Automatic gait of the newborn. Checking and meaning of reflexes of a newborn

Of particular importance in the neonatal period are the so-called basic unconditioned reflexes.

The main unconditioned reflexes of a newborn and infant are divided into two groups: segmental motor automatisms, provided by segments of the brain stem (oral automatisms) and the spinal cord (spinal automatisms).

Oral segmental automatisms:

Sucking reflex

With the introduction of the index finger into the mouth by 3-4 cm, the child makes rhythmic sucking movements. The reflex is absent in pareselic nerves, severe mental retardation, in severe somatic conditions.

Search reflex (Kussmaul reflex)

When stroking in the area of the corner of the mouth, the lips are lowered, the tongue is deflected and the head is turned towards the stimulus. Pressing on the middle of the upper lip causes the mouth to open and the head to extend. When pressing on the middle of the lower lip, the lower jaw drops and the head bends. This reflex is especially pronounced before feeding and is weakly expressed in the child immediately after feeding. Pay attention to the symmetry of the reflex on both sides. The search reflex is observed up to 3-4 months, then fades away. Asymmetry of the reflex - unilateral paris facial nerve. There is no reflex - bilateral paresis of the facial nerve, damage to the central nervous system.

proboscis reflex

A quick tap of the finger on the lips causes the lips to stretch forward. This reflex persists up to 2-3 months.

Palmar-mouth reflex (Babkin reflex)

When pressing with the thumb on the area of the palm of the newborn (both palms at the same time), closer to the tenar, the mouth opens and the head bends. The reflex is pronounced in newborns in the norm. Lethargy of the reflex, rapid exhaustion or absence indicate damage to the central nervous system. The reflex may be absent on the affected side with peripheral paresis. After 2 months it fades by 3 months. disappears

Spinal motor automatisms:

Protective reflex of the newborn

If the newborn is placed on the stomach, then a reflex turn of the head to the side occurs. This reflex is expressed from the first hours of life. In children with central nervous system damage, the protective reflex may be absent, and if the child's head is not passively turned to the side, he may suffocate.

Support reflex and automatic gait in newborns

The newborn does not have the readiness to stand, but he is capable of a support reaction. If you hold the child vertically in weight, then he bends his legs in all joints. The child placed on a support straightens the body and stands on half-bent legs on a full foot. The positive support reaction of the lower extremities is a preparation for stepping movements. If the newborn is slightly tilted forward, then he makes stepping movements (automatic gait of newborns). Sometimes, when walking, newborns cross their legs at the level of the lower third of the legs and feet. This is caused by a stronger contraction of the adductors, which is physiological for this age and outwardly resembles the gait in cerebral palsy.

The support reaction and automatic gait are physiological up to 1-1.5 months, then they are inhibited and physiological astasia-abasia develops. Only by the end of 1 year of life does the ability to stand and walk independently appear, which is considered as a conditioned reflex and requires the normal function of the cerebral cortex for its implementation. In newborns with intracranial injury, born in asphyxia, in the first weeks of life, the support reaction and automatic gait are often depressed or absent. In hereditary neuromuscular diseases, the support reaction and automatic gait are absent due to severe muscle hypotension. In children with lesions of the central nervous system, automatic gait is delayed for a long time.

Crawling reflex (Bauer) and spontaneous crawling

The newborn is placed on the stomach (head in the midline). In this position, he makes crawling movements - spontaneous crawling. If you put your palm on the soles, then the child reflexively pushes away from it with his feet and crawling intensifies. In the position on the side and on the back, these movements do not occur. Coordination of movements of arms and legs is not observed. Crawling movements in newborns become pronounced on the 3rd - 4th day of life. The reflex is physiological up to 4 months of life, then it fades away. Independent crawling is a precursor to future locomotor acts. The reflex is depressed or absent in children born in asphyxia, as well as in intracranial hemorrhages, spinal cord injuries. Pay attention to the asymmetry of the reflex. In diseases of the central nervous system, crawling movements persist for up to 6-12 months, like other unconditioned reflexes.

grasp reflex

Appears in a newborn with pressure on his palms. Sometimes a newborn wraps his fingers so tightly that he can be lifted up ( Robinson reflex). This reflex is phylogenetically ancient. Newborn monkeys are held on the mother's hairline by gripping the brushes. With paresis of the hand, the reflex is weakened or absent, in inhibited children the reaction is weakened, in excitable children it is strengthened. The reflex is physiological up to 3-4 months, later, on the basis of the grasping reflex, an arbitrary grasp of the object is gradually formed. The presence of a reflex after 4-5 months indicates damage to the nervous system.

The same grasping reflex can also be evoked from the lower extremities. Pressing the ball of the foot with the thumb causes plantar flexion of the toes. If you apply a dashed irritation to the sole of the foot with your finger, then there is a dorsiflexion of the foot and a fan-shaped divergence of the fingers (physiological Babinski reflex).

Reflex Galant

When the skin of the back is irritated paravertebral along the spine, the newborn bends the back, an arc is formed that is open towards the stimulus. The leg on the respective side often extends at the hip and knee joints. This reflex is well evoked from the 5th - 6th day of life. In children with damage to the nervous system, it may be weakened or completely absent during the 1st month of life. When the spinal cord is damaged, the reflex is absent for a long time. The reflex is physiological until the 3rd - 4th month of life. With damage to the nervous system, this reaction can be observed in the second half of the year and later.

Perez reflex

If you run your fingers, slightly pressing, along the spinous processes of the spine from the coccyx to the neck, the child screams, raises his head, unbends the torso, bends the upper and lower limbs. This reflex causes a negative emotional reaction in the newborn. The reflex is physiological until the 3rd - 4th month of life. Inhibition of the reflex during the neonatal period and a delay in its reverse development is observed in children with damage to the central nervous system.

