Reflexes and Developmental Milestones Flashcards
Term: present in the newborn; response to stimulus that occurs without conscious thought (involuntary movement)
Primitive reflexes
Primitive reflexes integrate/disappear by ___ months (
6
Reflex Response: facial arm extends and abducts, occipital arm flexes and abducts (fencing posture)
Asymmetrical tonic neck reflex (ATNR)
Asymmetrical Tonic Neck Reflex:
- Onset:
- Integration:
- Stimulus:
- present at birth (20 weeks post menstrual age
- 4 to 6 months
- turn head to the side
What happens if the ATNR reflex persists?
Limits the functional use of the UE including reaching, affects hand eye coordination.
Reflex Response: turns head and lips towards stimulus with the mouth opening and a trial of sucking the finger (food finding reflex)
Rooting reflex
Rooting Reflex:
- Onset:
- Integration:
- Stimulus:
- present at birth (28 weeks PMA)
- 3 months
- touch to the perioral area of hungry infant
What happens if the rooting reflex persists?
It affects feeding and general behavior.
Reflex Response: flexion of fingers (grasps with fingers)
Palmer grasp
Palmer Grasp:
- Onset:
- Integration:
- Stimulus
- present at birth (28 weeks PMA)
- 4 to 7 months
- pressure on palm of hand
What happens if the palmer grasp reflex persists?
They have fisted hands. They can’t functionally use the hands (reach, grasp and release). It also affects handwriting.
Reflex Response: flexion of toes (grasps with toes)
Plantar grasp
Plantar Grasp:
- Onset:
- Integration:
- Stimulus:
- present at birth
- 9 months
- pressure to ball of foot
Why does the plantar grasp reflex need to be integrated?
To allow for standing and walking
Reflex Response: lateral curvature of trunk on stimulated side, shifts hip toward side
Galant reflex aka Trunk incurvation
Galant Reflex aka Trunk Incurvation:
- Onset:
- Integration:
- Stimulus:
- birth (28 weeks PMA)
- 3 months
- in prone, stroke paravertebral skin
What happens if the galant reflex persists?
It affects upright posture.
Reflex Response: abduction and extension of arms, splaying of fingers, followed by flexion and adduction of arms, child typically cries
Moro reflex
Moro Reflex:
- Onset:
- Integration:
- Stimulus:
- birth (28 weeks PMA)
- 3 to 5 months
- head drop backward
What happens if the moro reflex persists?
It affects behavior.
What is the startle reflex?
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.
Reflex Response: high stepping movements with regular rhythm
Automatic walking/reflex stepping
Automatic Walking/Reflex Stepping:
- Onset:
- Integration:
- Stimulus:
- present at birth (37 weeks PMA)
- 3 to 4 months
- supported standing, lean child forward
Reflex Response:
- head flexion- elbows flexion and hips extend
- head extension- elbows extend and hips flex
Symmetrical tonic neck reflex (STNR)
Symmetrical Tonic Neck Reflex (STNR):
- Onset:
- Integration:
- Stimulus:
- 4 to 6 months after birth
- 8 to 12 months
- flexion or extension of head in quadruped position
What happens if the symmetrical tonic neck reflex persists?
It affects crawling, balance, and walking progression.
Crawling or Creeping? on elbows and knees, belly is close to/on the ground, more like an army crawl
Crawling
Crawling or Creeping? on hands and knees, belly is off the ground
Creeping
Reflex:
- 4 to 18 months
- Stimulus: hold infant suspended horizontally, hands under chest and stomach
- Response: extends neck, trunk and hips
Landau reaction
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
Tonic labyrinthine reflex
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
Placing reaction
Reflex:
- present at birth, integrates at 2 to 5 months
- Stimulus: pull to sitting from supine
- Response: arms will flex and head will lag
Traction or Pull-to-Sit
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
Crossed extension
Reflex:
- Onset: 35 weeks PMA
- Integration: 2 months (varies)
- Stimulus: supported standing
- Response: legs support weight
Positive support
Persistence of Primitive Reflexes
- Poor ___________ coordination
- Difficulty with reaching and ___________
- Feeding difficulty
- Delay in acquisition of ________ milestones
- Poor ___________ control
- eye-hand
- grasping
- motor
- postural
Term: set of functional skills or age specific tasks that most children can do at a certain age range
Milestones
“________ time” is important for motor development.
Tummy
Sleeping in the ________ position increases risk of SIDS.
prone
Age of Motor Milestones:
- Crawling
- Sitting
- Creeping
- Pull-to-Stand
- Independence Stance
- Walking
- 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
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
- Sits
- Rolls
- standing
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
- creeping
- cruising
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: _______
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
Name 5 gross motor “red flags.”
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
Name 3 social-emotional developmental red flags.
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
Name 3 cognitive developmental red flags.
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
Name 3 fine motor developmental red flags.
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
Name 3 communication developmental red flags.
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
