6. Heel to Ear

This maneuver measures passive flexor tone about the pelvic girdle by testing for passive flexion or resistance to extension of posterior hip flexor muscles.

The infant is placed supine and the flexed lower extremity is brought to rest on the mattress alongside the infant's trunk.

The examiner supports the infant's thigh laterally alongside the body with the palm of one hand. The other hand is used to grasp the infant's foot at the sides and to pull it toward the ipsilateral ear.

The examiner fells for resistance to extension of the posterior pelvic girdle flexors and notes the location of the heel where significant resistance is appreciated. Landmarks noted in order of increasing maturity include resistance felt when the heel is at or near the: ear (-1); nose (0); chin level (1); nipple line (2); umbilical area (3); and femoral crease (4).

Heel to ear

-1 0 1 2 3 4 5
Heel To Ear    

References :
Ballard JL, Khoury JC, Wedig K, et al: New Ballard Score, expanded to include extremely premature
infants. J Pediatrics 1991; 119:417-423.

Neuromuscular Maturity

Physical Maturity