Primitive Reflexes, Developmental Milestones, APGAR GP(TPAL_

Moro Reflex

Stimulus: sudden neck extension

Response: Shoulder flex & abd, elbow ext, followed by shoulder ext abd, elbow flex

Age: 4-6 mos

Startle Reflex

Stimulus: sudden noise, clapping

Reponse: same as moro & crying

Age: 4-6 mos

Asymmetric Tonic Neck Reflex (ATNR)

AKA Archer’s reflex/ Fencer’s reflex

Helpful for dressing

Stimulus: head turning to side

Response: extremities extend on face side, flex on occiput side

Age: 6-7 mos

Symmetric Tonic Neck Reflex (STNR)

AKA Cheerleader

Quadruped pos

Stimulus: neck flexion extension

Response: arms flex, leg extend; arms extend, legs flex (UE same with neck mvt, LE opp)

Age: 6-7 mos

Tonic Labyrinthine Reflex

Stimulus: head position in space, stongest at 45 degrees from horizontal

Response: supine - extension; prone - flexion

Age: 4-6 (same as moro & startle)

Positive Supporting Reflex

Stimulus: light pressure or weight bearing on plantar surface

Response: legs extend for partial support of body weight

Age: 2-5 mos

Protective Extension Reflex

Stimulus: displacement of trunk in downward direction, while held or while sitting in FWD, Side, BWD

Response: extension of legs in downward and extension of arms in sitting

Age:

Sitting -

Ant - 5-7

Lat - 6-8

Post - 7-8

Standing - 12-14

Palmar Grasp Reflex

Stimulus: touch or pressure on palm of stretching finger flexors

Response: finger flexion, hand fisting

Age: 5-6 mos

Plantar Grasp Reflex

Stimulus: pressure on sole distal to metatarsal head

Response: flexion of all toes

Age: 12-14. Mos

Rooting Reflex (for feeding)

Stimulus: stroking lips or around mouth

Response: moving head towards stimulus

Age: 3-4 mos

Placement or placing reflex

Stimulus: tactile contact on dorsum of hand/foot

Response: extremity flexion to place hand/foot over an obstacle

Age: before end of 1st year

Automatic neonatal walking reflex

Stimulus: vertical support/held upright, feet touching surface

Response: alternating steps

Age: 3-4 mos

Neck righting/body devotional reflex

Stimulus: neck rotation in supine

Response: sequential body rotation

Age: 4 mos

Newborn

• flexor tone predominated

• In prone, turns head side to side

• Rounded spine in sitting

4 months

• head in midline

• Chin tucks when pulled to sit

• In prone, neck extends 90 deg and lifts chest slightly

• Turns to supine (prone to supine)

7 months

• maintain sitting, may lean in arms

• Rolls supine to prone

• Bears all weight & bounce

• Cervical lordosis

10 months

• creeps on all 4s

• Pivots in sitting

• Stands momentarily

• Cruises

• Slight bowleg

• Increased lumbar lordosis

• Waves bye bye

• Says mama dada

• Plays peek a boo

14 months

• walks alone on high to mid guard

• Wide base

• Excessive knee & hip flexion

• Foot contact on entire sole

• Slight genu valgus

• Pelvic tilt and pelvic rotation

18 months

• arms at low guard

• Mature base of support

• Heel strike

• Walks backward

• Seats self in chair

2 years

• begins running

• Walks up and down stairs with non alternating feet

• Jumps in place

3 years

• runs well

• rides tricycle

• Broad jumps

• Walks up stairs with alternating feet

• Descends stairs with non alternating feet

• Throws overhand/overhead

4 years

• walks down stairs with alternating feet

• Hops on one foot

• Plantar arches develops

• Sits up from supine pos without rotating

• Throws underhand

5 years

• skips

• Tiptoes

• Balances 10 seconds

• Kicks w 1 foot

• Throws diagonal

6 years

• rides bicycle

• Skates

7 years

Continuing refinement of skills

Appearance 0

Blue all

Appearance 1

Blue limbs

Pink body

Appearance 2

Pink all

Pulse 0

No pulse/absent

Pulse 1

< 100 bpm

Pulse 2

> 100 bpm

Grimace 0

No activity

Grimace 1

Grimace

Grimace 2

Cry/cough

Activity 0

Limp

Activity 1

Weak

Activity 2

Strong/spontaneous

Respiration 0

No response

Respiration 1

Irregular/slow

Respiration 2

Good cry

Gravidity

Total number of pregnancies

Parity

Number of times mother has given birth to viable child (viable = > 20 wks)

T (full term)

> 37 weeks

P (premature)

20-36 weeks

A (abortion)

< 20 weeks

L (living children)

Living children…

Multiple pregnancies

Twins