AND baby are divided into two groups: segmental motor automatisms provided by segments of the brain stem (oral automatisms) and spinal cord (spinal automatisms), and suprasegmental postural tonic automatisms(centers of the medulla oblongata and midbrain).

Spinal motor automatisms[ | ]

Protective reflex of the newborn[ | ]

If the newborn is placed on the stomach, then a reflex turn of the head to the side occurs. This reflex is expressed from the first hours of life. In children with central nervous system involvement, the protective reflex may be absent, and if the child's head is not passively turned to the side, he may suffocate. In children with cerebral palsy, with an increase in extensor tone, a prolonged rise of the head and even tipping it back is observed.

Support reflex and automatic gait in newborns[ | ]

The newborn does not have the readiness to stand, but he is capable of a support reaction. If you hold the child vertically in weight, then he bends his legs in all joints. The child placed on a support straightens the body and stands on half-bent legs on a full foot. The positive support reaction of the lower extremities is a preparation for stepping movements. If the newborn is slightly tilted forward, then he makes stepping movements (automatic gait of newborns). Sometimes, when walking, newborns cross their legs at the level of the lower third of the legs and feet. This is caused by a stronger contraction of the adductors, which is physiological for this age and outwardly resembles the gait in cerebral palsy.

The support reaction and automatic gait are physiological up to 1-1.5 months, then they are inhibited and physiological astasia-abasia develops. Only by the end of 1 year of life does the ability to stand and walk independently appear, which is considered as a conditioned reflex and requires the normal function of the cerebral cortex for its implementation. In newborns with intracranial injury, born in asphyxia, in the first weeks of life, the support reaction and automatic gait are often depressed or absent. In hereditary neuromuscular disorders, ground response and automatic gait are absent due to severe muscular hypotension. In children with lesions of the central nervous system automatic gait is delayed for a long time.

Crawling reflex (Bauer) and spontaneous crawling[ | ]

The newborn is placed on the stomach (head in the midline). In this position, he makes crawling movements - spontaneous crawling. If you put your palm on the soles, then the child reflexively pushes away from it with his feet and crawling intensifies. In the position on the side and on the back, these movements do not occur. Coordination of movements of arms and legs is not observed. Crawling movements in newborns become pronounced on the 3-4th day of life. The reflex is physiological up to 4 months of life, then it fades away. Independent crawling is a precursor to future locomotor acts. The reflex is depressed or absent in children born in asphyxia, as well as in intracranial hemorrhages, spinal cord injuries. Pay attention to the asymmetry of the reflex. In diseases of the central nervous system, crawling movements persist for up to 6-12 months, like other unconditioned reflexes.

grasp reflex[ | ]

Appears in a newborn with pressure on his palms. Sometimes a newborn wraps his fingers so tightly that he can be lifted up ( Robinson reflex). This reflex is phylogenetically ancient. Newborn monkeys are held on the mother's hairline by gripping the brushes. With paresis of the hands, the reflex is weakened or absent, in inhibited children the reaction is weakened, in excitable children it is strengthened. The reflex is physiological up to 3-4 months, later, on the basis of the grasping reflex, an arbitrary grasp of the object is gradually formed. The presence of a reflex after 4-5 months indicates damage to the nervous system.

The same grasping reflex can also be evoked from the lower extremities. Pressing the ball of the foot with the thumb causes plantar flexion of the toes. If you apply a dashed irritation to the sole of the foot with your finger, then there is a dorsiflexion of the foot and a fan-shaped divergence of the fingers (physiological Babinski reflex).

Reflex Galant [ | ]

When the skin of the back is irritated paravertebral along the spine, the newborn bends the back, an arc is formed that is open towards the stimulus. The leg on the respective side often extends at the hip and knee joints. This reflex is well evoked from the 5-6th day of life. In children with damage to the nervous system, it may be weakened or completely absent during the 1st month of life. When the spinal cord is damaged, the reflex is absent for a long time. The reflex is physiological until the 3-4th month of life. With damage to the nervous system, this reaction can be observed in the second half of the year and later.

Perez reflex [ | ]

If you run your fingers, slightly pressing, along the spinous processes of the spine from the coccyx to the neck, the child screams, raises his head, unbends the torso, bends the upper and lower limbs. This reflex causes a negative emotional reaction in the newborn. The reflex is physiological until the 3-4th month of life. Inhibition of the reflex during the neonatal period and a delay in its reverse development is observed in children with damage to the central nervous system.

