Correspondence

A Baby with a Babinski Reflex

N Engl J Med 1999; 340:1929-1930June 17, 1999

Article

To the Editor:

In describing the image of the Babinski sign in an infant, Neelon and Harvey (Jan. 21 issue)1 state that the “reflex is present in normal newborn infants and disappears as the central nervous system matures.” Although this statement has been made in many textbooks, it does not reflect my experience in 28 years of practicing pediatric neurology. The findings that refute this concept were reported by Hogan and Milligan in the Journal in 1971.2 They studied 100 newborns ranging in age from two hours to seven days. Ninety-three of the infants had bilateral flexor plantar responses, four had bilateral extensor responses, and three had a unilateral extensor response. These findings support the concept that a gentle stimulus of the sole in early infancy will almost always produce a flexor plantar response. Although it is often difficult to determine the true reflex because of withdrawal, a very gentle stimulus will usually provide the examiner with an accurate result.

Richard G. Curless, M.D.
Jackson Memorial Hospital Center, Miami, FL 33101

2 References

1. 1

   Neelon FA, Harvey EN. The Babinski sign. N Engl J Med 1999;340:196-196
   Full Text | Web of Science | Medline

2. 2

   Hogan GR, Milligan JE. The plantar reflex of the newborn. N Engl J Med 1971;285:502-503
   Full Text | Web of Science | Medline

Author/Editor Response

Dr. Neelon replies:

To the Editor: Dr. Curless's quibble with the description that accompanied our image of the Babinski sign appears to turn on the statement that an extensor (that is, a positive) response is present in newborns. Dr. Curless says he does not find such responses, but even the study he cites1 found extensor responses in 7 percent of the infants tested. And there have been other such observations by clinicians — and artists. Extension of the great toe, like that in our image, can be seen clearly in paintings of the Madonna and Child by Botticelli, Raphael, Correggio, and Rubens, among others. Descriptions that buttress our position are found in several clinical studies,2-4 which record extensor responses in 60 to 90 percent of infants.

Francis A. Neelon, M.D.
Duke University Medical Center, Durham, NC 27710

4 References

1. 1

   Hogan GR, Milligan JE. The plantar reflex of the newborn. N Engl J Med 1971;285:502-503
   Full Text | Web of Science | Medline

2. 2

   Ross ED, Velez-Bprras J, Rosman NP. The significance of the Babinski sign in the newborn -- a reappraisal. Pediatrics 1976;57:13-15
   Web of Science | Medline

3. 3

   Katiyar GP, Sen S, Agarwal KN. Plantar response during infancy. Acta Neurol Scand 1976;53:390-394
   CrossRef | Web of Science | Medline

4. 4

   Jaynes ME, Gingold MK, Hupp A, Mullett MD, Bodensteiner JB. The plantar response in normal newborn infants. Clin Pediatr (Bologna) 1997;36:649-651
   CrossRef