Peds (L5) - Examination (Pt. 2)

What are Brazelton's behavioral states (red, yellow, green light) for infants?

1. quiet sleep --> red light/don't treat

2. active sleep --> red light/don't treat

3. drowsy --> green light/ okay to treat

4. quiet alert --> green light/okay to treat

5. active alert --> yellow light/ treat or assess with cautio

6. crying --> red light/don't treat

What are reflexes?

involuntary stereotyped movement responses to a specific stimuli

When do most reflexes integrate?

by 1st birthday

What are 2 reasons explaining why infant reflexes might not completely disappear?

- may be inhibited by maturing CNS

- may be integrated into new movements --> indicates cortical control or higher brain levels are maturing and taking over

What are infant reflexes a simple and quick assessment tool of?

the maturity and integrity of the CNS in newborns and young infants

What can severe deviations from reflexive time frames indicate?

a neurological immaturity or dysfunction

What are the components of infant reflex documentation?

-absent or present

-unilateral or bilateral --> symmetrical/asymmetrical

-integrated or not

-age appropriate

-obligatory

What are obligatory reflexes?

every time the stimulus is applied the reflex is present --> abnormal response

even for ATNR at its peak

Primitive reflexes are also known as ____ ____ or ____ ____

infant reflexes

developmental reflexes

rooting reflex is also known as the ____reflex and the ____ ____ reflex

search

cardinal point

What is the stimulus and response of the rooting/searching reflex?

S: touch check anywhere around the mouth

R: head moves toward stimuli and mouth opens (searching for da booba)

What is the duration of the rooting/searching reflex?

28 weeks GA to 3 months postpartum

What is the significance of a lack of the rooting/searching reflex?

-problematic for nutrition

-sign of CNS or sensorimotor dysfunction

What reflex is the rooting/searching reflex in conjunction with?

Sucking

The rooting/searching reflex helps contribute to ___/___ ___ reflexes.

head/body righting

What is the stimulus and response of the sucking reflex?

S: touch of infant's lips with finger or nipple

R: sucking action

what is the significance of an absence of the sucking reflex?

problematic for nutrition

What infants reflexes are used to test for symmetry of movement?

-galant

-moro

-palmar

-plantar

-neck righting

-body righting

-stepping

What is the stimulus and normal response of the galant reflex?

S: gentle stimulation along the paravertebral line from shoulders down to hips --> both sides 3 cm from midline

R: incurving or flexing of trunk TOWARD the side, assessing with production of folds in skin

What is the duration of the galant reflex?

32 weeks GA to 2 months

What is the duration of the sucking reflex?

28 weeks GA to 3 months postpartum

What dysfunctions can occur if the galant reflex persists past normal timeframes?

-lead to scoliosis

-may cause considerable delays in the development of symmetrical stabilization of the trunk and of independence of the head necessary for sitting, standing, and walking

T/F: the galant reflex would be absent above the level of a transverse Spinal cord lesion

false; below

What is the stimulus and expected response of the palmar grasp reflex?

S: pressure on palm of hand

R: fingers and NOT the thumb close

What is the duration of the palmar reflex?

birth -4-6 months postpartum

What is the significance of an absent palmar reflex?

may indicate neurological problems that could interfere with:

-ability to grasp and release objects voluntarily

-weight bearing on one hand for propping, crawling, and protective responses

T/F: an indwelling thumb is a normal reflexive response

false; could indicate neurological issue

What is one of the most noticeable infant reflexes?

palmar grasp

What infant reflex may lead to voluntary reaching or grasping?

the palmar reflex

What is the stimulus and expected response of the plantar grasp reflex?

S: touching the ball of the foot

R: toes flex or grasp

What is the duration of the plantar grasp reflex?

28 weeks gestation - 9 months

What does asymmetry of the plantar reflex possibly indicate?

insult or lesion on one side of the brain

What does failure to obtain or late persistence of the plantar reflex indicate?

general depression of the CNS or sensorimotor depression

What can a persistent plantar reflex interfere with? 4

-weight shift

-standing

-walking

-balance reactions

What does a completely absent plantar reflex indicate?

defect in SC

What is the stimulus and expected response of the neonatal neck righting reflex?

S: place infant in SUPINE with the head in midline, then turn their head to one side

R: the body will follow the direction of the head turn AND the body will turn as a whole

What is the duration of the neonatal neck righting reflex?

34 weeks GA --> inhibited by mature neck righting at 4-6 months

Persistence of the neonatal neck righting reflex can prevent what?

segmental rolling

What reflex is needed for an infant to learn how to roll from their back to their side?

neonatal neck righting reflex

What is the neonatal neck righting reflex also called?

neck on body reflex

What is the stimulus and expected response of the neonatal body righting reflex?

