New Born Reflexes

Contents
 Introduction
 Reflex arc
 Classification of reflexes
 Significance of reflexes
 Types of reflexes
 Conclusion
Introduction
 A reflex is an involuntary or automatic action that your
body does in response to something without even
having to think about it
 Neonatal reflexes – inborn reflexes present at birth &

occur in a predictable fashion
 Normally developing newborn should respond to

certain stimuli with these reflexes
Reflex arc
 Anatomical pathway for a reflex is
called as reflex arc
 It has 5 components :
 Receptor
 Afferent nerve
 Center
 Efferent nerve
 Effector organ
Classification of reflexes
 Depending upon whether inborn or acquired
 Unconditioned reflexes, inborn reflex

 Conditioned reflexes/acquired reflexes
Significance of reflexes
 Helps a paedodontist to identify whether the child is
developing normally or not
 Tells about what abnormalities the child may be

having if all reflexes are not proper
 Knowledge of development of motor skills – helps to

identify whether development is going on at a proper
rate or not
Types of reflexes
General body reflexes :
 Moro reflex/Startle reflex
 Palmar/grasp reflex
 Plantar grasp reflex
 Walking/stepping reflex
 Limb placement reflex
 Asymmetric tonic neck reflex
 Symmetric tonic neck reflex
 Babinski’s reflex
 Babkin reflex
 Parachute reflex
 Landau reflex
 Withdrawal reflex
 Trunk incurvation reflex
 Tendon reflexes
 Gallant’s reflex
 Tonic labyrinthine reflex
Facial reflexes :
 Nasal reflex
 Blink reflex
 Doll’s eye reflex
 Auditory orienting reflex
Oral reflexes :
 Rooting reflex
 Sucking reflex
 Swallowing reflex
 Gag reflex
 Cry reflex
General body reflexes
 Moro reflex/ startle reflex
 Begins at 28 weeks of gestation
 Initiated by any sudden movement of

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
 Within moments, the arms come together again
 Clinical significance
Its nature gives an indication of muscle tone
Failure of the arms to move freely or the hands to open

fully indicates hypotonia.
It fades rapidly and is not normally elicited after 6

months of age.
 Palmar/grasp reflex
 Begins at 32 weeks of gestation
 Light touch of the palm produces

reflex flexion of the fingers
 Most effective way -- slide the

stimulating object, such as a finger
or pencil, across the palm from the
lateral border
 Disappears at 3-4 months
 Replaced by voluntary grasp at 45

months
 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
 Plantar/grasp reflex
 Placing object or finger beneath the

toes causes curling of toes around the
object
 Present at 32 weeks of gestation
 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.
 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, disappears at
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.
 Limb placement reflex
 When the front of the leg below the

knee or the arm below the elbow is
brought into contact with the edge
of a table, child lifts the limbs over
the edge
 Present at birth, fades away rapidly
in early months of life
• Clinical significance
 Reflex is readily demonstrable in the
newborn and persistent failure to
elicit it at this stage, is thought to
indicate neurological abnormality
 Asymmetric tonic neck reflex
 When the face is turned to one side, the arm
and leg on the side to which the face is
turned extend and the arm and leg on the
opposite side flex.
 Most evident between 2-3 months of age
 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
 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 other toes
 Present at birth, disappears at approx 9-10

months
 Presence of reflex later may indicate disease

 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.
 Reflex can be demonstrated in the newborn, thus showing
a hand-mouth neurological link, even at that early stage
 Tonic labyrinthine reflex
 Labyrinths -- most important organs
concerned with the development of
anti-gravity postures and balance
 Movement of the head in any

dimension stimulates the labyrinths;
and produces the appropriate
responses
 Arms & legs extend when head moves

backwards, & will curl in when the
head moves forward
 Emerges in utero until approximately

4 months postnatally
Facial reflexes
 Nasal reflex
 Stimulation of the face or nasal cavity with water or local
irritants produces apnea in neonates
 Breathing stops in expiration with laryngeal closure in

infants – bradycardia & lowering of cardiac output
 Blood flow to skin, splanchnic areas muscles & kidney

decreases
 Flow to the heart & brain remains protected

 Blink reflex
 A bright light suddenly shone into the eyes, a puff of air

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
 Examination is a part of some neurological exams,

particularly when evaluating coma
 Satisfactory demonstration of these reflexes indicate –

