Pediatrics Occupational Therapy | Infant Reflexes, Feeding Development, Scissor skills and GM Peds Milestones

Pediatrics Occupational Therapy Notes

Infant Reflexes Video

  • Content divided into 3 categories
    • Emerges before birth
    • Emerges from birth to 6 months
    • Emerges around 6 months and persists
  • Part I: Reflexes that Emerge before birth
    • Observed within1 year
    • Integrated within 1 year
    • May reoccur after injury to the brain
    • Important for survival, posture and alignment of head with body
  • Rooting Reflex:
    • onset 28 weeks gestation
    • Integrated at 3 months
    • Test-stroke the baby’s check, mouth, lip
    • Response: head, tongue, mouth moves towards the stimulus
    • Search for and find food

Rooting Reflex

Hand and Upper Extremity | OT Notes

  • Suck Swallow Reflex
    • Onset: 28 weeks gestation
    • Integrated 2-5 months
    • Test: place finger inside mouth
    • Response: strong rhythmical sucking
    • Purpose: Eat food, Ingestion for nourishment

Suck Swallow Reflex

  • Traction
    • Onset: 28 weeks gestation
    • Integrated: 2-5 months
    • Test: try to pull up by forearms and pull to sit
    • Response: Head Lag, Flexion of UE, Reflexive grasp


  • MORO
    • Onset: 28 gestation
    • Integrated: 4-6 months
    • Test: create a falling sensation- rapidly drop the head backwards
    • Response: (1) arm extension and abduction (2) arm flexion and adduction
      • And crying


  • Plantar Grasp
    • Onset: 28 weeks gestation
    • Integrated: 9 month
    • Test: apply pressure at ball of foot
    • Response: toes curling in flexion
    • Purpose: increase tactile input to sole of foot -> prepares him for standing to eventually walk and run and maintain balance
      • If maintained child will be hypersensitive to touch and gravity insecurity while standing

Plantar Grasp

  • Galant
    • Onset: 32 weeks gestation
    • Integrated: at 2 months
    • Test: hold baby in prone suspension and stroke 1 side alongside spine
    • Response: lateral trunk flexion on stimulated side
    • Purpose: lateral trunk movements facilitating trunk stabilization and crawling
      • facilitation of hip movement and ROM in preparation for crawling and walking


  • Palmar Grasp
    • Onset: 37 weeks gestation
    • Integrated: 4-6 months
    • Test: place finger in baby’s palm
    • Response: reflexive grasp and finger flexion
    • Purpose: increases tactile input on the palms and facilitates grasp
      • If doesn’t integrate then poor fine motor coordination and development (manipulation, grasping,releasing)

Palmar Grasp

NEUROLOGICAL DEFICITS: SCI Functional | Myotomes | Rancho Los Amigos | Allen Cognitive Levels | Alzheimer’s | Dementia

  • ATNR (Asymmetric Tonic Neck Reflex)-fencing pose
    • Onset: 37 weeks gestation
    • Integrated: 4-6 months
    • Test: supine, rotate the head to 90 degrees on one side
    • Response: face side (arm extension), skull side (arm flexion)
      • Precursor for hand-eye coordination
      • If not integrated hand eye coordination limitations:
        • Poor reading comprehension – b/c without ATNR you can’t cross the midline
          • Poor visual tracking and eye pursuit
        • Poor hand writing (think about what would happen to the child’s arm if the child slightly rotates the head)
          • Head rotation dictates the arm extension on face side
        • Poor hand eye coordination causes asymmetrical arm movement
        • Difficulty bringing both hands to midline
        • Difficulty holding an object with both hands
        • Difficulty bringing an object to mouth
        • Difficulty reaching for objects in front of body while looking at it


  • Tonic Labyrinthine Reflex TLR
    • Onset: 37 weeks gestation
    • Integrated: 6 months
    • TLR Prone
      • Place baby in prone
      • Response: increase in flexor tone
    • TRL Supine
      • Place baby in supine
      • Response: increase in extensor tone
    • If not integrated then dysfunction in movement
      • Being in prone may make it hard to life and extend the head-
      • Being in supine would be hard to sit up from (getting up independently)
        • To get up need to be able to lift head off the floor (flex head)
        • Also can’t roll over
      • Poor posture, muscle tone and coordination

