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1. 0:04Today we're going to talk about
2. 0:06primitive reflexes in the newborn. And
3. 0:10we're going to demonstrate some of those
4. 0:11reflexes here on this newborn, Robert.
5. 0:13Robert is one month old. He'll be five
6. 0:15weeks tomorrow.
7. 0:17And um you can see I've got Robert
8. 0:19covered up to keep him warm for the
9. 0:21moment, but I have him undressed down to
10. 0:23a diaper. And that's going to be
11. 0:24important when I'm assessing those
12. 0:26reflexes so that I can really see the
13. 0:28movement of his body um without there
14. 0:30being closed in the way. Just a few um
15. 0:35general words about primitive reflexes.
16. 0:37Primitive reflexes are involuntary
17. 0:40movements that are present in the
18. 0:41newborn. They originate in the lower
19. 0:44portions of the central nervous system.
20. 0:47So they should be present in the
21. 0:49newborn. If we see them um that we see
22. 0:52that they're absent um we may be
23. 0:54concerned about proper neurological
24. 0:56development of those lower centers of
25. 0:58the central nervous system. As the baby
26. 1:00grows and develops, those reflexes
27. 1:03should actually go away or integrate.
28. 1:07And so if we see that those reflexes do
29. 1:09not integrate, we may be concerned that
30. 1:12the b that the higher centers of the
31. 1:13central nervous system aren't developing
32. 1:15properly because as those higher centers
33. 1:17develop, baby gains the ability to
34. 1:19voluntarily control movements and then
35. 1:21these reflexes should go away. And I'll
36. 1:23talk about each individual reflex and
37. 1:25when it should appear and and integrate.
38. 1:28But in general, we really see most of
39. 1:31these reflexes gone by six months of age
40. 1:33and certainly by by one year. um if they
41. 1:36don't go away, they could interfere with
42. 1:37with proper development. So, the first
43. 1:40reflex we're going to look at is the
44. 1:42asymmetrical tonic next reflex or the
45. 1:45ATNR.
46. 1:46So, Robert is sort of doing a partial
47. 1:49AT&R right now, but what we do for that
48. 1:50reflex is we turn the head to one side
49. 1:53and we see flexion of the arm on the
50. 1:55head side and extension of the arm on
51. 1:58the face side. And so, it's also called
52. 2:00the fencing reflex. So, we'll turn to
53. 2:02the other side. We always want to assess
54. 2:04both
55. 2:06sides so that we can see um if there are
56. 2:09any asymmetries because asymmetries can
57. 2:12be sort of a red flag. And Robert's
58. 2:14pretty relaxed here. So he's there we
59. 2:17go. There comes that reflex. So we see a
60. 2:19little bit of extension of that arm on
61. 2:20the face side, flexion on the head side.
62. 2:23And again, here's we see that 18R kind
63. 2:27of kick in. Um this reflex usually is uh
64. 2:31present at birth and integrates by about
65. 2:33four to six months of age. If the reflex
66. 2:35persists, it can um get in the way of
67. 2:38development of good eye hand
68. 2:39coordination and reaching and grasping.
69. 2:42So the next reflex that we're going to
70. 2:44look at is rooting. And so the rooting
71. 2:47reflex is sort of a a food finding
72. 2:49reflex. So I'm going to just stroke
73. 2:51Robert's cheek here. He's not happy that
74. 2:54I took away his pacifier. And you can
75. 2:56see he turned his head to find that
76. 2:58stimulus and then to suck. So we'll see
77. 3:00if he goes to the other side. And he
78. 3:02does. He overshot it a little bit. And
79. 3:03that's a real classic rooting when you
80. 3:05see that head going back and forth. Um,
81. 3:08and so we see that Robert has that
82. 3:09reflex present. Most babies uh all
83. 3:12should have that reflex at birth and it
84. 3:14usually integrates by about three months
85. 3:16of age when the baby really starts to
86. 3:18gain good head control and doesn't need
87. 3:20reflexive movement for food finding to
88. 3:22find that nipple um on the bottle or on
89. 3:24mom's breast and can really just go to
90. 3:27it on their own. The next reflex we're
91. 3:31going to look at are the grasping
92. 3:32reflexes. And so I'm going to note that
93. 3:36Robert's hands are mostly fisted, but
94. 3:38they open a little bit. And so when
95. 3:40they're kind of open here, I'm going to
96. 3:41put my thumb in his palm. And you can
97. 3:44see he's grasping me sort of rather
98. 3:47rather tightly. And then we see the same
99. 3:49thing in the feet. So if we push on the
100. 3:53toes,
101. 3:54we see those toes curl or push on the
102. 3:56ball of the foot, excuse me, those toes
103. 3:58curls pretty strongly.
