Newborn Reflexes and Behavior

When To Call

Call 911 Now

• Can't wake up
• Not moving or very weak
• Weak or absent cry and new onset
• Severe trouble breathing (struggling for each breath)
• New moaning or grunting noises with each breath
• Bluish (or gray) lips, tongue or face now
• You think your child has a life-threatening emergency

Go to ER Now

• Hard to wake up

Call Doctor or Seek Care Now

• Age less than 1 month old and looks or acts abnormal in any way. Examples are a poor suck or poor color.
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Breathing stopped for more than 10 seconds and now it's normal
• Trouble breathing, but not severe
• Seizure suspected
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Normal newborn reflexes and behavior
• Flying or mountain travel with a newborn

Care Advice

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 or abrupt movements. Frequent at birth. Slowly 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. The opposite arm and leg flexes. Goes away by 4 months of age.
• Chin Trembling
• Lower Lip Quivering
• Jitters or Trembling (see topic below)

Normal Jitters or Trembling when Crying:

• Jitters 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.
• Seizures are rare. During seizures, newborns are more than jittery. They have muscle jerking and blinking of the eyes. Babies can also make sucking movements of the mouth. They don't cry during seizures.
• Call Your Doctor If:
• The jitters get worse
• The jitters occur when your baby is calm

Normal Sleep Movements:

• Sleep is not quiet. Expect some of the following:
• Sudden jerks or twitches of the arms, hands or legs. If they only occur during sleep, they are most likely normal.
• How Long: last a few seconds, but can recur
• Timing: soon after falling asleep
• Normal at all ages, not just in newborns
• Suspect a seizure if: jerking occurs when awake or lasts more than 10 seconds

Normal Breathing Sounds and Noises:

• Throat Noises. Caused by air passing through normal saliva or refluxed milk. These gurgling noises are likely to build up during sleep. Slowly, the newborn learns to swallow more often.
• Nasal Noises are usually caused by dried mucus in the nose. Your baby most likely doesn't have a cold. A blocked or stuffy nose can interfere with feeding. This is because your baby can't breathe when the mouth is closed with feeding. Therefore, babies need help opening the nasal passages.
• Nasal Saline. Clean out the nose with saline (salt water) nose drops (such as store brand). If not available, can use bottled 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. Then, 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 nose drops or spray can be bought in any drugstore. No prescription is needed.
• Tobacco Smoke. Avoid tobacco smoke which can cause nasal congestion or sneezing. Avoid dust or any strong odors for the same reason.
• Call Your Doctor If:
• Nasal washes don't work
• Breathing becomes hard

Normal Irregular Breathing Patterns:

• Transient Breathing Pauses of Less Than 10 Seconds. Also Called Periodic Breathing. Often, the pause is followed by some faster breathing to "catch-up." These breathing pauses are normal if the baby is comfortable during them. A normal rate should be less than 60 breaths per minute. Usually resolves by 1 month of age. Call your doctor if: your baby is breathing fast or turned blue.
• Transient Rapid Breathing. Sometimes, newborns take rapid, progressively deeper breaths. This is so they can expand their lungs all the way. 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 stomach expands. The cause is the soft rib cage of some newborns. It tends to pull in during normal downward movement of the diaphragm.
• Yawning or Sighing (off and on) to open up the lungs
• Call Your Doctor If:
• Breathing becomes hard
• Breathing pauses last more than 10 seconds
• You have other questions or concerns

Normal GI Sounds And Noises:

• Belching air from stomach
• Passing gas per rectum
• Note: both of these are releasing swallowed air. They are normal, harmless and lifelong. They do not cause pain or crying.
• Gurgling or growling noises from the movement of food through the intestines
• Normal grunting with pushing out stools
• Hiccups are often caused by overeating. They can also be from a little acid irritating the lower esophagus. Give your baby a few swallows of water to rinse off the lower esophagus.

Normal Sleep Sounds And Noises:

• Moving during sleep transitions
• Occasional startle reflex or jerks
• Breathing noises - especially gurgling from secretions that sit in the throat.
• During light sleep, babies can normally whimper, cry, groan or make other strange noises.
• Parents who use a nursery monitor often become concerned about these normal sleep sounds.
• GI tract noises from normal movement of digested food

Normal Feeding Reflexes:

• Rooting Reflex. When the side of the mouth or cheek is touched, your baby turns to that side. He will open his 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. It is even present right after a feeding. This reflex fades between 6 and 12 months of age.

Normal Protective Reflexes:

• Sneezing To Clear Nose of Any Irritant. Sneezing helps 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. At first, they prefer to keep their eyes closed. They blink often with light exposure.

Flying With Newborns:

• Never fly during the first 7 days of life. If flying is needed, it's safe to fly after 7 days of age.
• If your newborn is not healthy, do not fly. Your child's doctor should give medical clearance first before flying.
• Your baby can be exposed to infections aboard aircraft. Therefore, it is preferable not to fly before 2 or 3 months of age.

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 are safe.
• If your newborn is not healthy, don't travel above 8,000 feet (2,438 meters). Your child's doctor should give medical clearance first.

Call Your Doctor If:

• Your baby starts to look or act abnormal in any way
• You think your child needs to be seen

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