Neonatal reflections: what they are and what they indicate

Neonatal reflections are automatic and involuntary responses to certain stimuli, present from birth, which reveal a lot on the health and neurological development of the newborn

What are the neonatal reflections? Among all the behaviors that characterize the first months of life, they are certainly among the most fascinating and curious; Not rarely, however, they trigger doubts and parental questions.
Neonatal reflections are signs that, if present and normal, express the correct functioning of the nervous system of babies.

These are, in simple words, automatic and involuntary responses to certain stimuli, present from birth, which reveal much on the health and neurological development of the newborn. To drive away the fears, let’s go into the world of neonatal reflections; let’s find out What are the main oneswhat they are for and what their absence can indicate.

What are the neonatal reflections?

There are several types of neonatal reflectionsall united by the fact that these are automatic and involuntary responses evoked since birth.
The characteristics of neonatal reflections offer an important indicator of the newborn neurological health; That’s why we pediatricians examine them carefully during the first visits.

THE main neonatal reflections They are those of development, also called “archaic” or “primitive”:

• SUUCT REFLYwhich allows the newborn to feed. He is evoked when he stimulates his palate with a finger or pacifier; At that moment, the child will start sucking. This reflection begins to develop during intrauterine life; Do you think that, during the ultrasounds, with a little luck, it is possible to observe the fetuses that suck their finger;
• Rooting reflection (or rooting), of fundamental importance because it allows, together with the reflection of suction, to feed. It occurs when you caress the newborn cheek or touches the corner of her mouth with the nipple (or with your finger, which simulates its shape). As an answer, the child will turn his head towards the stimulus and open his mouth, ready to suck;
• reflex of Moroperhaps the best known of the neonatal reflections, also known as the “reflection of fright”. It is evoked following several stimuli, such as suddenly letting the newborn head fall back, or after sudden movements or strong noises. The newborn reacts by widening his arms (abduction and extension), opening his hands and then bringing them back to the body (flexion and adduction), as if he tried to grab something, and then usually lead to a crying;
• Reflex of preventionwhich consists in the closure of the newborn hand around the object that stimulated its palm. A similar response is observed by exerting pressure with a finger or an object on the sole of the foot;
• Automatic march reflectionan answer obtained by supporting the newborn from the armpits and keeping it in a vertical position with your feet in contact with a flat surface. What happens, when do you do it? That the newborn hints at a sort of walk, with a slow alternation of flexion and extension of the legs;
• Reflex of Babinskian automatic response that appears by caressing or rubbing the plant of the baby’s foot. After this stimulus, the fingers of the feet will extend upwards and the other fingers will widen, like a fan;
• reflection of Galant (or on the truncated curving), obtained by placing the child in ventral suspension and then rubbing or stroking the skin along one side of his back. This evokes a movement of the trunk and also of the newborn towards the side of the stimulus; In a nutshell, he will curve the body towards the stimulated side;
• asymmetrical tonic reflex of the neckalso called “of the shielder”. When the newborn head is turned on one side, the arm and leg on the side towards which it looks extend, while the opposite arm and leg bend (posture of fencing);
• Reflex of extrusionor reflection of the push of the language. This reflection manifests itself when an object touches the front of the newborn language; In response, the newborn pushes the tongue out, expelling the object from the mouth.

In addition to primitive reflections, there are other lesser known reflections that pediatricians seek as they contribute to the neonatal neurological evaluation.
However, it must be specified that some of these neonatal reflections (such as tendon) can be difficult to obtain And, therefore, their presence/absence must be interpreted only in the light of the entire neurological examination.

What are neonatal reflections for?

What is the purpose of neonatal reflections? The reflections we have listed play a crucial role in ensure survival And it development of newborn. In what sense? Basically, each of them has a specific function:

• The reflection of suction and the reflex of rooting are fundamental for power supply. In fact, they allow the newborn to find the nipple and to suck effectively, ensuring the intake of the nutrients necessary for growth;
• Moro’s reflection has a evolutionary role of protectionbecause it allows the child to grab the mother or another support in response to perceived dangerous situations, such as that of an imminent fall;
• The prehension reflection helps the newborn to explore and develop the ability to grab objectsan ability that will become particularly important in the subsequent stages of motor development;
• in the same way, the reflection of the march has a preparatory function for future voluntary walking;
• Babinski’s reflection is an indicator of the development of the nervous system and the functionality of the spinal cord;
• Galant’s reflection takes on the meaning of removal from a stimulus nociceptive and participates in the development of the muscles and coordination necessary for the movement of the trunk and future walking;
• The tonic-asymmetrical reflection of the complex facilitates the development of the Hand-eye coordination and helps to establish a base for voluntary movement;
• The extrusion reflection serves to protect the newborn from the ingestion of solid objects that could cause suffocation, thus promoting a Safe and effective breastfeeding.

