Neurologic Examination and Newborn Reflexes

The neurologic examination of the newborn begins with the general appearance of the infant. The newborn should have a strong cry and exhibit symmetric movements; a high-pitched or weak cry can be associated with current illness or neurologic deficits. Asymmetric movements can indicate musculoskeletal or focal neurologic injury. Complete absence or asymmetry of any newborn reflex can indicate neurologic deficit or injury. The following developmental reflexes are present at birth in the normal newborn (Thureen et al., 2005): Rooting reflex: When the cheek is stroked, the infant turns the head toward the stimulus and opens the mouth as if preparing to feed.

Sucking reflex: Stroking the lips causes the infant to open the mouth and begin to make sucking movements. The strength and coordination of suck can be assessed using a gloved finger placed in the mouth.

Moro reflex (or startle reflex): The infant's head is raised several centimeters above the examination table while supporting the head and neck. The head is allowed to drop a short distance into the examiner's other hand, and the infant responds by abduction and extension of the arms and opening of the hands. The infant then flexes arms and closes the fists and brings them back in toward the body. Tonic neck reflex: With the infant lying supine, the head is turned to one side. The infant's arm on the side where the face is directed extends, and the opposite arm flexes.

Box 22-3 Common Benign Findings in the Newborn (Partial List)

Caput succedaneum (edema crossing suture lines)

Epstein's pearls (retention cysts) on hard palate

Erythema toxicum

Enlarged breasts (male or female)


Mild diastasis recti

Mild esotropia/exotropia



Mongolian spots

Nasolacrimal duct blockage (usually spontaneously resolves)

Neonatal pustular melanosis

Petechiae on presenting part (nonprogressive)

Protruding xiphoid

Salmon patches

Shortened tongue frenulum (does not need cutting) Subconjunctival hemorrhage at birth Umbilical hernia Vaginal discharge or bleeding

Table 22-2 Vital Signs in the First Days of Life

Vital sign

Normal value

Heart rate

100-180 beats/min

Respiratory rate

24-60 breaths/min

Systolic blood pressure

65-90 mm Hg

Diastolic blood pressure

50-70 mm Hg


<101.4° F (38.0° C) >96.8° F (36.0° C)

Data from Gunn VL, Nechyba C. The Harriet Lane Handbook, 16th ed, St Louis, Mosby, 2002; Rudolph AM. Kamei RK, Sagan P. Rudolph's Fundamentals of Pediatrics, 2nd ed. Norwalk, Conn, Appleton & Lange, 1998.

Palmar and plantar grasp: Stroking the palm of the hand causes the infant to grip the examining finger. This grip tightens as the examiner pulls away. When firm pressure is placed on the plantar surface of the foot, the toes curl in toward the examining thumb.

Stepping reflex: The infant is held with both feet touching the examination table. The infant should exhibit alternating stepping movements.

Truncal incurvation (Galant reflex): The infant is held in the prone position above the examination table. Stroking one side of the spine with a finger or cotton swab should cause the infant to flex the pelvis toward the side of the reflex.

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