Moro reflex

It is caused by various and not different methods: a blow to the surface on which the child lies, at a distance of 15 cm from his head, raising the extended legs and pelvis above the bed, sudden passive extension of the lower extremities. The newborn moves his arms to the sides and opens his fists - the 1st phase of the Moro reflex. After a few seconds, the hands return to their original position - phase II of the Moro reflex. The reflex is expressed immediately after birth, it can be observed during the manipulations of the obstetrician. In children with intracranial trauma, the reflex may be absent in the first days of life. With hemiparesis, as well as with obstetric paresis of the hand, an asymmetry of the Moro reflex is observed.

With pronounced hypertension, there is an incomplete Moro reflex: the newborn only slightly abducts his hands. In each case, the threshold of the Moro reflex should be determined - low or high. In infants with lesions of the central nervous system, the Moro reflex is delayed for a long time, has a low threshold, often occurs spontaneously with anxiety, various manipulations. In healthy children, the reflex is well expressed until the 4th - 5th month, then it begins to fade; after the 5th month, only some of its components can be observed.

Twenty-eight days - this is exactly how long the neonatal period lasts, during which the child's body is going through adaptation to completely new conditions for it now extrauterine life, so the reflexes of a newborn child play a major role here.

This is explained by the fact that a recently born baby is still deprived of many useful skills - nature takes care of it.

Basic reflexes

In this period, the baby has developed only unconditioned reflexes - that is, those that are laid down as if by default. Gradually, some of them disappear, giving way to conventional ones.

Conditioned reflexes can also be called the "personal experience" of the child, since they are acquired in the process of further development and maturation of the brain.

What are unconditioned (innate) reflexes for?

There are as many as fifteen clinically significant unconditioned reflexes in a baby - and their "fate" is very different: some are needed only in order to survive the difficult process of birth (therefore, they quickly disappear after birth), others - to give impetus to the development of new ones, and others remain for life.

Pediatric neonatologists divide the congenital reflexes of newborns into several groups:

Providing general normal vital activity (respiratory, sucking, swallowing, as well as spinal reflexes)
Aimed at protecting the child's body from external influences of bright light, cold, heat and other irritants
"Temporary" reflexes - for example, the breath holding reflex necessary to move through the mother's birth canal.

Click to enlarge (Basic reflexes)

oral reflexes

The ability to suckle a mother's breast or nipple on a bottle of artificial nutrition is called sucking reflex, and the ability to swallow food eaten - swallowable.

Swallowing reflex remains for life.

proboscis reflex - another kind of oral reflexes. If you easily touch the baby's lips, they bulge funny into a tube - just like the trunk of an elephant, because at this moment the circular muscle of the mouth involuntarily contracts. The proboscis reflex disappears by two to three months.

Babkin's reflex (palmar-oral) - a mixed version of the child's reaction, in which he opens his mouth slightly, if you gently press both thumbs at the same time with your thumbs. It is best expressed in the first two months of life, in the third it begins to fade and then disappears completely.

Kussmaul reflex (search) - an attempt to find food: if you touch the corner of the child's mouth, he turns his head to the irritant. It disappears quite quickly - three to four months after birth. In the future, the search for food occurs visually - the baby sees the breast or bottle.

spinal reflexes. Examining the baby immediately after birth and throughout the entire neonatal period, the pediatrician also pays attention to spinal reflexes - a set of reactions responsible for the state of the muscular apparatus.

Upper defensive reflex. One of the most important unconditioned reflexes that starts already in the first hours of life is the upper protective reflex. It manifests itself if the newborn baby is placed on the stomach: the head immediately turns to the side, and the baby tries to raise it. This is a protection against possible respiratory failure: the child thus restores air access to the respiratory tract. The reflex disappears a month and a half after birth.

Grasping reflexes

Reflexes Yanishevsky and Robinson in a newborn child, they manifest when he firmly grabs the fingers of his mother (doctor) with both hands and is able to hold them so strongly that he can even be lifted in this way. They are expressed up to three or four months, then weaken. The persistence of these reflexes at a later age is evidence of existing neurological problems.

Babinski's reflex - it is also called the plantar reflex: lightly stroking the edges of the soles from the outside causes the fingers to open in the form of a fan, while the feet bend from the back. Evaluation criteria are energy and especially the symmetry of movements. One of the longest-lived congenital reflexes - it lasts up to two years.

Other motor reflexes

Moro reflex - a biphasic reaction in which the child responds to a fairly loud knock on the changing table or any other sharp sound.

The first phase - the baby spreads his arms to the sides and opens his fingers, while straightening his legs.
The second phase is the return to the previous position. Sometimes a child can even hug himself, as it were - therefore the Moro reflex has another name - the “hug reflex”.

It is pronounced up to the age of five months of the baby.

Kernig's reflex - the reaction of the hip and knee joints to an attempt to unclench them by force after bending. Normally, this cannot be done. Disappears completely after four months.

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Automatic gait reflex , which is a very funny sight, consists in the attempts of the newborn to walk in the most real way, if he is raised and tilted forward a little. The evaluation criterion is the degree of completeness of support when “walking” on the entire foot. Reliance on the fingers and clinging of the feet to each other is a sign of disorders that require the supervision of a pediatric neurologist.

Support reflex - an attempt by the baby to stand on his feet, when, carefully holding him, they put him on a flat surface (on a table, for example). This is a two-phase reflex: first, the baby, having felt the touch of the support, sharply bends its knees, and then it becomes both feet and firmly presses the soles to the table. Well-defined support reflexes and "automatic" gait persist for one and a half months.

