Newborn reflexes

The Moro, reflex grasp and asymmetric tonic neck reflexes disappear before purposeful motor skills emerge.
Some reflexes appear at birth. Age (in mos) at disappearance is listed. Postural and other reflexes may develop later. Generally, they disappear between 3-6 mos. Red flag: Persistence of primitive reflexes at 9 mos may indicate neuromotor disorder. Failure to develop protective reactions** at 12 mos may indicate neuromotor d/o. (i.e. lateral protection develops at 7 mos. posterior protection at 1 year).

• Galant disappears by 2-3 mos (stroking along the paravertebral area causes lateral flexion of the trunk with the concavity toward the stimulated side)

• Ankle clonus: Reflects upper motor neuron lesion. Represents pyramidal tract dysfunction. 5-10 beats of ankle clonus can be normal in the first few weeks of life but sustained or asymmetric ankle clonus at any age is abnormal. (Nelson 16th ed) Correct technique: sudden dorsiflexion of foot with knee partially flexed.

• Placing/stepping: Disappears by 2 mos/variable (when the dorsal surface of one foot touches the underside of a table, the infant places the foot on the table top). Reappears when learns to walk - 10-15 mos. (Distinguish from positive support reflex)
• Rooting disappears by 3-4 mos (stroking the perioral skin at the corners of the mouth causes the mouth to open and turn to stimulated side)
• Palmar grasp disappears by 3-4 mos (pressing against palmar surface of the infant's hand results in flexion of all fingers, must extinguish in order to grab and let go of objects)
• Moro disappears by  4-6 mos: sudden movement of head, causes symmetric abduction and extension of the arms, followed by gradual adduction and flexion of the arms over the body)
• Tonic labyrinthine reflex:  In the supine position, the baby's head is extended back 45 degrees -> the shoulders should retract and legs extend "surrender posture." When flexing the neck to 45 degrees, the arms come forward (shoulder protraction) and the legs flex.
• Positive support reflex (postural reflex): Appears by 3 to 4 months of age. With support around the trunk, the infant is suspended and then lowered to pat the feet gently on a flat surface. This stimulus produces reflex extension at the hips, knees, and ankles so the infant stands up, completely or partially bearing weight. Children may go up on their toes initially, but should come down onto flat feet within 20 or 30 s before sagging back down toward a sitting position. Infants with prenatal or perinatal corticospinal tract disease will often refuse to support their weight on their feet.
• Landau (postural reflex): appears by 4-5 months of age. The Landau is an important postural reflex and should develop by 4 to 5 months of age. When the infant is suspended by the examiner’s hand in the prone position, the head will extend above the plane of the trunk. The trunk is straight and the legs are extended so the baby is opposing gravity. When the examiner pushes the head into flexion, the legs drop into flexion. When the head is released, the head and legs will return to the extended position. The development of postural reflexes is essential for independent sitting and walking.
• Assymetric tonic neck reflex: disappears by 4-6 mos (turning head to one side causes extension of extremities on that side, and flexion on the contralateral side, putting infant in 'fencing position; must extinguish in order to roll over). Consistently asymmetrical response may be a sign of hemiparesis on the affected side.
• ** Lateral propping or protective extension (a postural reflex): Appears by 7 months. Essential for the baby to be able to sit independently. Anterior propping actually develops first, then lateral propping. For anterior propping the baby will extend the arms forward to catch himself and prevent falling forward (tripod position, appears around 4 mos). Lateral propping occurs when the baby is falling to one side or the other and he extends the arm laterally to catch himself. To test this, baby can be tilted sideways. Asymmetric lateral propping can be an early sign of hemiparesis. The baby will prop on one side but on the paretic side he will not extend the arm to catch himself. Posterior propping occurs last: arms extend backward if infant is tilted backward.
• Plantar grasp disappears by 9-12 mos

• Babinski: May be present until 1 year of age, usually until walking starts, though some controversy exists. Abnormal if easily elicited, asymmetrical, or associated with other abnormal signs. Represents upper motor neuron lesions. Be suspicious if babinski present after 1 year of age. Elicit by stroking side of foot. If going up the middle of the sole, the grasp reflex may be elicited. Oppenheim technique for assessing the Babinski response: Run your thumb down the medial surface of the tibia - this avoids stimulation of plantar flexion or withdrawal response.
• Parachute: Appears at 6-7 mos, then becomes voluntary. Infant held by waist in horizontal position; rapidly moved downward. Reflex movement is arm extension. Tests upper extremity pyramidal function. Asymmetrical in hemiparesis.
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