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NEONATAL REFLEXES

      Dr. Balbirsingh
      J.L.N.Hospital Research centre,
      Bhilai Steel Plant
INTRODUCTION
   Actions in response to specific stimuli that are
    present in newborn infants.

   These are unconditioned reflexes and not learned
    or developed through experience.

   Normally developing neonates or infants are
    expected to respond to specific stimuli with a
    specific, predictable behaviour or action.
MORO’S REFLEXE
ELICITED BY :

PLACING THE BABY IN SEMI UPRIGHT POSITION

                       ↓
SUDDEN DROPING OF HEAD IN RELATION TO TRUNK
  AND CATCHING THE FALLING HEAD

DISAPPEARS AT 3 TO 6 MTHS
RESPONSE


   OPENING OF HAND

   EXTENSION AND ABDUTION OF UPPER EXTRIMITIES

   ANTERIOR FLEXION OF UPPER EXTRIMITIES

   AUDIBLE CRY
ABNORMALITIES:

DEPRESSED OR ABSENT
     GENERALISED DEPRESSION OF CNS



ASYMMETRICAL RESPONSE
     FRACTURE CLAVICLE
     ERB PALSY
     HEMIPARESIS


EXAGERGERATED RESPONSE
     KERNECTERUS
STARTLE REFLEX

   It is variant of Moro’s Reflex.

   Ellicited by: sudden loud noise or by
    tapping the sternum

   Response is like Moro’s reflex but
    elbow remain flexed and hands closed
PALMER GRASP
 Elicited By: Placing finger or object in open
  palm of each hand
 Response: Infant grasp the object and with
  attempted removal grip reinforced
   Appears at 28 weeks of gestation and
    disappears at 2-3 months of life

   Persistence beyond 6mths: Athetoid
    CP
TONIC NECK REFLEX
ASYMMETRIC TONIC NECK REFLEX
   Elicited By: Passive rotation of head in supine
      position
   Response: Extension of upper limb of same
     side and flexion of upper limb of opposite side
   Appears at birth and disappear at 3
    months

   Persistence > 3 months: Spastic CP

   Importance: Prevents body from
    rolling
TONIC NECK REFLEX
SYMMETRIC TONIC NECK REFLEX

      Elicited By: Passive extension of head in
       prone position
      Response: Extension of both UL & flexion of
       both LL
   Appears in 3 mths and disappear in 6mths
   Persistence > 6mths : CP


Importance: When baby learn to turn to prone
  position chocking over bed may asphyxiate him so
  if baby lift his chin by extension of neck both upper
  limbs extend automatically and chocking avoided.
GALANT REFLEX
   Elicited By: Holding the child in ventral
    suspension or placed in prone position and
    running finger down in paravertebral area on
    one side
   Response: Swinging of pelvis towards
    stimulated side
   Appears at birth disappear by 1 year

   Used for mapping sensory level of
    trunk
PEREZ REFLEX

   Elicited By: Holding the child in prone
    position and pressure applied upword
    along spine.

   Response: Flexion of arms and legs
    with extension of neck and cry

   Appear at birth and disappear at 6
    weeks
TRACTION RESPONSE

 Grasp the baby at his wrist and finger
  and pull to sit
 Response: Certain degree of head
  control is demonstrated and head is
  brought forward actively
ADDUCTION RESPONSE

   Elicited by: holding leg of baby in extension
    and sole of foot is rubbed

   Response: the other leg first withdraw and
    then extend with fanning of toes and bring
    toward the side of stimulation (as to push the
    noxious stimulus)
ROOTING REFLEX
                 (SEARCH REFLEX)
 Elicited By: Touching the corner of mouth
  lightly with finger
 Response: Bottom lip is lowered on same
  side and tongue moves towards the point of
  stimulation as finger slides away head turns
  to find it.
Appear 28 week & disappear 4-7 mths

Importance:
   Absence at birth and persistence beyond 7
   months indicate developmental delay


   Helps the baby for finding the breast
SUCKING REFLEX

 Elicited By: Introducing finger into babies
  mouth
 Response: Baby starts sucking vigorously

 Appear at 28 week disappear at 4-7 months

 Absence sucking at birth indicate sickness,
  persistence beyond 7 mths developmental
  delay
LANDAU REFLEX

 Elicited By: Holding the child in ventral
  suspension
 Response: Extension of head, spine
  and legs
   Appear at 3 months disappear at 9
    months

   Absence beyond 3 mths indicate motor
    weakness, mental sub normality & CP
PARACHUTE REFLEX

 Elicited By: Holding the child in ventral
  suspension and suddenly brought down
  the baby towards ground from height
 Response: Extension of both UL in
  attempt to avoid injury
   Appears at 6-9 months persists life
    long.

   Absent in CP and hemiplegia of
    affected limb
PLACING REFLEX

 Elicited by: Bringing the anterior aspect of tibia
  against edge of table
 Response: Lifts leg on the table



   Appear at birth and disapper
     at 6 weeks.
WALKING REFLEX

   Elicited by: holding the baby
    upright over the table so that sole
    of foot presses against the table

   Response: Reciprocal flexion and
    extension of leg simulating
    walking
   Appears at birth and disappear at
    6 week
PALMOMENTAL REFLEX

   Elicited by: Pressing the palm

   Response: Opening of mouth

   Appear at birth and disappear
    at 3 year
CONCLUSION

Knowledge of neonatal reflexes is important for
   Understanding the human development as a
     whole.
   Application for over all assessment of baby
   Recognition of possible neurodevelopemental
     damage in prenatal and perinatal period.
   Establishment of the prognosis for future
   Predicting the Childs future potential
THANKS

