Newborn Reflexes

Plantar grasp

Place finger at base of toes. Toes curl downward. Response lessens by 8 months

Palmar grasp

Place finger in palm of hand. Infants fingers curl around examiners fingers. Response lessens at 3-4 months

Crossed extension

Infant in supine position, examiner extends one leg of infant and presses down knee. Stimulation of sole of foot or fixated limb should case free leg to flex, adduct, and extend as if attempting to push away stimulating agent. Response: opposite leg flexes, adducts, then extends. Reflex should be present during newborn period.

Babinski (plantar)

On sole of foot, beginning at heel, stroke upward along lateral aspect of sole; then move finger across ball of foot. All toes hyperextend, dorsiflexion of big toe, recorded as positive sign. Absence requires neurologic evaluation, should disappear after 1 year of age. Response depends on infant's general muscle tone, maturity, condition.

Glabellar (Myerson)

Tap over forehead, bridge of nose, or maxilla of newborn whose eyes are open. Newborn blinks for first four or five taps. Continued blinking with repeated taps is consisted with extrapyramidal signs

Sucking and Rooting

Touch infant's lip, cheek, or corner of mouth with nipple or finger. Infant turns head toward stimulus and opens mouth.

Extrusion

Touch or depress tip of tongue. Newborn forces tongue outward. Response disappears about fourth to fifth month

Deep tendon

Use finger instead of percussion hammer to elicit patellar, or knee jerk, reflex; newborn must be relaxed. Reflex jerk is present, even with newborn relaxed, nonselective overall reaction may occur

Sucking and rooting specifics

Difficult to elicit after infant has fed. Weak or absent: preterm or neurologic defect. Response disappears after 3-4 months, but can persist up to 1 year.

Swallowing

Feed infant; swallowing usually follows sucking and obtaining fluids. Swallowing is usually coordinated with sucking and breathing and usually occurs without gagging, coughing, apnea, or vomiting.

Moro

Hold infant in semisitting, allow head and trunk to fall backward to angle of at least 30 degrees (with support). Place infant supine on flat surface; perform sharp hand clap. Symmetric abduction and extension are seen; fingers fan out and form a C with thumb and forefinger; slight tremor may be notes; arms abducted in embracing motion and return to relaxed flexion and movement. Cry may accompany. Legs may follow similar pattern of response. Preterm infant: not complete embrace, instead arms fall backward because of weakness.

Stepping or walking

Hold infant vertically under arms or on trunk, allowing one foot to touch table surface. Infant will simulate walking, alternating flexion and extension of feet; term infants walk on soles of their feet, preterm walk on toes. Normally present for 3-4 weeks.

Newborn Reflexes

Newborn has many primitive reflexes. Times at which these reflexes appear and disappear reflect the maturity and intactness of the developing nervous system

Magnet

Place infant in supine position, partially flex both lower extremities, and apply light pressure with fingers to soles of feet. While examiner's fingers maintain contact with soles of feet, lower limbs extend. Response: both lower limbs should extend against examiner's pressure. Absence: damage to CNS. Weak: after breech presentation without extended legs or may indicate sciatic nerve stretch syndrome. Breech with extended legs: evoke exaggerated response

Truncal incurvation (Galant)

Place infant prone on flat surface; run finger down back about 4-5 cm lateral to spine, first on one side and then down other. Response: trunk is flexed, and pelvis is swung toward stimulated side. Response disappears by fourth week. Varies but should be obtainable in all infants, including preterm. Absence: general depression of nervous system. With transverse lesions of cord, no response below level of lesion is present

Crawling

Place newborn on abdomen. Newborn makes crawling movements with arms and legs. Response should disappear by 6 weeks of age.

Pull-to-sit (traction response); postural tone

Pull infant up by wrists from supine position with head in midline. Response: Head lags until infant is in upright position; then head held in same plane with chest and shoulder momentarily before falling forward; infant attempts to right head. Response depends on general muscle tone and maturity and condition of infant

Moro specifics

Response present at birth, complete response until 8 weeks, body jerk seen between 8 and 18 weeks, response absent by 6 months if neurologic maturation not delayed, response may be incomplete if infant in deep sleep state. Asymmetric response: brachial plexus, clavicle, or humerus injury. Persistent response after 6 months: possible neurologic abnormality

Swallowing specifics

Response weak or absent, can indicate preterm birth, effects of maternal analgesics, illness that needs investigation. Sucking, swallowing, and breathing are often uncoordinated in preterm infant

Tonic neck or "fencing"

With infant in supine neutral position, turn head quickly to one side. Arm and leg on side extend, opposite arm and leg flex. Responses in leg more consistent. Response disappears by 3-4 months, incomplete response may be seen until third or fourth year. After 6 weeks persistent response sign of possible CP

Additional newborn responses

Yawn, stretch, burp, hiccup, sneeze. Spontaneous. Responses may be slightly depressed temporarily because of maternal analgesia or anesthesia, fetal hypoxia, infection. Normal. Sneeze not indicator of URI. Sucking may help hiccups. Preterm: signs of neurodevelopmental immaturity and physiologic stress.