Pediatrics Flashcards
Rooting reflex
Onset: 28 weeks gestation
Integrated: 3 months
Test: stroke baby’s cheek/mouth/lip
Response: head, tongue, mouth moves towards stimulis
- search & locate food, automatic, searching reflex
Suck-swallow reflex
Onset: 28 weeks gestation
Integrated: 2-5 months
Test: place finger inside baby’s mouth
Response: strong & rhythmical sucking
- eat food, ingestion for nourishment
Traction reflex
Onset: 28 weeks gestation
Integrated: 2-5 months
Test: pull baby up by forearms & pull to sit
Response: head lag due to little head control, complete flexion of UEs including hands (grasping to hold on)
- enhances reflexive grasp to gain voluntary control of this reflex
Moro reflex
Onset: 28 weeks gestation
Integrated: 4-6 months
Test: rapidly drop head backward to create falling sensation
response: phase 1: arm extension & abduction, phase 2: arm flexion, adduction, crying
- started & responds to unexpected environmental changes (loud noises, rapid movement)
- alarm system/fight or flight
Plantar grasp
Onset: 28 weeks gestation
Integrated: 9 months
Test: apply pressure with thumb on baby’s ball of foot
Response: toes curl in flexion
- provides tactile input to sole of food, prepares for walking, running, balance
- reflex retained = hypersensitivity to touch, gravitational insecurity while standing
Galant reflex
Onset: 32 weeks gestation
Integrated: 2 months
Test: hold baby in prone suspension & stroke one side of spine from neck to bottom
Response: lateral trunk flexion on stimulated side
- hip movement & ROM in preparation for walking & crawling
- facilitates lateral trunk movement, trunk stabilization, crawling
Palmar grasp reflex
Onset: 37 weeks gestation
Integrated: 4-6 months
Test: place finger in baby’s palm & apply pressure
Response: reflexive grasp with finger flexion
- increases tactile stimulation on palms and reflexive grasp
- not integrated: poor FM coordination, poor motor coordination (grasp & release), hand manipulation skills
ATNR
Onset: 37 weeks gestation
Integrated: 4-6 months
Test: baby supine, rotate head to side 90 degrees & hold for 5 seconds
Response: face side: arm extension, skull side: arm flexion
- fencing pose, precursor to hand-eye coordination
- if retained: poor reading comprehension due to issues crossing midline including eyes, poor visual tracking & eye pursuits, poor handwriting (head rotation —> arm extension on face side)
- if not integrated: difficulty bringing hands to midline, holding objects with both hands, bringing objects to the mouth, reaching for something in front of them
TLR (tonic labyrinthine reflex)
Onset: 37 weeks gestation
Integrated: 6 months
TLR prone:
- test: baby in prone
- response: body in flexor tone
TLR supine:
- test: baby in supine
- response: body in extensor tone
TLR impairments if it persists
Prone: extending head in prone (since in prone there is an increase in flexor tone, making it difficult to extend the head in prone)
Supine: sitting up independently, which requires flexing the neck (extensor tone dominates & makes it difficulty
- poor posture, muscle tone, coordination
STNR
Onset: 4-6 months
Integrated: 8-12 months
Test:
1) place in crawling position & flex the head —> arms flex, legs extend
2) place in crawling position & extend the head —> arms extend, legs flex
- precursor to crawling
- promotes static quadruped position in prep for crawling
Impairments if STNR persists
- difficulty sitting up from supine (requires neck flexion)
- head flexion = hips & legs will extend & interfere with sitting up
- poor muscle tone & posture (sitting posture if UE and LE are doing the opposite movements)
Landau reflex
Onset: 3-4 months
Integrated: 12-24 months
test: hold baby in horizontal prone suspension
Response: total extension of head, trunk, & extremities
- breaks up flexor tone, facilitates prone extension for posture
- Superman pose
Neck righting acting on body
Onset: 4-6 months
Integrated: 5 years
Test: baby supine, rotate head fully to one side
Response: log rolling (all towards head as 1 unit) to maintain alignment
- allows rolling (supine to side lying), maintain alignment
- precursor to crawling
Body righting acting on body
Onset: 4-6 months
Integrated: 5 years
Test; supine & bend one hip & knee towards chest