Moro reflex [ | ]

It is caused by various methods: by hitting the surface on which the child lies, at a distance of 15 cm from his head, by raising the extended legs and pelvis above the bed, by sudden passive extension of the lower extremities. The newborn moves his arms to the sides and opens his fists - the 1st phase of the Moro reflex. After a few seconds, the hands return to their original position - phase II of the Moro reflex. The reflex is expressed immediately after birth, it can be observed during the manipulations of the obstetrician. In children with intracranial trauma, the reflex may be absent in the first days of life. With hemiparesis, as well as with obstetric paresis of the hand, an asymmetry of the Moro reflex is observed.

With pronounced hypertension, there is an incomplete Moro reflex: the newborn only slightly abducts his hands. In each case, the threshold of the Moro reflex should be determined - low or high. In infants with lesions of the central nervous system, the Moro reflex is delayed for a long time, has a low threshold, often occurs spontaneously with anxiety, various manipulations. In healthy children, the reflex is well expressed until the 4-5th month, then it begins to fade; after the 5th month, only some of its components can be observed.

Oral segmental automatisms[ | ]

Sucking reflex[ | ]

With the introduction of the index finger into the mouth by 3-4 cm, the child makes rhythmic sucking movements. The reflex is unconditional and absent in paresis of the facial nerves, severe mental retardation, in severe somatic conditions. The sucking reflex in human children usually fades between three and four years of age, which explains why in many cultures breast-feeding lasts until the age of three or four years, i.e. up to the age at which the child suckles on his own breast. Anthropologist from the USA Professor Katherine A. Dettweiler came to the conclusion that the need for sucking, i.e. the natural duration of suckling at the breast (expected by our children) can last from 2.5 to 7.0 years.

Pathological reflexes arise as a result of damage to the pyramidal tract, which conducts impulses from the cerebral cortex to the spinal cord. passes from the anterior central gyrus of the cerebral cortex through the subcortical regions of the brain, the brain stem and ends in the cells of the anterior horns.

Pathological reflexes are observed not only in cases of damage to the pyramidal tract, but also in the norm in children 1-1.5 years old (see above). There are pathological reflexes: a) carpal; b) foot (flexion and extensor); c) oral automatism.

hand reflexes are characterized by the fact that various ways their evocation occurs reflex flexion of the fingers - they "bow".

Rossolimo's carpal symptom - the examiner applies a short jerky blow to the tips of the II-V fingers of the patient's hand with his fingertips (the hand is in the palm down position). In response, rhythmic flexion of the fingertips occurs.

Zhukovsky's symptom - the researcher strikes with a hammer on the palm at the base of the fingers. In response, rhythmic flexion of the fingertips occurs.

foot reflexes divided into extensor and flexion. The extensor foot reflexes are characterized by the fact that with various methods of inducing them, a reflex extension (extension) occurs. thumb.

Babinsky's symptom is caused by holding the handle of the neurological hammer, the blunt end of the needle along the outer edge of the sole (Fig. 9). In response, there is an extension of the thumb or a fan-shaped divergence of the toes. In children under 1.5 years of age, Babinski's symptom is physiological and is normally caused.

Oppenheim's symptom is caused by holding the back surface of the middle phalanx of the II and III fingers along the anterior surface of the lower leg of the subject. In response, there is a reflex extension of the big toe (Fig. 10).

Gordon's symptom is caused by compression of the gastrocnemius muscle of the subject's leg (Fig. 11). In response, there is a reflex extension of the big toe.

Schaeffer's symptom is caused by contraction of the Achilles (Fig. 12). In response, there is a reflex extension of the big toe.

Flexion foot reflexes are characterized by the fact that the fingers, with various methods of irritation, “nod”, “bow”.

Symptom of Rossolimo - the examiner with his fingertips delivers a short blow to the tips of the II-V fingers from the plantar side of the foot of the examinee. In response, there is a reflex flexion of the fingers.

Zhukovsky's symptom - caused by a hammer blow in the middle of the sole at the base of the fingers. In response, there is a reflex flexion of the fingers.

