An Overview:
Primitive Reflexes, also known as infant or primary reflexes, are automatic and unconscious adaptive responses that develop during the neonatal and infancy period of life. The purpose of primitive reflexes is for the survival and development of infants in the early months of life. Reflexes are also important because they create the early movements that allow the infant to engage with their environment and develop their sensory receptors (Melillo, 2011). As infants develop, these reflexes begin to integrate and prepare the child to move against gravity, position their body within space, and assume an appropriate posture suited for tasks (Gieysztor, Choinska, & Paprocka-Borowicz, 2015). Furthermore, when the reflexes integrate, they are replaced with voluntary motor movements which are purposeful and used to interact with the environment on a daily basis. Integration of reflexes should occur naturally as the child develops and as the brain grows.
Primitive Reflexes
Moro Reflex:
- The Moro reflex is a protective response to abrupt disruption of the body’s balance. It is elicited by pulling up on the arms with an infant laying on their back. This produces a sensation of falling when the arms are released, leading to outstretched arms at the shoulder and elbows, spreading of fingers, and then followed by immediate flexion of the arms tucked against the body alongside an audible cry (Taylor et al., 2004; Villaneda, 2018).
- Develops in Utero by 28 weeks
- Integrates by 6 months of age
Rooting Reflex:
- The rooting reflex can be elicited by gently stroking the cheek or bringing an object into the child’s visual field. This then leads the child to turn the head toward the object/stimuli and open the mouth with tongue thrusting (Modrell & Tadi, 2023).
- Develops in Utero at 28 weeks
- Integrates after 1- 4 month of age
Palmar Grasp Reflex:
- The palmar reflex is a response to input or stimuli within the palm portion of the hand. To elicit this reflex, provide sustained pressure to the palm of the hand, which will lead to the flexion or curling of the fingers grasping the object (Marques-de-Moraes et al., 2017).
- Develops in Utero by 28 weeks
- Integrates by 6 months of age
Asymmetrical Tonic Neck Reflex (ATNR):
- This reflex is characterized by turning the head to one side, followed by the arm and leg on the face side moving into extension outward, while the opposite arm and leg curls or flexes inward (Konicarova & Bob, 2013). The ATNR assists in moving one’s head side to side, swinging arms, and kicking legs. This reflex also develops muscle tone, stimulates the balance mechanisms within the body, and assists in developing eye hand coordination skills.
- Develops in Utero at 35 weeks
- Integrates at 3 – 9 months of age.
Spinal Galant Reflex
- The Spinal Galant reflex assists in movements of hips during the descending period out of the birth canal. It also aids in the development of range of motion and hip movement needed for crawling and walking. This reflex is elicited by providing stimuli on the child’s side near the hip, which is followed by that side of the body bending and curving toward the stimuli (Mihajlovska & Rashikj-Canevska, n.d.)
- Develops in Utero at 20 weeks
- Integrates at 6 months of age.
Tonic Labyrinthine Reflex (TLR)
- The TLR is elicited when a child is laying on the stomach and the body flexes inward into a ball form. Additionally, when laid on the back, the body goes into an extension tone. The TLR aids in learning about gravity and develops head and neck control. It is triggered when the head is tilted forward and backward and sends information to the brain regarding the body’s spatial position (Story, 2007).
- Develops in Utero at 12 weeks
- Forward flexion integrates at 4 months of age. Backward extension 3 months to 3 years of age
Landau Reflex
- The Landau reflex is useful in helping the child develop coordination between the upper and lower parts of the body as well as developing posture. This reflex is elicited by laying on the stomach and the child’s head, neck and back will extend, appearing as a superman pose (Mitchell, 1962).
- Develops at 4-5 months of age
- Integrates at 1 years of age
Symmetric Tonic Neck Reflex (STNR)
- The STNR aids in helping infants learn to move the top half and the bottom half of their body independently from one another. Also aids in making the transition from laying down to getting up on hands and knees for crawling. It appears when the child is on hand and knees, the head is flexed down which then leads to the arms flexing while the legs extend. When the head is placed in extension the arms extend while the legs flex (Story, 2007).
