NEUROPEDIATRIC EXAMINATION
PRIMITIVE REFLEXES
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Dominant form of movement for last 4 months
prenatally and first 4 months postnatally.
Primitive reflexes critical for human survival.
Postural reflexes believed to be foundation for
later voluntary movements.
Appearance and disappearance helpful in
diagnosing neurological disorders.
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The Central Nervous System (CNS) is the control center for
all thinking, learning, and moving. The development of an
efficient CNS is complex yet a certain amount is understood.
There are many factors which contribute to a person being
able to move well, speak fluently, play and develop the skills
necessary for every day living and learning.
The development of the CNS commences from conception,
develops in a regular sequence and is the same for all
humans regardless of cultural influences.
- Survival reflexes occurring sequentially in the first few weeks of
fetal development
- Automatic, stereotyped movements, directed by a very primitive
part of the brain (brainstem).
- executed without involvement of higher levels of the brain (the
cortex).
- Ideally short lived and as each fulfils its function is replaced by
more sophisticated structures (Postural Reflexes) which are
controlled by the cortex
- Considered aberrant and evidence of an immaturity within the CNS
if present beyond their time.
Reflexive movements occur during the last 4 months
of prenatal life and the first 4 months after birth
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Reflexes occur subcortically (below the level of the
higher brain centers)
E.g., palmer grasp
Many of the reflexes do not completely disappear
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First, they are inhibited by the maturing nervous
system
Second, they are integrated into new movement
behaviors
Infant reflexes are called
primitive reflexes
Asymmetric
tonic neck
reflex
Symmetric tonic neck reflex
Moro reflexes
Startle reflex
Primitive reflexes are
repressed by 6 months of age
Primitive reflexes are
important for
Protection
Nutrition
Sucking reflex
Rooting reflex
Survival
Labyrinthine reflex
Postural reflexes
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Prevalent belief: automatic movement is “practice”
for future voluntary movement
 Other experts believe these reflexes may not be related
to future motor development
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Emanate from higher brain centers
These reflexes disappear when voluntary behavior
surfaces
When the stepping reflex is stimulated, walking may
begin at an earlier age
Link between stimulation of the reflex preceding the
disappearance phase and early movement
Small amounts of practice can lead to significant
results
Infant Reflex
Future Voluntary
Movement
Crawling
Crawling
Labyrinthine
Upright posture
Palmar grasp
Grasping
Stepping
Walking
Can help determine the level of neurological
maturation
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Reflexes are age-specific in normal, healthy infants
Moro reflex
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May signify a cerebral birth injury if lacking or
asymmetrical
Asymmetric tonic neck reflex
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May indicate cerebral palsy or other neurological
problem
Reflex
Moro
Concern when lacking, weak,
asymmetrical or persisting
Cerebral birth injury
Asymmetric Cerebral palsy; other neural
tonic reflex damage
Development Examination
Measures several infant reflexes from
birth to 24 months
 Purpose: develop profile of child’s
movement in relation to what is expected
at a specific age
 Useful in determining motor delay
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PRIMITIVE REFLEXES
POSTURAL REFLEXES
 Galant
 Stepping
 Palmar Grasp
 Crawling
 Sucking
 Swimming
 Search
 Head and Body Righting
 Moro
 Parachuting
 Startle
 Labyrinthine
 Asymmetric Tonic Neck
 Pull Up
 Symmetric Tonic Neck
 Plantar Grasp
 Babinski
 Palmar Madibular
 Palmar Mental
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If the child is stroke paravertebrally with one finger, the
body will curves
The concavity of pelvis proceed
toward the direction of the
stimulus given.
