Newborn Reflexes and Behavior

Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 6/1/2011
Last Revised: 8/1/2011
Content Set: Pediatric HouseCalls Symptom Checker
Copyright 1994-2012 Barton D. Schmitt, M.D.

1. Normal Primitive Reflexes From Immature Nervous System:
• Startle Reflex (Moro or embrace reflex): Brief stiffening of the body, straightening of arms and opening of hands. Follows noise, abrupt movement or other stimulation. Frequent at birth, then gradually resolves by 4 months of age.
• Tonic-Neck Reflex (Fencer's Reflex): When head is turned to 1 side, the arm and leg on that side straightens and the opposite arm and leg flexes. Disappears by 4 months of age.
• Chin Trembling
• Lower Lip Quivering
• Jitteriness (see Topic 2)
2. Normal Jitteriness:
• Jitteriness or trembling of the arms and legs during crying is normal in newborns. It should stop by 1 to 2 months of age.
• If your baby is jittery when not crying, it could be abnormal. Give her something to suck on. (Reason: normal trembling should stop with sucking.)
• Convulsions are rare. During convulsions, newborns are more than jittery. They also have muscle jerking, blinking of the eyes, sucking movements of the mouth, and they don't cry.
• Call Your Doctor If: jitteriness becomes worse or occurs when baby is calm.
3. Normal Breathing Sounds and Noises:
• Throat Noises: Caused by air passing through normal saliva or refluxed milk. These gurgling noises are especially likely to build up during sleep. Eventually, the newborn learns to swallow more frequently.
• Nasal Noises are usually caused by dried mucus in the nose, not by a cold. A blocked or stuffy nose can interfere with feeding, because your baby can't breathe when the mouth is also closed off with feeding. Therefore, they need help opening the nasal passages.
• Nasal Washes: Clean out the nose with normal saline or warm water. Use 1 drop at a time and do 1 side at a time. Repeat this several times. This will loosen up the dried mucus so it can be sneezed out or swallowed. If needed, use a suction bulb. Avoid Q-tips which can injure the lining of the nose. (Saline nosedrops - add 1/2 teaspoon (2 ml) of table salt to 1 cup (8 ounces or 240 ml) of warm water.)
• Tobacco Smoke: Avoid tobacco smoke which can cause nasal congestion or sneezing. Avoid fuzz, dust or any strong odors for the same reason.
• Call Your Doctor If:
• Nasal washes don't work
• Breathing becomes difficult
4. Normal Irregular Breathing Patterns:
• Transient Breathing Pauses of Less Than 10 Seconds (Also Called Periodic Breathing): These breathing pauses are normal if the baby is comfortable during them, the rate is less than 60 breaths per minute, and the baby doesn't turn blue. Usually resolves by 1 month of age.
• Transient Rapid Breathing: Occasionally, newborns take rapid, progressively deeper, stepwise breaths to expand their lungs completely. This is normal if the breathing slows to normal within a minute or so.
• Seesaw Breathing: With breathing, the chest seems to contract when the abdomen expands. The cause is the soft rib cage of some newborns that tends to pull in during normal downward movement of the diaphragm.
• Yawning or Sighing (intermittent) to open up the lungs
• Call Your Doctor If:
• Breathing becomes difficult
• Breathing pauses last more than 10 seconds
• You have other questions or concerns
5. Normal GI Sounds And Noises:
• Belching air from stomach
• Passing gas per rectum
• NOTE: Both of these mechanisms release swallowed air. They are normal, harmless, lifelong and do not cause pain or crying.
• Normal grunting with passage of stools
• Hiccups: Hiccups are usually caused by overeating or a little acid irritating the lower esophagus. Give your baby a few swallows of water to rinse off the lower esophagus.
6. Normal Sleep Sounds And Noises: Normal sleep is not motionless or quiet. Expect some of the following:
• Moving during sleep transitions
• Occasional startle reflex or jerks
• Breathing noises - especially gurgling from secretions that accumulate in the throat.
• During light sleep, babies can normally whimper, cry, groan or make other strange noises.
• Parents who use a nursery monitor commonly become concerned about these normal sleep sounds.
• GI tract noises from normal movement of digested food
7. Normal Feeding Reflexes:
• Rooting Reflex: When the side of the mouth or cheek is touched, your baby turns to that side and opens mouth in preparation for nursing. Present until 6 months of age.
• Sucking Reflex: Will suck on anything placed in the mouth. This survival reflex does not imply hunger and is even present right after a feeding. This reflex fades between 6 and 12 months of age.
8. Normal Protective Reflexes:
• Sneezing To Clear Nose of Any Irritant: Sneezing is a protective mechanism to open the nose. It's usually caused by dust, fuzz, tobacco smoke or other strong odors. If sneezing becomes frequent, use nasal washes. This is not caused by an allergy.
• Coughing to clear lower airway
• Blinking: After spending 9 months in darkness, newborns have light-sensitive eyes and initially prefer to keep their eyes closed. They blink frequently with light exposure.
9. Flying With Newborns:
• Never fly during the first 7 days of life. If flying is essential, it's safe to fly after 7 days of age.
• If your newborn is not healthy, do not fly until you have medical clearance from your child's doctor.
• However, because of the exposure to infections aboard aircraft, it is preferable not to fly before 2 or 3 months of age.
10. Mountain Travel With Newborns:
• Avoid mountain travel above 8,000 feet (2,438 meters) for the first month of life.(EXCEPTION: family lives there year-round)
• Travel to destinations below 8,000 (2,438 meters) feet is safe.
• Brief drives over higher mountain passes is safe.
• If your newborn is not healthy, don't travel above 8,000 feet (2,438 meters) until you have medical clearance from your child's doctor.
11. Call Your Doctor If:
• Your baby starts to look or act abnormal in any way

Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 6/1/2011
Last Revised: 8/1/2011
Content Set: Pediatric HouseCalls Symptom Checker
Copyright 1994-2012 Barton D. Schmitt, M.D.