Infant Reflexes Onset, Integration And Significance

Front 1

Rooting

Back 1

28 wks gestation-3 mo-Absent of babies depressed by barbiturates; asymmetry may indicate insult to one side of the brain or facial injury; turning away from stimulus will occur with babies who are full

Front 2

Sucking

Back 2

28 weeks gestation-2-5 mo-Poor sucking found in apathetic babies; barbiturates depress sucking; failure to obtain or late persistence of sucking reflex indicate depression of CNS or sensorimotor depression

Front 3

Neonatal Neck Righting

Back 3

Begins at 34 weeks of gestation-Inhibited by neck righting with rotation along body axis at 40 mo.-Needed for child to roll from back to side; asymmetrical response to one side or rolling over and over are abnormal

Front 4

Moro

Back 4

Begins at 28 weeks of gestation-5-6 mo-Asymmetry indicate insult to one side of the brain, injury to peripheral nerves of extremities or injury to the muscle of the extremity; failure to obtain or late persistence indicates general depression of CNS or sensorimotor depression; different from startle reaction.

Front 5

Traction

Back 5

Begins at 28 weeks of gestation-4-5 mo-Asymmetry may indicate insult to one side of the brain or injury to shoulder muscle or peripheral nerves; easily obtained in neonate; if persists after 4-5 mo will inhibit voluntary reach and grasp

Front 6

Plantar Grasp

Back 6

Begins at 28 weeks of gestation-9 mo-Asymmetry may indicate insult to one side of brain; Failure to obtain or late persistence indicates general depression of CNS or sensorimotor depression; should disappear before standing erect with support; exaggeration of response at age-appropriate time is insignificant

Front 7

Palmar Grasp

Back 7

Birth- 2 months-4-5 mo-Following development of grasp index, infant begins to reach and utilize crude palmar grasp; Asymmetry may indicate insult to one side of the brain, primary muscle weakness or peripheral nerve injury; must be inhibited to get voluntary prehension (the act of grasping or seizing)

Front 8

Flexor Withdraw

Back 8

Begins at 28 weeks of gestation-1-2 mo-Asymmetry may indicate insult to one side of the brain, injury to peripheral nerve of extremity or muscle weakness; Failure to obtain or late persistence may indicate general depression of CNS or sensorimotor depression

Front 9

Crossed Extension

Back 9

Begins at 28 weeks of gestation-4 mo-Asymmetry may indicate insult to one side of the brain, injury to peripheral nerves of extremity or muscle weakness; failure to obtain or late persistence may indicate general depression of the CNS or sensorimotor dysfunction

Front 10

Extensor Thrust

Back 10

Begins at 28 weeks of gestation-1-2 mo-Asymmetry may indicate insult to one side of the brain, injury to peripheral nerves of extremity or muscle weakness; failure to obtain or late persistence may indicate general depression of CNS or sensorimotor depression

Front 11

Proprioceptive Placing (UE)

Back 11

Birth (40 weeks of gestation)-2 mo-Asymmetry may indicate insult to one side of the brain, injury to peripheral nerves of extremity or muscle weakness; may be obtained at any age as a withdrawal response if traction exerted against hand to point of discomfort

Front 12

Proprioceptive Placing (UE)

Back 12

Begins 35 weeks of gestation-2 mo-Asymmetry may indicate insult to one side of the brain, injury to peripheral nerves of extremity or muscle weakness; may be obtained at any age as a withdraw response if traction exerted against foot to point of discomfort

Front 13

Positive Supporting (neonatal)

Back 13

Begins at 35 weeks gestation-1-2 mo-Prerequisite for spontaneous stepping reflex; progresses from 35 weeks of gestation, can aid in determining gestational age; indicates progression of muscle tonus; absent in infants with hypotonia, primary muscle weakness

Front 14

Positive Support – weight bearing (mature)

Back 14

6-9 mo-Persists throughout life-Needed for upright standing and walking; Asymmetry may indicate insult to one side of the brain, injury to peripheral nerves of extremity or muscle weakness

Front 15

Spontaneous Stepping

Back 15

Begins at 35 weeks gestation; strongest in full term infants at 3 weeks-2 mo-Premature infants walk in toe-heel fashion, full term infants walk heel-toe fashion; asymmetry may indicate insult to one side of the brain, injury to peripheral nerves of extremity or muscle weakness; stepping reaction is integrated in parallel with neonatal positive supporting

Front 16

Visual Placing (UEs)

Back 16

3-4 mo-Persists throughout life-Asymmetry may indicate insult to one side of the brain, injury to peripheral nerves of extremity or muscle weakness; requires visual response (not seen in newborns); Failure to obtain may indicate general depression of CNS or sensorimotor dysfunction

Front 17

Visual Placing (LEs)

Back 17

3-5 mo-Persists throughout life-Asymmetry may indicate insult to one side of the brain, injury to peripheral nerves of extremity or muscle weakness; requires visual response (not seen in newborns); placing of both feet if only one is stimulated is abnormal; needed for independent walking

Front 18

Galant

Back 18

32 weeks gestation-2 mo; may persist-One of the most common reflexes in normal newborns; absent response below level of a transverse lesion of the spinal cord; long lasting persistent response can lead to a scoliosis; Retention may cause considerable delay in the development of symmetrical stabilization of the trunk and of independence of the head necessary for sitting, standing, or walking

Front 19

Tonic Labyrinthine

Back 19

Birth (40 weeks gestation)-8 mo (?)-If dominates posture and persists, motor development will be delayed; child will not be able to lift head to clear airway in prone; child won’t be able to bring hands to mouth in supine