Ankylosing spondylitis I - is caused by a blow of the hammer on the back of the foot in the region of the IV-V metatarsal bones. In response, there is a reflex flexion of the fingers.

Symptoms of oral automatism occur with bilateral damage to the cortico-nuclear pathways (paths from the cortex to the nuclei).

The palmo-chin reflex is caused by irritation of the palm. In response, there is a contraction of the muscles of the chin.

The labial proboscis reflex is caused by either a stroke irritation of the lips. In response, there is a protrusion of the lips.

Grasping reflexes occur when the frontal lobe is affected, along with symptoms of oral automatism, mental and speech disorders. There are several grasping reflexes.

The symptom of automated grasping occurs with stroke irritation of the palm. In response, there is a flexion of the fingers of the hand (the patient grabs the object).

A symptom of obsessive grasping - the patient grabs all the surrounding objects.

Along with pathological reflexes in paralyzed or paretic limbs, an increase in tendon and periosteal reflexes, muscle reflexes, and protective reflexes occur.

defensive reflexes- involuntary shortening or lengthening of a paralyzed limb (flexion or extension of it), which occurs in response to pain, temperature, cold irritation. For example, in response to a needle prick, the paretic limb bends into,. With a sharp painful flexion of the toes, flexion of the leg occurs in the hip, knee and joints.

Protective reflexes manifest themselves in different ways. If the paretic limb was bent, then after an injection, a sharp cooling - it unbends, if it is unbent - it bends. Similar phenomena are noted on the hands.

They are an involuntary withdrawal of a paralyzed limb in response to irritation.

protective (shortening) Bekhterev-Marie-Foy reflex caused by repeated stroke irritation, a pinch, a touch of something cold on the skin of the sole, or a sharp plantar flexion of the toes. In response, there is a "triple shortening" - flexion of the paralyzed leg in the hip, knee and ankle joint;

protective shortening (lengthening) reflex of the upper limb- in response to irritation of the upper half of the body, the upper limb is brought to the body and bent at the elbow and wrist joints (shortening reflex) or the upper limb is extended in these joints (extension reflex).

Pathological synkinesis

Synkinesias (friendly movements) are involuntary movements that occur against the background of arbitrary ones. Various physiological synkinesis can be noted in healthy individuals. For example, when walking, there are additional hand movements such as "go-ahead".

Pathological synkinesis- these are involuntary movements in a paralyzed limb that occur when performing voluntary movements in non-paralyzed muscle groups. The formation of pathological synkinesis is based on the tendency to irradiate excitation to a number of neighboring segments of its own and opposite side, which is normally inhibited by the cortex. With the defeat of the pyramidal pathways, this tendency to spread excitation ceases to be inhibited. There are three types of pathological synkinesis: global, imitation, coordinating.

Global synkinesis- involuntary movements of paralyzed limbs that occur with strong muscle tension in healthy limbs. For example, patients are asked to strongly clench a healthy hand into a fist, in response, an involuntary “shortening” movement occurs in a paralyzed limb, which the patient cannot voluntarily perform.

Imitative synkinesis consist in the fact that the paralyzed limb involuntarily "repeats" the movements of the healthy one, although the same movement cannot be voluntarily performed.

Coordinator synkinesis- involuntary contractions of paretic muscles when trying to voluntarily contract other muscles that are functionally related to them. This includes Strümpel's tibial phenomenon the patient in the supine position cannot produce dorsiflexion of the foot on the side of the paresis, but when he flexes lower limb in the knee joint, especially with resistance, at the same time, extension in the ankle joint is involuntarily performed.

Table number 2. Differential diagnosis of central and peripheral paralysis

	TYPE OF PARALYSIS
	PERIPHERAL	CENTRAL
Muscle trophism	Atrophy (hypotrophy)	There is no atrophy (diffuse mild hypotrophy is possible)
Muscle tone	Atonia (hypotension)	Spastic hypertension (jackknife symptom)
deep reflexes	Missing (or declining)	Increased, expanded reflexogenic zone (hyperreflexia)
Clonuses	Missing	Can be called
Pathological reflexes	Missing	Are called
defensive reflexes	Missing	Can be called
Pathological synkinesis	Missing	May occur
Electrical excitability of nerves and muscles	Altered (degeneration reaction)	not violated
Prevalence of paralysis	Usually limited (segmental or neural)	Diffuse (mono- or hemiparesis)

In order for a newborn baby to survive after childbirth and quickly adapt to new living conditions, nature gave the crumbs reflexes. This is the name of the reaction to any stimuli, both acting on the baby from the outside, and internal. At the same time, a newly born baby has many reflexes that he needs only in the first months of life. Checking and evaluating them helps determine if the baby is healthy.

