✅ Model Answer:
• Reflex: Moro reflex (startle reflex).
• Maneuver: Hold infant supine, support head and trunk. Allow head to drop back suddenly 1-2 cm (or produce loud noise). Alternatively, lower infant suddenly in examiner's arms.
• Normal response: Phase 1 – symmetric extension and abduction of arms, opening of hands; Phase 2 – adduction and flexion of arms back across chest (embracing movement).
• Present at birth, integrates by 3-6 months.

✅ Model Answer:
• Moro – integrates by 3-6 months
• Rooting – integrates by 3-4 months
• Sucking – integrates by 4-6 months (becomes voluntary)
• Palmar grasp – integrates by 3-4 months
• Plantar grasp – integrates by 9-12 months
• ATNR (fencing) – integrates by 4-6 months
• Galant (truncal incurvation) – integrates by 2-6 months
• Stepping/walking – integrates by 2-3 months
• Babinski (extensor plantar) – normal up to 12-24 months

✅ Model Answer:
• Absent Moro: Bilateral absent – severe CNS depression (HIE, sedation, intracranial hemorrhage, metabolic encephalopathy). Unilateral absent – brachial plexus injury (Erb's palsy), clavicle fracture, humerus fracture, hemiplegia.
• Asymmetric Moro: Weak/absent abduction on one side – suspect ipsilateral brachial plexus injury (C5-C6), clavicle fracture, shoulder dislocation. Delayed/incomplete adduction – hypotonia.
• Exaggerated Moro: Hyperekplexia, kernicterus.
• Persistent Moro beyond 6 months: Cerebral palsy, developmental delay.

✅ Model Answer:
• Rooting: Stroke cheek or corner of mouth → infant turns head toward stimulated side and opens mouth. Present at birth, integrates by 3-4 months.
• Sucking: Place finger or nipple on lips → rhythmic sucking movements. Present at 32 weeks, well-coordinated in term infants, integrates by 4-6 months.
• Clinical significance: Absent rooting/sucking – CNS depression, severe illness, prematurity, sedation. Weak/ineffective sucking – preterm, neurological impairment, cardiac disease, respiratory distress. Persistent rooting beyond 4-6 months – developmental delay, cerebral palsy.

✅ Model Answer:
• Elicitation: Place index finger into infant's palm from ulnar side and press gently.
• Normal response: Fingers curl around examiner's finger (strong, symmetric grip).
• Integration age: 3-4 months (replaced by voluntary grasping).
• Plantar grasp: Stimulate sole just below toes → toes curl downward. Integrates by 9-12 months.
• Asymmetry: Unilateral weak/absent grasp suggests brachial plexus injury (C8-T1 – Klumpke palsy), fracture, or hemiplegia. Bilateral absent – hypotonia, CNS depression.

✅ Model Answer:
• Elicitation: With infant supine and relaxed, turn head slowly to one side.
• Normal response (fencing posture): Ipsilateral arm extends (toward face side); contralateral arm flexes. Opposite occurs when head turned other side.
• Integration age: 4-6 months.
• Persistence beyond 6 months: Inhibits midline development, delays rolling, sitting, crawling. Associated with cerebral palsy (spastic, dyskinetic), intellectual disability. Causes asymmetric crawling, hand preference before 1 year (abnormal). May lead to scoliosis.
• Absent ATNR at birth: CNS depression, hypotonia, severe encephalopathy.

✅ Model Answer:
• Galant reflex (truncal incurvation reflex): Stroke skin of infant's back 2-3 cm from midline, from shoulder to buttocks (infant prone or held vertically).
• Normal response: Trunk curves toward stimulated side, hip movement to same side.
• Integration age: 2-6 months.
• Absent or asymmetric Galant: Possible spinal cord lesion (myelomeningocele, tethered cord), neuromuscular disease, CNS depression.
• Persistence beyond 6 months: May indicate neurological abnormality (cerebral palsy).

✅ Model Answer:
• Babinski reflex (plantar response): Stroke lateral aspect of sole from heel to toe, curving medially across ball of foot.
• Normal newborn response: Upgoing (extensor) great toe with fanning of other toes – normal (physiological) due to corticospinal tract immaturity.
• Integration/transition: Usually becomes downgoing (flexor) by 12-24 months; some may have extensor response up to 2-3 years.
• Abnormal extensor response beyond 24-36 months: Upper motor neuron lesion (cerebral palsy, spinal cord injury, brain tumor, hereditary spastic paraplegia).
• Absent Babinski (no response): Peripheral neuropathy, spinal shock.

✅ Model Answer:
• Elicitation: Hold infant upright under arms, allow soles of feet to touch flat surface. Tilt infant slightly forward.
• Normal response: Alternating stepping movements (placing steps).
• Present at birth: Strong in term infants, less coordinated in preterm.
• Integration age: Disappears by 2-3 months (reappears as voluntary walking around 12-15 months).
• Clinical significance: Absent stepping – possible hypotonia, spinal cord lesion, neuromuscular disease, or HIE. Asymmetric stepping – hemiplegia, hip dysplasia, or leg injury. Persistence beyond 4-5 months – possible cerebral palsy. In preterm infants, stepping may be absent or weak due to immaturity.

✅ Model Answer:
• Tonic labyrinthine reflex (TLR): Supine → increased extensor tone (head back, arms/legs extension). Prone → increased flexor tone. Present at birth, integrates by 4-6 months. Persistence beyond 6 months interferes with rolling, sitting; may indicate cerebral palsy.
• Landau reflex: Hold infant prone in air (suspend by trunk). Normal response: Head extends, back straightens, legs extend (full body extension against gravity). Appears at 3-4 months, integrates by 12-18 months. Absent Landau → hypotonia, neuromuscular weakness, or developmental delay.

✅ Model Answer:
• Indicates neurological immaturity or brain injury – cerebral palsy, intellectual disability, PVL in preterm infants, HIE with long-term sequelae, genetic syndromes.
• Specific examples: Persistence of ATNR beyond 6 months → interferes with midline crossing, hand-eye coordination, crawling, reading skills. Persistence of Moro beyond 6 months → hyperekplexia or CNS abnormality. Persistence of palmar grasp beyond 6 months → interferes with fine motor development.
• Management: Early referral to pediatric neurology and physical/occupational therapy for neurodevelopmental intervention.

✅ Model Answer:
• Order – start with least disturbing: 1) Observe infant (posture, spontaneous movements). 2) Palmar grasp. 3) Rooting (stroke cheek). 4) Sucking (after rooting). 5) Plantar grasp. 6) ATNR (turn head – may cause crying). 7) Galant (prone/vertical – can cause crying). 8) Moro (most disturbing – always last).
• Why Moro last? It is a strong startle that can make infant irritable and alter other reflexes.
• Room temperature and state: Infant should be warm, in active alert or quiet alert state; test when infant not crying or deeply asleep.