Newborn Reflexes: Types, Meaning and What's Normal in Infants

Medically Reviewed By Dr. Namrata Kumari, DM (Neonatology) - Chengalpattu Medical College and Hospital, Chengalpattu, MD (Paediatrics) - Patna Medical College and Hospital, Patna, MBBS - Patna Medical College and Hospital, Patna., Associate Consultant - Paediatric Care

Updated on: Oct 09, 2026
Published on: Sep 22, 2026

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Newborn reflexes are automatic, involuntary movements. One may have these from birth happening without any conscious control or prior learning. Controlled by the brainstem and other lower brain centres these primitive reflexes support feeding, protection and early survival while also signalling healthy nervous system development.

Doctors check these reflexes during routine newborn exams to assess neurological function. If a reflex is absent, asymmetric, unusually weak or lingers past your expected age it may point to an underlying neurological or developmental issue that needs further evaluation.

What Are Neonatal Reflexes

Neonatal reflexes also called primitive reflexes or infant reflexes are predictable motor responses elicited by specific stimuli in the first weeks and months of life. They originate in subcortical structures and the brainstem. They are present precisely because the cerebral cortex (which will eventually regulate and inhibit most voluntary movement) is not yet functionally dominant at birth.

As the baby's nervous system develops, these reflexes gradually disappear. Reflexes that persist well beyond their expected disappearance age, that are absent when they should be present or that are asymmetric warrant clinical attention.

Types of Reflexes in Newborns

Neonatal reflexes fall into several broad categories.

Primitive reflexes: Present at birth, driven by brainstem circuits, and normally suppressed as the cortex matures (including the Moro reflex, palmar grasp, rooting, sucking, stepping, tonic neck and Babinski reflexes).
Protective reflexes: Responses that protect the newborn from immediate harm like the blink reflex (in response to light or touching near the eye), the gag reflex (protecting the airway) and the withdrawal reflex (pulling the limb away from a painful stimulus)
Feeding reflexes: The rooting reflex and sucking reflex work together to initiate and sustain breastfeeding. Their absence or weakness directly affects nutritional intake.

Sucking Reflex and Swallowing Reflex

The sucking reflex is present from approximately 32 to 34 weeks of gestation and is well established by 36 weeks. In a term newborn, touching the roof of the mouth (palate) or the lips stimulates a rhythmic sucking movement. The nutritive sucking reflex involves a coordinated suck-swallow-breathe cycle.

The rooting reflex is elicited by stroking the corner of the mouth or the cheek. The infant turns toward the stimulus and opens the mouth preparing for feeding. Together rooting and sucking help the newborn locate and latch onto the breast or bottle.

The swallowing reflex, present from approximately 10 to 14 weeks of gestation, coordinates with sucking to ensure milk passes safely into the oesophagus rather than the airway. Prematurity, hypoxic-ischaemic injury or neuromuscular conditions can impair the suck-swallow-breathe coordination, leading to aspiration risk and feeding difficulty.

Moro Reflex

The Moro reflex also called the startle reflex is a bilateral, symmetrical response to a sudden change in head position or a loud noise. When elicited, the infant throws both arms outward and upward, opens the hands, arches the back and then brings the arms back together as if embracing, often accompanied by crying.

The Moro reflex is present from 28 weeks of gestation and fully established by term. It begins to fade at around 2 months of age and is typically absent by 4 to 6 months. Absence in a term newborn, a unilateral Moro reflex, or persistence beyond 6 months are all clinically significant.

A unilateral absent Moro reflex may indicate a brachial plexus injury (Erb's palsy), which can occur during difficult deliveries involving shoulder dystocia or excessive traction on the head. A missing unilateral Moro reflex at the newborn examination is often the first clinical sign of brachial plexus injury.

Palmar Grasp Reflex

The palmar grasp reflex is elicited by placing a finger or object in the palm of the infant's hand. The infant's fingers curl automatically around the object and grip it. This reflex is present from approximately 16 weeks of gestation and is well established at birth.