Front 20

Asymmetrical Tonic Neck (ATNR)

Back 20

Birth-2 mo-4-6 mo-Disappears as neck righting with rotation appears; must be integrated for child to roll over; asymmetry may indicate insult to one side of the brain, injury to peripheral nerves of extremity or muscle weakness; response is never totally obligatory; CNS dysfunction if persists beyond 6 mo; Problems associated with persistent or dominant ATNR: inability to engage hands in midline, scoliosis, subluxation or dislocation of hip on skull side, inability to grasp and regard an object at the same time, inability to balance well enough to walk unaided

Front 21

Symmetrical Tonic neck (STNR)

Back 21

4-6 mo-8-12 mo-Integration of this reflex coincides with crawling in four point position; may be used to get infant into four point position

Front 22

Amphibian

Back 22

6 mo-Persists throughout life-Helpful in assisting assumption of hands and knees position; asymmetry may indicate insult to one side of the brain, injury to peripheral nerves of extremity or muscle weakness

Front 23

NOB (neck on body)

Back 23

Birth- 4 mo, matures at 4-6 mo-Persists throughout life-Needed for child to roll form supine to prone and prone to supine; indicates rotation around body axis developed in child;

Front 24

BOB (body on body)

Back 24

Birth- 4 mo, matures at 4-6 mo-Persists throughout life-Asymmetry may indicate insult to one side of the brain, injury to peripheral nerves of extremity or muscle weakness; modifies the neck righting reflex; important in acquisition of sitting, all fours position and standing. Persistence beyond five years indicates general depression of CNS

Front 25

Labyrinthine Righting (LRR)

Back 25

Birth- 2 mo-Persists throughout life-Needed for head control as child moves in space, body can turn freely around head; allows child to lift head from prone and supine; starting point for chain reflexes in space (Laudau)

Front 26

Optical Righting (OR)

Back 26

Birth- 2 mo-throughout life-Needed for head control as child moves in space, body can turn freely around head (work along long LRR); allows child to lift head from prone and supine; starting point for chain reflexes in space (Laudau)

Front 27

BOH

Back 27

Birth- 2 mo-Persists throughout life-Needed to lift head when lying in prone

Front 28

Landau

Back 28

3-4 months, reaches peak at 5-6 months-12-24 months-This is not an isolated reaction, produced by labyrinthine righting, optical righting, body on body, body on head, and neck righting. Never invariably present even during the second half of the first year; poor quality of response seen in children with congenital myopathies, or hypotonia; breaks up total flexor pattern seen at birth, promotes extension

Front 29

Protective Extension: UE forward (parachute reaction)

Back 29

6-7 months-Persists throughout life-Needed for sitting with arm support and four point kneeling; asymmetry may indicate insult to one side of the brain, muscle weakness or peripheral nerve injury

Front 30

Protective Extension: UE sideways

Back 30

7 months-Persists throughout life-Asymmetry may indicate insult to one side of the brain, muscle weakness or peripheral nerve injury; needed for sitting with and without hand support, failure to obtain indicates general depression of the CNS.

Front 31

Protective Extension: UE backwards

Back 31

9-10 mo-Persists throughout life-Asymmetry may indicate insult to one side of the brain, muscle weakness or peripheral nerve injury; needed for good sitting balance and trunk rotation; Failure to obtain indicates general depression of CNS

Front 32

Protective Extension: LE downward

Back 32

4 mo-Persists throughout life-asymmetry may indicate insult to one side of the brain, muscle weakness or peripheral nerve injury; needed for standing with arm support and for self protection from a fall

Front 33

Protective Extension: LE Staggering Reaction

Back 33

15-18 mo-Persists throughout life-asymmetry may indicate insult to one side of the brain, muscle weakness or peripheral nerve injury; protects the upright posture when the body is displaced by a horizontal force; needed for safe, independent ambulation

Front 34

Tilting/ Balance Reactions: Prone

Back 34

5 mo-Persists throughout life-Modifies righting reflexes; asymmetry may indicate insult to one side of the brain, muscle weakness or peripheral nerve injury; Necessary part of balance mechanism for sitting and supporting prone on hands; Labyrinths must be intact for tilting to be present

Front 35

Tilting/ Balance Reactions: supine

Back 35

7-8 mo-Persists throughout life-Asymmetry may indicate insult to one side of the brain, muscle weakness or peripheral nerve injury; Reactions in supine and sitting are needed for sitting without support; indicates righting reaction have been modified

Front 36

Tilting/ Balance Reactions: sitting

Back 36

7-8 mo-Persists throughout life-Asymmetry may indicate insult to one side of the brain; needed for sitting without support; indicates righting reactions have been modified

Front 37

Tilting/ Balance Reactions: all fours

Back 37

9-12 mo-Persists throughout life-Asymmetry may indicate insult to one side of the brain or primary muscle weakness; Labyrinths must be intact for tilting to be present; need for crawling on all four and standing

Front 38

Tilting/ Balance Reactions: standing

Back 38

12-21 mo-Persists throughout life-Asymmetry may indicate insult to one side of the brain or primary muscle weakness; Labyrinths must be intact for tilting to be present; need for child to stand and walk independently

Front 39

Postural Fixation

Back 39

Appears with the development of competence against gravity in the basic milestone positions -Persists throughout life-Sustains and balances the baby as a whole and its individual parts (head, trunk, and extremities) in a position appropriate to the activity of the movement and to any external forces which may be acting on it