Response: segmental rolling (mature, body parts rolling in segments) of upper trunk & spine to maintain head & body alignment
- helps to facilitate rolling from supine to side lying but uses leg to initiate roll
Optical head righting
Onset: birth to 2 months
Integrated: persists throughout life
Test: hold baby suspended vertically & tilt off center (move side to side or forward & backward)
Response: upright positioning of head, orients head in space
- corrects head in space when body not upright
- uses visual cues in environment to maintain head in up position
Labyrinthine righting
Onset: birth to 2 months
Integration: persists throughout life
Test: cover eyes (no visual cues) but maintain head in upright & rinse to vertical in relation to gravity as body follows head movement
- orients head in space
- mediated by vestibular system (labyrinth in the ear)
Downward parachute
Onset: 4 months
Integrated: persists
Test: lower baby towards surface while suspended vertically
Response: extension of LEs
- protection/anticipation of fall
- accurate placement of feet
Forward parachute
Onset: 6-9 months
Integrated: persists
Test: quickly tip baby forward while vertically suspended
Response: rapid UE extension/neck in anticipation
- protective response for falls
Sideward parachute
Onset: 7 months
Integration: persists
Test: tip baby to the side while sitting
Response: arm extends & abducts to the side
- protects against falls
Backwards parachute
Onset: 9-10 months
Integration: persists
Test: quickly tip baby back while sitting
Response: backward arm extension, arm extension to one side spinal rotation
- protects against falls
Prone tilting
Onset: 5 months
Test: position baby in prone on tilt board & raise 1 side of the surface
Response: spine curves on raised side, both arms & legs will extend & abduct
- maintain equilibrium without arm support
- ability to make postural adjustments
Supine tilting
Onset: 7-8 months
Test: position baby supine/sitting on tilt board & raise 1 side
Response: spine curves on raised side, both arms & legs will extend & abduct
- maintain equilibrium without arm support
- ability to make postural adjustments
Quadruped tilting
Onset: 9-12 months
Test: position baby on all 4s on tilt board & raise 1 side
Response: spine curves on raised side, both arms & legs will extend & abduct
- maintain equilibrium without arm support
- ability to make postural adjustments
Standing tilting
Onset: 12-21 months
Test: baby standing on tilt board & raise 1 side
Response: spine curves on raised side, both arms & legs will extend & abduct
- maintain equilibrium without arm support
- ability to make postural adjustments
First line of defense for falls
Equilibrium reactions
2nd line of defense for falls
Protective reactions
Reflexes that emerge before birth
1) rooting: integrated 3 months
2) suck-swallow: integrated 2-5 months
3) traction: integrated 2-5 months
4) Moro: integrated 4-6 months
5) plantar grasp: integrated 9 months
6) galant: integrated 2 months
7) ATNR: integrated 4-6 months
8) TLR: integrated 6 months
Reflexes that emerge from birth
1) STNR: integrated 8-12 months
2) Landau: integrated 12-24 months
Righting reactions
- Postural reflex present from approx 3-6m that functions to orient the body in response to visual & vestibular input
- Help to assume a position by maintaining/restoring normal head position
1) body on body
2) neck on body
3) body on head - all integrated at 5 years
Lifetime reflexes that persist
1) optical head righting
2) labyrinthine righting
3) protective reactions
4) equilibrium reactions
Protective & equilibrium reactions
Protective:
1) downward parachute
2) forward parachute
3) sideward parachute
4) backward parachute
Equilibrium:
1) prone tilting
2) supine tilting
3) quadruped tilting
4) standing tilting
Exploratory play
Play occupation that uses sensory input to learn new experiences (e.g. infant touching mother’s face)
- also referred to as sensorimotor play
Relational play
Play occupation that uses toys consistent with their intended purpose (e.g. pretending to self-feed with a spoon)
- also referred to as functional play
Pretend play
Play occupation that involves making objects/toys perform intended actions (e.g. pretending to use a phone to talk)
