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 uterinelife.
• They should be fully present at birth and are gradually inhibited by
higher centers in the brain during postnatallife.
8. MORO REFLEX
Begins at 28weeks of gestation
Initiated by any sudden movementof 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 toopen fully indicates
hypotonia.
It fades rapidly and is not normally elicited after 6 months of age.
MORO REFLEX
10. PALMAR/GRASP REFLEX
Begins at 32weeks ofgestation
Light touch of the palmproduces reflex flexion of the
fingers
Most effective way -- slide the stimulating object, such as
afinger or pencil, across the palm fromthe lateral border
Disappears at 3-4months
Replaced by voluntary grasp at45 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 32weeks ofgestation
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, disappearsat 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 2-3months ofage
• 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 2-3months ofage
Clinical significance
Not normally easily seen or elicitedin
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
othertoes
Present at birth, disappears at approx9-
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 defensivereaction
• Clinical significance
Absent or abnormal in childrenwith
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.
22. BLINK REFLEX
A bright light suddenly shown into the eyes, a puff ofair 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 evaluatingcoma
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 weekor 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 tothe 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
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 -- 28weeks IU
Well established – 32-34weeks 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 – 28weeks IU
Well established – 32-34weeks IU
Disappears around 12 months
31. GAG REFLEX
(PHARYNGEAL REFLEX)
Seen in 19weeks 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 21-29weeks of IU life