Normal until Reflex Stimulus Response

0-6 mos *Moro Supine, back of head supported Abduction & extension of arms, hands
Suppressed at above table, drop head backwards, open, *crying, followed by arm
4-6 mos *5-6 also associated with loud noise adduction as if in an embrace
mos; onset
28wks gest

1 mo Hand opening Stroke ulnar border of palm & little Automatic opining of hand
finger
2 mos Rooting cardinal ptsu Touch corner of mouth Bottom lip lowers on same side &
tongue moves towards point of
stimulation; when finger slides away,
head turns to follow

Center of upper lip stimulated Lip elevates, tongue moves towards

place stimulated; if finger slides along
oronasal groove, then head extends
Center bottom lip stroked
Lip is lowered, tongue directed to site of
stimulation; if finger moves towards
chin, mandible is lowered & head flexes

2 mos Primary walking Hold baby upright & tip forwards Initiates reciprocal flexion and
Suppressed at (automatic walk: reflex (and side to side), sole of foot presses extension of legs
3-4 mos stepping) vs. table
2 mos Galant’s trunk Stroke back lateral to the spine Flexion of trunk towards side of
incurvation stimulus
2 mos Automatic sitting Pressure is placed on the thighs and Child pulls to sitting from supine
head is held in flexion, supine
position
2 mos *Flexor withdrawal Supine, head midposition, legs Uncontrolled flexion response of
*onset 28wks extended, stimulate (*noxious) sole stimulated leg, do not confuse with
gest; integ 1- of foot response to tickling
2mos

2 mos Extensor thrust Supine, head midposition, one leg Uncontrolled extension of stimulated
extended, opposite leg flexed, leg, do not confuse with response to
stimulate sole of flexed leg tickling

2 mos *Crossed extension Supine, head midposition, legs Opposite leg adducts, extends, IR, foot
*onset 28wks extended, stimulate (*noxious) PF (typical scissor position)
gest; integ 1- medial surface of one leg by tapping *Opposite LE flexes, adducts, extends
2mos

3 mos Sucking Introduce a finger into mouth Sucking action of lips and jaw
3 mos Rooting Touch baby’s cheek (or lips) Head turns towards stimulus
Suppressed at
4 mos
3 mos *Palmar grasp Press finger or other suitable object Fingers flex & grip object (head in
Suppressed at into palm from ulnar side midline during test)
5-6 mos Stretching finger flexors
*4-6 mos;
onset birth
3 mos Tonic labyrinthine prone Turn px prone, head in midposition Unable to extend head, retract
Suppressed at (reaction to prone) Head position in space, strongest at shoulders, extend trunk, arms, legs
4-6 mos 45 degrees from horizontal) (flexor tone predominates)

3 mos **Positive supporting Hold px in standing, press down on Increase of extension in legs, and PF,
Suppressed at soles of feet genu recurvatum may occur
3-5 mos,
replaced by
volitional WB
with support
*onset birth;
integ 6mos

3-5 mos Negative supporting Hold in WB position Child sinks astasia

3 mos – 2.5 Landau Child held in ventral suspension, lift Head, spine, legs, shoulders extend
yrs, strong at head
10 mos
5 mos Neck righting/body Supine, rotate head to one side, Body rotates as a whole in same
Suppressed at derotational active or passive direction as the head
4 mos Sequential body rotation from shoulder
replaced by to pelvis toward direction of face
volitional
rolling
6 mos, usually **ATNR Px supine, head in midposition, arms Extension of arm & leg on face side, or
pathologic & legs extended, turn head to one increase in extensor tone, flexion of
Suppressed at side arm & leg on skull side or increase in
6-7 mos flexor tone
*4-6 mos;
onset birth
 9 mos *Foot/plantar grasp Press sole behind toes Grasping response of feet
Suppressed at
12-14 mos
when walking
achieved
*onset 28wks
gest; integ
9mos

Remains Placing/placement Bring anterior aspect of foot or hand Child lifts limb up to step unto table
Suppressed against edge of a table
before end of
1st year
Remains *Startle Sudden loud noise or tapping the Elbow is flexed (not extended as in the
Suppressed at sternum Moro reflex) and hand remains closed,
4-6mos *crying
Same as Moro reflex
Rare, usually **STNR Px in quadruped position or over Arms flex or flexor tone dominates, legs
pathologic tester’s knees, flex head extend or extensor tone dominates
Suppressed at
6-7 mos Arms extend or extensor tone
*8-12 mos; As above, extend head dominates, legs flex or flexor tone
onset 4-6mos dominates

Pathological **Tonic labyrinthine Px supine, head in midposition, arms Extensor tone dominates when arms &
Suppressed at supine & legs extended legs flexed passively
4-6 mos *Symmetrical TLR Head position in space, strongest at
*onset birth; 45 degrees from horizontal
integ 6mos

