What should I do if I'm concerned about my baby's reflexes?

Baby Reflexes: When to Be Concerned and What to Do

If you're concerned about your baby's reflexes, you should consult your pediatrician immediately for a proper neuromotor examination, as abnormal reflexes may indicate neurological issues that require early intervention to improve outcomes related to morbidity, mortality, and quality of life. 1

Understanding Normal Baby Reflexes

Baby reflexes are automatic responses that are present at birth and typically follow a predictable pattern of development:

• Present from birth (even in premature infants):

  • Upper and lower extremity grasp reflexes 2
  • Red reflexes (should be detectable and symmetric) 1, 3

• Present by 30 weeks postconceptional age in most infants:

  • Moro reflex
  • Asymmetric tonic neck reflex
  • Galant reflex 2

• Developing later and not always complete at term:

  • Lower extremity placing
  • Positive support
  • Stepping reflexes 2

When to Be Concerned

You should be concerned about your baby's reflexes if you notice:

1. Persistence of primitive reflexes beyond their expected disappearance age
2. Absence of protective reflexes that should be present
3. Asymmetry in reflexes (one side different from the other)
4. Abnormal tone (increased or decreased muscle tone)
5. Delayed acquisition of motor skills 1

Assessment Algorithm for Concerned Parents

Step 1: Document Your Observations

Keep a detailed record of:

• What specific reflex or movement concerns you
• When you first noticed it
• Whether it's consistent or intermittent
• Any associated symptoms (irritability, feeding issues, etc.)

Step 2: Consult Your Pediatrician

Your pediatrician will perform:

• Neuromotor examination including:
  • Cranial nerve examination (eye movements, pupillary reactivity)
  • Assessment of muscle tone and strength
  • Evaluation of primitive reflexes and protective reflexes
  • Observation of posture and movement quality 1

Step 3: Potential Specialized Evaluations

Based on the initial assessment, your doctor may recommend:

• Developmental assessment by specialists if delays are suspected 1
• Hearing evaluation if auditory responses are abnormal 1
• Vision assessment including red reflex testing 3
• Further neurological evaluation if abnormalities are detected 1

Key Reflexes to Monitor

Reflex	Normal Response	When to Be Concerned
Red reflex	Symmetric red reflection from retina	Absent, white, or asymmetric reflection [1,3]
Moro (startle)	Symmetric extension and abduction of arms followed by flexion	Asymmetric response or persistence beyond 6 months [4]
Grasp	Fingers curl around object placed in palm	Asymmetric grasp or persistence beyond 4-6 months [1]
Tonic neck	When head is turned to one side, arm and leg extend on that side	Persistence beyond 4-6 months [4]

Important Considerations

• Premature infants should be evaluated based on corrected gestational age, not chronological age 1, 2
• Sleep position should be supine (on back) to reduce SIDS risk, regardless of reflex development 1
• Developmental milestones should be monitored alongside reflex assessment 1

Warning Signs Requiring Immediate Attention

Seek immediate medical attention if your baby shows:

• Seizure-like movements
• Significant change in level of alertness
• Brief resolved unexplained events (BRUE) such as changes in color, breathing, tone, or consciousness 1
• Regression of previously attained skills 1

Remember that early identification of neuromotor issues is critical for timely intervention and improved outcomes. Don't hesitate to voice your concerns to your pediatrician, as you know your baby best.