Pediatric Rehabilitation -- Physical Medicine and Rehabilitation Board Review -- NCBI Bookshelf

Reflex	Stimulus	Response	Age of Suppression	Clinical Significance
Moro	Sudden neck extension	Shoulder abduction, shoulder, elbow, and finger extension followed by arm flexion adduction	4–6 months	Persists in CNS pathology, static encephalopathy
Startle	Sudden noise, clapping	Same as motor reflex	4–6 months	Persists in CNS pathology, static encephalopathy
Rooting	Stroking lips or around mouth	Moving mouth, head toward stimulus in search of nipple	4 months	Diminished in CNS pathology, may persist in CNS pathology
Positive supporting	Light pressure or weight bearing on plantar surface	Legs extend for partial support of body weight	3–5 months replaced by volitional weight bearing with support	Obligatory or hyperactive abnormal at any age, early sign of lower extremity spasticity, may be associated with scissoring
Asymmetric tonic neck	Head turning to side	Extremities extend on face side, flex on occiput side	6–7 months	Obligatory response abnormal at any age, persists in static encephalopathy
	Neck flexion	Arms flex, legs extend	6–7 months	Obligatory response abnormal at any age, persists in static encephalopathy
Symmetric tonic neck	Neck extension	Arms extend, legs flex
Palmar grasp	Touch or pressure on palm or stretching finger flexors	Flexion of all fingers, hand fisting	5–6 months	Diminished in CNS suppression, absent in lower motorneuron (LMN) paralysis; persists/hyperactive in spasticity
Plantar grasp	Pressure on sole distal to metatarsal heads	Flexion of all toes	12–14 months when walking is achieved	Diminished in CNS suppression, absent in LMN paralysis; persists/hyperactive in spasticity
Autonomic neonatal walking	On vertical support plantar contact and passive tilting of body forward side to side	Alternating automatic steps with support	3–4 months	Variable activity in normal infants, absent in LMN paralysis
Placement or placing	Tactile contact on dorsum of foot or hand	Extremity flexion to place hand or foot over an obstacle	Before end of first year	Absent in LMN paralysis or with lower extremity spasticity
Neck righting or body derotational	Neck rotation in supine	Sequential body rotation from shoulder to pelvis toward direction of face	4 months replaced by volitional rolling	Non-sequential leg rolling suggests increased tone
Tonic labyrinth	Head position in space, strongest at 45° from horizontal Supine Prone	Predominant extensor tone Predominant flexor tone	4–6 months	Hyperactive/obligatory abnormal at any age, persists in CNS damage/static encephalopathy

Reflex

Stimulus

Response

Age of Suppression

Clinical Significance

Moro

Sudden neck extension

Shoulder abduction, shoulder, elbow, and finger extension followed by arm flexion adduction

4–6 months

Persists in CNS pathology, static encephalopathy

Startle

Sudden noise, clapping

Same as motor reflex

4–6 months

Persists in CNS pathology, static encephalopathy

Rooting

Stroking lips or around mouth

Moving mouth, head toward stimulus in search of nipple

4 months

Diminished in CNS pathology, may persist in CNS pathology

Positive supporting

Light pressure or weight bearing on plantar surface

Legs extend for partial support of body weight

3–5 months replaced by volitional weight bearing with support

Obligatory or hyperactive abnormal at any age, early sign of lower extremity spasticity, may be associated with scissoring

Asymmetric tonic neck

Head turning to side

Extremities extend on face side, flex on occiput side

6–7 months

Obligatory response abnormal at any age, persists in static encephalopathy

Neck flexion

Arms flex, legs extend

6–7 months

Obligatory response abnormal at any age, persists in static encephalopathy

Symmetric tonic neck

Neck extension

Arms extend, legs flex

Palmar grasp

Touch or pressure on palm or stretching finger flexors

Flexion of all fingers, hand fisting

5–6 months

Diminished in CNS suppression, absent in lower motorneuron (LMN) paralysis; persists/hyperactive in spasticity

Plantar grasp

Pressure on sole distal to metatarsal heads

Flexion of all toes

12–14 months when walking is achieved

Diminished in CNS suppression, absent in LMN paralysis; persists/hyperactive in spasticity

Autonomic neonatal walking

On vertical support plantar contact and passive tilting of body forward side to side

Alternating automatic steps with support

3–4 months

Variable activity in normal infants, absent in LMN paralysis

Placement or placing

Tactile contact on dorsum of foot or hand

Extremity flexion to place hand or foot over an obstacle

Before end of first year

Absent in LMN paralysis or with lower extremity spasticity

Neck righting or body derotational

Neck rotation in supine

Sequential body rotation from shoulder to pelvis toward direction of face

4 months replaced by volitional rolling

Non-sequential leg rolling suggests increased tone

Tonic labyrinth

Head position in space, strongest at 45° from horizontal Supine Prone

Predominant extensor tone Predominant flexor tone

4–6 months

Hyperactive/obligatory abnormal at any age, persists in CNS damage/static encephalopathy

From Molnar GE, Alexander MA. Pediatric Rehabilitation 3rd ed. Philadelphia: Hanley & Belfus, 1999: page 20, table 2-3, with permission