The palmar grasp reflex normally fades between 3 and 6 months of age as voluntary hand opening and reaching develop. A strong, persistent palmar grasp reflex beyond 6 months may suggest motor cortex immaturity. An asymmetric grasp reflex may indicate injury to the contralateral motor cortex or a peripheral brachial plexus injury.

Stepping Reflex in Newborns

The stepping reflex also called the walking or dance reflex is one of the more visually striking neonatal reflexes. When the infant is held upright with the soles of the feet touching a flat surface, it lifts one foot and then the other in an alternating stepping movement that resembles walking.

The stepping reflex is present from approximately 24 to 36 weeks of gestation and well established at term. It normally disappears by around 2 months of age. The stepping reflex is not the precursor to independent walking. Voluntary walking, which develops at 9 to 12 months, is a cortically controlled behaviour. The early disappearance of the stepping reflex is due to cortical inhibition, not a loss of function.

Blinking and Gag Reflex in Newborns

The blink reflex protects the eyes from bright light and foreign objects. In the newborn, a sudden bright light or a gentle touch near the eye produces an involuntary blink. Its absence in a term newborn may indicate visual pathway dysfunction or a generalised neurological problem.

The gag reflex protects the airway. Stimulation of the back of the throat or tongue triggers a retching response that prevents foreign material from entering the larynx. The gag reflex is present by approximately 18 weeks of gestation and is reliably present in all healthy term newborns. Its absence in a newborn is a red flag for brainstem dysfunction and is associated with severe hypoxic-ischaemic encephalopathy (HIE), which is a significant cause of neonatal morbidity.

Newborn Reflexes Chart

Reflex	Typical Response	Why It Matters	Usually Fades By
Rooting	Turns head toward a cheek stimulus and opens the mouth	Helps the baby locate the nipple and begin feeding	3–4 months
Sucking	Rhythmic sucking when the palate or nipple is stimulated	Essential for feeding; absence may indicate neurological problems	3–4 months (nutritive sucking continues)
Moro (Startle)	Arms extend outward, then come back toward the body; baby may cry	Assesses brainstem function and symmetry	4–6 months
Palmar Grasp	Fingers tightly grasp an object placed in the palm	Indicates normal neurological development; persistence may suggest delayed cortical maturation	3–6 months
Stepping	Alternating stepping movements when held upright with feet touching a surface	Demonstrates intact motor pathways	1–2 months
Plantar (Babinski)	Big toe moves upward while the other toes fan outward	Normal in infants; persistence in older children may indicate neurological disease	12–18 months
Tonic Neck (Fencing)	Turning the head causes the arm on the same side to extend and the opposite arm to flex	Supports early hand-eye coordination and motor development	4–6 months
Galant	Trunk curves toward the side when the skin along the back is stroked	Assesses spinal cord function; asymmetry may indicate spinal abnormalities	4–6 months
Blink	Eyes close automatically in response to light or a nearby object	Protects the eyes; absence may suggest visual or neurological impairment	Persists throughout life
Gag	Retching or gagging when the back of the throat is stimulated	Protects the airway; absence in a newborn requires urgent evaluation	Persists throughout life

Reflexes in Paediatrics: Why They're Checked

Checking neonatal reflexes is a structured part of the newborn examination because these responses provide a rapid, non-invasive assessment of neurological integrity across multiple levels of the nervous system, each testing a specific neural arc or pathway.

Paediatricians assess newborn reflexes at the initial newborn examination, at hospital discharge and at subsequent well-baby visits (typically at 6 weeks, 10 weeks, and 14 weeks). The Indian Academy of Paediatrics (IAP) growth monitoring and developmental surveillance guidelines include reflex assessment as part of routine neurodevelopmental screening. Government-employed ASHA workers and auxiliary nurse midwives (ANMs) in India are also trained to identify warning signs including absent or atypical reflex responses.

When a Missing Reflex Is a Concern

Not every absent reflex is an emergency. The following situations are clinically significant.