Bauer reflex (spontaneous crawling) can be observed by placing the baby on his stomach and placing his palms on his soles: he begins to crawl, while pushing off from the created support and helping himself with his hands. Appearing on 3-4 days, this reflex disappears after 3-4 months.

Reflex Galant - the reaction of the spine to an external stimulus. If you run your finger along the entire length of the ridge, then the child arches his back, while straightening his leg from the side of the stimulus.

There are also postural reflexes newborns - attempts to redistribute muscle tone when the body posture changes in the absence of the ability to hold the head, sit and walk.

Magnus-Klein reflex - the reaction of the extensor and flexor muscles of the shoulder, forearm and hand, in which the child assumes a "swordsman's pose". This happens when the baby's head is turned to the side. You can observe how the arm and leg are straightened from the side where the child's face is. On the opposite side, they, on the contrary, bend. This reflex lasts up to two months.

Weak reflexes or when to sound the alarm

It happens that some reflexes in a baby turn on late or do not appear very clearly. This may be due to trauma during childbirth, illness, and may also be an individual reaction to certain medications.

Also, weakness of oral and spinal reactions is commonly noted in preterm infants and in those born with mild asphyxia.

Interestingly, the weak reflexes in a newborn child associated with the search for food and its absorption (sucking and swallowing) can be explained simply by the fact that the baby is simply not hungry. Most clearly they appear before feeding.

The most frightening situation is when there are no reflexes at all. The complete absence of reflexes in a newborn child is a reason for immediate resuscitation, which should be carried out only by specialists.

Moro reflex Extension reflex and support reflex Automatic walking reflex Bauer reflex Reflex Talent Perez reflex Assessment of the development of the newborn All pages

In the study of unconditional reflex activity, the child must be in a state of wakefulness, not be wet and hungry, so that reflex reactions are not suppressed by a reaction to discomfort. When examining unconditioned reflexes, it is necessary to ensure that the irritations applied do not cause pain to the child. Unconditioned reflexes and movements are examined in three positions: on the back, on the stomach and in a state of vertical suspension. When evaluating the results of the examination, it is necessary to take into account not only the presence, but also the severity of a particular reflex (bright, moderate, weak, absent), the uniformity and time of its appearance from the moment of irritation (quickly, late), completeness, the strength of the response and the speed of extinction .

In a healthy full-term and even premature infant with a body weight of at least 2100 g, unconditioned reflexes can be expressed to varying degrees, which is determined by the type of nervous activity of the child, the time of day when reflexes are determined, and the physiological state. If, despite repeated attempts, it is not possible to evoke a reflex, it can be stated that it is suppressed. At the same time, unconditioned reflexes, especially reflexes of oral automatism (search, sucking, proboscis), as well as the Babkin reflex and the Moreau reflex, can occur at the slightest irritation, which sometimes creates the impression of a spontaneous reflex. In such cases, the reflex zone is usually expanded, the latent period is shortened, and with repeated irritations there is no tendency for it to fade. Then they talk about a pathological increase in the reflex.

Inhibition of unconditioned reflexes or their excessive severity indicate damage to the nervous system. In the early period of the newborn, inhibition of unconditioned reflexes is most often due to:

intrauterine hypoxia;
asphyxia in childbirth;
intracranial birth trauma;
anomalies in the development of the brain;
hereditary metabolic diseases;
toxic-infectious diseases.

The absence or sharp inhibition of unconditioned reflexes can also be associated directly with a violation of muscle tone - its sharp increase (some malformations of the brain, asphyxia during childbirth) or with its pronounced decrease (spinal amyotrophy, congenital myopathy, etc.). In this case, there may be an uneven decrease in unconditioned reflexes. So, with spinal amyotrophy, against the background of a general decrease in the activity of unconditioned reflexes, reflexes of oral automatism remain relatively intact. Activation of reflexes of oral automatism is characteristic of pseudo-bulbar disorders.

Pronounced asymmetry of reflexes (normally evoked on the one hand and absent or depressed on the other) is associated, as a rule, with peripheral damage to the nerves, roots, and cells of the anterior horns of the spinal cord. Less often, the asymmetry of the reflexes is due to central hemiparesis. With obstetric paresis of the hand, the Babkin reflex and the Robinson reflex may be absent. The paretic hand does not take part in the Moro reflex. With paresis of the facial nerve, the search reflex on the affected side is not fully expressed - the corner of the mouth does not take part in the reflex response. Asymmetry of the Talent reflex is observed with unilateral lesions of the spinal cord, with hemihypoplasias. With a transverse injury to the spinal cord below the level of injury, there will be no response characteristic of this reflex, as well as a cross extensor reflex and a jerk reflex.

Among the many physiological reflexes, the following have the greatest diagnostic value.

Sucking reflex. If you put a nipple in your baby's mouth, he starts to make active sucking movements. Disappears at the end of the first year.

The sucking reflex is absent: paresis of the facial nerves, profound mental retardation, serious condition.

Kussmaul reflex(search reflex) - with dashed skin irritation in the area of the corner of the mouth (do not touch the lips), the corner of the mouth drops, the tongue deviates and the head turns towards the stimulus (search for the mother's breast). The reflex is especially well expressed before feeding. Fades away in 6-7 weeks, disappears by the end of the first year.

Reflex asymmetryKussmaul: unilateral paresis of the facial nerve.

ReflexKussmaul is missing: bilateral paresis of the facial nerve, damage to the central nervous system.

Proboscis reflex. It is caused by a light tapping of a finger on the cheek at the corner of the mouth. There is a contraction of the circular muscle of the mouth, causing the lips to stretch with the proboscis.