Pathological **Associated reactions Have px squeeze an object Clench of other hand or increase of tone
*onset 0- (hemiplegic squeeze with uninvolved in other parts of the body, abnormal
3mos; integ 8- hand) overflow
9yrs

*Reflexes under primitive/spinal reflexes

**Reflexes under tonic/brainstem reflexes

Italic font from Molnar

Italic font with * from Sullivan

 Onset/Integration Primitive Reflex Stimulus Response

Onset 28wks gest; Traction Grasp forearm and pull up Grasp and total UE flexion
integ 2-5mos from supine to sitting
Midbrain/Cortical Reflexes

Onset 4-6mos; integ Neck righting on body (NOB) Passive head rotation Log roll
5yrs
Same as above Body righting on body (BOB) Passive upper/lower trunk Unmoved follows
rotation in supine
Onset 0-2mos; integ Labyrinthine head righting Vision occluded, tip body Head vertical, mouth horizontal
persists
Same as above Optic righting Vision not occluded, tip body Same as above

Onset 0-2mos; integ Body righting on head (BOH) Prone/supine Same as above
5yrs
Onset arms 4-6mos Protective extension Displace COG outside BOS Arms or legs extend and abduct
legs 6-9 mos; integ
persists
Onset prone 6mos, Equilibrium reactions – tilting Displace COG by tilting or Trunk curve toward stimulus with
supine 7-8mos, moving support surface extension and abduction of
sitting 7-8mos, extremities on that side, protective
quadruped 9-12 mos, extension on opposite side
standing 12-21 mos;
integ persists

Same as above Equilibrium reactions – Displace COG out of BOS Trunk curve toward stimulus with
postural fixation extension and abduction of
extremities on side to which force
applied
 Reflex Emerges at Stimulus Response

Rising 2-6 mos Hold blindfolded px in prone, Head rises to normal position, face vertical,
Labyrinthine head in space, as head drops mouth horizontal
righting
Vestibular righting Prone 2 mos As above in supine
(decrease of head Supine 3-4 mos As above
lag) Hold blindfolded px in space
6 mos – hold around pelvis, tilt to Head rights itself to normal position, face
the side vertical, mouth horizontal

Optical 6 mos As above, no blindfold As above

Amphibian 4-6 mos Px prone, head in Automatic flexion outward of hip & knee on
midposition, legs extended, same side
lift pelvis on one side

Body righting
-Derotative 4-6 mos Supine – rotate head or one Active derotation at waist, i.e., segmental
knee one side, passive rotation of trunk between shoulders & pelvis

-Rotative 6-10 mos Rotate hip & knee or arm or Active segmented rotation (hyperactive at 10
head actively mos, cannot lie supine)

Lift reaction (not 5-6 mos Lift body through space Head rises/lifts
the pathological lift
reaction)
Shoulder/pelvic 3-6 mos Fix distal part/s of limb Rise up on to limb
girdle righting
Tilt reactions
-Supine & prone 6 mos Px on tiltboard, arms & legs Lateral curving of head & thorax, protective
extended, tilt board to one reaction in limbs accompany trunk reaction
side

-Four-point 7-12 mos Px in quadruped position, tilt Lateral curving of head & thorax, abduction-
kneeling towards one side extension of arm & leg on raised side &
protective reactions on lowered side may
accompany this

- - Tilt forward & back (AP) Forward – head & back flex
Backward – head & back extend

-Sitting 9-12 mos Px seated on chair – tilt px to Head & thorax curve abduction-extension of
6-8 mos one side, tilt forward AP back arm & leg on raised side, other protective
reactions may accompany this
Tilt forward
-Sitting 6-8 mos Tilt back Child extends head & back
Child flexes head & trunk
Px in kneel-standing position,
-Kneel-standing 18 mos pull or tilt px on one side As above

Px in standing, tilt sideways,

tilt AP
-Standing 12-18 mos Trunk as above
12-14 mos
Staggering 12-18 mos Move to left or right side
reactions push or holding arm Hopping, or step sideways to maintain
Move forward equilibrium

Move backwards Hopping or step backwards to maintain

equilibrium or DF feet going on to heels
Saving from falling 5-10 mos Prone – sudden tip Immediate extension of arms with abduction
Protective Sitting ant – 5-7 downward and extension of fingers to save and then prop
extension or mos Sitting – sudden tip the child
parachute Lateral – 6-8 mos downward
reactions Posterior – 7-8 mos Standing – sudden tip
Standing 12-14 mos downward

6-9 mos

Standing – sudden tip

9-12 mos sideways – one arm

Standing – sudden tip

backwards – both arms