Newborn Reflexes: Nursing Assessment

What are newborn reflexes?

Newborn reflexes are involuntary movements that occur in response to specific stimuli. These reflexes are not learned but hardwired into your baby's nervous system, serving as a fascinating window into their early development. From the moment the baby enters the world, these reflexes play a crucial role in their ability to interact with and adapt to their surroundings.

Nurselabs (2023) identifies the following reflexes: Blink Reflex, Rooting Reflex, Sucking Reflex, Extrusion Reflex, Palmar Grasp Reflex, Walk-in-Place Reflex, Tonic Neck Reflex, Moro Reflex, Babinski Reflex, Reflexes of Spinal Cord Integrity, and Landau Reflex.

In a cross-sectional study of 67 high-risk newborns, those with normal sucking and Babinski reflex responses tended to have favorable birth-related variables, respiratory conditions, and mental status, underscoring the necessity for additional research on primitive reflexes in high-risk newborns to deepen our understanding of their clinical implications (Sohn et al., 2011).

Understanding the significance of these reflexes is like deciphering a secret language your baby speaks in the early days of life. For instance, the Moro reflex, commonly known as the startle reflex, is triggered when your baby experiences a sudden change in position or hears a loud sound. Witnessing those tiny arms and legs fling outward and then drawing back in a protective embrace is adorable and indicative of a healthy system responding to stimuli.

Some reflexes will gradually disappear as your baby grows, paving the way for intentional, learned movements. The disappearance of certain reflexes, like the extrusion reflex, which causes your baby to thrust their tongue out when their lips are touched, is a positive indicator of normal development.

What reflexes should be present in a newborn?

• Blink reflex: This is a protective response where the baby rapidly closes their eyes in reaction to a sudden stimulus. This involuntary movement helps shield the delicate eyes from potential harm, such as a sudden burst of light.
• Rooting reflex: The reflex engages the baby in turning their head toward the touch on the baby's cheek, illustrating their instinctual quest for nourishment. It aids breastfeeding by helping the baby find the source of nutrition, and the gentle stroking motion triggers this response. The rooting and sucking reflexes are interconnected and often work in tandem.
• Sucking reflex: Integral to feeding, this reflex involves the baby instinctively sucking on anything that touches their lips. Premature babies may exhibit an immature sucking ability, requiring additional attention and support in fostering successful feeding habits.
• Extrusion reflex: The Extrusion Reflex is characterized by the baby thrusting their tongue out when touching their lips. This reflex, often seen in newborns, gradually disappears as the baby's sucking ability matures.
• Palmar grasp reflex: When the baby appears to be gripping an object placed in their palm, the reflex showcases an instinctive grasp reflex triggered by pressure on the baby's palm. This reflex is considered normal in the early months of life.
• Walk-in-place reflex: The walk-in-pace reflex, also called the walking or dance reflex, involves stepping movements when holding the baby upright with feet touching the surface. Though observed at birth, this reflex diminishes around three months, offering a glimpse into the baby's innate ability to simulate walking movements.
• Tonic neck reflex: The tonic neck reflex manifests as a fencing posture, with the baby turning their head to one side. The opposite arm bends during this reflex while the baby's head turns. This reflex is a normal part of early development, and its presence is typically observed until around six months of age.
• Moro reflex: The baby's moro reflex, often called the startle reflex, manifests as a startle response with a sudden head movement or loud sound. It is an instinctual reaction involving the baby spreading their arms and bringing them back in, suggesting normal neurological development.
• Babinski reflex: This is characterized by the fanning out of the baby's toes when the sole is stroked. This response is normal in infants but is expected to disappear by age one.
• Reflexes of spinal cord integrity: These reflexes involve assessing spinal reflexes and movements, providing insights into the baby's overall neurological development and spinal cord function.
• Landau reflex: Evident when the baby extends their legs when held horizontally; this emerges around three months and may persist for a year. This reflex offers a glimpse into the baby's developing motor skills and body control.

How does the assessment work?

Whether you're a parent, caregiver, or healthcare professional, having this document on hand will guide you through the exciting journey of understanding a newborn's reflexes. Follow these simple steps to make the most of this Printable Newborn Reflexes Assessment:

Step 1: Download the template

Start by downloading the assessment template, and if you prefer a tangible copy, feel free to print it for a hands-on experience.

Step 2: Newborn information

Fill in the essential details at the top of the template, including the patient's name, date of birth, and assessment date. This ensures that each assessment is tailored to the baby's unique developmental timeline.

Step 3: Reflex types overview

Take a moment to review the provided overview of newborn reflex types. Familiarize yourself with each reflex's description and example observations, setting the stage for a thorough assessment.

Step 4: Table instructions

Explore the organized table, divided into columns for Reflex Type, Description, Example Observation, Comments or Notes, and Reflex Present Checklist. This structure simplifies the process, allowing you to document and track each reflex systematically.

Step 5: Reflex assessment

For each reflex type, follow the corresponding instructions. Conduct observations and mark the checklist to indicate whether the normal reflexes are present or absent. Utilize the Comments or Notes column to add specific details or observations that enhance the overall assessment.

Step 6: Overall assessment

Once individual reflex assessments are complete, consider the collective findings. Evaluate your baby's neurologic development by reviewing the reflexes and gaining insight into their early milestones.

Following these straightforward steps, the assessment becomes a valuable tool, empowering caregivers and healthcare professionals.

References

Sohn, M., Ahn, Y., & Lee, S. (2011). Assessment of primitive reflexes in high-risk newborns. Journal of Clinical Medicine Research. https://doi.org/10.4021/jocmr706w

Tabangcora, I. D. (2023, July 22). 11 Newborn reflexes: Nursing assessment and care. Nurseslabs. https://nurseslabs.com/newborn-reflexes/#h-1-blink-reflex