Babkin's reflex(reflex palmar-roto-head, hand-mouth). Caused by finger pressure on the palmar surface in the tenor area (elevation of the thumb) of the newborn. In response, the newborn makes a grasping movement, opens his mouth and bends his head, turning it towards the stimulus. Babkin's reflex disappears by 3-4 months. With hydrocephalus, cerebral palsy with a lack of mental development and the formation of speech can be caused at the age of over 5 months.

Babkin reflex asymmetry: obstetric paresis of the hand.

The Babkin reflex is absent or reduced: damage to the brachial plexus, asphyxia, cerebral hemorrhage, brainstem lesions (spontaneous nystagmus, lack of pupillary response to light, a symptom of a floating gaze, impaired swallowing), paresis of the flexors of the fingers.

Reflex asymmetric neck-tonic. It is called in a newborn lying on his back, turning his head to the side. At the same time, the tone of the extensors of the upper and lower extremities increases on the side facing the face, and decreases on the other side ("swordsman's posture").

Reflex is delayed: intrauterine and birth disorders.

Robinson reflex(grasping reflex, tonic grasping reflex) - a continuation of the Babkin reflex. The child must grab the doctor's fingers so that it can be lifted. You can also cause a reflex from the lower extremities, if you press your finger on the sole at the base of the II-III fingers - this causes plantar flexion of the fingers.

Robinson's reflex weakens by 3-4 months of life and by the year it completely disappears.

Asymmetry of the Robinson reflex: obstetric paresis of the hand.

Robinson's reflex is absent: severe birth trauma, cerebral palsy, damage to peripheral nerves (paresis of both hands).

Babinsky reflex. Stroke irritation of the sole in a child of the first months of life causes extension and fan-shaped divergence of the fingers. The physiological Babinski reflex is accompanied by flexion of the hip, lower leg and dorsiflexion of the foot.

Moro reflex invoked in various ways:

the child, who is in the hands of a doctor, is sharply lowered down to a distance of 20-30 cm, and then lifted up to the initial level;
quickly straighten the lower limbs;
sharply hit the table on which the child lies, at a distance of 15-20 cm from the head on both sides.

In response to these actions, the child leans back, his shoulders unbend and his arms spread apart (the first phase of the reflex). In the second phase of the reflex (the hug reflex), the hands return to their original position. It normally lasts up to 4 months. Weakens by 2-3 months.

Moro reflex asymmetry: obstetric paresis of the arm, fracture of the clavicle.

Moro reflex weakened: hemorrhages in the brain.

Moro reflex absent: paresis of both hands, cerebral damage, cerebral edema.

The straightening reflex and the support reflex. The child, raised by the armpits, bends the legs in all joints. Placed on a support, he unbends his legs, straightens his torso, neck and stands on half-bent legs on a full foot.

Reflex missing: hypertonicity, cerebral palsy (ICP).

Automatic walking reflex. It is a continuation of the straightening and support reflexes. If the child standing on the table is slightly tilted forward, then he makes step movements that are not accompanied by the movement of the hands. Sometimes when walking, the legs cross at the level of the lower third of the legs or feet.

There is no automatic walking reflex:(crossing the legs and standing on the fingers - the "pose of a ballerina"): hypertonicity, spastic paresis, cerebral palsy.

Bauer reflex(crawling reflex). It is called when the child is placed on his stomach and the support for his soles is created with the palm of his hand. The child, starting from the support, begins to crawl.

Reflex Galant(paravertebral reflex) - with dashed skin irritation near and along the spine, an arcuate flexion of the body and a turn of the head in the direction of the stimulus occur. Sometimes the leg is extended and retracted.

Asymmetry of the Galant reflex: unilateral lesion of the spinal cord, hemihypoplasia.

Galant reflex is absent: paresis of the back muscles, severe birth trauma.

Perez reflex caused by light pressure with a finger on the spinous vertebrae from the coccyx to the neck. It is manifested by a loud cry, raising the head, arching the body (lumbar lordosis), raising the pelvis, flexing the lower and upper extremities, and general muscular hypertension. Sometimes there is urination and defecation. This reflex should be investigated last, as the child reacts negatively to it (crying).

Weakens and disappears the Perez reflex by 2-3 months of age.

Peres reflex absent: severe damage to the central nervous system.

When evaluating the results of a study of unconditioned reflexes in newborns, it must be borne in mind that they are of diagnostic value only in combination with other symptoms. A change in any one reflex in the absence of other neurological disorders has no independent diagnostic value.

A moderate increase in the main congenital reflexes can be observed with a mild form of perinatal encephalopathy (syndrome of increased neuro-reflex excitability).

A significant decrease in basic congenital reflexes can be a manifestation of:

hypertensive-hydrocephalic syndrome;
syndrome of depression of the central nervous system.

The results of the study of the state of the nervous system in a child in the first month of life give only a qualitative description. Quantitative characteristics of the identified disorders of neuropsychic development using scoring makes it possible for the local doctor to predict early the likelihood of deviations in the activity of the central nervous system and in the further development of the child. In addition, a quantitative assessment helps to differentiate the causes of developmental deviations, as it allows you to more clearly establish which functions suffer in the first place and to the greatest extent (L.T. Zhurba, E.M. Mastyukova).

According to the proposed method, a quantitative assessment is carried out on the basis of indicators that are evaluated according to a four-point system (optimal development of a function - 3 points, its absence - 0 points), taking into account the dynamics of normal age development. The optimal score on the scale of age development corresponds to 30 points.

A score of 27-29 points can be considered as a variant of the age norm, but it must be borne in mind that if a child loses 3 points in terms of any one function or due to the presence of risk factors, it should be classified as a risk category for developmental disorders or the possibility of detecting local disorders (vision, hearing, etc.). Such a child needs mandatory dynamic observation by a neurologist.

When assessing 23-26 points, the child is referred to the risk group.

A score of 13-22 clearly indicates developmental delay.

