Infant reflexes chart: 7 primitive reflexes and when they integrate

An infant reflexes chart is a one-page clinical reference that lists the seven primitive reflexes present at birth. Each row gives the stimulus, the expected response, and the ages the reflex should appear and integrate. A final column names the findings that warrant referral.

Primitive reflexes are automatic movements controlled by the brainstem, and their presence is a sign of normal neurological development. According to the American Academy of Pediatrics (AAP), they are present at birth and fade as the cerebral cortex matures and voluntary movement develops.

Knowing when each reflex should appear, and when it should integrate, is what separates normal variation from a referral. Most published reflex charts stop at that timeline. This one carries two more columns. One gives you wording for the record, and the other names the patterns that send an infant to neurology.

Key takeaways

An infant reflexes chart records seven primitive reflexes, how to elicit each one, the expected response, and the age it should integrate.

Integration ages run from about 2 months for the Moro reflex to around 2 years for the Babinski reflex.

Absent, asymmetric, or persistently hyperactive reflexes belong in the record and often warrant neurological referral.

A reflex that persists past its integration age is called a retained reflex and may signal delayed neurological maturation.

Digital forms let you capture reflex findings at the cot side and flag an abnormal result for follow-up.

What is an infant reflexes chart?

An infant reflexes chart is a standardized table that lists the seven core primitive reflexes checked during a newborn or infant examination. Each row covers a single reflex and records:

• the name of the reflex
• the stimulus used to trigger it
• the expected normal response
• the age at which it should be present
• the age at which it typically disappears
• clinical notes on abnormal findings

Primitive reflexes originate in the brainstem and serve a protective function in newborns. They are present at birth and integrate as the developing brain takes over voluntary control of movement. A newborn cannot choose to perform one, and that automatic quality is what makes reflex testing a reliable indicator of neurological health.

The seven primitive reflexes and when they integrate

Every standard reflex chart covers these seven, which appear consistently across pediatric assessment guidelines and clinical practice standards.

• Moro reflex (startle reflex). Triggered by sudden movement or a loud noise. The infant throws both arms out symmetrically, then brings them back in. Disappears at about 2 months.
• Rooting reflex. Triggered by stroking the cheek. The infant turns the head toward the touch and opens the mouth. Disappears around 4 months in awake infants, and may persist during sleep to 7-8 months.
• Sucking reflex. Triggered by contact with the roof of the mouth. The infant sucks automatically. Disappears around 2-4 months, though older infants can suck voluntarily.
• Tonic neck reflex (fencing reflex). When the infant’s head turns, the arm on that side extends and the opposite arm flexes. Disappears around 5-7 months.
• Grasp reflex (palmar and plantar). Place an object in the infant’s palm or against the sole, and the infant grips it. The palmar grasp disappears by 5-6 months and the plantar grasp by 9-12 months.
• Babinski reflex (plantar reflex). Stroke the sole of the foot, and the big toe points up while the other toes fan out. This is normal in infants but indicates pathology in adults. Disappears around 2 years.
• Stepping reflex. Held upright with the feet touching a surface, the infant makes stepping motions. Disappears around 2 months, then re-emerges later as voluntary walking.

The integration ages matter more than the order of the list. Plotted on a single axis, they show how little the windows actually overlap.

How to run a reflex assessment in five steps

Recording the exam in a medical records management system standardizes how you test, document, and follow up. The workflow runs in five steps.

Step 1: Prepare the infant and the room. Make sure the infant is calm, warm, and on a safe surface with room to move. A distressed or cold infant can show diminished or absent reflexes, which creates false red flags.

Step 2: Test each reflex in sequence. Work down the chart row by row, using the exact stimulus listed for each reflex. Note the response as symmetric or asymmetric, present or absent, weak or strong.

Step 3: Record the finding against the expected response. For each reflex, mark the response normal, absent, delayed, asymmetric, or exaggerated. An asymmetric finding, such as a Moro present on the right but weak on the left, always warrants further evaluation.

Step 4: Check the finding against the infant’s age. Cross-reference chronological age with the chart’s age-of-integration column. A reflex that is still hyperactive or present past that age may point to delayed neurological maturation, and often to an occupational therapy referral.

Step 5: Flag abnormal findings and plan the follow-up. Any absent, asymmetric, or persistently hyperactive reflex needs a clear note and a stated next step. That step is a same-visit repeat exam, a recheck at the next visit, or an immediate referral to neurology or developmental pediatrics. A medical referral form keeps the handover consistent once the finding leaves your room.

Abnormal findings and when to refer

Most newborns and young infants have normal reflex responses. A handful of patterns, though, warrant careful attention and possible referral.