The reflexes of a newborn are an indicator that the child is healthy and developing normally.

Basic reflexes and their types

Inborn reflexes, which are also called unconditioned, are extremely important for the survival of a newborn. Thanks to them, the baby can take his first breath, find his mother's breast, suck milk or grab onto his mother if he feels a fall. These are physiological reflexes that should be present in all healthy babies. Many of them fade and completely disappear by 3-4 months of age.

If they remain at an age when they should have been absent for a long time, these will be pathological reflexes. However, there are many unconditioned reflexes that do not disappear. For example, important physiological reflexes that remain in a child even after the neonatal period are represented by vomiting, corneal, swallowing and other reflexes.

If reflexes do not pass to due date may need to consult a neurologist

Further, as the little one grows, new reflexes appear in his life, based on the experience of the baby. They are called conditional, because certain conditions are needed to develop them, for example, if a mother breastfeeds a toddler in a certain position, then when she puts the baby in this position, the baby will immediately begin to make sucking movements. Conditioned reflexes important for the crumbs of the first year of life include grasping objects with hands, chewing and walking independently.

Pediatricians divide all congenital reflexes into groups depending on their focus. They highlight reflexes that:

• Provide vitality. The baby will not be able to live without sucking, swallowing and breathing reflexes, as well as without spinal reflexes (the so-called reactions associated with the state of the child's muscular apparatus).
• Protect the baby from external irritants. Such irritants can be heat, cold, bright light and other factors.
• Baby needs it temporarily. An example of such reflexes is holding the breath when the baby moves through the birth canal, as well as the pushing reflex, thanks to which the baby is protected from solid food entering the digestive tract until a certain age (so that the child does not choke).

The unconditioned reflexes of a newborn, which are caused by exposure to or near the mouth, are called oral. This group of reflexes includes sucking, proboscis, swallowing, search (it is also called the Kussmaul reflex), Babkin's reflex and others. The reflexes for which the spinal cord is responsible are called spinal reflexes. These include the reflexes of Moreau, Galant, Bauer, supports, grasping, protective and other reflexes.

Table of basic innate reflexes

Name of the reflex, age of manifestation	How to cause and what reaction is normal
sucking (from the first hours after childbirth to 3-4 months)	Pass along the baby's cheek, insert the index finger into the baby's mouth or give the baby a breast or a bottle - the baby will begin to make sucking movements.
Protective (from the first hours after childbirth to 1.5 months)	Lay the baby on the stomach - the baby will reflexively turn his head to the side.
Prehensile (from birth to 3-6 months)	Press something on the baby's palms - the child will grab the object or your fingers with his palms.
supports (from birth to 1-2 months)	Place the baby vertically so that the baby touches the legs of a solid support - the baby will straighten the body and stand on a full foot.
stepper (from birth to 1-2 months)	Put the baby upright and tilt the baby forward a little - the baby will make several automatic step movements when tilted.
Search (from birth to 3-4 months)	Stroking the cheek or corner of the baby's mouth - the child will turn his head in the direction of irritation, lower his lip and move his tongue. If you press on upper lip baby, the baby will unbend his head and open his mouth, and when you press on the lower lip, they cause the head to bend and lower the lower jaw.
Breath holding (from birth to 4-5 months)	Lower the baby into the water, sprinkle water on the baby's face or direct a stream of air into the baby's face - the baby will hold her breath for a few seconds and close her eyes.
Galanta (from 5-6 days of life to 3-4 months)	Run your hand along the child's back along the spine - the baby will arch the back, and the leg on the side of the reflex call will straighten in the joints.
proboscis (from birth to 2-3 months)	Quickly touch the baby's lips with your finger - the baby will pull the lips forward.
Babinsky (from birth to 1-2 years old)	Draw a stroke on the sole of the child - the foot will bend from the back, and the fingers will fan out.
Robinson (from birth to 3-6 months)	Give the baby the thumbs and lift the baby - the baby will tightly clasp his fingers with his palms and will hold on.
Perez (from birth to 3-4 months)	Run your fingers along the baby's spine (along its spinous processes), moving up from the coccygeal bone to the cervical region - the baby will start screaming (the reflex challenge is perceived negatively by the baby), raise his head, straighten up and bend his legs and arms.
Babkina (from birth to 2-3 months)	Press your thumbs on both palms of the crumbs - the baby will open his mouth and bend his head.
Moreau (from the first day after birth to 4 months)	Put the baby on the back and hit the surface on both sides of his head, raise the legs of the crumbs along with the pelvis, sharply lower the baby in his arms 20-30 cm down, and then lift it back - the baby will take the handles to the sides and open the fists, after which will return his hands back as if he were hugging someone.
Bauer (from 3-4 days of life to 4 months)	Lay the child on his stomach, and then put his palm on his feet - the baby will begin to crawl spontaneously, pushing off the hand with his feet, but without coordinating his movements (this causes the second name of this reflex - “spontaneous crawling”).