A child with a score below 13 has severe general developmental delay as a result of an organic lesion of the central nervous system.

For greater reliability of the assessment obtained during the first patronage, it is necessary to repeat the study during repeated patronage.

A quantitative assessment of the age development of the newborn in all parameters in combination with clinical data will allow, if necessary, to consult the child early with a neuropathologist, and therefore approach the formulation of a nosological diagnosis and prescribe not only adequate rehabilitation therapy, but also determine the timing of dynamic observation by a neuropathologist . In cases where it is necessary, the child is hospitalized.

Quantification of the development of the newborn (1st week)

(L.T. Zhurba, E.M. Mastyukova)

№	Index	Response score, points
№	Index	3	2	1	0
Dynamic Features
1	The ratio of sleep and wakefulness (sociability)	Sleeps calmly, wakes up only for feeding or when wet, falls asleep quickly	Sleeps calmly, does not wake up wet and for feeding or full and dry does not fall asleep	Does not wake up hungry and wet, but full and dry does not fall asleep or often screams for no reason	It is very difficult to wake up or sleeps little, but does not scream, or screams constantly
2	Voice reactions	The cry is loud, clear with a short inhalation and an extended exhalation	The cry is quiet, weak, but with a short inhalation and an extended exhalation	The cry is painful, piercing or isolated sobs on inspiration	There is no cry, or separate screams, or an aphonic cry
3	Unconditioned reflexes	All unconditioned reflexes are evoked, symmetrical	Require longer stimulation, or are rapidly depleted, or are inconsistently asymmetric	Not all are called, or after a long latency period and repeated stimulation, are rapidly depleted, or are persistently asymmetric	Most reflexes are not triggered
4	Muscle tone	Symmetric flexor tone overcome by passive movements	Mild asymmetry or a tendency to hypo or hypertension without affecting posture or movement	Persistent asymmetries, hypo- or hypertension, limiting spontaneous movement	Postures of opisthotonus or embryo or frog
5	Asymmetric cervical tonic reflex	When turning the head to the side, it unsteadily unbends the "front" arm	-	Constant extension or no extension of the arm when turning the head to the side	Swordsman Pose
6	Chain symmetrical reflex	Absent	-	-	-
7	Sensory reactions	Squints and worries in bright light; turns his eyes to the source of light; shudders at loud noise	One of the responses is questionable	One of the responses of score 3 is absent or two or three responses are doubtful	All reactions from score 3 are missing
Risk factors
8	stigmas	Missing	No more than 5-6	More than 6 and located mainly in the facial area	More than 8 or the presence of gross malformations
9	cranial nerves	No pathology or non-permanent mild convergent strabismus, or non-permanent mild Graefe's symptom	Combination of 2 features from score 3 or mild facial asymmetry or intermittent horizontal nystagmus	Permanent strabismus or severe nystagmus, or permanent Graefe's symptom, or bulbar or pseudobulbar syndrome	Combination of symptoms listed in score 1
10	Pathological movements	There are no single rare athetoid movements of the fingers, or a rare high-frequency tremor of the chin, hands during screaming, feeding, passive movements	Frequent athetoid finger movements or fine, high frequency tremors not associated with anxiety	Combination of 2 of the symptoms listed in score 2, or large-scale spontaneous tremor, or sporadic facial muscle twitches	convulsions

How is the neonatal period determined, what is its duration? It is scientifically substantiated that this period lasts 28 days, at this time the primary adaptation of the child to the environment takes place. The reflexes of the newborn help the adaptation, these are the inherent mechanisms that allow the baby to perform their first (yet unconscious) actions.

Types of reflexes - classification

There are 2 types of reflexes - conditional and unconditional, in infancy only unconditional ones work, laid down from birth. Conditional ones appear later, on the basis of experience.

In total, 15 unconditioned reflexes of newborns are distinguished, each of them has its own purpose. Some appear and disappear immediately, others fade slowly, and still others remain forever.

There are several groups of basic reflexes of newborns:

Aimed at ensuring general life activity (breathing, swallowing, sucking, spinal motor automatisms).
Providing safety for the child's body when exposed to external stimuli.
"Temporary", which work to maintain a single process. For example, there is a reflex breath holding, so that the child can move through the birth canal.

Table of basic reflexes of newborns by months

oral reflexes

From the very first minutes of life, a small organism needs food. No one teaches to suck milk from the breast and swallow the baby, everything is based on reflex activity.

Sucking reflex The baby has it since birth. Thanks to him, the baby is able to grasp the nipple of the breast or the pacifier with his lips and makes rhythmic sucking movements. The reflex is strongly pronounced up to a year, it is natural for the appearance of the main teeth, with the help of which sucking is replaced by chewing.

Up to 3 years, it remains mild. The intensity of sucking signals the degree of hunger of the baby, if the child is full, then the sucking becomes weaker, it is expressed stronger towards the meal. The constant weakness of the sucking reflex is due to many reasons, the establishment of which occurs with the help of a doctor.

Swallowing reflex promotes swallowing of the received food. It is caused by the work of the medulla oblongata and persists for life.

proboscis reflex it persists for a shorter time - by two to three months it disappears. Touching a finger or an object to the baby's lips causes the mouth to curl into a tube, resembling a small trunk.

Babkin's reflex, it is also called palmar-oral. If you lightly press both palms of the child, then the baby slightly opens his mouth. By three months, the reaction fades away, after which it disappears completely.

Search reflex (Kussmaul) . An attempt to touch the cheek at the corner of the mouth (very lightly) leads to a search for a stimulus, that is, a search for food. After three months, the reflex disappears, the baby determines the source of food visually. When checking it, you should not touch the lips of the crumbs directly, otherwise you will get a proboscis reflex.

