Reflexes and developmental milestones

Question 1

What are primitive reflexes?

Answer 1

response to stimulus that occurs without conscious thought (involuntary movement)
Present in newborns
Integrate (disappears) by 6 months so voluntary movement can be attained

Question 2

What happens if primitive reflexes stay too long or are absent?

Answer 2

Persistence of reflexes: impact motor development, impacts neurological system
Absence: concerned about development of neurological system

Question 3

What is the ATNR?

Answer 3

asymmetrical tonic neck reflex
Onset: present at birth (20 weeks pma)
Integration: 4-6 months
Stimulus: turn head to side
Response: facial arm extends and abducts, occipital arm flexes and abducts (fencing posture)

Question 4

How would non integration of ATNR affect function?

Answer 4

reaching, feeding, sitting, posture, attention

need to get rid of it so you can gain voluntary control of arms

Question 5

What is the rooting reflex?

Answer 5

Onset: present at birth (28 weeks pma)
integration: 3 months
Stimulus: touch the perioral area of hungry infant
Response: turns head and lips towards stimulus with the mouth open and a trial of sucking the finger (food finding)

Question 6

What happens to rooting reflex if baby isn’t hungry?

Answer 6

may have weaker response or none at all

Question 7

What is the palmar grasp reflex?

Answer 7

Onset: present at birth (28 weeks pma)
Integration: 4-7 months
Stimulus: pressure on palm of hand
Response: flexion of fingers (grasps)

Question 8

What happens if palmar grasp reflex isn’t integrated?

Answer 8

can’t use hands because they will be in a fist, writing affected
Need to be able to grasp and release voluntarily

Question 9

What is the plantar grasp reflex?

Answer 9

Onset: present at birth
Integration: 9 months
Stimulus: pressure to ball of foot
Response: flexion of toes (grasps with toes)

Question 10

What I plantar grasp isn’t integrated?

Answer 10

will have trouble with walking and balance

Question 11

What is the galant reflex (trunk incurvation)?

Answer 11

Onset: birth (28 weeks pma)
Integration: 3 months
Stimulus: in prone, stroke paravertebral skin
Response: lateral curvature of trunk on stimulated side, shifts hips toward side

Question 12

What if galant reflex isn’t integrated?

Answer 12

affects upright posture

Question 13

What is moro reflex?

Answer 13

Onset: birth (28 weeks pma)
Integration: 3-5 months
Stimulus: head drop backward
Response: abduction and extension of arms, splaying of fingers, followed by flexion and adduction of arms, child typically cries

Question 14

What is moro reflex isn’t integrated?

Answer 14

has affect on behavior in general

Question 15

What is startle reflex?

Answer 15

stimulus is loud noise with same response

Question 16

What is the automatic waling/reflex stepping?

Answer 16

Onset: present at birth (37 weeks pma)
Integration: 3-4 months
Stimulus: supported standing, lean child forward
Response: high stepping movements with regular rhythm

Question 17

What is the STNR?

Answer 17

Symmetrical tonic neck reflex
Onset: 4-6 months after birth
Integrates: 8-12 months
Stimulus: flexion or extension of head in quadruped position
Response: Head flexion= arms flex and hips extend, Head extension= arms extend and hips flex

Question 18

What is flexor withdrawal reflex?

Answer 18

Onset: 28 weeks pma
Integrates: 1-2 months
Stimulus: noxious to sole of foot
Response: flexion and withdrawal of stimulated leg

Question 19

What is crossed extension reflex?

Answer 19

Onset: 28 weeks pma
Integrates: 1-2 months
Stimulus: noxious to sole of foot
Response: flexion of stimulated leg and then extension of opposite leg with adduction

Question 20

What is positive support reflex?

Answer 20

Onset: 35 weeks pma
Integrates: 2 months
Stimulus: supported standing
Response: legs support weight

Question 21

What are consequences of persistent primitive reflexes?

Answer 21

poor hand eye coordination
difficulty with reaching and grasping
feeding difficulty
delay in acquisition of motor milestones
poor postural control

Question 22

What are syndromes that have absent or persistent primitive reflexes?

Answer 22

TBI, CP, genetic syndromes, developmental delay

Question 23

Why is tummy time important?

Answer 23

important for infant motor development, encourages postural control

Question 24

What are gross motor developments for neonates?

Answer 24

Fetal position (physiological flexion)
May be able to extend neck to drag face from side to side in prone.
Head bobs when held in sitting or upright position- no head control
Movements are reflexive

Question 25

What are the average ages for gross motor milestones: belly crawl, hands/knees crawl, cruise, ascend stairs, walk alone, and descend stairs?

Answer 25

Belly crawl- 6.8 mo
hands/knees crawl- 8.1 mo
cruise: 9.3 mo
ascend stairs: 11 mo
walk alone: 11.9 mo
descend stairs: 12.5 mo

Question 26

What are average ages for standing without support, standing with assistance, walking with assistance, and standing alone?

Answer 26

sitting w/o support: 6 mo
stand with assistance: 7.6 mo
walking with assistance: 9.2 mo
stand alone: 11 mo

Question 27

What is average age for crawling?

Answer 27

2 months

Question 28

What is average age for sitting?

Answer 28

6-7 months

Question 29

T/F: the average age for creeping is 8-10 months?

Answer 29

True

Question 30

T/F: the average age for walking is 10-12 months?

Answer 30

False: 14-18 months

Question 31

What is average age for pull to stand?

Answer 31

9-10 months

Question 32

What is average age for independent stance?

Answer 32

12-13 months

Question 33

What are developmental milestones for rolling?

Answer 33

1-2 months: roll side lying-> supine
4 months: prone-> supine
4-5 months: supine-> side lying
6-8 months: supine-> prone
9 months: development of segmental rotation rather than log rolling

Question 34

When does a child start to gallop? Skip?

Answer 34

Gallop at 4 years

Skip at 5-6 years

Question 35

How old is a child if they can creep up and down stairs? Walk up/down stairs with hand held, throw ball?

Answer 35

8-15 months

15-18 months

Question 36

If a child can run stiffly how old are they?

Answer 36

20 months

Question 37

What should a child be able to do at 2.5 years?

Answer 37

walk up/down stairs without support, kick ball forward

Question 38

What can a child do at 3 years versus 3.5 years?

Answer 38

3 years: runs well, walk up stairs alternating feet, catches ball with arms and body
3.5 years: walk down stairs alternating feet, jumps up with both feet, hops on one foot

Question 39

What are gross motor “red flags”?

Answer 39

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
social-emotional
cognitive
fine motor
communication

Question 40

What are walking milestones?

Answer 40

walk between 9-15 months
50% walk independently by 11.5 months
90% of kids will walk by 15 months
gait fully mature by age 7

Question 41

If a child can sit independently, roll independently (prone to supine and back), bears weight in prone on extended arms, and can maintain supported standing how old are they?

Answer 41

6 months old

Question 42

If a child has good sitting balance, moves in and out of sitting, begins pulling to stand and cruising, takes steps with hands held, and has independent mobility by creeping how old are they?

Answer 42

9 months