Chapter 9 The Infant: Basic Assessment and Health Promotion 265

TABLE 9-3

Assessment of Infant Reflexes

Reflex Description Appearance/Disappearance

Rooting Touching babys cheek causes head to turn towardthe side touched.

Present in utero at 24 weeks; disappears 34months; may persist in sleep 912 months

Sucking Touching lips or placing something in babysmouth causes baby to draw liquid into mouthby creating vacuum with lips, cheeks, andtongue.

Present in utero at 28 weeks; persists through earlychildhood, especially during sleep

Bite Touching gums, teeth, or tongue causes baby toopen and close mouth.

Disappears at 35 months when biting isvoluntary, but seen throughout adult years incomatose person

Babkin Pressure applied to palm causes baby to openmouth, close eyes.

Present at birth; disappears in 2 or 4 months

Pupillary response Flashing light across babys eyes or face causesconstriction of pupils.

Present at 32 weeks of gestation; persiststhroughout life

Blink Baby closes both eyes. Remains throughout lifeMoro or startle Making a loud noise or changing babys position

causes baby to extend both arms outward withfingers spread, then bring them together in atense, quivery embrace

Present at 28 weeks of gestation; disappears at 47 months

Withdrawing Baby removes hand or foot from painful stimuli. Present at birth; persists throughout lifeColliding Baby moves arms up and face to side when object

is in collision course with face.Present at birth or shortly after; persists in modified

form throughout lifePalmar grasp Placing object or finger in babys palm causes his

or her fingers to close tightly around object.Present at 32 weeks of gestation; disappears at

34 months, replaced by voluntary grasp at 45 months

Plantar grasp Placing object or finger beneath toes causescurling of toes around object.

Present at 32 weeks of gestation; disappears at912 months

Tonic neck or fencing (TNR)

Postural reflex is seen when infant lies on back withhead turned to one side; arm and leg on theside toward which he or she is looking areextended while opposite limbs are flexed.

Present at birth; disappears at approximately 4 months

Stepping, walking, dancing

Holding baby upright with feet touching flatsurface causes legs to prance up and down as ifbaby were walking or dancing.

Present at birth; disappears at approximately 24 months; with daily practice of reflex, infantmay walk alone at 10 months

Reaching Hand closes as it reaches toward and grasps atobject at eye level.

Present shortly after birth if baby is upright; comesunder voluntary control in several months

Orienting Head and eyes turn toward stimulus of noise,accompanied by cessation of other activity,heartbeat change, and vascular constriction.

Present at birth; comes under voluntary controllater; persists throughout life

Attending Eyes fix on a stimulus that changes brightness,movement, or shape.

Present shortly after birth; comes under voluntarycontrol later; persists throughout life

Swimming Placing baby horizontally, supporting him or herunder abdomen, causes baby to make crawlingmotions with his or her arms and legs whilelifting head from surface as if he or she wereswimming.

Present after 3 or 4 days; disappears at approxi-mately 4 months; may persist with practice

Trunk incurvation Stroking one side of spinal column while baby ison his or her abdomen causes crawling motionswith legs, lifting head from surface, and incurva-ture of trunk on the side stroked.

Present in utero; then seen at approximately thirdor fourth day; persists 23 months

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266 Unit III The Developing Person and Family Unit: Infancy Through Adolescence

VisionVision is the least well-developed sense at birth. In utero, the fetus haslittle to look at, and thus, the connection between the eyes and thevisual cortex does not develop until after birth. The eyes of thenewborn are smaller than of the adult. Retinal structures are im-mature, muscles of the lens are weak, and the optic nerve is under-developed. Initial vision is blurred. The visual abilities changefrom birth to 4 months of age. As these structures mature and thenewborn has visual experiences, visual ability improves (15, 56).Tear glands do not begin to function until 2 to 4 weeks of age (15,56, 87).

The following are characteristics of newborn vision (13, 15, 31,38, 56, 91):

1. Acuity: Clarity of vision begins within the first day but is ini-tially blurred. Later, 8 to 20 inches are necessary for focus. Vi-sual acuity can be measured at 20/100 to 20/400.

2. Fixation: The newborn directs both eyes to the same point inspace for a specific limited time (4 to 18 seconds), focuses brieflyon objects, and follows to midline. The ability to fixate or coor-dinate eye movements is greater in the first hours of life thanduring several succeeding days.

3. Tracking: The baby follows visually large moving objects, begin-ning a day after birth.

4. Discrimination: The baby demonstrates preference for particu-lar sizes and shapes (large circles, dots, or squares); large pic-tures or objects; contrasts of black and white patterns(concentric circles, bulls-eye); and medium (yellow, pink,green) over dim (blue) or bright (orange, red) colors. Lesscomplex stimuli and reflecting objects over dull surfaces arepreferred.

5. Conjugation: The baby moves the eyes together; refixation ismore frequent.

6. Sensitivity to light: Reaction to light is equal to that of adults.7. Scanning: The newborn is able to move his or her eyes over the

visual field and focus briefly on a satisfying image, and prefers toscan edges and contours of complex shapes. Peripheral visionis narrow.

8. Accommodation: The baby is able to adjust the eyes fordistance. The preferred distance is 8 inches for infants up to 1 month in age.

9. Visual preference: The baby varies amount of time spent look-ing at different sights in the environment.

The infant maintains contact with the environment throughvisual fixation, scanning, and tracking and pays more attentionto stimuli from the face than to other stimuli as depicted inFigure 9-4 . The newborn looks at the mothers face whilefeeding and while sitting upright and prefers a human face to amobile toy. The newborn follows the path of an object, crying orpulling backward if it comes too close to his or her face. By theage of 1 month, the baby has a pupillary reflex, can distinguishbetween the face of the mother and a stranger, and differentiatesbetween brightness and darkness. Bright lights cause discomfort.

Teach parents that a baby needs eye contact and the opportu-nity to see the human face and a variety of changing scenes andcolors. Providing a mirror or chrome plate that reflects light andobjects and rotating the bed help the baby use both eyes, avoidingone-sided vision. Hang cardboard black and white mobiles, espe-cially those that make sound, and have them within reach of thebabys kicking feet. Later the infant enjoys other colors and designsthat are within grasp. By age 2 months, the baby can see the ceil-ing and decorations on it. As the baby grows older the crib shouldbe low enough for him or her to see beyond the crib.

Parents should be reassured that the antibiotic ointment cor-rectly placed in the babys eyes at birth will not damage vision but

TABLE 9-3

Assessment of Infant Reflexes

Reflex Description Appearance/Disappearance

Babinski Stroking bottom of foot causes big toe to raisewhile other toes fan out and curl downward.

Present at birth; disappears at approximately 9 or10 months: presence of reflex later may indicatedisease

Landau Suspending infant in horizontal, prone positionand flexing head against trunk causes legs toflex against trunk.

Appears at approximately 3 months; disappears atapproximately 1224 months

Parachute Sudden thrusting of infant downward from hori-zontal position causes hands and fingers toextend forward and spread as if to protect selffrom a fall.

Appears at approximately 79 months; persistsindefinitely

Biceps Tap on tendon of biceps causes biceps to contractquickly.

Brisk in first few days, then slightly diminished;permanent

Knee jerk Tap on tendon below patella or on patella causesleg to extend quickly.

More pronounced first 2 days; permanent

Data from references 38, 56, 91.

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