Tonic Labyrinthine Reflex TLR

Burn Classification and Rehabilitation Occupational Therapy

  • Part 2: Reflexes that emerge from birth to 6 months (all these reflexes should get integrated)
  • Symmetric Tonic Neck Reflex (STNR)
    • Onset: 4-6 months
    • Integrated: 8-12 months
    • Crawling with head flexed
      • UE flex, LE extend = BUTT UP IN AIR
    • Crawling with head extended
      • UE extend, LE bend and tuck under butt
    •  Purpose: promotes static quadruped position -> preparing for crawling
    • If not integrated:
      • Difficulty sitting up from sidelying supine
        • To get up need to flex head – which will extend hips and legs making it hard to sit up
      • Poor muscle tone and posture
        • While sitting-when arms are bent then legs will extend = CHILD SLOUCHING
        • Child then sits up by flexing legs and the arms will extend over table (slouching on table)
      • Difficulty focusing

Difficulty focusingTLR vs STNR

Pediatric Assessments: Developmental | Motor and Visual | Sensory

    • Landau-aka SUPERMAN
      • Onset: 3-4 months
      • Integrated: 12-24 months
      • Test: hold baby up in air in prone suspension
      • Response: extension of head, trunk, extremities
      • Purpose: break up flexor tone which will facilitate prone extension
        • Helps with posture development
  • Landau-aka SUPERMAN
    • Righting Reactions
      • assume position,
      • maintain alignment head-trunk and trunk-limbs
      • Initiate rolling
    • Neck Righting
      • Onset: 4-6 months
      • Integrated: 5 years
      • Test: baby in supine and rotate head to one side
      • Response: rest of body rolls in direction of head (log rolling of baby to maintain alignment)
        • Log rolling-body moves as one unit (non segmental), no trunk rotation, less mature
      • Purpose: facilitate rolling, maintains alignment of head and body; transition from supine to sidelying
  • Neck Righting
  • TYPES OF GROUPS : Developmental | Task-Oriented, Thematic, Topical, Evaluation & Instrumental 
    • Body Righting – aka body acting on body (initiate with legs)
      • Onset: 4-6 months
      • Integrated: 5 years
      • Test: baby in supine and flex one knee or hip toward chest
      • Response: segmental rolling of upper trunk and spine
        • Body parts moving in segments; requires rotation within body axis
      • Purpose: facilitate rolling through spinal/trunk rotation

Body Righting

    • Part Three: Lifetime reflexes that persist
    • Optical Head Righting
      • Onset: Birth-2 months
      • Integrated: persists
      • Test: hold baby suspended vertically and tilt off center
      • Response: upright positioning of head-able to orient head in space
      • Purpose: orient the head in space
        • Optical righting-mediated by visual system (using visual cues from environment)

Optical Head Righting

    • Labyrinthine Righting
      • Onset: birth-2 months
      • Integrated: persists
      • Test: cover eyes (no visual cues for orientation)
      • Response: maintain head in upright position and rise vertical in relation to gravity
        • Mediated by VESTIBULAR SYSTEM
      • Purpose: orient head in space
        • The labyrinthine is a structure in our ear that helps maintain and regain balance
        • If not integrated-poor balance, poor orientation

FRAMES OF REFERENCE: Ecology of Human Performance | Occupational Adaptation

    • Protective Reactions
    • Downward Parachute Protective Response
      • Onset: 4 month
      • Integrated: persists
      • Test: lower baby onto surface while vertically suspended
      • Response: extension of LE
      • Purpose: provides protection against impact or anticipation of a fall and accurate placement during fall

Downward Parachute Protective Response

    • Forward Parachute Protective Response
      • Onset: 6-9months
      • Integrated: persists
      • Test: rapidly tip baby forward while vertically suspended
      • Response: extension of UE/ hands opening
        • Purpose: protection against fall

Forward Parachute Protective Response

    • Sideward Parachute
      • Onset: 7 months
      • Integrated: persists
      • Test: tip baby to the side while in sitting position
      • Response: arm extension and abduction to the side
      • Purpose: protect from fall

Sideward Parachute

    • Backwards Parachute
      • Onset: 9-10 months
      • Integrated: persists
      • Test: tip baby off balance backward while sitting
      • Response: arm extension backward or arm extension to 1 side with spinal rotation
      • Purpose: protective defense against fall
  • Backwards Parachute
    • Equilibrium Reactions

Equilibrium Reactions

      • Prone Tilting-think of surfer paddling on surface board and lifting one side of body
      • Equilibrium reactions are the first line of defense against falling, maintain balance and postural adjustments
        • Protective reactions are the second line of defense against falling
Prev1 of 4

Burn Classification and Rehabilitation Occupational Therapy

Burn Classification and Rehabilitation Occupational Therapy


NEUROLOGICAL DEFICITS: SCI Functional | Myotomes | Rancho Los Amigos | Allen Cognitive Levels | Alzheimer’s | Dementia