104. 4:02And so this grasping reflex um in the
105. 4:05palm the palmer grasp usually integrates
106. 4:07by about four to seven months of age.
107. 4:10Planter grasp is going to integrate by
108. 4:12about 9 to 12 months of age. And this
109. 4:14really coincides with development of
110. 4:16reach and grasp in the upper extremity.
111. 4:19So if the reflex persists beyond 4 to 7
112. 4:22months, then the baby's going to have
113. 4:24trouble developing the ability to
114. 4:26voluntarily grasp and release an object.
115. 4:28And if reflex persists past 9 to 12
116. 4:31months um as terms of planter grasp then
117. 4:34baby may have difficulty learning to
118. 4:36stand and walk.
119. 4:40Okay. So the next reflex that we're
120. 4:42going to look at is the galant reflex.
121. 4:44And that reflex involves holding the
122. 4:47baby in sort of a prone or a suspended
123. 4:50position.
124. 4:51And we stroke
125. 4:53the spine. And we see here that the baby
126. 4:58shifts his hips
127. 5:00towards that the side. So this is also
128. 5:05sometimes called and his is just not
129. 5:06very strong right now. He might be a
130. 5:08little bit young for this.
131. 5:11There we see it a little bit there. And
132. 5:13there we go. Back to the other side. One
133. 5:15side and then the other side. There we
134. 5:18go. So
135. 5:20that reflex sometimes is also called
136. 5:22like the trunk um incurvation because
137. 5:25you stroke along the side of the baby's
138. 5:28spine and the trunk actually curves
139. 5:30towards that side and again you do it in
140. 5:32prone or a slightly suspended position
141. 5:34and usually you'll see those hips
142. 5:36shifting back and forth. That reflex is
143. 5:39going to integrate um at around 3 to six
144. 5:41months.
145. 5:43And then uh the mororrow reflex is one
146. 5:46that I usually save for fairly late in
147. 5:48an assessment because it can be
148. 5:50upsetting um to the baby. Um it's
149. 5:53essentially a startle reflex
150. 5:56and so or the startle is actually a
151. 5:58component of the moro. So what we do is
152. 6:00we hold the baby in a seated or sort of
153. 6:02semi- reclined position and we drop him
154. 6:04back and we see the arms
155. 6:08extend out to the side in a startle and
156. 6:10then they come back in toward the trunk.
157. 6:14And then we see the cry. And so there's
158. 6:17three parts to that reaction
159. 6:20or that reflex
160. 6:22again. You drop the baby's head
161. 6:23backwards, usually catching it in your
162. 6:25hand or you can put a pillow behind them
163. 6:27so that the pillow can catch them. You
164. 6:29see the arms extend outward in a
165. 6:30startle. Then the baby brings the arms
166. 6:33back in and typically typically cries as
167. 6:36well. And this reflex um typically
168. 6:40integrates by about 3 to 5 months. But
169. 6:42again, we do see sometimes when when
170. 6:45even adults are under extreme stress,
171. 6:47they're they're going to startle. So, um
172. 6:49but this the startle shouldn't be nearly
173. 6:51be as strong um after about the 3 to 5
174. 6:54month age range. And then finally, the
175. 6:56last um reflexes I'm going to show you
176. 7:00are the standing and stepping.
177. 7:03And so our newborns
178. 7:06actually should
179. 7:09should be able to stand and bear some
180. 7:10weight. And Robert is bearing some
181. 7:13weight here. It's definitely on sort of
182. 7:15a bended leg. And it's it's
183. 7:18and then we're going to see maybe some
184. 7:21stepping out of him. Let's see the baby
185. 7:25forward.
186. 7:31He's not doing very much stepping right
187. 7:33now, which is really not that uncommon
188. 7:36um for a baby at five weeks.
189. 7:41We see that newborns are going to um
190. 7:45when placed in a standing position, they
191. 7:47are going to bear weight and stand. And
192. 7:50if you lean them forward slightly,
193. 7:51they're going to do some stepping. But
194. 7:54often by about one to two months, these
195. 7:56reflexes begin to integrate or
196. 7:58disappear. um really simply because the
197. 8:01baby starts to gain weight and the legs
198. 8:03really become and the body really become
199. 8:05too heavy for the baby to support and
200. 8:07for the baby to do some stepping. So at
201. 8:101 to two months of age, it might be a
202. 8:11little bit early for that to be gone. Um
203. 8:13but not not that unusual. This is a
204. 8:16reflex that you're really those standing
205. 8:18and stepping you're really going to see
206. 8:19in those really really new babies. Um,
207. 8:22but again once they're usually by about
208. 8:24two months old, we see those reflexes,
209. 8:26the standing and stepping reflexes
210. 8:28disappear.
211. 8:30So that's just a little bit about
212. 8:31reflexes.
213. 8:33Thank you, Robert, for helping us today.