General Indicators Of Central Nervous System Disease During Infancy

1. Abnormal localized neurologic findings

2. Asymmetry of movement of extremities

3. Failure to elicit expected primitive reflexes

4. Late persistence of primitive reflexes

5. Reemergence of vanished primitive reflexes

6. Delays in reaching developmental milestones

Gross motor Fine motor

Cognitive and language Social and emotional

Primitive Reflexes That Should Be Part of the Routine Neurologic Examination of Infants

Primitive Reflex

Maneuver

Ages

Palmar

Grasp

Reflex

Place your fingers into the baby's hands and press against the palmar surfaces.

The baby will flex all fingers to grasp your fingers.

Birth to Persistence beyond 4 mos suggests

3-4 mos cerebral dysfunction.

Persistence of clenched hand beyond 2 mos suggests central nervous system damage, especially if fingers overlap thumb.

Plantar

Grasp

Reflex

Moro Reflex (Startle Reflex)

Asymmetric Tonic Neck Reflex

Asymmetric Tonic Neck Reflex

Touch the sole at the base of the toes. The toes curl.

Positive Support Reflex

Touch the sole at the base of the toes. The toes curl.

Birth to 6-8 mos

Persistence beyond 8 mos suggests cerebral dysfunction.

Hold the baby supine, supporting the head, back, and legs. Abruptly lower the entire body about 2 feet.

The arms abduct and extend, hands open, and legs flex. Baby may cry.

With baby supine, turn head to one side, holding jaw over shoulder.

The arms/legs on side to which head is turned extend while the opposite arm/leg flex. Repeat on other side.

Hold the baby around the trunk and lower until the feet touch a flat surface.

The hips, knees, and ankles extend, the baby stands up, partially bearing weight, sags after 20-30 seconds.

Birth to 4-6 mos

Birth to 2 mos

Birth or 2 mos until 6 mos

Persistence beyond 4 mos suggests neurologic disease; beyond 6 mos strongly suggests it.

Asymmetric response suggests fracture of clavicle or humerus or brachial plexus injury.

Persistence beyond 2 mos suggests neurologic disease.

Lack of reflex suggests hypotonia or flaccidity.

Fixed extension and adduction of legs (scissoring) suggests spasticity due to neurologic disease.

Additional Primitive Reflexes That Should Be Tested If Neurologic Abnormality Is Suspected

Primitive Reflex

Maneuver

Ages

Rooting Reflex

Trunk Incurvation (Galant's) Reflex

Placing and

Stepping Reflexes

Landau Reflex

Trunk Incurvation (Galant's) Reflex

Placing and

Stepping Reflexes

Suspend the baby prone with one hand.

The head will lift up and the spine will straighten.

Parachute Reflex

Stroke the perioral skin at the corners of the mouth.

The mouth will open and baby will turn the head toward the stimulated side and suck.

Support the baby prone with one hand, and stroke one side of the back 1 cm from midline, from shoulder to buttocks.

The spine will curve toward the stimulated side.

Hold baby upright from behind as in positive support reflex. Have one sole touch the tabletop.

The hip and knee of that foot will flex and the other foot will step forward.

Alternate stepping will occur.

Suspend the baby prone with one hand.

The head will lift up and the spine will straighten.

Birth to 3-4 mos

Parachute Reflex

Birth to 2 mos

Birth

(best after 4 days). Variable age to disappear

Birth to 6 mos

Suspend the baby prone and slowly lower the head toward a surface.

The arms and legs will extend in a protective fashion.

4-6 mos and does not disappear

Absence of rooting indicates severe generalized or central nervous system disease.

Absence suggests a transverse spinal cord lesion or injury.

Persistence may indicate delayed development.

Absence of placing may indicate paralysis.

Babies born by breech delivery may not have placing reflex.

Persistence may indicate delayed development.

Delay in appearance may predict future delays in voluntary motor development tion. Some neurologic abnormalities produce deficits or slowing in cognitive and social development. As stated, infants who have developmental delay may have abnormal findings on the neurologic examination because much of the examination is based on age-specific norms.

A normative measure of development is the developmental quotient, which is shown here:

The development of an infant or child can be assessed using standard scales such as the DDST for each of the types of development. For example, you can assign to a child a gross motor developmental quotient, a fine motor developmental quotient, a cognitive developmental quotient, and so forth.

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