS EYE WILL REMAIN STATIONARY TEMPORARY REFLEX 17. STRETCH REFLEX WHEN THE SKELETAL MUSCLE IS STRETCHED THE MUSCLE CONTRACTS PERMAMNENT REFLEX

7. TEMPORARY REFLEXES 1. ROOTING REFLEX This reflex starts when the corner of the baby's mouth is stroked or touched. The baby will turn his or her head and open his or her mouth to follow and root in the direction of the stroking. This helps the baby find the breast or bottle to start feeding. This reflex lasts about 4 months. - In an infant with an intact CN 5, stroking or touching the corner of his or her mouth will initiate the rooting reflex. If the infant has CN 5 dysfunction, it may result in the absence of the rooting reflex.

8. 2. SUCKING REFLEX Rooting helps the baby get ready to suck. When the roof of the baby's mouth is touched, the baby will start to suck. This reflex doesn't start until about the 32nd week of pregnancy and is not fully developed until about 36 weeks.  Premature babies may have a weak or immature sucking ability because of this.  Because babies also have a hand-to-mouth reflex that goes with rooting and sucking, they may suck on their fingers or hands.    -  infants with poor or absent suck reflex usually have moderate or lack of oxygen around the time of birth.

9. 3. STARTLE RELFEX T he Moro reflex is often called a startle reflex. That’s because it usually occurs when a baby is startled by a loud sound or movement. In response to the sound, the baby throws back his or her head, extends out his or her arms and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him or her and trigger this reflex. This reflex lasts until the baby is about 2 months old. -Absence on both sides suggests damage to the brain or spinal cord. Absence on only one side suggests either a broken shoulder bone or an injury to the group of nerves that run from the lower neck and upper shoulder area into the arm may be present

10. 4. TONIC NECK REFLEX When a baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. This is often called the fencing position. This reflex lasts until the baby is about 5 to 7 months old. - Absence of this reflex in the neonate is a threatening implication of underlying neurological damage. Asymmetrical tonic neck reflex (sometimes called the tonic labyrinthine reflex) is activated as a result of turning the head to one side.

11. 5 . PALMER GRASP REFLEX Stroking the palm of a baby's hand causes the baby to close his or her fingers in a grasp. The grasp reflex lasts until the baby is about 5 to 6 months old. A similar reflex in the toes lasts until 9 to 12 months. -The absence or a weak response of this reflex during early infancy may reflect peripheral nerve or spinal cord involvement resulting in hyperactivity in children with spasticity in their upper limbs.

12. 6. STEPPING / DANCE REFLEX This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when held upright with his or her feet touching a solid surface. This reflex lasts about 2 months. -The total absence of the stepping reflex as well as it's continuance after 4 months of age in babies could be due to a number of reasons like motor nerve injury, severe neurological deficit during birth.   However,  babies with cerebral palsy  or a condition known as the neonatal abstinence syndrome will have an absence of stepping reflex. This could be due to drugs which are taken by the mother like opiates and methadone during the time of pregnancy.

13. 7. SPINAL PEREZ REFLEX Perez reflex consists on the normal response of an infant when held in a prone position and pressed with a finger along the spine from the sacrum to the neck. The response is described as crying, flexion of the limbs and head elevation and pelvis. It can also trigger urination and defecation. -When reflex responses are absent this could be a clue that the spinal cord, nerve root, peripheral nerve, or muscle has been damaged. When reflex response is abnormal, it may be due to the disruption of the sensory (feeling) or motor (movement) nerves or both.

14. 8. BABKIN REFLEX The Babkin reflex occurs in new born babies, and describes varying responses to the application of pressure to both palms.  Infants may display head flexion, head rotation, opening of the mouth, or a combination of these responses. -same as moro relex

15. 9. DOLL'S EYE REFLEX WHEN THE INFANTS HEAD IS SLOWLY TURNED,THE INFANTS EYE WILL REMAIN STATIONARY

16. 10. BABINSKI REFLEX        Babinski reflex is one of the normal reflexes in infants.  Babinski reflex occurs after the sole of the foot has been firmly stroked.  The big toe then moves upward or toward the top surface of the foot. The other toes fan out.  This reflex is normal in children up to 2 years old. It disappears as the child gets older. It may disappear as early as 12 months.