The inborn reflexes of a newborn are called unconditioned reflexes.

You can see how to check many important reflexes by watching the following video.

Causes of an abnormal response to a reflex challenge

How to develop reflexes?

For the successful development of conditioned reflexes in a child early age it is important to act systematically and regularly. For example, to stimulate the grasping reflex, the baby needs to constantly put various objects into the hands, hang toys over the crib that the baby wants to touch, offer to grab things that he liked.

With regular exercise, parents can develop crawling, walking, chewing and many other reflexes that the baby masters in the first year of life.

To develop the reflexes of the child, you need to regularly engage with him.

What to do if reflexes are reduced or absent?

In some infants, reflexes do not appear immediately or their inclusion is delayed, which is often associated with birth trauma or CNS disease. Immediately after childbirth, the pediatrician should check the basic reflexes and help the baby if they are absent.

The doctor checks for reflexes in the baby immediately after his birth

The sucking reflex is especially important, because with the help of it the baby receives food. If it is absent, the baby has to be fed through a bottle or tube, and in some cases, nutrients must be administered intravenously.

After discharge from the maternity hospital, all children are examined monthly by a pediatrician, and in a situation where any reflex is poorly expressed or persists after the period in which it should fade away, the doctor will refer the baby for a more detailed examination to a neurologist. The specialist will evaluate all reflexes and, if necessary, prescribe the treatment required for the baby.

In the next video, the popular doctor Komarovsky will tell you even more about the unconditioned reflexes of a newborn baby.

Twenty-eight days - this is exactly how long the neonatal period lasts, during which the child's body is going through adaptation to completely new conditions for it now extrauterine life, so the reflexes of a newborn child play a major role here.

This is explained by the fact that a recently born baby is still deprived of many useful skills - nature takes care of it.

Basic reflexes

In this period, the baby has developed only unconditioned reflexes - that is, those that are laid down as if by default. Gradually, some of them disappear, giving way to conventional ones.

Conditioned reflexes can also be called personal experience» child, as they are acquired in the process of further development and maturation of the brain.

What are unconditioned (innate) reflexes for?

There are as many as fifteen clinically significant unconditioned reflexes in a baby - and their “fate” is very different: some are needed only in order to survive the difficult process of birth (therefore, they quickly disappear after birth), others - to give impetus to the development of new ones, and others remain for life.

Pediatric neonatologists divide the congenital reflexes of newborns into several groups:

1. Providing general normal vital activity (respiratory, sucking, swallowing, as well as spinal reflexes)
2. Aimed at protection child's body from external influences of bright light, cold, heat and other irritants
3. "Temporary" reflexes - for example, the breath holding reflex necessary to move through the mother's birth canal.

Click to enlarge (Basic reflexes)

oral reflexes

The ability to suckle a mother's breast or nipple on a bottle of artificial nutrition is called sucking reflex, and the ability to swallow food eaten - swallowable.

Swallowing reflex remains for life.

proboscis reflex - another kind of oral reflexes. If you lightly touch the baby's lips, they bulge funny into a tube - just like an elephant's trunk, because at this moment the circular muscle of the mouth involuntarily contracts. The proboscis reflex disappears by two to three months.

