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Neonatal Reflexes

Definition

Neonatal reflexes or primitive reflexes are the inborn behavioral patterns that develop during uterine life. They should be fully present at birth and are gradually inhibited by higher centers in the brain during the first three to 12 months of postnatal life. These reflexes, which are essential for a newborn's survival immediately after birth, include sucking, swallowing, blinking, urinating, hiccupping, and defecating. These typical reflexes are not learned; they are involuntary and necessary for survival.

Description

A normal birth is considered full term if the delivery occurs during the thirty-seventh to fortieth week after conception. Developmentally, the baby is considered a neonate for the first 28 days of life. At birth, the neonate must immediately make five major adjustments:

Under normal developmental conditions, these neonatal reflexes represent important reactions of the nervous system and are only observable within a specific period of time over the first few months of life. The following reflexes are normally present from birth and are part of a normal newborn evaluation:

Common problems

The presence and strength of a reflex is an important indication of neurological functioning. Within the first 24 hours after birth, a healthcare provider evaluates an infant's neurological functioning and development by testing and observing these reflexes. If a reflex is absent or abnormal in an infant, this may suggest significant neurological problems. In normal development, the primary reflex system is inhibited or transformed in the first year of life and a secondary or postural reflex system emerges. The secondary system forms the basis for later adult coordinated movement. Absence or presence of a reflex is a symptom, not a disorder.

Severe persistence of primary reflexes indicates predominantly persistent physical problems. Relatively milder persistence, however, is associated with less severe disorders that include specific reading difficulties.

The process of inhibition of these reflexes in the earliest months of life remains unknown but it has been assumed that this process cannot occur after early childhood because neonatal movement is largely stereotypical and follows the patterns of the primary reflex system. Thus, the early movements of the fetus and newborn were previously viewed as passive byproducts of the central nervous system. They are viewed as interactive and having a reciprocal effect on the underlying central nervous system structure and functioning. This implies that the actual rehearsal and repetition of primary reflex movements play a role in the inhibition process itself.

Parental concerns

An evaluation of neonatal reflexes is performed during well-baby examinations. The abnormal presence of infantile reflexes in an older child can be discovered during a neurological examination. Assessment of neonatal reflexes is a screening tool for at-risk children with neurological difficulties. Primary reflexes may persist for certain children beyond their normal time span causing a disruption in subsequent development. Children with neurological damage will have a common denominator of prolonged neonatal reflexes. Since recent studies have demonstrated that repetition of these reflexes seems to eventually inhibit them, parents can work with the infant by assisting with the repetition of persistent reflexes.

KEY TERMS

Palmar —Referring to the palm of the hand.

Plantar —Relating to the sole of the foot.

Postural —Pertaining to the position of the head, neck, trunk and lower limbs in relation to the ground and the vertical.

Prone —Lying on the stomach with the face downward.

Supine —Lying on the back with the face upward.

Visuosensory —Pertaining to the perception of visual stimuli.

Resources

Blythe, Peter. The Role of the Primitive Asymmetrical Tonic Neck Reflex (ATNR) in Balance, Co-ordination Problems and Specific Learning Difficulties, including Dyslexia. Chester, UK: INPP, Monograph 2002.

Goddard, Sally. Reflexes, Learning and Behavior. Eugene, OR: Fern Ridge Press, 2002.

Seidel, Henry M., Rosenstein, et al. Primary Care of the Newborn, 3rd ed. St. Louis, MO: Mosby, 2001.

Bein-Wierzbinski, W. "Persistent Primitive Reflexes in Elementary School Children." Presented at the 13th European Conference of Neuro-Developmental Delay in Children with Specific Learning Difficulties Chester, UK (2001).

Blythe, Sally G. "Neurological Dysfunction, a Developmental Movement Programme used in Schools and the Effect upon Education." The Bangor Dyslexia Conference, University of Bangor, North Wales (July 2003).

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098. (847) 434-4000. Web site: http://www.aap.org..

The International Dyslexia Association. Chester Building, Suite 382;8600 LaSalle Road; Baltimore, MD 21286-2044. (410) 296-0232 or (800) 222-3123. Web site: http://www.interdys.org.

Primary Movement 2004. Available online at http://www.primarymovement.org.

Primitive and Postural Reflexes—The Theory. Available online at http://www.inpp.org.uk/htm.

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