Course:KIN366/ConceptLibrary/InfantReflexes

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Movement Experiences for Children
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KIN 366
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Instructor: Dr. Shannon S.D. Bredin
Email: shannon.bredin@ubc.ca
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Infant reflexes are involuntary movements that infants make in response to a certain stimulus. Infant reflexes are only present during infancy and disappear over time as their central nervous system develops (Gretchell & Haywood, 2009). Periods of appearance and disappearance depend on the specific reflex. Infants who lack certain reflexes or have a prolonged presence of certain reflexes are at risk for developmental delays or have possible neurological damage (Futagi et al., 2012)

Purpose of Infant Reflexes

The purpose of infant reflexes is debated and there are multiple theories in attempts to explain them. The three most common theories include the structural theory, functional theory and the applied theory (Gretchell & Haywood, 2009). The structural theory is based on the concept that reflexes are a product of the neurological system and it is just the way the body works; The functional theory suggests that reflexes are survival instincts for the infant, and sets them up to eat, and grasp; The applied theory connects the infants reflexes to future voluntary movements and allows for the infant to practice these movements (Gretchell & Haywood, 2009).

Types of Infant Reflexes

Primitive Reflexes

Primitive reflexes are involuntary and are controlled by the brainstem (Gretchell & Haywood, 2009). The majority of primitive reflexes are present at birth in full term newborns, and begin to disappear as the central nervous system develops, and are eventually replaced with voluntary movements (Sohn, Ahn & Lee, 2011). These reflexes are strong at birth and tend to disappear around 4 months of age (Gretchell & Haywood, 2009)

Asymmetrical Tonic Neck Reflex

When lying in supine position, if the head of the infant is turned to one side, the same side arm and leg extend in a reflexive response (Gretchell & Haywood, 2009). The asymmetrical tonic neck reflex is present from before birth to 4 months of age. Persistence of the asymmetrical tonic neck reflex is associated with cerebral palsy (Paine, 1964).

Palmar Grasping Reflex

When an infant has the palm of his/her hand touched by an object or finger, they respond with the palmar grasping reflex, which is the hand tightly closing around the object (Gretchell & Haywood, 2009). This reflex is typically present from prenatal to 4 months of age. According to the applied theory this response could be associated with preparing the infant for future movements of reaching and grasping (Gretchell & Haywood, 2009). The absence of this reflex is associated with the development of cerebral palsy (Futagi et al., 2011)

Moro Reflex

When an infant is lying in supine position, and its head is lightly shaken (as by tapping a pillow), the infant responds by extending his/her arms and legs, spreading the fingers, followed by flexing of the arms and legs (Gretchell & Haywood, 2009). The moro reflex is present from prenatal to 3 months of age. Prolonged presence of this reflex after 6 months has been linked to cerebral defects of motor function (Paine, 1964).

Sucking Reflex

If the face of an infant is touched above or below the lips, it elicits a sucking motion (Gretchell & Haywood, 2009). The sucking reflex is present at birth and continues until 3 months of age. Through the functional theory this could be explained by a survival instinct to look for food or breast milk.

Babinski Reflex

When the foot of an infant is stroked from the heel to the toes, the infant will respond be extending his/her toes (Gretchell & Haywood, 2009). This reflex is typically seen from birth to 4 months of age (Gretchell & Haywood, 2009).

Searching or Rooting Reflex

If the cheek of an infant is touched with a smooth object, the response is to turn his/her head towards the side of the cheek that was touched (Gretchell & Haywood, 2009). This reflex is present from birth to 1 year of age. Through the functional theory this response assists with survival of the infant as they are searching for food or breastmilk.

Palmar-mandibular Reflex (Babkin)

When pressure is applied to both palms of the infant, they respond by opening their mouth, closing their eyes and flexing their head (Gretchell & Haywood, 2009). This reflex is typically seen from 1 month until 3 months of age (Gretchell & Haywood, 2009).

Plantar Grasping Reflex

If the ball of the foot of the infant is stroked, the infant responds with contracting their toes around the object that stroked the foot (Gretchell & Haywood, 2009). This reflex is present at birth and continues until 12 months of age. Absence of the plantar grasping reflex is associated with the development of cerebral palsy (Futagi et al., 2011).

Postural Reflexes

Postural reflexes assist the infant in maintaining their posture in different environments (Gretchell & Haywood, 2009). Some of the reflexes keep the infants head upright, and help them roll over (Gretchell & Haywood, 2009). Postural reflexes usually appear around 2 months of age, and disappear around 12 months of age (Gretchell & Haywood, 2009).

Derotative Righting Reflex

When the infant is lying in supine position and the legs and pelvis are turned towards the other side, the infant responds by having the head and trunk follow the rotation (Gretchell & Haywood, 2009). The same reflex is also true for the opposite; if the head of the infant is turned sideways, the body will also follow suit in rotation (Gretchell & Haywood, 2009). This reflex begins at 4 months of age, following the asymmetrical tonic neck reflex. In infants with cerebral palsy this reflex usually appears later and is present for longer than in infants without cerebral palsy (Paine, 1964).

