Assessing the nervous system of a newborn baby is a vital part of the routine postnatal checkup performed by midwives in Nigerian health facilities. This evaluation helps confirm that the brain and spinal cord are developing properly and functioning as expected after birth. Midwives look closely at the baby's muscle tone, posture, alertness, and spontaneous movements. A normal newborn typically presents with flexed limbs and responds actively to handling. Conducting this assessment early helps catch congenital issues or birth injuries before they lead to severe developmental delays.
Primitive reflexes are automatic, involuntary muscle responses that babies are born with. Controlled by the subcortical regions of the brain, these movements help the newborn survive and adapt to life outside the womb during the early months. As the higher centers of the brain mature, these reflexes gradually disappear or integrate, making way for voluntary, purposeful movements. Checking these reflexes gives midwives a reliable window into the structural integrity of the infant central nervous system.
The grasp reflex is observed in both the hands and the feet, each requiring a specific technique to elicit properly.
Primitive reflexes appear at predictable gestational ages and fade out as the infant grows. The palmar grasp is usually very strong at birth and begins to weaken around three to four months of age, paving the way for intentional reaching and grabbing. The plantar grasp stays present a bit longer, usually fading around nine to twelve months as the baby prepares for standing and walking. A delay in the fading of these reflexes can point to delayed neurological maturation.
Midwives must be alert to abnormal reflex responses during physical examinations. A totally absent grasp reflex on both sides points to severe central nervous system depression, birth asphyxia, or major hypotonia. Conversely, an asymmetric grasp—where one hand responds strongly and the other does not—often suggests a localized injury like a brachial plexus palsy or a clavicle fracture sustained during a difficult delivery. Any unexpected persistence of these reflexes past the normal age range requires prompt pediatric referral.