An absent or abnormal sucking reflex is an indirect indicator of neurological maturity in newborn infants. Primitive reflexes are important in the newborn neurological examination. The Babinski reflex involves the stimulation of the lateral foot resulting in dorsiflexion of the great toe and fanning of the other toes. This reflex develops by 28 weeks gestation and disappears by six months. The grasping reflex can be elicited by providing sustained pressure on the palmar aspect of the hand, resulting in flexion of the patient’s fingers grasping the object providing the pressure. The reflex develops by 28 weeks gestation and disappears by six months. The infant experiences the sensation of falling when the arms are released, resulting in abduction at the shoulder and extension at the elbow with the spreading of the fingers, followed by immediate flexion of the upper extremities and an audible cry. The Moro reflex is a protective response to the abrupt disruption of body balance and is elicited by pulling up on the arms with an infant in the supine position. Onset at 35 weeks gestation and disappears by three months. The infant will extend its arm to the side of the rotated face and flex the contralateral arm. The asymmetric tonic neck reflex is performed by manual rotation of the infant’s head to one side. This reflex is thought to be an adaptive response to protect newborn eyes from injury. This test should be performed from above and behind the patient to remove visual stimuli. Glabellar tap reflex occurs in response to repeated tapping of the patient’s head between eyebrows, which elicits blinking that normally would disappear after 4 to 5 taps. The palmomental reflex involves puckering of skin on the ipsilateral side and brief contraction of the mentalis muscle after brisk stroking of the patient’s palm. Rooting begins at 32 weeks gestation and decreases after one month. The rooting reflex, mouth turning toward an object, is seen in response to light stroking on the cheek or bringing an object into the patient’s visual field. The snout reflex is when the lips pucker after pressure on the upper lip. It is observed when the oral region is stimulated or an object is inserted into the mouth and is first seen at 14 weeks gestation. The sucking reflex is important for coordination with breathing and swallowing. Primitive oral reflexes include sucking, rooting, and snout reflexes. These central nervous system motor responses are eventually inhibited by 4 to 6 months of age as the brain matures and replaces them with voluntary motor activities but may return with the presence of neurological disease. Several reflexes are important in the assessment of newborns and young infants. Primitive reflexes are involuntary motor responses originating in the brainstem present after birth in early child development that facilitate survival.
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