The leg and arm ipsilateral will
be strach, and the contralateral
will be curve
Syn: Spinal reaction
Disappear in 2-3 months
Patologic: dissapear  Spinal
medulla lesion, CNS depression
Palm
of hand lifts back of head
Hand is removed suddenly so that
head begins to fall
Head
Moro
is supported
reflex precedes the startle
reflex and causes the arms and legs
to extend immediately rather than
flex
Duration: prenatal 4-6 months
postpartum
Patologic: disappear  CNS
depression, persists  RM, CNS
dysfunction, delay sitting/head
control, asymmetrical  injury to
one side of brain, parese plexus
brachialis, fracture
clavicula/humerus
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Synonim: bow and arrow or fencer’s
position
Causes flexion on one side and
extension on the other
Not always seen in newborn
Facilitates the development of
bilateral body awareness
Duration: after birth-3 months
Patologic: persist  Cerebral palsy
The palmar grasp reflex
is
one of the most
noticeable
reflexes to
emerge
Appears in utero
Endures through the 4th month postpartum
Negative palmer grasp: neurological problems
(spasticity)
Leads to voluntary reaching and grasping
The
toes appear to be grasping
Stimulus is touching the ball of
the foot
This reflex must disappear
before the baby can stand or walk
Duration: birth-1 years
Patologic: negative  medula
spinalis lesion, perifer nervous
system lesion (must disappear
before the baby can stand or
walk)
Propping
reflexes
Related to upright posture
This reflex is a conscious
attempt to break a potential fall
Duration: 4 months-1 years
Patologic: (-) CP, asymetris
 neuromusculer/orthopaedi
dysfunction
Stimulus /
Response
Duration
S: touch of lips
R: sucking action
In utero - 3 months postpartum
Concerns
No reflex problematic for nutrition
Other
Often in conjunction with searching reflex
Stimulus /
Response
Duration
S: touch cheek
R: head moves toward stimuli
Weeks prenatal - 3 months postpartum
Concerns
No reflex problematic for nutrition
No reflex or lack of persistence may be
sign of CNS or sensorimotor dysfunction.
Often in conjunction with sucking reflex.
Contributes to head/body-righting reflexes.
Other
Stimulus /
Response
Duration
S: Same as Moro
R: Arms and legs flex
2-3 months after Moro disappears – 1 year
Other
Less severe startle reflexes elicited
through lifespan
Stimulus /
Response
Duration
Concerns
S: Baby sitting up and tip forward
R: Neck and arms flex, legs extend
S: Baby sitting up and tip backward
R: Neck and arms extend, legs flex
After birth – 3 months
Persistence may impede many motor skills
and cause spinal flexion deformities
Stimulus /
Response
Duration
S: Stroke bottom or lateral portion of foot
R: Great toe turns downward
Birth – 4 months
Concern
Test of the pyramidal tract (i.e. ability to
perform conscious / voluntary movement)
Stimulus /
Response
Duration
S: Pressure to both palms or hair to hand
R: Eyes close, mouth opens, and/or neck
flexes (which tilts the head forward)
Birth – 3 months
Other
Also called the Babkin reflex
Stimulus /
Response
Duration
S: Scratch base of palm
R: Lower jaw opens and closes
Birth – 3 months
Stimulus /
Response
Duration
S: Infant upright with feet touching surface
R: Legs lift and descend
After birth – 5-6 months
Concerns
Essential forerunner to walking
Other
Sometimes called walking reflex
Developmental changes in reflex over time
Stimulus /
Response
Duration
S: Prone position on surface, stroke
alternate feet
R: Legs and arms move in crawling action
Birth – 3-4 months
Concerns
Precursor to later voluntary creeping
Stimulus /
Response
Duration
Other
S: Infant held horizontally
R: Arms and legs move in coordinated
swimming type action
2 weeks after birth – 5 months
Recognition of reflex led to popularity of
infant swim programs
Stimulus /
Response
Duration
S: Supine, turn body in either direction
R: Head “rights” itself with the body
S: Supine, turn head in either direction
R: Body “rights” itself with the head
Head:1-6 months; Body: 5 months-1 year
Concerns
Related to voluntary rolling movements.
Stimulus /
Response
Duration
S: Baby held upright, tilted in one direction
R: Baby tilts head in opposite direction
2-3 months – 1 year
Concerns
Related to upright posture
Other
Also considered primitive reflex
Stimulus /
Response
Duration
S: Sitting/standing, hold hands, tip in one
direction
R: Arms flex or extend in to maintain
upright position
3 months – 1 year
Concerns
Related to upright posture