10.04 Newborn Reflexes

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Overview

  1. Newborns have various reflexes that are present at certain times and all eventually disappear accept for the swallow reflex.

Nursing Points

 

General

  1. These reflexes should be present for the time frame listed. If they are NOT, then there may be neuro issues
  2. If these issues persist or resurface AFTER the time frame listed, that may also indicate neuro issues.

Assessment

  1. Suck reflex
    1. Finger, nipple touches roof of mouth and infant begins to suck
    2. Doesn’t disappear but becomes voluntary by 4 months
  2. Rooting reflex
    1. Stimulus: Touch finger, cheek, lip, corner of mouth with nipple
    2. Response: Turns head that direction, opens mouth, takes in nipple, sucks
    3. Disappears after 4 months
  3. Swallowing reflex
    1. Stimulus: Sucking or something touches back of throat
    2. Response: Coordinated sucking and swallowing
    3. Permanent
    4. Concern noted if persistent gagging, coughing or emesis observed
  4. Palmar grasp reflex
    1. Stimulus: Place a finger in their hand
    2. Response: Curls hand fingers around examiners finger
    3. Disappears at 6 months
  5. Plantar grasp reflex
    1. Stimulus: Rub bottom of foot
    2. Response: Toes curl downward
    3. Lessens at 9-12 months
  6. Moro/startle reflex
    1. Stimulus: Gently slightly lift newborn up from lying position and allow to fall back
    2. Response: Symmetrical spreading of arms out (abducts), then pulling of arms in (adducts)
    3. Disappears at 4 months
    4. Can occur spontaneously while sleeping
    5. Swaddle newborn while sleeping to prevent disturbed sleep
  7. Pull to Sit reflex
    1. Stimulus: Pull from supine to sitting
    2. Response: Head will lag behind
    3. Disappears at 4-5 months
  8. Babinski reflex
    1. Stimulus: Stroke gently upward on lateral side of foot
    2. Response: Toes fan
    3. Disappears at by age 2
    4. If this is not present, there could be neuro issues
  9. Stepping reflex
    1. Stimulus: Hold newborn up in standing position
    2. Response: Simulates walking
    3. Disappears at 2 months
  10. Crawling reflex
    1. Stimulus: Place newborn on stomach
    2. Response: Makes crawling movements with extremities
    3. Disappears at about 6 weeks
  11. Tonic neck/fencing reflex
    1. Head turns to one side
    2. Arm on same side extends while other side is flexed
    3. Disappears by 7 months

Therapeutic Management

  1. Attempt to keep baby calm
  2. Assist mother at the breast with these reflexes

Nursing Concepts

  1. Human development
  2. Comfort

Patient Education

  1. Educate during feedings about rooting
    1. Can be helpful to initiate feedings

Reference Links

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Video Transcript

In this lesson I am going to help you understand the newborn reflexes and how to elicit the different responses.
So just a few basics to guess us started. Reflexes are just inborn responses for survival. Most have been defined as to why we do them. All reflexes of the newborn will disappear by a certain time frame and if they don’t it could mean neurological and also if they go away and then come back it could be a neuro problem. I’m going to go through the important newborn reflexes to know and give you helpful ways to remember about when they disappear. You might not be tested on this for OB but it will probably show back up in pediatrics and neuro. There is a range in the books and of course they all say different things about this range so I went with the average just to give you an idea of when you should not longer expect to see the reflex response. Ok let’s look at these reflexes.