- also referred to as symbolic or imaginary play
Social play
Play occupation that includes
- interaction with & emotionally relating to others
- behavior and skills to develop & progress throughout childhood
Gross motor play
Play occupation that involves full body, kinesthetic motor movements (e.g. climbing on a play structure)
Constructive play
Play occupation that involves using toys/objects to produce or build something (e.g. put together a puzzle)
Play occupations
Meaningful, intrinsically motivating, & purposeful performance activities of childhood, types include:
1) exploratory play
2) relational play
3) pretend play
4) constructive play
5) social play
6) gross motor play
Grasp pattern
Fine motor function of the hand, either precision or power, used to manipulate items. Patterns include
1) cylindrical grasp
2) power grasp
3) tripod grasp
Power grasp
Used when stability & strength are required, involves:
- ulnar digits flexed with ulnar side of hand controlling object
- radial digits less flexed while manipulating object
Hook grasp
Pretension grasp used to carry an item with a handle (lunchbox, briefcase) without using thumb & palm
Cylindrical grasp
Used for holding a tube-shaped item (drinking glass, baseball bat)
Lateral pinch
Prehensile pattern used to grasp a small item with the thumb opposed to the radial side of the index finger (placing a key in a lock)
Pincer grasp
Prehensile grasp used to manipulate small objects with thumb opposed to index & middle finger (picking up a pencil)
Tripod grasp
Precision grasp used to manipulate small objects with thumb opposed to index and middle finger tips, providing more stability than pincer grasp (e.g. writing tool)
Tip pinch
Pinch used to pick up & hold small objects with thumb opposed to end of index finger, forming an oval shape (e.g. picking up a pin)
Spherical grasp
Used to pick up & hold round items (apple, baseball)
Primitive developmental reflexes
- automatic movements performed by an infant without conscious effort in response to a stimulus, typically integrated by early childhood & are a precursor to functional movement
- a persistent primitive reflex is typically indicative of a CNS dysfunction
Protective extension
Postural response
- 6 m integrated & continues throughout life
- reflexive straightening of UEs in response to LOB
Equilibrium reaction
Postural reflex
- integrated at 6m & persists throughout life
- reflexive response to maintain/recover balance
- shifting body to reorient to midline
Emotional regulation development: neurophysiologic modulation phase
- phase of emotional regulation development
- birth -2-3 m
- ability to regulate arousal (e.g. self sooth, respond to parental soothing)
- activate organized patterns of behavior (e.g. routine sleep-wake cycles)
Emotional regulation development: sensorimotor modulation phase
Phase of emotional regulation development
- 3-9 m
- enjoyment of sensorimotor play
- sensory exploration
- possible sensory modulation challenges
Emotional regulation development: control phase
- phase of emotional regulation development
-12-18 m - emerging awareness of social demands
- varying levels of inhibition & compliance
- self-initiated monitoring relating to understanding of consequences
Emotional regulation development: self-control phase
between 24-48 months
- emerging sense of identity
- demonstrated knowledge of social rules
- minimal flexibility and adaptation to change
Emotional regulation development: self-regulation phase
36 months +
- emerging flexibility to adapt to unexpected change
- self-awareness
- capacity to evaluate own behavior
Stage of motor learning: exploratory stage
Between 1-3 months
infant learns about the self & environment, using primitive movement patterns to
- swipe at objects
- initiate reach
- complete low level skills
Stage of motor learning: perceptual learning
Between 3-6 months
Infant uses perceptual skills developed through exploration to
- more accurate and direct reach
- consistency of movement patterns
- engagement in trial-and-error learning
Stage of motor learning: skill achievement
Between 6-9 months
- high adaptability
- both perceptual learning and increased self-organization
- using action patterns that are orderly and efficient