Spinal automatisms

spinal reflexes newborns characterize the infant's muscular apparatus and its condition.

defensive reflex is found in turning the head when laying the crumbs on the stomach. In this way, the child opens air access to the respiratory tract. With damage to the central nervous system, this reflex is usually absent.

Grasping (monkey) reflex - the ability to firmly grasp and hold the fingers of an adult placed in the palms of an infant. Raising the fingers is another similar Robinson reflex. Weakening occurs by four months.

- this is when, when stroking the soles, the fingers open in a fan-shaped way, and the feet bend from the back.

Reflexes of the newborn - plantar reflex (Babinsky)

This reflex is preserved up to two years, the symmetry of the reaction and energy is an indicator for evaluating the child.

Moro reflex (hugs) - a reaction consisting of two phases that occurs in response to noise or knocking.

At first, the baby spreads his arms in different directions and opens his fingers, while his legs straighten. Then the arms and legs return to their original position, resembling a hug. This reflex is observed up to five months. An incomplete Moro reflex or its asymmetry is manifested in lesions of the nervous system.

Kernig's reflex observed when it is not possible to unclench the hip joint after flexion. After reaching four months, it completely disappears.

Automatic walking reflex tested with armpit support and a slight forward lean. The baby takes steps without accompanying them with hand movements. Normally, the baby should lean on the entire foot and walk without clinging.

If the legs are slightly crossed, then this is considered acceptable in the first 1.5 months. The ability to walk independently is an already acquired skill, due to the complex work of the cerebral cortex, which develops by the age of 1 year. If the "automatic gait" remains for a long time, then this may be a manifestation of a CNS lesion.

Support reflex visible when the baby, holding, is placed on a hard surface. First he pushes his feet away, then he flattens out, pressing his tiny soles firmly against the ground. During the entire month and a half, the support and walking reflexes are well expressed.

Crawling reflex (Bauer) - it is called spontaneous crawling, this happens when the baby is placed on the stomach or back. The movements are intensified if you put your palm on the soles of the child, the baby can even move forward. There is a reflex for 3-4 days, and extinction for third fourth month. An alarming sign is a violation of symmetry or the preservation of creeping movements up to six months - a year.

Reflex Galant called the response of the spinal area to an external stimulus. If you move your finger along the back, then the child will arch the back and straighten the leg from the side of impact.

Postural reflexes (automatisms)

The group of these reflexes is based on the redistribution of muscle tone as the child's motor development progresses. While the baby is not yet able to hold his head, cannot sit, walk and stand, his muscles must be regulated. The medulla oblongata and, subsequently, the midbrain are responsible for regulation.

Magnus-Klein reflex (asymmetric tonic neck) - the baby takes the "swordsman's pose" if his head is turned on its side while the little one is on his back. That is, the limbs where the face turns are unbent, and the opposite ones are bent.

Name	How to stimulate	Response to stimulus	Appearance (age)	Disappearance (age)	Reasons for deviations
Search	cheek stroking	Turning the head to the stimulus, opening the mouth	From birth	3-4 months (in sleep up to 12 months)	Lethargy, depression of the nervous system. cerebral palsy
sucking	Touching lips or mouth	Sucking movements	From birth	4 months (in sleep up to 7 months)	The satiated one reacts badly. Prematurity, CNS depression
Cervical tonic ("swordsman")	While the baby is on his back, turn his head to the side	Straightening the arms and legs from the side of the turned head; on the opposite side, the arm and leg are bent	Birth - 2 months	4-6 month	Inability to get out of this state or persistence from 6 months - violations of motor neurons
Prehensile	Put your finger in the child's hand	Firm grasping of the fingers with both hands	From birth	3-6 month	CNS lesions
Walking reflex	Underarm support, slight forward lean. Feet must touch the surface	Similarity of steps, alternating movements of the legs	From birth	2-4 month	Absence: cerebral palsy, paralysis of the legs, depression of the child
Reflex Moro (hugs)	Sudden sound or pop when the baby is lying on its back	Symmetrical opening of the arms and straightening of the legs, after a few seconds wrapping your arms around yourself	From birth	Up to 4 months	Paralysis or fracture of the clavicle leads to asymmetry, absence or long action - disorders of the brain structures
plantar reflex	Pressing on the toes	Symmetrical finger curl	From birth	4-8 month	cerebral palsy, brain damage
Babinski's reflex	Run along the sole to the fingers from the heel	Finger unclenching fan-shaped	From birth	About a year	cerebral palsy, CNS lesions

Checking the severity of reflexes is carried out with the help of a neurologist and a pediatrician, they are able to determine how well the functions of the infant's nervous system work.

What affects the untimely appearance of reflexes in newborns?

The reasons are completely different, ranging from trauma during childbirth, ending with an individual reaction to medications. Spinal or oral reflexes of the newborn are mild in case of prematurity or mild asphyxia.

It is not always necessary to sound the alarm if sucking and searching behavior is weakly expressed, perhaps the baby is just full, then he does not show strong reflex activity. But before feeding, on the contrary, sucking and searching are intensified.

If the reflexes of the newborn are not observed at all, then this is an occasion for immediate qualified medical care. The most important life support functions can suffer if the baby is not properly maintained in time. There can be several reasons: severe malformations of intrauterine development, severe asphyxia, injuries sustained during childbirth.

Of course, parents should have information about innate reflexes, but only an experienced neonatologist or pediatrician can professionally assess the state of health of a child. Deviations from the norm are significant and not very, with minor violations, the doctor will prescribe treatment or special procedures. If the deviations are strong, then the doctor will help to understand the reasons, and will be able to take emergency measures so that the baby is not in danger.

