Pediatrics Exam 1: Lecture 5

considered

Infant's behavioral state must be

Brazelton's Behavioral states

how do we rate an infant's behavioral state

- quiet sleep

- active sleep

- drowsy

- quiet alert

- active alert

- crying

what are the Brazelton's Behavioral states (6)

- quiet sleep

- active sleep

- crying

what are the "no testing" or "red light" criteria according to Brazelton's behavioral states (3)

active alert

what are the "yellow light" criteria according to Brazelton's behavioral states

- drowsy

- quiet alert

what are the "green light" criteria according to Brazelton's behavioral states (2)

- involuntary stereotyped movement responses to a specific stimuli

- influence movement of the fetus

what are infant reflexes (2)

28 weeks gestation

when do infant reflexes begin to emerge

1st birthday

when do infant reflexes integrate

may not

Infant reflexes (may/may not) not completely disappear

- may be inhibited by maturing CNS

- may be integrated into new movements

(2) reasons as to why infant reflexes may not completely disappear

- simple & quick assessment tool

- assesses maturity & integrity of CNS in newborn & young infants

- useful in determining level of neurological maturation

the use & application of infant reflexes (3)

- neurological immaturity

- neurological dysfunction

severe deviations from time frames of infant reflexes can indicate (2)

- absent

- present

- left or right

- age-appropriate

- integrated

- obligatory

(6) things to document when assessing reflexes

palmar grasp present well after child is walking

example of an obligatory response

obligatory

every time the stimulus is applied, you will see the reflex but well after the reflex is supposed to be integrated

- infant reflexes

- developmental reflexes

another name for primitive reflexes (2)

- search reflex

- cardinal point reflex

another name for rooting reflex (2)

touch cheek or anywhere around the mouth

stimulus for rooting/search reflex

head moves toward stimuli & mouth opens

response for rooting/searching reflex

28 weeks gestation to 3 months postpartum

duration of rooting/search reflex

- no reflex is problematic for nutrition

- no reflex or lack of persistence may be a sign of CNS or sensorimotor dysfunction

significance of rooting/search reflex (2)

sucking reflex

rooting/search reflex in often in conjunction with

head/body-righting reflexes

rooting/search reflex contributes to

touch of infant's lips with finger or nipple

stimulus for sucking reflexes

sucking action

response for sucking reflex

28 weeks gestation to 3 months postpartum

duration for sucking reflex

- no reflex is problematic for nutrition

- assess whether is sustainable or consistent

significance of sucking reflex (2)

rooting reflex

sucking reflex is often in conjunction with

- galant reflex

- moro reflex

- palmar grasp

- plantar grasp

- neck righting

- body righting

- stepping reflex

(7) reflexes that assess symmetry

>/= 3 months

we should not see asymmetry in an infant that is ____ old

gently stimulate along the paravertebral line (paraspinals; 3 cm from midline) and from shoulder down to hips on both sides

stimulus for galant reflex

- Incurving of trunk toward the stimulated side

- production of skin folds

response for galant reflex (2)

32 weeks gestation to 2 months

duration for galant reflex

- absent response could mean a transverse lesion of spinal cord

- long lasting persistent response could mean scoliosis

- retention could cause delay in development of symmetrical stabilization of the trunk & independence of head for sitting, standing, or walking

significance of galant reflex (3)

pressure on palm of hand

stimulus for palmar grasp

- fingers close

- the thumb does NOT close

response for palmar grasp (2)

birth to 4-6 months

duration of palmar grasp

neurological problem

absence of palmar grasp may indicate

- ability to grasp & release objects voluntarily

- WB on open hand for propping, crawling, protective responses

absence of palmar grasp could interfere with (2)

one of the most noticeable reflexes

what is so significant about the palmar grasp

voluntary reaching or grasping

palmar grasp may lead to

touching the ball of the foot

stimulus for plantar grasp

toes flex

response for plantar grasp

28 weeks gestation to 9 months

duration of plantar grasp

insult to one side of the brain

asymmetrical plantar grasp means

- depression of the CNS

- sensorimotor depression

failure to obtain plantar grasp or a late persistence indicates (2)

- weight shifting

- walking

- balance reaction

plantar grasp interferes with (3)

defect in spinal cord

absence of plantar grasp may indicate

- place infant in supine with head in midline

- turn head to one side

stimulus for neonatal neck righting (2)

