Reflexes and Developmental Milestones

Question 1

Term: present in the newborn; response to stimulus that occurs without conscious thought (involuntary movement)

Answer 1

Primitive reflexes

Question 2

Primitive reflexes integrate/disappear by ___ months (

Answer 2

6

Question 3

Reflex Response: facial arm extends and abducts, occipital arm flexes and abducts (fencing posture)

Answer 3

Asymmetrical tonic neck reflex (ATNR)

Question 4

Asymmetrical Tonic Neck Reflex:

• Onset:
• Integration:
• Stimulus:

Answer 4

• present at birth (20 weeks post menstrual age
• 4 to 6 months
• turn head to the side

Question 5

What happens if the ATNR reflex persists?

Answer 5

Limits the functional use of the UE including reaching, affects hand eye coordination.

Question 6

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

Answer 6

Rooting reflex

Question 7

Rooting Reflex:

• Onset:
• Integration:
• Stimulus:

Answer 7

• present at birth (28 weeks PMA)
• 3 months
• touch to the perioral area of hungry infant

Question 8

What happens if the rooting reflex persists?

Answer 8

It affects feeding and general behavior.

Question 9

Reflex Response: flexion of fingers (grasps with fingers)

Answer 9

Palmer grasp

Question 10

Palmer Grasp:

• Onset:
• Integration:
• Stimulus

Answer 10

• present at birth (28 weeks PMA)
• 4 to 7 months
• pressure on palm of hand

Question 11

What happens if the palmer grasp reflex persists?

Answer 11

They have fisted hands. They can’t functionally use the hands (reach, grasp and release). It also affects handwriting.

Question 12

Reflex Response: flexion of toes (grasps with toes)

Answer 12

Plantar grasp

Question 13

Plantar Grasp:

• Onset:
• Integration:
• Stimulus:

Answer 13

• present at birth
• 9 months
• pressure to ball of foot

Question 14

Why does the plantar grasp reflex need to be integrated?

Answer 14

To allow for standing and walking

Question 15

Reflex Response: lateral curvature of trunk on stimulated side, shifts hip toward side

Answer 15

Galant reflex aka Trunk incurvation

Question 16

Galant Reflex aka Trunk Incurvation:

• Onset:
• Integration:
• Stimulus:

Answer 16

• birth (28 weeks PMA)
• 3 months
• in prone, stroke paravertebral skin

Question 17

What happens if the galant reflex persists?

Answer 17

It affects upright posture.

Question 18

Reflex Response: abduction and extension of arms, splaying of fingers, followed by flexion and adduction of arms, child typically cries

Answer 18

Moro reflex

Question 19

Moro Reflex:

• Onset:
• Integration:
• Stimulus:

Answer 19

• birth (28 weeks PMA)
• 3 to 5 months
• head drop backward

Question 20

What happens if the moro reflex persists?

Answer 20

It affects behavior.

Question 21

What is the startle reflex?

Answer 21

The stimulus is a loud nose and the response is the same as the moro reflex. May only see the flexion and abduction of arms.

Question 22

Reflex Response: high stepping movements with regular rhythm

Answer 22

Automatic walking/reflex stepping

Question 23

Automatic Walking/Reflex Stepping:

• Onset:
• Integration:
• Stimulus:

Answer 23

• present at birth (37 weeks PMA)
• 3 to 4 months
• supported standing, lean child forward

Question 24

Reflex Response:

• head flexion- elbows flexion and hips extend
• head extension- elbows extend and hips flex

Answer 24

Symmetrical tonic neck reflex (STNR)

Question 25

Symmetrical Tonic Neck Reflex (STNR): - Onset: - Integration: - Stimulus:

Answer 25

- 4 to 6 months after birth - 8 to 12 months - flexion or extension of head in quadruped position

Question 26

What happens if the symmetrical tonic neck reflex persists?

Answer 26

It affects crawling, balance, and walking progression.

Question 27

Crawling or Creeping? on elbows and knees, belly is close to/on the ground, more like an army crawl

Answer 27

Crawling

Question 28

Crawling or Creeping? on hands and knees, belly is off the ground

Answer 28

Creeping

Question 29

Reflex: - 4 to 18 months - Stimulus: hold infant suspended horizontally, hands under chest and stomach - Response: extends neck, trunk and hips

Answer 29

Landau reaction

Question 30

Reflex: - 0 to 6 months - Prone position: stimulus- lift infant up; response- maximal flexor tone - Supine position: stimulus- lift infant up; response- maximal extensor tone

