A Therapists Guide to Fix the Developmental Delay of Baby Milestones

Baby development and reflexes

Tuesday, November 2, 2010@ 6:51 PM

Tonic neck reflexIn the next few posts I am going to cover some basic information pertaining to baby development, reflexes and motor milestones. There is a relationship between these things that is important to understand.

Abnormal reflexes or reflexes which don’t “disappear” at the appropriate time can be indicative of developmental problems. Reflexes which don’t disappear when they should can prevent certain motor patterns from emerging.

 Understanding the nature of the reflexes and what they do can help you to recognize potential issues. It will also help you to use these reflexes as a means to encourage good movement. I will explain the reflexes and how their presence or absence can affect the baby’s motor skills.

Reflexes are involuntary movements. They occur as a response to a specific activity or to a specific stimulus. Absent or abnormal reflexes can be a signal that there is unusual brain or nerve activity.

 Many reflexes are present at birth and they integrate as the baby develops. Others develop later on and can remain for a lifetime. An example of a later reflex would be a protective response such as throwing out hands to break a fall. Following is a list of newborn and early reflexes and their descriptions, as well as how to test them.

Rooting reflex: This reflex occurs when you stroke or touch the side/corner of a baby’s mouth. The baby will turn toward that direction and open her mouth. This reflex helps the baby find the nipple for feeding. When this is absent, the baby has a hard time getting to the breast or bottle. The reflex generally fades by 3 to 4 months but can last longer. Please remember that this is involuntary and does not signal hunger.

Sucking reflex: The sucking reflex and the rooting reflex are important to feeding. Once the baby has latched onto the nipple, and the nipple touches the roof of the baby’s mouth, the sucking reflex is stimulated. Many premature babies and babies with neurological issues have a weak or absent sucking response. Without it, they can’t express the milk and consequently have feeding problems. These babies may need to have a feeding tube if they can’t get sufficient nutrition. A helpful exercise is to massage the baby’s cheeks in a circular motion as they are being fed. You can, if you are able, use your thumb and index finger to massage, and use your other fingers to press gently under the jaw. And keep in mind that just like the rooting reflex, initiation of sucking does not indicate hunger.

Tongue trust: When the baby’s lips are touched, the tongue pushes forward. This helps with extrusion of the milk while the baby is sucking. This reflex lasts until around 4 months of age. Bear in mind that it can last longer. When it is still present and you try to give the baby solid food, she will push the food out. This does not mean that she doesn’t like the food. It means the reflex prevents her from getting the food into position to swallow, and that she is not ready for solid food. For babies who do not lose this reflex, feeding problems result. A trained feeding therapist is generally advised.

Moro reflex: Some people know this as the startle reflex. It presents when the baby hears a loud noise and thrusts out her arms and leg, and throws back her head. She will generally start crying. Even her own crying can elicit this reflex. It tends to fade around six months but can persist. Babies born with fetal alcohol syndrome and neurological problems like cerebral palsy do not lose this reflex. It can interfere with sitting and other positions because it will cause the child to lose her position when suddenly startled.

Grasp reflex: Everyone is familiar with this reflex. When you press your finger into a baby’s palm, she will close her fingers tightly around your finger (or other item). This reflex can be stronger in premature infants. It usually fades within a few months. A weak grasp reflex is problematic because the baby does not get sufficient input into the hand to foster hand development. It also impacts her ability to explore her environment and play with toys. She won’t be able to hold and shake a rattle or other toy. If the reflex persists, the baby has a hard time letting go of items. This can interfere with the development of exploration and play skills. For example, a persistent grasp reflex prevents a baby from dropping a shape into a shape sorter. An abnormal response can be improved with therapeutic intervention.

Tonic neck reflexes: I wrote reflexes because there are actually 2. I learned these as ATNR (asymmetrical tonic neck reflex) and STNR (symmetrical tonic neck reflex). The one that is most commonly referenced is the first. This is when a baby is on her back and her head is turned to one side, she assumes a “fencers position”. The arm where the face is turned stretches straight out, and the opposite arm bends at the elbow with the hand up toward the head. The knee might also bend. The disappearance of this reflex is very important. Imagine if this position resulted every time your baby turned her head. Not only that, but it prevents what is called bilateral integration. That is the ability to use both sides of your body at the same time and to be able to bring your hands to midline (center). Without this ability your baby cannot crawl, cannot learn dressing skills and ultimately cannot write – a few of the many potential problems.

The STNR is the reflex that is elicited when your baby is prone (on her tummy). This reflex causes her to push off with her hands and flex her knees. It is the precursor to crawling.

Stepping reflex: This is the reflex that can make new parents think their baby is physically advanced. When the baby is supported under her arms and her feet touch a supporting surface, she will take “steps” as if walking. This reflex disappears quickly.

Babinski reflex: This is tested on newborns. When the bottom of the foot is firmly stroked, the big toe curls up and the other toes fan out. Lack of this reflex can indicate a neurological problem. This reflex lasts until about age 2. If it continues after that age, it is also indicative of possible nerve damage. This response can be the sign of a problem with the nerve paths running from the spinal cord to the brain.

Galant reflex: This is another reflex which is tested at birth to rule out brain damage. You hold the baby suspended with your hand and face down, and run a finger from the neck to the lower back on one side of the spine. The baby should flex toward the side that is stimulated. Absence of this reflex can indicate brain damage.

Landau reflex: The Landau appears at about 4 months and integrates around 12 months. Therapists refer to this as the “superman” test. When you place the baby face down and lift in the air with one hand under the tummy. Wait for the reaction. The baby should lift arms and legs as if flying. This indicates the presence of extensor tone that is necessary to break up newborn flexion.

Flexor withdrawal: The onset of this response is from 28 weeks gestation until about 2 months normally. For children with neurological disorders, it may persist. It is tested with the baby on her back and her legs straight. A noxious (irritating) stimulus is applied to the bottom of the foot. The baby should withdraw the foot by flexing at the hip and knee. Failure to respond can mean a central nervous system disorder.

Neck righting on body and Body righting: These two emerge at 34 weeks gestation and integrate by around 5 months. If you place the baby on her back, and turn her head, her body should turn in the same direction. Conversely, if you bring the arm across the body, the body will roll toward the turn. These reflexes are ideal for helping a baby learn to roll over.

There are more reflexes which I did not list. They emerge later and I will discuss them in another post. The reflexes described above are infant reflexes and have a role in baby development. Some of them help with the development of skills and some inhibit development if they linger.

Many of the techniques I write about and that are shown in my videos use these reactions to help elicit good movement patterns.

I talk often about the importance of meeting milestones on time. If your baby exhibits any abnormal reflex signs, it is important to have her evaluated.

Exercise and facilitation techniques can help force the integration of reflexes, or help develop patterns despite the persistence of an abnormal reflex. The sooner these issues are addressed, the better for your baby’s development.

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