- body will follow direction of head turn

- body will turn as a whole

response for neonatal neck righting (2)

34 weeks gestation to inhibited by mature neck righting at 4-6 months

duration of neonatal neck righting

needed for infant to roll from their back to their side

significance of neonatal neck righting

one side being abnormal

asymmetrical neonatal neck righting can be due to

segmental rolling

persistent neonatal neck righting prevents

neck on body reflex

neonatal neck righting is also referred to as

- place infant in supine with head in midline

- flex one leg toward the chest

- rotate the leg across the body

- force infant to roll over

stimulus for neonatal body righting (4)

thorax, chest, & head will follow pelvis as a whole

response for neonatal body righting

34 weeks gestation to inhibited by mature body righting at 4-6 months

duration for neonatal body righting

prevents segmental rolling

significance of neonatal body righting

- further motor delays

- child unable to use rotational components of movement

prevention of segmental rolling leads to (2)

- support infant's head & shoulders with hands

- allow head to drop back 20-30° with respect to trunk

- stretch neck muscles

stimulus for moro reflex (3)

- abduction of UE

- extension of elbows, wrist, & fingers

- followed by adduction of arms at the shoulder & flexion at the elbow

response for moro reflex (3)

28 weeks gestation to 4-6 months

duration of moro reflex

- insult to one side of the brain or nerve supply

- Erb's Palsy

asymmetry of moro reflex indicates (2)

depression of CNS or sensorimotor system

failure to obtain or late persistence of the moro reflex indicates

startle reflex is elicited by a loud noise

how is moro reflex different from startle reflex

breaking up flexor postures at birth

moro reflex is involved in

- sitting

- protective tilting reacrions

moro reflex MUST disappear before (2)

normal full-term infants

moro reflex SHOULD be universally present in

increases

reaction time ___ with age

sudden loud noise

stimulus for startle reflex

elbows & hands remain flexed

response for startle reflex

4-6 months

when does a baby start to sit

- support infant in the vertical position

- examiner's hands under the arms & around the chest

stimulus for neonatal positive support (2)

- partial WB & partial extension at the hips & knees

- slight flexion

response for neonatal positive support (2)

35 weeks gestation to 1-2 months

duration for neonatal positive support

spontaneous stepping reflex

neonatal positive support is a prerequisite for

muscle tonus

neonatal positive support indicates progression for

- hypotonia

- primary muscle weakness

absence of neonatal positive support indicates (2)

- interfere with standing, weight shifting, walking, & balance reactions

- lead to contractures of ankles in PF

if neonatal positive support (CP) persists, it can interfere with & lead to

- support infant in vertical position with hands under the arms & around chest

- feet touching the table surface

- incline the infant forward & gently move infant forward to accomplish stepping

stimulus for walking/stepping reflex (3)

infant will make alternating, rhythmical & coordinated stepping movements

response for walking/stepping reflex

37 weeks gestation to 2 months

duration of walking/stepping reflex

- insult to one side of the brain

- muscle weakness

- injury

asymmetry of walking/stepping reflex (3)

birth to 4-6 months

duration of ATNR

- prone, supine, or supported sitting

- position infant's head of labyrinth in inner ear to inform position in space

stimulus for TLR (2)

- head back

- body & extremities tend to move in extension with shoulder retraction

response for TLR in supine or supported sitting (2)

- head dropped forward

- body & extremities tend to move into flexion with shoulder protraction

response for TLR in prone or supported sitting (2)

birth to 6 months

duration of TLR

6-8 months

duration of STNR

- support infant in vertical position

- examiner's hands under the arms & around chest

- move infant so dorsum of one hand lightly presses against the edge of table

stimulus for proprioceptive placing of arms (3)

- arms flex & hands brought above the table

- arm then extends with wrist extended & finger extended & abducted

- in newborns, fingers may remain fisted

response for proprioceptive placing of arms (3)

birth to 2 months

duration of proprioceptive placing of arms

- hold infant in vertical position with examiner's hands under arms

- support head of infant

- lift infant so that dorsum of one-foot presses lightly against the edge of the table

stimulus for proprioceptive placing of legs (3)

- flexion of hip, knee & ankle

- leg extends

- foot is placed squarely on top of table

response for proprioceptive placing of legs (3)

35 weeks gestation to 2 months

duration for proprioceptive placing of legs