Answer 30

Tonic labyrinthine reflex

Question 31

Reflex: - 0 to 6 months - Stimulus: put dormum of foot or back of hand on edge of table - Response: placing of foot or hand on table top

Answer 31

Placing reaction

Question 32

Reflex: - present at birth, integrates at 2 to 5 months - Stimulus: pull to sitting from supine - Response: arms will flex and head will lag

Answer 32

Traction or Pull-to-Sit

Question 33

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

Answer 33

Crossed extension

Question 34

Reflex: - Onset: 35 weeks PMA - Integration: 2 months (varies) - Stimulus: supported standing - Response: legs support weight

Answer 34

Positive support

Question 35

Persistence of Primitive Reflexes - Poor ___________ coordination - Difficulty with reaching and ___________ - Feeding difficulty - Delay in acquisition of ________ milestones - Poor ___________ control

Answer 35

- eye-hand - grasping - motor - postural

Question 36

Term: set of functional skills or age specific tasks that most children can do at a certain age range

Answer 36

Milestones

Question 37

"________ time" is important for motor development.

Answer 37

Tummy

Question 38

Sleeping in the ________ position increases risk of SIDS.

Answer 38

prone

Question 39

Age of Motor Milestones: - Crawling - Sitting - Creeping - Pull-to-Stand - Independence Stance - Walking

Answer 39

- Crawling: 2 months - Sitting: 6 to 7 months - Creeping: 8 to 10 months - Pull-to-Stand: 9 to 10 months - Independence Stance: 12 to 13 months - Walking: 14 to 18 months

Question 40

Gross Motor Development Milestones- 6 months: - ______ independently - ______ independently (prone to supine and back) - Bears weight in prone on extended arms - Can maintain supported ________ with hand held and good trunk control

Answer 40

- Sits - Rolls - standing

Question 41

Gross Motor Development Milestones- 9 months: - Independent mobility by __________ - Good sitting balance - Moves in and out of sitting - Begins pulling to stand and __________ - Takes steps with hands held

Answer 41

- creeping | - cruising

Question 42

Other Milestones: - 8 to 15 months: ________ up and down stairs - 15 to ___ months: walks up/down stairs with hand held, throws ball forward - ___ months: runs stiffly - ____ years: walks up/down stairs without support, kicks ball forward - 3 years: runs well, walks up stairs _________ feet, catches ball with arms and body - ____ years: walks down stairs alternating feet, jumps with both feet, hops on one foot - 4 years: ________ - 5 to 6 years: _______

Answer 42

Other Milestones: - 8 to 15 months: creeps - 15 to 18 months - 20 months - 2.5 years - 3 years: alternating - 3.5 years - 4 years: gallops - 5 to 6 years: skips

Question 43

Name 5 gross motor "red flags."

Answer 43

Persistence of reflexes Lack of leg movements "Stuck" in head/neck/trunk hyperextension Extremely floppy (low tone) Spasticity Athetoid movement (lack of control of movement, slow, involuntary, writhing movements) Extremely rigid Inability to achieve midline head/extremities (in supine) Only unilateral movements "Bunny hops" instead of creeping Walks on toes with adducted legs

Question 44

Name 3 social-emotional developmental red flags.

Answer 44

Infant who cannot be comforted Extreme irritability or lethargy Toddler who does not distinguish familiar persons from strangers Toddler who will not make eye contact Preschooler who cannot function in groups or does not understand rules Preschooler with excessively aggressive behaviors Preschooler who excessively fights with siblings

Question 45

Name 3 cognitive developmental red flags.

Answer 45

Infant who does not know caregivers by 3 months Failure to develop object permanence Failure to develop play by 4 to 8 months Toddler who cannot point to a picture when object named Three year old who does not know full name and refer to self Toddler who cannot recognize different shapes Preschooler with no imaginative play Preschooler who fails to ask questions and explore the environment

Question 46

Name 3 fine motor developmental red flags.

Answer 46

Persistent palmar grasp Asymmetry off hand/arm use Thumb grasped inside of palm Failure to reach or grasp Using primitive reflexes to grasp or release Early handedness Neglect of one side Poor handwriting, drawing, use of crayons Difficulty with finger manipulation of objects, throwing and retrieving Failure to develop pincer grasp when appropriate Difficulty with self feeding, dressing, toileting

Question 47

Name 3 communication developmental red flags.

Answer 47

Caregiver concerned infant producing sounds or infant response to sound Lack of babbling or cooing in an infant Infant who fails to turn to voice of caregiver Less than 50 words at 2 years of age Failure of non-family members to understand speech by age 4 Preschooler who repeats syllables and words when talking Preschooler who is not developing grammar