Pediatric Reflexes

What reflexes are integrated before 6 months

Flexor withdrawal
Crossed extension
Traction
ATNR
Palmar grasp

When is the onset of the flexor withdrawal reflex

28 weeks gestation

When is the flexor withdrawal reflex integrated

1-2 months

What is the stimulus for the flexor withdrawal reflex

Noxious stimulus (pinprick) to sole of foot

What response does the flexor withdrawal reflex produce

Toes extend, foot dorsiflexes, LE flexes uncontrollably

What is the onset for the crossed extension reflex

28 weeks gestation

When is the crossed extension reflex integrated

1-2 months

What is the stimulus for the crossed extension reflex

Noxious stimulus to ball of foot of LE fixed (held in place) in extension

What is the response for the crossed extension reflex

Opposite LE flexes, then adducts and extends

What is the onset for the traction reflex

28 weeks gestation

When is the traction reflex integrated

2-5 months

What is the stimulus for the traction reflex

Grasp forearm and pull up from supine into sitting position

What is the response for the traction reflex

Grasp and total flexion of the UE

What is the onset of the ATNR reflex

Birth

When is the ATNR reflex integrated

4-6 months

What is the stimulus for the ATNR reflex

Rotation of the head to one side

What is the response to the ATNR reflex

Flexion of skull limbs (back of head), Extension of the jaw limbs (face)
“Bow and arrow” posture → flexion of one side and extension of the other)

What is the onset of the palmar grasp reflex

Birth

When is the palmar grasp reflex integrated

4-6 months

What is the stimulus for the palmar grasp reflex

Maintained pressure to palm of hand

What is the response of the palmar grasp reflex

Maintained flexion of fingers

Which reflexes are integrated around 6 months

Moro
Symmetrical Tonic Labyrinthine (TLR/STLR)
Positive Supporting

What is the onset for the moro reflex

28 weeks gestation

When is the moro reflex integrated

5-6 months

What is the stimulus for the moro reflex

Drop patient backward from sitting position

What is the response to the moro reflex

Extension, abduction of UEs, hand opening and crying followed by flexion, adduction of arms across chest

What is the onset of the TLR/STLR reflex

Birth

When is the TLR/STLR reflex integrated

6 months

What is the stimulus for the TLR/STLR reflex

Prone or supine position
Preferred to try both

What is the response to the TLR/STLR reflex

Prone → increased flexor tone of all limbs
Supine → increased extensor tone of all limbs

What is the onset of the positive supporting reflex

Birth

When is the positive supporting reflex integrated

6 months

What is the stimulus for the positive supporting reflex

Contact to the ball of the foot in upright standing position

What is the response to the positive supporting reflex

Rigid extension (co-contraction) of the LEs

What reflexes are integrated after 6 months

Plantar grasp
STNR
Startle

What is the onset for the plantar grasp reflex

28 weeks gestation

When is the plantar grasp reflex integrated

9 months

What is the stimulus for the plantar grasp reflex

Maintained pressure to ball of foot under toes

What is the response to the plantar grasp reflex

Maintained flexion of toes

What is the onset of the STNR reflex

4-6 months

When is the STNR reflex integrated

8-12 months

What is the stimulus for the STNR reflex

Flexion or extension of the head

What is the response to the STNR reflex

Head flexion → flexion of UEs, extension of LEs
Head extension → extension of UEs, flexion of LEs

What is the onset for the startle reflex

Birth

When is the startle reflex integrated

Persists

What is the stimulus for the startle reflex

Sudden loud or harsh noises

What is the response to the startle reflex

Sudden extension or abduction of UEs, crying (adults usually scream)

What does a persistent ATNR reflex affect

Feeding
Supine to prone rolling

What does a persistent STNR reflex affect

Crawling
Quadruped

What does a persistent plantar grasp reflex affect

Standing
Walking

What does a persistent TLR reflex affect

Reciprocal creeping or functional movements in supine or prone

What does the Galant reflex cause babies to do

Curve their hip outward if the lower back is stroked next to the spine

What is the purpose of the Galant reflex

Encourage movement and develop ROM in the hip in preparation for walking and crawling