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Newborn Reflexes
By Iris Dawn Tabangcora, RN - June 10, 2016

Neonatal Nurse Designed

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Watching newborns with their odd-timed kicking is a wonderful sight of life inside the hospital. They are like
bundles of nerves waiting for nurses and doctors to touch them so they can begin their little spontaneous
dance with occasional twitching and flailing. These involuntary movements that newborns exhibit when
stimulated are called newborn reflexes.

Some of the newborn reflexes.

These reflexes aid newborns to survive while they have limited control over their body. These also provide
health clues, which is why assessment of the neuromuscular function is part of the general newborn
examination. Specific focus should be given to newbornsʼ alertness, muscle tone and strength, head
control, and response to manipulation and handling.

Neonatal Nurse Designed

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Here are simple maneuvers for 11 newborn reflexes:

1. Blink Reflex
Blink reflex is the rapid eye closure exhibited by newborns upon coming of objects near it. Similar with
adults, this reflex serves a protective function against hurting the eye. It can be elicited by shining a strong
light (e.g. flashlight, otoscope light, etc.) on the eyes. Blink reflex can also be elicited by a sudden
movement of an object towards the eye. This is important in assessing newbornsʼ visual attentiveness.

2. Rooting Reflex
Brushing the cheek or stroking near the mouth of the newborn will cause the head of the newborn to turn to
that direction. This reflex is called rooting reflex, which helps the baby find the source of food. For an
instance, during breastfeeding, when the mother allows her breast to brush the cheek of the newborn, this
allows the newborn to turn to its direction and begin sucking. However, this reflex disappears on the sixth
week because by that time, the baby is able to steadily focus on a food source.

3. Sucking Reflex
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helps the baby find food. For an instance, when the lips of the baby touch the motherʼs breast or a bottle,
the baby would begin sucking and so food is taken in. Sucking reflex disappears at six months of age.

4. Extrusion Reflex
Until four months of age, any food placed on the anterior portion of the tongue of babies will be expelled by
them. This serves a protective function by preventing the baby from swallowing substances that are toxic or
poisonous. This is also the reason why complementary feeding or introduction of solid food is done at about
six months of age.

5. Palmar Grasp Reflex

Objects placed on newbornsʼ palms will be grasped by newborns. They tend to close their fingers on these
objects and sometimes their grasps are so strong that they can be momentarily raised from supine position
through this reflex. Palmar grasp reflex disappears between six weeks to three months.

6. Walk-in-Place Reflex
If newborns are held in a vertical position with their feet touching a hard solid surface, newborns will take
few, alternating steps. This can last until three months of age, the time where they start to bear a good
portion of their weight without being hindered by this reflex.

An almost similar reflex to this is called placing reflex. However, the major difference lies in the manner of
eliciting it. The anterior surface of the newbornʼs lower leg is made to touch the edge of a bassinet or a
table. Then, the newborn makes few lifting motions as if to step onto the table.

7. Tonic Neck Reflex

Turning a newbornʼs head to one side will cause the extremities to on that side extends while the opposite
extremities contracts or flexes. This is also called boxer of fencing reflex because of the position of the
newborn. Of all reflexes, this is the one which appears to have no function. However, it is being linked to eye
stimulation and handedness. This disappears between 8-12 weeks.

8. Moro Reflex
There are many ways to elicit Moro reflex. However, the most common method used is the “drop method”
wherein the nurse lifts the baby completely off the bed while supporting the head and the neck, and then
the nurse lowers the baby rapidly till there is only 4-8 inches between the baby and the bed. It is important
to note that while doing this, the baby is kept in supine position. Complete Moro reflex involves bilateral
abduction of arms, extension of forearms, and full opening of hands. This is then followed by slow return of
hands towards the midline and then followed by curling of the fingers.

Startle reflex is different from Moro reflex in the sense that it lacks full extension and hand opening and can
be elicited spontaneously by sudden noise or movement.

9. Babinski Reflex
When the nurse strokes the sole of the foot in an inverted “J” curve from the heel upward, the newbornʼs
toes fan. It is only in newborns that positive Babinski reflex is considered normal. It normally disappears
after the 3rd month.

10. Reflexes of spinal cord integrity

There are three reflexes to test spinal cord integrity of newborns. First on the list is magnet reflex, which
can be elicited by applying pressure on the soles of the foot of newborns lying in supine position. As a
response, the newborns would push back against the pressure.

The second reflex to test spinal cord integrity is called crossed extension reflex. This is exhibited by the
newborn in supine position by raising his other leg and extending it when the other leg is extended and, the
sole of that foot is irritated or rubbed by a sharp object (e.g. thumbnail). This is like the act of the newborn
trying to push the hand away that irritates the other leg.

Lastly, newborns lying in prone position would flex their trunk and swing their pelvis towards the direction of
the touch when their paravertebral area is touched by a probing finger. This reflex is called trunk
incurvation reflex.

11. Landau Reflex

Babies will exhibit some degree of muscle tone if they were made to lie in a prone position with the nurseʼs
hand supporting the trunk. While they are not expected to raise their head or arch their back in this
position, babies who will sag into an inverted “U” position show extremely poor muscle tone. In such cases,
further assessment and management is needed.

It is essential for nurses to master these simple maneuvers to promote health and safety of newborns.
Neuromuscular dysfunctions can signal a lot of serious health problems like spinal cord injury, neonatal
sepsis, and even inborn errors of metabolism. Through these simple maneuvers, health problems can be
detected early and medical interventions will be instituted right away.

References:

X. Gleason, K. and Devaskar, S. (2012). Averyʼs Diseases of the Newborn. Philadelphia, PA: Saunders
]. Pillitteri, A. (2010). Maternal and Child Health Nursing: Care of the Childbearing and the Childrearing
Family. Philadelphia, PA: Lippincott Williams and Wilkins

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TAGS Babinski Reflex Blink Reflex Cross Extension Reflex Extrusion Reflex Landau Reflex Magnet Reflex

Moro Reflex Newborn Reflexes Palmar Grasp Reflex Rooting Reflex Sucking Reflex Tonic Neck Reflex

Trunk Incurvation Reflex Walk-In-Place Reflex

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