Any strange manifestation of the child's behavior requires increased attention, because his successful adaptation to the world depends on it. The reflexes of a newborn are the care of nature itself so that the baby can feel as comfortable as possible.

As soon as a calf and a deer are born, they immediately jump to their feet, and the newborn monkey clings to the mother's fur with its fingers and hangs on it like on a liana. Their actions are guided by the genetic memory of a biological species, into which innate newborn reflexes. The human cub also has them, and they are very different.

All mothers know that in the first months of life, the baby knows how to swim and dive - it holds its breath and closes its eyes when water gets on its face. He does this solely thanks to innate reflexes, which fade away if they are not supported. You will work with the crumbs in the bath to develop this skill, and it will be fixed for life. But there are also such innate reactions that fade away by a certain date - it is impossible to save them, and it is not necessary. A child who has left infancy does not need a sucking reflex - so it disappears in the second year. According to the strength and severity of congenital reflexes of newborns, as well as whether they cease to exist in time, giving way to more complex motor reactions, a pediatrician and a neurologist can say a lot about the state of the nervous system and the prospects for the development of the baby. And they took them into service, developing gymnastics for the smallest. By evoking certain reflexes in the right sequence, experts force the baby to work with muscles - after all, you can’t explain to him what should be done, but thanks to innate motor reactions, everything happens by itself.

Exercises for newborns

Put your thumbs in the palms of the baby lying on the back. Holding on to them, he tenses a little, raises his head, bends his arms, tears off his shoulders from the swaddle, as if trying to sit down (only you don’t need to put him on for real yet). A healthy full-term baby can do this exercise from 2-4 weeks.

Sucking reflex

The so-called reflexes of oral (oral) automatism, which are carried out on the lowest floor of the subcortex - at the level of the brain stem, are responsible for ensuring that the child is always full.
It is worth giving a mother a breast to a baby, and he automatically makes sucking movements. The baby generally sucks everything that gets into the mouth, whether it's a pacifier, a finger, a toy, the edge of a diaper. What to pay attention to. Rhythmic sucking soothes the baby. For him, this is both hard work (when you have to get milk from his mother's breasts) and pleasure (when he sucks on a pacifier). It is very important that the baby satisfy his need to suck (and this is easiest to do when breastfeeding). If he was not sucked to his heart's content in infancy, they can form - from sucking a finger and hair to biting nails.

When it fades
Weakens after 12 months, and finally disappears by 1.5 years. True, the baby will make sucking movements in a dream even at an older age, especially if he sleeps sweetly and deeply.

Search reflex

To call it, it is enough to touch the dummy to the cheek on the side of the baby's mouth (without touching the lips). The corner of his mouth will immediately drop, the baby will turn his head towards the irritant. And if you press the nipple a little on the middle of the lower lip, the child will open his mouth, fold it with his proboscis and slightly bend his neck - he will try to grab the pacifier. These reactions are especially pronounced before feeding, when the baby is hungry. Have you noticed: before taking the nipple more firmly, does the baby shake its head a little? Over time, this gesture will acquire a semantic coloring - it will accompany the reproachful "ay-ay-ay!" or a resounding "no!" The basis for such a conversation in body language will be precisely the search neonatal reflex. With its help, the baby gradually masters facial expressions, and in particular learns to smile. What to pay attention to. The grimaces of the crumbs, when the doctor or mommy cause a search reflex, should be the same (symmetrical) on both sides. If this is not the case, the baby needs to be shown to a pediatric neurologist: if one half of the face reacts differently than the other, birth trauma and inflammation of the facial nerve must be excluded. When it fades After 3-4 months, the need for a search reflex disappears: the baby already reacts not to the touch of the nipple to the lips, but to its appearance - he notices that mom picks up a pacifier or is preparing to feed, and opens her mouth.

Wean your baby two or three times during feeding (just be careful not to upset or anger him). You see - he is again looking for a nipple, reaching for it! This is very useful for the development of facial muscles and the formation of the speech apparatus.

proboscis reflex

A quick and light touch of a mother's finger or a pacifier to the baby's lips makes the baby fold them with a proboscis. This reaction is a constant element of sucking movements. It is even sung about her in a song: “Sponges with a bow, eyebrows with a house ...” What to look for. Pediatric neurologists have such a concept - “mouth attention”. This is when the baby of the first months of life carefully peers into the face of the mother bending over him and seems to be trying to copy her facial expressions. And first of all, the mouth comes into motion. This is where the proboscis comes to the rescue neonatal reflex helping the baby fold the lips with a touching bow.

When it fades
After 2-3 months. If the reflex persists longer, show the baby to a pediatric neurologist!

Palmar mouth reflex

Lay the child on the back, take his hand in yours and lightly press your thumb into the center of the palm, first from one side and then from the other side. The baby opens its mouth and bows its head. What to pay attention to. Did the child suffer from oxygen starvation while in the mother's tummy, or during childbirth? Got a birth injury? Were you born weak? If in the first days the palmar-oral reflex in newborns- this is a good sign: the nervous system is perfectly recovering after the tests! What to pay attention to. The reflex is not called from any one side? The reason is the weakness of the muscles of the arm (paresis). Be sure to tell your pediatrician and pediatric neurologist about this!

When it fades
Ideally, by 3 months. The palmar-mouth reflex should give way to voluntary hand-mouth reactions, which are very important for the baby, and are formed on its basis. First, the baby pulls a toy into his mouth, opening it wide (it is important for the baby to recognize the object not only by touch, but also by taste), and then he brings cookies and a spoonful of porridge to it. If this reflex intensifies over time and occurs even at the slightest touch to the children's hands, it means that not everything is in order with the nervous system of the crumbs. Observation and treatment by a neurologist will help prevent the formation of cerebral palsy.

What can a newborn do?