Labyrinthine Righting Reflex

When the infant is supported upright and is tilted, the head will move to remain in upright position. This reflex is present from 2 to 12 months of age (Gretchell & Haywood, 2009). Infants who do not elicit this reflex often have a vestibular impairment and limited postural control which delays gross motor function (Kaga, Suzuki, Marsh & Tanaka, 1981).

Pull-up Reflex

When an infant is supported while sitting upright and the body is tipped backwards or forwards, the infant responds by flexing the arms. This reflex usually lasts from 3 to 12 months (Gretchell & Haywood, 2009).

Parachute Reflex

If an infant is help upright and lowered toward the ground quickly, the legs of the infant will extend. This parachute reflex also elicits the arms to extend if the infant is tilted forward, backward or sideways (Gretchell & Haywood, 2009). The elicited response of the legs extending when being lowered to the ground begins at 4 months, while the reflex for being tilted sideways begins at 6 months, being tilted forwards begins at 7 months and being tilted backwards begins at 9 months (Gretchell & Haywood, 2009). Infants with cerebral palsy are likely to acquire the parachute reflex later than other infants (Paine, 1964).

Locomotor Reflexes

Locomotor reflexes are reflexes infants have that resemble voluntary movements, but it happens much earlier in comparison to when the actual voluntary movements occur (Gretchell & Haywood, 2009).

Crawling Reflex

From birth to 4 months, when in prone position, if pressure is applied to the soles of the feet of the infant, a crawling pattern is seen in the arms and legs (Gretchell & Haywood, 2009).

Stepping Reflex

From birth to 5 months of age, if the infant is held upright and placed on a flat surface, a walking pattern is produced (Gretchell & Haywood, 2009). Newborns who are missing this reflex are usually associated with motor defects (Paine, 1964).

Swimming Reflex

When an infant from 11 days old until 5 months old is placed in or over water in a prone position, the infant responds with a swimming movement of the arms and legs (Gretchell & Haywood, 2009).

Factors Affecting Appearance, Persistence or Abnormalities of Infant Reflexes

High-risk infants such as those with low-birth weight or those who are very premature tend to have more abnormal or missing reflexes (Sohn et al., 2011). According to Marquis et al. (1984) there is strong connection between infants with low-birth weight who had a longer than usual persistence of reflexes and motor developmental delays in the same infants. Neurological damage is another factor that may affect infant reflexes (Futagi et al., 2012). Cerebral palsy, Down syndrome, and autism are all factors that can affect abnormal reflexes in infants (Futagi et al., 2012).

Practical Application

It is important for nurses, doctors and neurologists to be aware of and assess the appearance and persistence of reflexes. The absence or continued persistence of certain infant reflexes can be indications of possible neurological issues, physical or developmental delays (Sohn et al., 2011). For example an absent labyrinthine righting reflex is a sign of vestibular or hearing defects in the infant (Kaga et al., 1981). High-risk infants undergo neurological assessments by nurses and doctors as early as possible after birth. By doing this, they can detect any possible abnormalities that may need further examination before the infant leaves the hospital (Perry et al. 2014). Further reflex testing should be done to follow up with postural reflexes that do not appear until 3 or 4 months of age (Gretchell & Haywood, 2009). Pediatricians, general practitioners and nurses should continue to follow up with the infant and ensure primitive reflexes have disappeared and postural reflexes have begun to appear (Perry et al., 2014). Neurological assessments are very simple and quick to perform; easy to do in a hospital setting, as well as in underdeveloped countries with limited resources (Zafeiriou, 2004). It would also be beneficial for parents of infants to become familiar with assessing reflexes so that they can notice any odd behavior and seek further examination from a medical professional. These assessments are very important and can act as an early screening assessment to identify infants at risk for developmental disorders (Zafeiriou, 2004).


References

Futagi, Y., Toribe, Y., and Suzuki, Y. (2012). The grasp reflex and Moro reflex in infants: Heirarchy of primitive reflex responses. International Journal of Pediatrics, 20(12), 1001-1011.

Getchell, N., Haywood, K. M., (2009) Life Span Motor Development. United States of America: Thomson-Shore, Inc., 95-100.

Kaga, K., Suzuki, J., Marsh, R., and Tanaka, Y. (1981). Influence of labyrinthine hypoactivity on gross motor development of infants. Annals of the New York Academy of Sciences, 412-420.

Marquis, P. J., Ruiz, N. A., Lundy, M. S., and Dillard, R. G. (1984). Retention of primitive reflexes and delayed motor development in very low birth weight infants. Journal of Developmental & Behavioral Pediatrics, 5(3), 124-126.

Paine, R. (1964). The evolution of infantile postural reflexes in the presence of chronic brain syndromes. Developmental Medicine and Child Neurology, (6), 345-361.

Perry, S., Hockenberry, M., Lowdermilk, D., Wilson, D., Sams, C., Keenan-Lindsay, L. (2014). Maternal child nursing care in canada. Elsevier Health Sciences, 621-637.

Sohn, M., Ahn, L., Lee, S. (2011). Assessment of primitive reflexes in newborns. Journal of Clinical Medicine Research, 3 (6), 285–290.

Zafeiriou, D. (2004). Primitive reflexes and postural reactions in the neurodevelopmental examination. Pediatric Neurology, (31), 1-8.