 No cerebral depression
 Contraction of appropriate muscles in response
 Doll’s eye reflex Head
(Oculocephalic reflex)
 Passive turning of the head of
the newborn leaves the eye
“behind”
Eye
 A distinct time lag occurs before

the eyes move to a new position
in keeping with the head position
 Disappears at within a week or

two of birth
 Failure of this reflex to appear

indicates a cerebral lesion
 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 to the
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
 Reflex responses are made use of in tests of infants for

hearing loss
 Pattern of the localization responses indicates the level of

neurological maturity
Oral reflexes
 Rooting reflex
 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
 Onset -- 28 weeks IU
 Well established – 32-34 weeks IU
 Disappears – 3-4 months
 Persistence can interfere with sucking
 Absence of this is seen in neurologically impaired
infants.
 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 – 28 weeks IU
 Well established – 32-34weeks IU
 Disappears around 12 months
 Clinical significance :
Persistence may inhibit voluntary sucking
 Sigmund Freud - Any kind of deprivation of the

activity will lead to fixation resulting in oral habits
 Gag reflex
(Pharyngeal reflex)
 Seen in 19 weeks 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
 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.
 Cry reflex
 Non conditioned reflex which

accounts for its lack of its
individual character
 Sporadic in nature
 Starts as early as 21-29 weeks of IU

life
 Importance of cry
 It is infant’s first verbal communication
 Can be interpreted as a message of urgency or distress
 Indicates:
 Hunger
 Pain
 Discomfort
Conclusion
Appropriate knowledge of reflexes enables a paedodontist
 to identify whether the child is developing normally or
not
 to identify whether development is going on at a proper
rate or not
 Knowledge of abnormalities if all reflexes are not proper
References
 Shobha Tandon. Textbook of Paedodontics
 MS Muthu. Paediatric Dentistry, Principals & practice

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Contents

 Neonatal reflexes – inborn reflexes present at birth &

 Normally developing newborn should respond to

 Unconditioned reflexes, inborn reflex

 Tells about what abnormalities the child may be

 Knowledge of development of motor skills – helps to

 Begins at 28 weeks of gestation

 Initiated by any sudden movement of

 Elicited by -- pulling the baby halfway

 Consists of rapid abduction & extension

Failure of the arms to move freely or the hands to open

It fades rapidly and is not normally elicited after 6

 Begins at 32 weeks of gestation

 Light touch of the palm produces

 Most effective way -- slide the

 Disappears at 3-4 months

 Replaced by voluntary grasp at 45

 Exceptionally strong grasp reflex -- spastic form of cerebral

 May be asymmetrical in hemiplagia & in cases of cerebral

 Persistence beyond 3-4 months indicate spastic form of

 Placing object or finger beneath the

 When sole of foot is pressed

 When the front of the leg below the

 Stimulus consists of a firm painful stroke

 Response consists of movement (flexion or

 Present at birth, disappears at approx 9-10

 Presence of reflex later may indicate disease

 Deep pressure applied simultaneously

 Stimulus is followed by flexion or

 Fades rapidly and normally cannot be

 Movement of the head in any

 Arms & legs extend when head moves

 Emerges in utero until approximately

 Breathing stops in expiration with laryngeal closure in

 Blood flow to skin, splanchnic areas muscles & kidney

 Flow to the heart & brain remains protected

 A bright light suddenly shone into the eyes, a puff of air

 Purpose – to protect the eyes from foreign bodies & bright

 May be associated tensing of the neck muscles, turning of

 Reflexes are easily seen in the neonate and continue to be

 Examination is a part of some neurological exams,

 Satisfactory demonstration of these reflexes indicate –

 A distinct time lag occurs before

 Disappears at within a week or

 Failure of this reflex to appear

 A sudden loud and unpleasant noise :

 Seen first at about 4 months of age

 Thereafter, head turning towards sound stimuli occurs and the

 Reflex responses are made use of in tests of infants for

 Pattern of the localization responses indicates the level of

 When corner of mouth is touched, lower

 When finger slides away, head turns to

 When center of lip is stimulated, lip

 Sigmund Freud - Any kind of deprivation of the

 Seen in 19 weeks of IU life

 Reflex contraction of the back

 Evoked by touching the roof of

 It, along with reflexive pharyngeal swallowing, prevents

 Non conditioned reflex which