Babkin's reflex (palmar-mouth) - a mixed version of the child's reaction, in which he opens his mouth slightly, if you gently press both thumbs at the same time with your thumbs. It is best expressed in the first two months of life, in the third it begins to fade and then disappears completely.

Kussmaul reflex (search) - an attempt to find food: if you touch the corner of the child's mouth, he turns his head to the irritant. It disappears quite quickly - three to four months after birth. In the future, the search for food occurs visually - the baby sees the breast or bottle.

spinal reflexes. Examining the baby immediately after birth and throughout the entire neonatal period, the pediatrician also pays attention to spinal reflexes - a set of reactions responsible for the state of the muscular apparatus.

Upper defensive reflex. One of the most important unconditioned reflexes that starts already in the first hours of life is the upper protective reflex. It manifests itself if a newborn baby is placed on his stomach: the head immediately turns to the side, and the baby tries to raise it. This is a protection against possible respiratory failure: the child thus restores air access to the respiratory tract. The reflex disappears a month and a half after birth.

Grasping reflexes

Reflexes Yanishevsky and Robinson in a newborn child, they manifest when he firmly grabs the fingers of his mother (doctor) with both hands and is able to hold them so strongly that he can even be lifted in this way. They are expressed up to three or four months, then weaken. The persistence of these reflexes at a later age is evidence of existing neurological problems.

Babinski's reflex - it is also called the plantar reflex: a slight stroking of the edges of the soles from the outside causes the fingers to open in the form of a fan, while the feet bend from the back. Evaluation criteria are energy and especially the symmetry of movements. One of the longest-lived congenital reflexes - it lasts up to two years.

Other motor reflexes

Moro reflex - a biphasic reaction in which the child responds to a rather loud knock on the changing table or any other sharp sound.

• The first phase - the baby spreads his arms to the sides and opens his fingers, while straightening his legs.
• The second phase is the return to the previous position. Sometimes a child can even hug himself, as it were - therefore the Moro reflex has another name - the “hug reflex”.

It is pronounced up to the age of five months of the baby.

Kernig's reflex - the reaction of the hip and knee joints to an attempt to unclench them by force after bending. Normally, this cannot be done. Disappears completely after four months.

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Automatic gait reflex , which is a very funny sight, consists in the attempts of the newborn to walk in the most real way, if he is raised and tilted forward a little. The evaluation criterion is the degree of completeness of support when “walking” on the entire foot. Reliance on the fingers and clinging of the feet to each other is a sign of disorders that require the supervision of a pediatric neurologist.

Support reflex - an attempt by the baby to stand on his feet, when, carefully holding him, they put him on a flat surface (on a table, for example). This is a two-phase reflex: first, the baby, having felt the touch of the support, sharply bends his knees, and then he becomes both feet and firmly presses the soles to the table. Well-defined support reflexes and "automatic" gait persist for one and a half months.

Bauer reflex (spontaneous crawling) can be observed by placing the baby on his stomach and placing his palms on his soles: he begins to crawl, while starting from the created support and helping himself with his hands. Appearing on 3-4 days, this reflex disappears after 3-4 months.

Reflex Galant - the reaction of the spine to an external stimulus. If you run your finger along the entire length of the ridge, then the child arches his back, while straightening his leg from the side of the stimulus.

There are also postural reflexes newborns - attempts to redistribute muscle tone when the body posture changes in the absence of the ability to hold the head, sit and walk.

Magnus-Klein reflex - the reaction of the extensor and flexor muscles of the shoulder, forearm and hand, in which the child assumes a "swordsman's pose". This happens when the baby's head is turned to the side. You can observe how the arm and leg are straightened from the side where the child's face is. On the opposite side, they, on the contrary, bend. This reflex lasts up to two months.

Weak reflexes or when to sound the alarm

It happens that some reflexes in a baby turn on late or do not appear very clearly. This may be due to trauma during childbirth, illness, and may also be an individual reaction to certain medications.

Also, weakness of oral and spinal reactions is commonly noted in preterm infants and in those born with mild asphyxia.

Interestingly, the weak reflexes in a newborn child associated with the search for food and its absorption (sucking and swallowing) can be explained simply by the fact that the baby is simply not hungry. Most clearly they appear before feeding.

The most frightening situation is when there are no reflexes at all. The complete absence of reflexes in a newborn child is a reason for immediate resuscitation, which should be carried out only by specialists.