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INFANT REFLEXES AND

DEVELOPMENTAL MILESTONES
Second Semester 2023
Dr. Sakher Obaidat
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Objectives
• Discuss the “stages” of motor development in children
birth to 6 years
• Recognize primitive reflexes and normal motor skills in
children birth to 6 years
• Correctly identify the approximate age of a typically-
developing child based on his or her reflexive behaviors,
movement patterns, and motor skills
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Gross Motor Development in the First

Year
Neonate - newborn
• Physiological flexion
(fetal position)

• Maybe be able to extend neck to drag face from side to side in

prone
• “Back-to-Sleep” campaign - decreased incidence of SIDS (Sudden
Infant Death Syndrome)
• Head bobs when held in sitting or upright position- no head control
• Movements are reflexive
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Primitive Reflexes
 Present in the newborn

 Predictive movements in response to a stimuli that occurs without

conscious thought (involuntary movement)

 Integrates (goes away/disappears) by 9-12 months so voluntary

movement can be attained

 Persistence of primitive reflexes may signal brain abnormalities

and impacts motor development

 If absent in the newborn or present past 12 months - Concern about

development of the neurological system.
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Primitive Reflexes - ATNR

Fencing posture
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Asymmetrical Tonic Neck Reflex (ATNR)

Onset : Present at birth (20w pma)
Integration: 4-6 months

Stimulus: Turn head to the side

Response: Facial arm extends and abducts,
occipital arm flexes and abducts (fencing posture)
May also see similar response in LE

 What if it does not integrate? What motor developmental and functional

problems would this pose?

Pma (post menstrual age) , same as gestational age (GA)

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Rooting Reflex
Onset: Present at birth (28 w pma)
Integration: 3 months

Stimulus: Touch to the perioral area of hungry infant

Response: Turns head and lips towards stimulus with the
mouth opening and a trial of sucking the finger (food finding)

• Different from sucking reflex

• Sucking reflex (0-6 months): touch lips
• Response-automatic sucking

 What if it does not integrate?

 What motor developmental and functional problems
would this pose?
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Palmer Grasp
Onset: Present at birth (28w pma)
Integration: 4-7 months

Stimulus: Pressure on palm of hand

Response: Flexion of fingers (grasps) with fingers)

 What if it does not integrate?

 What motor developmental and functional problems
would this pose?
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Plantar Grasp
Onset: Present at Birth
Integration: 9 months

Stimulus: Pressure to ball of foot

Response: Flexion of toes (grasps with toes)

 What if it does not integrate?

 What motor developmental and functional problems
would this pose?
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Galant Reflex
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Galant Reflex (Trunk Incurvation)

Onset: Birth (28w pma)
Integration : 3 months

Stimulus: in prone, stroke paravertebral skin

Response: Lateral curvature of trunk on stimulated
side, shifts hip toward side
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Moro Reflex
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Moro Reflex
Onset: Birth (28w pma)
Integration: 3-5 months

Stimulus: Sudden head drop backwards

Response: Abduction and extension of arms, splaying
of fingers, followed by flexion and adduction of arms.
Child typically cries

Startle reflex:
Stimulus is loud noise with same response
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Automatic walking/reflex stepping

Onset: Present at birth (37w pma)
Integration: 3-4months

Stimulus: Supported Standing, lean child forward

Response: High stepping movements with regular rhythm
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Symmetrical Tonic Neck Reflex (STNR)

Onset: 4-6 months after birth (bridging or transitional reflex)
Integrates: 8-12 months
Stimulus: Head in Flexion or extension - in quadruped
position
Response:
When head is flexed: flexion of UEs and extension of LEs
When head is extended: extension in UEs and flexion in
LEs

http://visiontherapyathome.com/symmetrical-tonic-neck-reflex
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Reflex Onset Integration Stimulus Response

ATNR

Rooting

Palmar Grasp

Plantar Grasp

Flexor Withdrawal

Crossed Extension
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Reflex Onset Integration Stimulus Response

Galant
(trunk
incurvation)

Moro

Positive
Support
Automatic
walking/
stepping
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Tonic Labyrinthine reflex

Onset: Birth
Integration: 6 months

Stimulus: Lift infant up in prone or supine position

Response: Flexor tone will dominate in prone position and
extensor tone in supine
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Landau reaction reflex

Onset: 4 months
Integration: 18 months

Stimulus: Hold infant in horizontal suspension

Response: Extends neck, trunk and hips
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Persistence of primitive reflexes

• Poor eye-hand coordination
• Difficulty with reaching and grasping
• Feeding difficulty
• Delay in acquisition of motor milestones
• Poor postural control
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Absence or persistence of primitive

reflexes
• TBI
• Cerebral Palsy
• Genetic syndromes
• Developmental delay
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Gross Motor Development in the First

year
Milestones
o Set of functional skills or age specific tasks that most children can
do at a certain age range

o Not strictly occurring at a particular age

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Average Ages and Ranges of Attainment of

Gross Motor Milestones From Two Studies

Campbell, 2017
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Campbell, 2017
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Creeping vs Crawling
“Historically when reading international literature, the term
creeping is used for movement on the belly and crawling is
used for on all fours, which is the reverse of the usual
United States professional terminology. In recent years,
there is much greater inconsistency in United States
professional terminology, and it is now best to add
descriptive terms when discussing crawling and creeping,
such as crawling on belly or creeping on the hands and
knees”

(Effgen, 2013)
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Other milestones…
 8-15 months: Creeps up and down stairs

 15-18 months: Walks up/down stairs with hand held, throws ball forward

 20 months: runs stiffly

 2.5 years: Walks up/down stairs without support (marking time), kicks ball forward

 3 years: runs well, walks up stairs alternating feet, catches ball with arms and body

 3.5 years: Walks down stairs alternating feet, jumps up with both feet, hops on one
foot

 4 years: gallops

 5-6 years: skips

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Gross motor “red flags”

• Persistence of reflexes
• Lack of leg movements
• “Stuck” in head/neck/trunk hyperextension
• Extremely floppy
• Spasticity
• Athetoid movement
• Extremely rigid
• Inability to achieve midline head/extremities
• Only unilateral movements
• “Bunny hops” instead of creeping
• Walks on toes with adducted legs
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Other Red flags……

Red flags in other developmental domains

• Social-emotional
• Cognitive
• Fine Motor
• Communication/Language
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Motor Development and Control

Campbell’s Physical Therapy Expert Consult
• Chapter 3, video 3-1

https://expertconsult.inkling.com/read/palisano-campbells-physical-
therapy-children-5e/videos/video-3-1
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References
• Robert J. Palisano, Margo N. Orlin, Joseph Schreiber.
Campbell’s Physical Therapy for Children, 5th edition.
Elsevier, 2017.
• Effgen, Susan K. Meeting the Physical Therapy needs of
Children, 2nd edition. F.A. Davis 2013