But When neonatal reflections appear and disappear? Neonatal reflections develop Already in the womb And they are present at birth. In the majority of cases, neonatal reflections disappear within the first 6-12 months of life, as the nervous system of the mature child. More specifically:

• The SUUCT REFLY It is sometimes already visible around the 18th week of intrauterine life, but it becomes very present around 32 weeks. After i 3-4 months of life He begins to lose intensity, tending to disappear almost always within the year, despite being sometimes observed during sleep for some time to follow;
• Rooting’s reflection also develops during intrauterine life around the 32nd week of gestation. Tends to disappear within 4-6 months of life;
• Moro’s reflection appears around the 32nd week gestation and is well developed within the 37th week. Disappears within 3-6 months of life;
• The reflections of prehension (palm and footbed) are well developed within the 32nd week of age. The palm -taking reflection is generally present up to 3 months of life In term infants, while the foot socket reflection is generally present up to 6 months of age;
• The march reflection is present starting from 32nd week of gestation and disappears within 1-2 months of life;
• Babinski’s reflection develops around the 32nd week of gestation, despite being very difficult to observe it during ultrasound checks in pregnancy. Among all the reflections is the one that takes the most time to disappear (2 years);
• Galant’s reflection is present starting from 32 weeks of gestation and disappears between 3 and 4 months of life;
• The toned-asymmetrical reflection of the neck usually appears around the 35th week of gestation and disappears within 3-4 months of life in term infants;
• The reflux of extrusion generally develops starting from the 32nd week of pregnancy e disappears between 4 and 6 months, indicating that the child is therefore ready to take solid foods.

When to worry about the absence of neonatal reflections

After all these premises, we reach the most delicate point: what are the possible problems of neonatal reflections? Development reflections are considered abnormal if they are, for example, asymmetrical.
Asymmetry could indicate an underlying hemiplegia (weakness or paralysis of one side of the body), nerve lesions, cerebral paralysis or other neurological anomalies.

In the same way, as well as the disappearance of neonatal reflections It is a sign of progress in the child’s neurological development, the persistence of some of them beyond the expected period could indicate neurological problems. In this article, however, we will focus on the absence of neonatal reflections. Although they are generally present In all infants, the absence of one or more of these reflections may indicate the presence of problems of various kinds.

That’s why both parent and doctors, in the first months of life, will have to carefully monitor the behavior of the newbornin such a way as to promptly identify any anomalies.
THE’absence of neonatal reflections It can be caused by different conditions, including:

• anomalies Present before the birth that affect neurological development (genetic syndromes) or that cause brain damage to the fetus (intrauterine infections, brain malformations, exposure to toxins in pregnancy);
• prematurity (the more serious, the greater the neurological immaturity, with reduced or absent reflections);
• brain and neurological damage arise during childbirth, as because of trauma, dystocia di shoulder, intracranial hemorrhage, asphyxiation at birth or infections;
• Conditions arose after childbirth capable of causing neurological damage, such as neonatal infections, severe jaundice (kernittero), metabolic or coagulation disorders.

The reduction or absence of some neonatal reflections, in addition to telling us of the responsible pathological cause, in the term infant has been associated with a increased risk of developing cerebral paralysis Spastica, as in the case of the alterations that involve the reflex of plantar prey.
However, it should be noted that, in some cases, the absence of a neonatal reflection could be temporary and not to indicate a serious problem.

This applies, for example, for a good part of those premature babies that could show Less developed reflections due to the transitory immaturity of the nervous system.

Then there is to consider the physiological variability What interests the world of pediatrics: your child’s reflex of Moro must not necessarily be identical to that of a peer.
Each baby is unique and consequently, it can show variations in the reflective behavior compared to the others. The absence (or the reduction) of neonatal reflections must never be neglected and always goes reported to the pediatricianso that a more in -depth evaluation can be carried out and identify the anomalies that could arouse concern.