Absent rooting or sucking reflex in a term newborn, particularly if feeding is difficult or impossible.
Absent or asymmetric Moro reflex at birth as a completely absent bilateral Moro reflex suggests severe neurological impairment.
Absent gag reflex in a newborn is a red flag for brainstem dysfunction.
Persistence of primitive reflexes well beyond their expected disappearance age. A palmar grasp reflex persisting beyond 6 months, a Moro reflex persisting beyond 6 months, or a tonic neck reflex persisting beyond 6 months may indicate motor cortex dysfunction, cerebral palsy, or a neurodevelopmental disorder. Cerebral palsy is the most common motor disability of childhood.

Conclusion

Newborn reflexes are not incidental features of early life; they are a structured, clinically interpretable window into the developing nervous system. Their presence at the right age, their symmetry and their timely disappearance all carry diagnostic information. For parents, understanding that these responses are normal and temporary reduces unnecessary anxiety. For paediatricians and neonatal teams, systematic reflex assessment at every developmental checkpoint is one of the most sensitive early screens for neurological and developmental pathology.

FAQs

What are newborn reflexes and why do they matter?

Newborn reflexes are automatic & involuntary responses driven by the brainstem and subcortical structures. They indicate neurological integrity, support feeding and protect the infant. Their presence, symmetry, and timely disappearance are all clinically informative.

What is the sucking reflex in babies?

The sucking reflex is triggered by touching the roof of the mouth or placing a nipple in the mouth producing rhythmic sucking (essential for feeding). It is present from 32 to 34 weeks of gestation and fades by 3 to 4 months.

What is the Moro (startle) reflex?

The Moro reflex is a bilateral response to a sudden change in head position or a loud noise. The infant throws both arms outward then brings them back together. It is present at term and fades by 4 to 6 months.

What is the palmar grasp reflex?

The palmar grasp reflex is triggered by placing an object in the palm of the infant's hand (causing the fingers to curl and grip automatically).

What is the stepping reflex in newborns?

The stepping reflex is elicited by holding the infant upright with the soles of the feet touching a flat surface. The infant makes alternating stepping movements resembling walking. It is present at birth and disappears by 2 months.

What is the gag reflex in newborns?

The gag reflex is triggered by stimulation of the back of the throat and produces a retching response that protects the airway. It is present in all healthy term newborns. Its absence in a newborn is a warning sign for brainstem dysfunction.

How many primitive reflexes do babies have?

Newborns have approximately 10 to 15 recognised primitive reflexes, including the Moro, palmar grasp, rooting, sucking, stepping, tonic neck, Babinski, Galant and blink reflexes.

When do newborn reflexes disappear?

Most primitive reflexes disappear between 2 and 6 months as the cerebral cortex matures. The Moro reflex fades by 4 to 6 months, the palmar grasp by 3 to 6 months and the stepping reflex by around 2 months. The gag and blink reflexes persist lifelong.

Why do paediatricians check infant reflexes?

Paediatricians check infant reflexes because each reflex tests a specific neural pathway. Absent, asymmetric or persistently present reflexes can indicate neurological injury, cerebral palsy, brachial plexus injury or neuromuscular disease. Reflex assessment is part of routine developmental surveillance.

What does it mean if a newborn reflex is missing?

A missing reflex is always clinically significant. Absent sucking or rooting may indicate hypoxic-ischaemic encephalopathy or neuromuscular disease. An absent gag reflex indicates brainstem dysfunction. Asymmetric Moro reflex is the most common sign of neonatal brachial plexus injury.

References

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2. Allen MC, Capute AJ. Tone and reflex development before term. Pediatrics. 1990;85(3 Pt 2):393–9. https://pubmed.ncbi.nlm.nih.gov/2309984/

3. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. Arch Neurol. 1976;33(10):696–705. https://doi.org/10.1001/archneur.1976.00500100030012

4. National Neonatology Forum of India. Evidence based clinical practice guidelines. NNF India. 2010. https://www.nnfi.org/index.php/clinical-practice-guidelines

5. Bhat RY, Bhatt GC. Hypoxic-ischaemic encephalopathy in newborns: management in India. Indian Pediatr. 2019;56(4):307–14. https://doi.org/10.1007/s13312-019-1519-5