Newborn Development

Sensory Development

Reflexes

• Rooting Reflex (Birth – 3 months): baby turns towards the direction of the corner of the mouth that is stimulated. Mnemonic: roots growing toward the water.

  

• Galant Reflex (Birth – 3 months): elicited by holding newborn face down and stroking the side of the spine. Baby laterally flexes towards the stimulated side. Mnemonic: going to a gala and posing.
• Suck Swallow Reflex (Birth – 6 months): elicited by a finger or nipple or bottle in the mouth resulting in baby rhythmic sucking-swallowing.
• Palmar Reflex (Birth – 6 months): fingers grasp (flex) when baby’s palm is stimulated.

  

• Plantar Grasp (Birth – 9 months): similar to palmar, but for the feet when sole is stroked the toes flex.

  

• Traction Reflex (Birth – 6 months): elicited by pulling into sitting resulting in baby flexing their head and ending in a sitting position. Mnemonic: pulling is a form of traction; traction of neck resulting in it following the body into flexion.

  

• Moro Reflex (Birth – 6 months) / Startle Reflex: elicited by a sudden noise or by raising the baby’s head and allowing it to drop. Baby extends their arms and legs and neck and then rapidly brings their arms together. Mnemonic: baby got scared from a moron playing loud music in the nursery.

  

• Tonic Labyrinthine Reflex (Birth – 6 months): elicited by changes in the position of the head and body in relation to gravity and causes a tonic extension of the limbs when the head is tilted backward and a tonic flexion of the limbs when the head is tilted forward.
  • Believed to help with the development of postural control and balance. As the reflex integrates and disappears, the infant begins to develop more advanced motor skills, such as rolling over, sitting up, and crawling.
  • Mnemonic: so named because it is influenced by the orientation of the labyrinth, which is the part of the inner ear that helps with balance and spatial orientation. Labyrinth also means a network of passages; mazes. All extremities follow the neck. Think of there being 2 sets of mazes, e.g., front and back of the paper: side A (neck flexion = extremity flexion) and side B = opposite.
• ATNR (Birth – 6 months) / Fencing Reflex: elicited by head turning to one side. A=asymmetric (arms are different), T=tonic (involves a sustained muscle tone or contraction in the neck muscles), N=neck (neck turns towards the same side as head), R=reflex. Mnemonic: remember what ATNR stands for as it describes the reflex position.

  

• Landau Reflex (3 months – 2 years): elicited when the infant is held horizontally in the prone position (facing down) and the head is lifted. Results in a curve-like shape, with the legs and arms extending and the head lifting up.
  • Considered an important milestone in the development of motor skills, as it helps the infant to develop postural control, balance, and coordination. As the reflex integrates and disappears, the infant gains more control over their body and is able to perform more complex movements, such as crawling, standing, and walking.
  • Mnemonic: airplane landing

    

• Parachute Reflex (Infancy – Lifetime): elicited when the baby (or adult) is suspended in mid-air and suddenly moved towards the ground, as if falling. They will automatically extend their arms and legs forward, as if trying to catch themselves, even if they are not actually falling. Helps to protect the body in the event of a sudden fall or loss of balance. Mnemonic: baby folds like a parachute with the “top” of parachute being the mid-section of body, “bottom” of parachute being all the extremities.

  

• STNR (6 months – 12 months) / Crawling Reflex: Notice this is not primitive/newborn and begins at 6 mos. S=symmetric. Functions to help baby get onto their hands and knees for crawling; transitional reflex.
  • Symmetrical extension of the arms and flexion of the legs when the head is extended.
  • Symmetrical flexion of the arms and extension of the legs when the head is flexed.
  • Mnemonic: arms follow the neck in flexion/extension (arms are closer to the head than legs); legs are opposite. May be tempting to remember that since it’s called symmetrical the upper and lower extremities are symmetrical, but it’s the left/right of the upper or lower extremities. Remember the function of STNR. Baby has different movement patterns for upper vs. lower because this helps facilitate movement in crawling. If the upper and lower extremities were the same in flexion or extension they would be in a prone / quadruped pattern instead of this unique pattern (see image).

    

• Gag and Cough Reflex (present from birth and continue throughout life, although their sensitivity and strength may change over time): a combination of two different reflexes (gag + cough) that protect the airway and prevent foreign objects from entering the lungs.

Oral Motor Development and Diet

Ages are approximate and may vary among infants.

Skills:

1. Sucking and drinking
2. Swallowing
3. Biting and chewing

Birth

• Tongue: extension-retraction pattern for primitive suckle-swallow from bottle or breast.
• No biting or chewing; liquid-only diet.

4-5 Months

• Pureed foods, but relies on formula or breast milk for primary nutrition.
• Continues to use the sucking pattern.
• Begins munching with up and down jaw movement (phasic bite and release).
• Munching is primitive and not controlled or sustained.
• The tongue moves up and down when sucking for milk.

6 Months

• Thicker pureed and lumpy foods.
• Up-down movement of the jaw is less automatic.
• Tongue: up/down with a bottle, extension-retraction from cup, side-to-side with chewing and some lateralization.

9 Months

• More foods consumed
• Sucking pattern strong with no liquid loss
• 3:1 suck swallow/breathe pattern
• Diagonal munching with food transfer to the sides (lateral movement)

12 Months

• Meats and chopped foods
• Controlled and sustained bite, e.g., cookie
• Rotary chewing movements
• Easily transfers foods to the sides.

18 Months

• Hard cookie
• Controlled and sustained bite
• Developed rotary chewing

24 Months

• All foods except thought meats or skins
• Chewing with circular rotary movements¹ 

Bookmark

1. Case-Smith, J., Allen, A. S., & Pratt, P. N. (2001). Occupational therapy for children. St. Louis: Mosby.[↩]