Let’s look at some of these reflexes. The Suck reflex is when a finger or nipple touches the roof of mouth and the infant begins to suck. Now this one doesn’t disappear but becomes voluntary by 4 months. So think about it if something hits the roof of your mouth you make a voluntary decision to start sucking the straw or lollipop. You can remember 4 months because the word suck has 4 letters. The rooting reflex is done by stimulating the corner of the mouth with something like a finger or nipple and the infant will respond by turning its head that direction, opens mouth. So if you didn’t figure out this is a response to alert baby where the food is. So you can see in this image how the side of the cheek or mouth is being stroked and the infant’s mouth opens and will turn towards the stimulus. This will also disappears after 4 months and you can remember because the root word, root is four letters as well. The swallowing reflex occurs when something like food touches the back of throat and swallowing occurs. This as you can imagine would be permanent. This is the only reflex that remains permanent. Of course if a neuro problem occurs like a stroke it could inhibit it. So remember we always need to be able to swallow so that reflex should stick around.
The palmar grasp reflex is one of my favorites. A stimulus like a finger in their hand causes them to curl their fingers around and grasp. I love this one because all the parents fall in love thinking their child is holding their hand when really it is a reflex, but I never ruin it for them! This reflex disappears at 6 months and it is super helpful that palmar has 6 letters to remember this! The plantar grasp is very similar it is just occurring at their foot instead of hand. So put a finger at the top of their foot and they will curl and close their toes down. This lessens around 12 months and I remember this because it is the time frame that they start walking. Can you imagine if a 12 month old was up trying to walk and every time the floor hit that part of the food they curled their toes down? It wouldn’t work so well! The moro and startle reflex are used interchangeably and are my least favorite!. If you gently lift the newborn up from lying position and allow to fall back it startles them and they will spread their arms out and then pull them back in. You can see in this image they have liften and gently dropped the infant back which elicited the startle or moro reflex. This disappears at 4 months and moro has four letters too! I don’t like this reflex because I don’t like to scare the babies and also the worst is that it can occur spontaneously while sleeping. My boys would always get woken up by this. They would fall asleep on me and I’d attempt to put them down and just when I finally get comfortable they have reflexed and woken up again. Swaddling can be a big help for this.
Ok so a few more important reflexes. The pull to sit reflex is done by pulling from supine to sitting and the head will lag behind behind they have no head control. In an infant with neonatal abstinence syndrome you will do this and the head will stay in line because they are so tight and showing neurological signs of the withdrawl. So a regular baby this should disappear at 4 months. So pull has 4 letters or also just think at that point they have good head control. Those muscles have strengthened so if you do it they aren’t going to let their head drop instead they are going to be holding their head up and checking out the world. The babinski reflex is done by stroking gently upward on lateral side of foot and the toes should fan out, this will disappear by age 2. Babinski has 2 letter B’s so 2 years. The stepping reflex is done by holding the newborn up in standing position and they will simulates walking. They are not sure why they do this and why it would disappear by 2 months but it is a reflex. Stepping has 2 letter “p”s so 2 months.
The crawling reflex is done by placing the newborn on its stomach and it will make a crawling movement with extremities and this disappears at about 6 weeks. So two ways to remember this that I came up with are the number 6 looks like a crawling baby when writing it sideways and you can also remember that around 6 months they usually start to crawl. The tonic neck or fencing reflex is seen when the infant turns its head to one side then the arm on same side extends while other side is flexed. You can see in this image the arm is extended on the side the head is turned. It is also called fencing because it’s like the baby is in that fencing position like it’s going to sword fight. So fencing has 7 letters and this disappears by 7 months. It is very convenient how a lot of the time frames matched up with the number of letters for us to remember!
So there isn’t a ton to know here on management and education but you want to try and keep the baby as calm as possible while you assess reflexes. No parents wants to listen to their baby scream as you are startling or doing different reflexes to get a response. So try to keep the baby as calm as possible. And when the mother has the baby to breast you can elicit responses like rooting and show her. She can use these reflexes to help initiate feedings. You can explain that by touching the side of the mouth with the breast the baby will turn its head and also that she needs to get the baby to take a big mouthful of breast tissue to initiate the suck reflex. This will also protect mom’s nipples but it is a great way to ensure she remembers to get a big mouthful for the baby.

Human development and comfort are our concepts because we want to provide comfort while performing various reflexes and this is all part of human development.
Ok so let’s look at the important pieces. Our newborns are born with reflexes that are going to help them respond to their new environment. Some of the most important are rooting, sucking, and swallowing because they all are important for feeding purposes. The reflexes all disappear accept for swallowing that never leaves us. Most reflexes disappear around 4-6 months and remember the little helpful tips I gave to remembering each time frame. It becomes a neuro concern if the reflex never disappears or if it disappears and comes back.

Make sure you check out the resources attached to this lesson and watch the video showing some of these reflexes. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 9

Placing a finger in an infant’s palm will illicit which response?

  • Question 2 of 9

The babinski reflex should cause which of the following to occur?

  • Question 3 of 9

Which best describes the Galant reflex as seen on a neurological exam of a newborn infant?

  • Question 4 of 9

Which reflex will help the newborn find the breast to begin breastfeeding?

  • Question 5 of 9

The nurse is talking with new parents about newborn reflexes. The mother wants to know when they should expect their baby to lose the tonic neck reflex. Which of the following is an appropriate answer for the nurse to give?

  • Question 6 of 9

Which newborn reflex does not go away by 1 year of age?

  • Question 7 of 9

The nurse is talking with new parents about infant reflexes. The parents want to know when they should expect their baby to lose the Moro reflex. Which of the following is an appropriate answer by the nurse?

  • Question 8 of 9

A nurse is caring for a newborn in the nursery and educating the family on reflexes. The family asks how long the reflexes will stay. The nurse explains that most reflexes disappear at a certain age, except one that becomes voluntary. Which reflex is this?

  • Question 9 of 9

The nurse is talking with new parents about the different reflexes. The mother wants to know when they should expect their baby to lose the Babinski reflex. Which of the following is an appropriate answer for the nurse to give?

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