S: place infant in supine with the head in midline --> flex one leg up toward chest and rotate the leg across the body to force infant to roll over

R: the thorax, chest and head will follow pelvis as a whole

What is the duration of the neonatal body righting reflex?

34 weeks GA --> inhibited by the mature body righting at 4-6 months

What can the neonatal body righting reflex prevent if persistent?

development of segmental rolling --> leads to motor delays bc the child will be unable to use rotational components of movement

What is another name for the neonatal body righting reflex?

body on body reflex

What is the stimulus and expected response of the moro reflex?

S: support infant's head and shoulders with hands --> allow head to drop back 20-30 degrees with respect to the trunk, stretching the neck muscles

R: ABDuction of the UEs with extension of the elbows, wrist, fingers --> followed by ADDuction of the arms at the shoulder and flexion at the elbows

What is the duration of the moro reflex?

28 weeks GA to 4-6 months

What infant reflex is involved in breaking up flexion postures present at birth?

moro reflex

T/F: the moro reflex should be universally present in normal or full term infants

true

Asymmetry of the moro reflex could indicate what?

insult to one side of the brain or to a nerve supply --> possible Erb's palsy

The moro reflex must disappear before what is possible?

sitting

Does the moro reflex come before or after protective and tilting reactions?

before

T/F: reaction time of the moro reflex increases with age

true

What is the stimulus and expected response of the startle reflex?

S: sudden loud noise

R: abduction of the UE with flexion of the elbows, extension of the wrist and fingers, followed by adduction of the arms and flexion of the elbows

same as moro but elbows remain flexed throughout

What is the stimulus and expected response of the neonatal positive support reflex?

S: support infant in the vertical position with PT hand's under the arms and around the chest

*allow infant's LEs to make full and firm contact with the mat or table*

R: weight bearing and extension at the hips and knees --> infant is only bearing partial weight and the hips and knees are only slightly extended

What is the duration of the neonatal positive support reflex?

35 weeks GA to 1-2 months

What reflex is a prerequisite for the spontaneous stepping reflex?

neonatal positive support reflex

When is the neonatal positive support reflex absent?

with hypotonia or primary muscle weakness

What can a persistent neonatal positive support reflex interfere with?

-standing

-weight shifting

-walking

-balance reactions

-contractures of ankles in PF

The ___ ___ ___ reflex indicates progression of muscle tonus

neonatal positive support

What is the stimulus and expected response of the Walking/stepping reflex?

S: support infant in the vertical position with PT hand's under the arms and around the chest

allow infant's LEs to make full and firm contact with the mat or table --> incline and move the infant forward to accomplish stepping

R: infant will make alternating rhythmical and coordinated stepping movements

What is the duration of the walking/stepping reflex?

37 weeks GA to 2 months

What does asymmetry of the walking/stepping reflex indicate?

-insult to one side of the brain

-muscle weakness

-injury

What is the difference btw a preterm and full term infant's walking or stepping reflex if no other injuries or dysfunctions are present?

full term --> coordinated, rhythmical heel to toe pattern like that of mature gait

preterm --> jerky, uncoordinated toe to heel gait

T/F: in full term infants, the UE will participate more strongly than the LE during the ATNR

true

The ATNR must be integrated in order for the infant to be able to ____

roll

Persistence of the ATNR will interfere with....

-appearance of mature neck righting

-attainment of symmetry of posture

What is the duration of the ATNR?

birth - 4-6 months

What is the stimulus of the tonic labyrinthine reflex?

position infant in prone or supine --> position of the infant's head in these positions is the stimulus

labyrinthine in the inner ear informs the infant of their position in space

What are the expected responses of the tonic labyrinthine reflex?

supine or sitting supported with the head back --> body and extremities tend to move in extension with shoulder retraction

prone or sitting supported with head dropped forwards --> body and extremities tend to move into flexion with shoulder protraction

What is the duration of the tonic labyrinthine reflex?

birth to 6 months

What does persistence of the tonic labyrinthine reflex interfere with?

-rolling

-lifting head in prone or supine

-propping on elbows with extended hips

-ability to flex trunk and hips to come to sitting from supine

What reflex if persistent may cause full body extension and therefore interfere with sitting and/or standing balance?

tonic labyrinthine reflex

what is the duration of the STNR?

birth to 6-8 months

integration of what reflex coincides with creeping?

STNR

what can happen as a result of a persistent STNR?

-creep like a rabbit or bunny hop

-hinders good sitting posture

-increases difficulty walking

-increases difficulty getting to the floor from standing

what reflexes, if persistent, can interfere with an infant's ability to roll?

-neonatal neck AND body righting --> prevent segmental rolling

-ATNR

-TLR