17. PERMANENT REFLEXES 1. COUGH REFLEX Cough, an expulsive reflex initiated when the respiratory tract is irritated by infection, noxious fumes, dust, or other types of foreign bodies. The reflex results in a sudden expulsion of air from the lungs that carries with it excessive secretions or foreign material from the respiratory tract.

18. 2. TRACTION REFLEX When a new born is pulled by the arms from a lying to a sitting position, the head lags at first. The baby then flexes, lifting the head to the midline to the rest of the body before it falls forward.

19. 3. WITHDRAWAL REFLEX Withdrawal reflex is another precautionary reflex and is a natural way for the baby to avoid colliding with any object.             How to Check When your baby is sitting, suddenly move your face close to his, you will notice that the baby will turn his head away. He would do the same if an object suddenly moves closer to him.

20. 4. PARACHUTE REFLEX This reflex occurs in slightly older infants (starts between 6 and 7 months and become fully mature by 1 year of age) when the child is held upright and the baby's body is rotated quickly to face forward (as in falling). The baby will extend their arms forward as if to break a fall, even though this reflex appears long before the baby walks

21. 5.TENDON REFLEX 

22. 6. BLINK REFLEX Blink reflex is stimulated by momentarily shining a bright light directly into the neonate's eyes causing him or her to blink. This reflex should not become inhibited.

23. 7. STRETCH REFLEX Dev Med Child Neurol. 1986 Aug;28(4):440-9.  doi : 10.1111/j.1469-8749.1986.tb14281.x. Stretch reflexes of the normal infant B M Myklebust ,  G L Gottlieb ,   G C Agarwal PMID: 2944785 DOI:  10.1111/j.1469-8749.1986.tb14281.x Abstract Tendon-jerk reflexes were tested in normal, full term infants aged one to four days. EMGs were recorded from gastrocnemius-soleus and tibialis anterior muscles. Reflex-like EMGs were evoked when tapping sites which should not excite the muscles from which that activity is recorded--this included the simultaneous activation of antagonistic muscles by a tendon tap. The possible mechanisms which could produce these results are discussed, as are the possible relationships between the proposed pathways and the reciprocally excitatory paths in cerebral palsy.

24. Review Article BARTLETT, DOREEN June 1997 Primitive Reflexes and Early Motor Development  Journal of Developmental & Behavorial Paediatrics Vol 18-issue 3-p 151-157 To investigate the relationship between primitive reflexes and typical early motor development, 156 full-term infants with normal 18-month developmental outcomes were assessed using a modified Primitive Reflex Profile (PRP) and the Alberta Infant Motor Scale (AIMS) at 6 weeks and 3 and 5 months. No significant positive or negative correlations were obtained between the scores of the PRP and the AIMS at any of the ages assessed. Similarly, PRP scores did not differ between infants scoring above and below the 50th percentile on the AIMS. Primitive reflexes were unrelated to motor development. If this finding is maintained among infants at risk for motor disability, observational assessment of spontaneously generated movement, rather than isolated testing of primitive reflexes, might yield more valuable information on the child's overall level of maturation. Intervention for children with identified motor delays or neurological impairments might not need to be focused on either suppression or enhancement of these motor functions.

25. CONCLUSION An indepth information on neonatal reflexes covered the different types of reflexes that are present in newborns which are also temporary and over a period of time become permanent reflexes. When the question of implications of a missing reflexe arises then, a reflex can be decreased or absent if there is a problem with the nerve supply. If a certain reflex is decreased or absent, it will show that the nerve might be compressed. Not all nerve roots have a reflex associated to them. This presentation also gave details of which particular reflex is present at what time in a newborns life,whether the child is developing normally or not, whether development is taking place at a normal rate or not and to gain knowledge of abnormalities if all reflexes are not proper 

26. REFERENCES http://www.slideshare.net/drajayagale/neonatal-reflexes http://www.slideshare.net/koilonychai/reflexes-present-in-infants http://www.Medlineplus.gov/ency/article/003294.htm http://www.wikiepedia.com http://www.khanacademy.org/science/healthcare-and-medicine https://journals.lww.com/jrnldbp/Abstract/1997/06000/Primitive_Reflexes_and_Early_Motor_Development.2.aspx