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Neonatal Reflexes Guide

  • 1. NEONATAL REFLEXES Dr. Balbirsingh J.L.N.Hospital Research centre, Bhilai Steel Plant
  • 2. INTRODUCTION  Actions in response to specific stimuli that are present in newborn infants.  These are unconditioned reflexes and not learned or developed through experience.  Normally developing neonates or infants are expected to respond to specific stimuli with a specific, predictable behaviour or action.
  • 3. MORO’S REFLEXE ELICITED BY : PLACING THE BABY IN SEMI UPRIGHT POSITION ↓ SUDDEN DROPING OF HEAD IN RELATION TO TRUNK AND CATCHING THE FALLING HEAD DISAPPEARS AT 3 TO 6 MTHS
  • 4. RESPONSE  OPENING OF HAND  EXTENSION AND ABDUTION OF UPPER EXTRIMITIES  ANTERIOR FLEXION OF UPPER EXTRIMITIES  AUDIBLE CRY
  • 5. ABNORMALITIES: DEPRESSED OR ABSENT  GENERALISED DEPRESSION OF CNS ASYMMETRICAL RESPONSE  FRACTURE CLAVICLE  ERB PALSY  HEMIPARESIS EXAGERGERATED RESPONSE  KERNECTERUS
  • 6. STARTLE REFLEX  It is variant of Moro’s Reflex.  Ellicited by: sudden loud noise or by tapping the sternum  Response is like Moro’s reflex but elbow remain flexed and hands closed
  • 7. PALMER GRASP  Elicited By: Placing finger or object in open palm of each hand  Response: Infant grasp the object and with attempted removal grip reinforced
  • 8. Appears at 28 weeks of gestation and disappears at 2-3 months of life  Persistence beyond 6mths: Athetoid CP
  • 9. TONIC NECK REFLEX ASYMMETRIC TONIC NECK REFLEX  Elicited By: Passive rotation of head in supine position  Response: Extension of upper limb of same side and flexion of upper limb of opposite side
  • 10. Appears at birth and disappear at 3 months  Persistence > 3 months: Spastic CP  Importance: Prevents body from rolling
  • 11. TONIC NECK REFLEX SYMMETRIC TONIC NECK REFLEX  Elicited By: Passive extension of head in prone position  Response: Extension of both UL & flexion of both LL
  • 12. Appears in 3 mths and disappear in 6mths  Persistence > 6mths : CP Importance: When baby learn to turn to prone position chocking over bed may asphyxiate him so if baby lift his chin by extension of neck both upper limbs extend automatically and chocking avoided.
  • 13. GALANT REFLEX  Elicited By: Holding the child in ventral suspension or placed in prone position and running finger down in paravertebral area on one side  Response: Swinging of pelvis towards stimulated side
  • 14. Appears at birth disappear by 1 year  Used for mapping sensory level of trunk
  • 15. PEREZ REFLEX  Elicited By: Holding the child in prone position and pressure applied upword along spine.  Response: Flexion of arms and legs with extension of neck and cry  Appear at birth and disappear at 6 weeks
  • 16. TRACTION RESPONSE  Grasp the baby at his wrist and finger and pull to sit  Response: Certain degree of head control is demonstrated and head is brought forward actively
  • 17. ADDUCTION RESPONSE  Elicited by: holding leg of baby in extension and sole of foot is rubbed  Response: the other leg first withdraw and then extend with fanning of toes and bring toward the side of stimulation (as to push the noxious stimulus)
  • 18. ROOTING REFLEX (SEARCH REFLEX)  Elicited By: Touching the corner of mouth lightly with finger  Response: Bottom lip is lowered on same side and tongue moves towards the point of stimulation as finger slides away head turns to find it.
  • 19. Appear 28 week & disappear 4-7 mths Importance:  Absence at birth and persistence beyond 7 months indicate developmental delay  Helps the baby for finding the breast
  • 20. SUCKING REFLEX  Elicited By: Introducing finger into babies mouth  Response: Baby starts sucking vigorously  Appear at 28 week disappear at 4-7 months  Absence sucking at birth indicate sickness, persistence beyond 7 mths developmental delay
  • 21. LANDAU REFLEX  Elicited By: Holding the child in ventral suspension  Response: Extension of head, spine and legs
  • 22. Appear at 3 months disappear at 9 months  Absence beyond 3 mths indicate motor weakness, mental sub normality & CP
  • 23. PARACHUTE REFLEX  Elicited By: Holding the child in ventral suspension and suddenly brought down the baby towards ground from height  Response: Extension of both UL in attempt to avoid injury
  • 24. Appears at 6-9 months persists life long.  Absent in CP and hemiplegia of affected limb
  • 25. PLACING REFLEX  Elicited by: Bringing the anterior aspect of tibia against edge of table  Response: Lifts leg on the table  Appear at birth and disapper at 6 weeks.
  • 26. WALKING REFLEX  Elicited by: holding the baby upright over the table so that sole of foot presses against the table  Response: Reciprocal flexion and extension of leg simulating walking  Appears at birth and disappear at 6 week
  • 27. PALMOMENTAL REFLEX  Elicited by: Pressing the palm  Response: Opening of mouth  Appear at birth and disappear at 3 year
  • 28. CONCLUSION Knowledge of neonatal reflexes is important for  Understanding the human development as a whole.  Application for over all assessment of baby  Recognition of possible neurodevelopemental damage in prenatal and perinatal period.  Establishment of the prognosis for future  Predicting the Childs future potential