Primitive Reflexes: Their Contribution to the Early Detection of Cerebral Palsy

In evaluating the infant for significant motor impairment, a framework to organize and analyze data is presented. Five general areas of information are essential: (1) motor milestone attainment, (2) the classic neurological examination, (3) primitive reflex and postural reaction patterns, (4) progressive vs static nature of the dysfunction, and (5) associated evidence for neurological dysfunction and/or structural nervous system damage. A sixth criterion, age of onset, is relevant - but controversial - to making the specific diagnosis of cerebral palsy. The treatment of and prognosis for children with cerebral palsy have been linked to the historical and examination features outlined, particularly primitive reflexes. For the practicing pediatrician, understanding the fundamentals of the primitive reflex/postural reaction transition and achieving clinical facility with the elicitation of these signs represent skills that are readily acquired, easy to incorporate in routine clinical practice, and diagnostically useful.