Crawling, standing and even walking - all this is obtained by the newborn by itself, without the slightest effort. The set of movements performed in the first months of life is the same, and even more than that, it is strictly mandatory for all babies and is programmed at the level of the spinal cord. Over time, these reactions disappear so that the child can develop the appropriate skills on his own - once and for all his life.

defensive reflex

Put the baby on the tummy - he turns his head to the side. Without this automatic reaction, the child would simply suffocate, burying his face in the pillow!

What to pay attention to. If the nervous system of the baby is not mature enough or suffered during childbirth, the protective reflex may be absent. Then mommy will have to turn the baby's head herself, laying it on her tummy, and constantly monitor this in the first months. The other extreme, associated with an overreaction, is also alarming: the child not only turns his face away, but also throws back his head, holding it in this position for quite a long time. This indicates an increase in the tone of the muscles of the neck and back. For what reason it is so strengthened - the children's neurologist should understand! When it fades
Completely - by 3 months, and weakens when the baby is one month old.

Crawl reflex

They put the newborn on the tummy, and he tries to crawl in a plastunsky way. Mom put her hand to the children's feet - the baby began to push off from them with his legs, crawled even more actively. What a little partisan! What to pay attention to. If the movements on one side are not as active as on the other, most likely the child has problems with tone. In babies who have suffered oxygen starvation (asphyxia) or birth trauma, the reflex may be absent. Such a baby needs special neurological treatment, and when a month old - massage and gymnastics. True, even healthy babies refuse to crawl in the first 3-4 days of life. It's quite normal. But if the corresponding movements did not appear later, it is necessary to show the child to a specialist.

When it fades
At 4 months.

Fitball for a newborn

Put the child on the back and press your palms or an inflatable ball tightly against his feet - the baby will push off the obstacle, strengthening the muscles of his legs.

Support and automatic gait reflex

Take the baby under the armpits (face to you), creating support for his head with your fingers (on both sides). Hold vertically on weight - he will tighten his legs. Now put it down on the changing table. The baby will stand, fully loading the foot. Check - the fingers are not tight, the legs are slightly bent. Slightly tilt his torso forward, and the baby will take a few steps. Ideally, the legs should not cross, but if this still happens in the lower third of the legs, do not worry - this option is also acceptable for a newborn. What to pay attention to. If reflex in a newborn absent, one of two things - either the baby has weak muscles, or the nervous system has suffered. Does the baby walk on straight legs, crossing them high? Relies not on the entire foot, but only on its edge, tightens the fingers? Tell the neurologist about it!

When it fades
At 1-1.5 months. After that, the baby's legs give way by themselves when mommy tries to put him on the swaddle. Only closer to the year the child will again learn to stand, and then walk.

grasp reflex

You put your fingers in the hands of the baby, and he grabs them so tightly that he can even hang in your arms if you slightly lift him up. Monkeys clinging to their mother's hair do the same. Here is a visible confirmation of Darwin's evolutionary theory! Moreover, a grasping reflex can also be evoked on the soles. You just need to slightly press your thumb on the ball of the foot - and the fingers will immediately bend. And if you quickly and abruptly draw the blunt end of the pencil along the sole of the crumbs, they will disperse like a fan (Babinsky's reflex).

What to pay attention to?
If the grasping is very active, then the baby is too excitable. Is the capture weak and not always called? The nervous system is inhibited, depressed. In both cases, it is imperative to consult the child with a neurologist.

When it fades
Babinsky's reflex - a year, grasping - in 3-4 months. After all, he should be replaced by arbitrary grasping: the baby saw the toy, reached out and took it.

Fingers fanned out

Gently lay the baby on the back, take his legs from below by the heels, holding them between the index and middle fingers, as if in a slingshot. Stroke the edges of the feet with your thumbs - in response, he will turn them outward and fan out his fingers. Press gently on the pads of the feet at the base of the toes - the baby will immediately squeeze them. This exercise can serve as an excellent prevention of flat feet!

Moro reflex

If you dropped the bottle on the changing table next to the baby or lifted it too sharply by the legs when changing the diaper, the baby gets scared - spreads the handles to the sides and opens
palms, and then folds her fists again and presses them to her chest.

What to pay attention to?
Mom should be interested in whether the child spreads her arms evenly. If one lags behind the other, then the tone let us down. It is bad when there is no reflex in the first days after birth - this indicates a birth trauma. Does the baby spread its arms every minute when you change clothes, at the slightest noise and even for no reason at all? The nervous system is overexcited - consult a specialist!

When it fades At 4-5 months.

Reflex Talent

Put the baby on the tummy and slide the tip of your index finger to the left of the spine (departing from it no more than 1 cm) from top to bottom. The baby will arch the back in the opposite direction. Now do the same on the right.

What do you need to pay attention to? The reaction should be the same on both sides. It is called from the 5-6th day of life. If reflex in newborns weakened or absent during the first month, show the child to a neurologist.

When it fades At 3-4 months.

We develop a beautiful posture.

Call the Talent reflex in turn to the left and right of the spine several times in a row to strengthen the muscles of the back - this will help the baby develop a beautiful posture in the future.

Perez reflex

Be warned: Toddlers really don't like this exploration! In order not to disturb the baby once again, let the neurologist check the Perez reflex. He will run his finger along the spine from the bottom up, slightly pressing on the spinous processes that are palpable under the skin. In response to such an appeal, the child will scream in protest, raise his head, straighten his body, and bend his arms and legs. It's obvious that he's uncomfortable! But now both mommy and the doctor can be calm for the baby - his reaction is good, muscle tone is uniform, everything is in order with the spinal cord.

What to pay attention to? The absence, inhibition or too long preservation of this reflex indicates damage to the central nervous system.

When it fades At 3-4 months.