• Absent reflexes at birth. A primitive reflex that is completely absent on the initial exam may indicate central or peripheral nervous system injury, muscle weakness, or skeletal trauma. Repeat the assessment in a calm, warm room before you conclude the reflex is absent.
• Asymmetric reflexes. A reflex present on one side but weak, delayed, or absent on the other may suggest localized nerve injury. A brachial plexus injury from birth trauma is the common cause. Asymmetry is a clear referral indicator.
• Hyperactive or exaggerated reflexes. A reflex that is unusually strong, sustained too long, or triggered too easily may indicate upper motor neuron involvement or raised intracranial pressure. This warrants neurological evaluation.
• Persistence past the integration age. A retained primitive reflex may signal delayed neurological development. A Moro reflex still strongly present at 9 months sits well past its 2-month window. That points to developmental delay or a neurological condition needing assessment.
• Babinski interpretation. A positive Babinski, with the big toe up and the toes fanning, is normal and expected in infants up to about age 2. An absent Babinski in both feet in a newborn is abnormal and warrants referral.

Why reflex testing catches problems early

Reflex assessment is one of the most sensitive tools available for finding neurological problems early. A systematic approach using a reflex chart does three things for the exam.

• It catches developmental delays before they widen.
• It identifies birth injuries and neurological conditions that need immediate intervention.
• It keeps documentation consistent, so no abnormal finding is lost between visits.

Reflex testing is one part of the wider newborn neurological exam. A neuro exam cheat sheet covers the cranial nerve and motor checks that sit alongside it.

Structured reflex assessment also supports continuity of care. When the findings are recorded in the same format every time, a colleague can read the exam at a glance. They see what was tested, what was found, and what you concluded, which reduces misinterpretation at handover.

Retained primitive reflexes beyond infancy

In most children, primitive reflexes integrate on schedule. Some infants show retained primitive reflexes, which persist or re-emerge beyond the expected integration age.

This appears in children with cerebral palsy, developmental delay, autism spectrum disorder, and ADHD. The evidence linking retained reflexes to learning and behavior difficulties is still developing. Treat a retained reflex as a prompt to assess rather than a diagnosis.

When a reflex persists abnormally, occupational therapists and developmental pediatricians may recommend integrated movement programs or neurodevelopmental therapy. The chart therefore earns its place beyond newborn screening. It tracks reflex status through the first years of life and identifies candidates for early intervention.

How to document reflex findings in clinical notes

Clear documentation protects you clinically and supports patient safety. Record each of the following.

• Date and time of the assessment
• The infant’s age in days, weeks, or months
• Each reflex tested, the stimulus used, and the response observed
• Whether responses were symmetric or asymmetric
• Any absent, delayed, or hyperactive findings
• The clinical impression, whether normal, concerning, or abnormal and requiring referral
• The plan, whether routine follow-up, a repeat exam at the next visit, or immediate specialist referral

Capturing these fields on digital intake forms cuts transcription errors. It also lets you flag an abnormal result for follow-up as you type it.

Who performs the infant reflex exam

Any clinician who assesses newborns or infants should know the reflex chart. That includes obstetricians, midwives, pediatricians, family medicine doctors, nurse practitioners, and registered nurses in birthing centers or pediatric practices. Occupational therapists and physical therapists use it too.

Practitioners who never run the full exam still need to tell a normal response from an abnormal one. That way a concern reaches the right colleague quickly.

How Pabau standardizes reflex documentation and referral

In most practices the reflex chart lives on paper. A clinician ticks a printed grid, writes a line in the notes, and the finding sits inside one visit’s record. Comparing this month’s exam with the last one means pulling both files.

Practice management software like Pabau turns the chart into a structured form instead. Each reflex becomes its own field, so the response is picked rather than written out. The finding saves straight into the client record, and every past assessment sits on the same timeline.

Because the fields are structured, an abnormal answer can trigger the next action on its own. Pabau’s automated workflows book the recheck, send the parent a reminder, or queue the referral letter. Your record then shows the finding and what you did about it.

Standardize every infant reflex assessment

Pabau turns your reflex chart into structured form fields, stores each assessment on the client’s timeline, and flags abnormal findings for follow-up. Your team records the exam once and the referral trail builds itself.

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Conclusion

The value of a reflex chart is consistency. Two clinicians testing the same infant a month apart should produce notes that compare line for line. A shared chart is what makes that possible.

Download the chart, adapt the wording to your practice, and use it at every infant assessment from birth onward. The exam itself will not get much faster. What changes is the record, which another clinician can act on without calling you first.

Book a demo to see how Pabau keeps reflex findings, follow-ups, and referrals in one client record.

Continue your research

Running the wider neurological exam? Neuro checks nursing assessment sets out the observations that sit alongside reflex testing at the bedside.

Need the cranial nerve component? Cranial nerve nursing assessment walks through all twelve nerves and what an abnormal response means.

Recording the rest of the newborn check? Vital signs record gives you a structured sheet for temperature, pulse, respiration, and blood pressure.

Tracking findings across visits? Clinical progress notes show how to write each visit so the next clinician can follow the thread.

Frequently asked questions