- Develops at 6-9 months of age
- Integrate between 9-12 months of age
Retained Reflexes
Retained reflexes refers to when a child’s primitive reflexes do not integrate and remain present. Retained primitive reflexes can disturb the natural development in sensory, gross motor, cognition, and psychomotor skills within the child’s life. Additionally, retained reflexes can also create difficulties in both social and educational skills. (Gieysztor, Choninska, & Paprocka-Borowicz, 2015). Reasons for retention of primitive reflexes can include a variety of causes. Some common causes include but are not limited to decreased tummy time in infancy, lack of crawling, chronic ear infections, head injuries, trauma, exposure to toxins, and or use of different medications. This list is not exhaustive and having items on this list does not automatically lead to retention of primitive reflexes
Signs of Retained Primitive Reflexes and Impact on Function
Moro Reflex:
- Hypersensitivity to one or more sensory systems
- Vestibular deficits (motion sickness, poor coordination and balance)
- Oculomotor and visual perceptual problems
- Hypersensitivity to sounds
- Allergies and lowered immune system
- Adverse reactions to drugs
- Hypoglycemia
- Anxiety or nervousness
- Poor stamina
- Poor adaptability
Rooting reflex
- Anterior Tongue Tie
- Thumb sucking
- Oral hypersensitivity
- Poor eating
- Speech and articulation problems
- Swallowing and chewing deficits
Palmar Grasp Reflex
- Poor manual dexterity
- Deficits with pencil grasp
- Poor visual coordination
- Poor posture during handwriting
- Poor writing skills
- Correlated speech and hand movements
- Dysfunction of tactile and proprioceptive sensory systems
Asymmetrical Tonic Neck Reflex (ATNR)
- Unable to cross eyes easily or hurts when crossing
- Difficulty crossing midline
- Eyes jump over words or lines
- Poor balance
- Right left confusion
- No consistent hand dominance past age 6
- Mixes up “d” and “b” or other letters and numbers
- Difficulty skipping or marching
- Poor reading (dyslexia), handwriting, spelling, and math skills
- Poor expression of ideas on paper
Spinal Galant Reflex
- Fidgeting
- Bedwetting
- Poor endurance
- Poor concentration and attention
- Poor short term memory
- Very sensitive to several senses
- Hip rotation to one side (scoliosis)
- Poor posture
- Poor gross motor coordination
- Difficulty reading
Tonic Labyrinthine Reflex (TLR)
- Poor posture (hunched)
- Weak muscles (easily fatigued)
- Poor muscle tone
- Fear of heights
- Stiff jerky movements
- Toe walking
- Poor balance
- Difficulty walking up/down stairs
- Spatial problems (bumps into furniture, stands, too close)
- Speech and or auditory difficulties
- Poor sequencing (telling stories, counting, organizing)
- Poor sense of time and unable to tell time
Landau Reflex
- Poor posture and muscle tone
- Summersaults are challenging
- Poor coordination for activities that require upper and lower body to move together
- Delayed motor development
Symmetric Tonic Neck Reflex (STNR)
- Poor posture
- Headaches from muscle tension in the neck
- Ape like walking (hunched posture)
- “W” sitting
- Poor eye hand coordination
- Messy eater
- Unable to cross eyes easily or hurts when crossing
- Fidgety or stands/sits frequently
- Difficulty copying from board
- Difficulty when asked to crawl (unusual crawling pattern)
- Poor attention skills
Integrating Primitive Reflexes
The integration of primitive reflexes has been shown to improve many facets of a child’s development. When integrated, overall motor development, higher learning, attention, sensory processing, and more can improve (Jackson, 2020). Primitive reflex integration can be addressed by both physical therapists and occupational therapists who receive special training and extended education. These service providers will assess the child and determine which reflexes are retained. From these results, the occupational or physical therapist will then create an individualized program that includes both play and exercises that will aid in integrating the retained reflexes. Occupational and physical therapists will also provide training and education on said program which will allow the child and caregiver(s) to carry out the exercises through play at home. Regular participation, conducted 1-2 times per day, is needed in order to retrain the body and build new neural pathways in the brain (Jackson, 2020).
Why Occupational Therapy
Occupational therapists are trained professionals that specialize and address a variety of domains which are impacted by retained primitive reflexes. For example, occupational therapists assess and treat individuals of all conditions, background, ability level, and age (AOTA, 2020). Areas in which occupational therapists address include motor developmental delays, including both gross and fine motor delays, social emotional regulation difficulties, executive functioning challenges, attention difficulties, sensory processing disorders/difficulties, and more (AOTA, 2020). According to research, integration therapy provided by occupational therapists has the capacity to significantly decrease the number of cues needed for attention, posture, visual perceptual skills, and gross motor exercises (Jackson, 2020). Therefore, through play based exercises and activities, occupational therapists can address the retained primitive reflexes and aid in your child’s overall development.
References
Akhtar, N. (2022). Spinal Galant Reflex. Retrieved from https://drnageena.com/the-spinal-galant-reflex
American Occupational Therapy Association (AOTA). (2020). Occupational therapy practice framework: Domain and process fourth edition. The American Journal of Occupational Therapy, 74(2). https://doi.org/10.5014/ajot.2020.7452001
Andrich, P., Shihada, M. B., Vinci, M.K., Wrenhaven, S. L., & Goodman, G.D. (2018). Statistical relationship between visual skill deficits and retained primitive reflexes in children. Optometry & Visual Performance, 6(3), 106-111.
Arbuckle, A. (2013, January 26). Rooting Reflex. Retrieved from https://www.flickr.com/photos/aarbuckle9/8416689403
Berne, S. A. (2006). Primitive reflexes: Considerations in the infant. Optometry & Vision Development, 37(3) 139. https://doi.org/1557-4113
Blog on OT. (n.d.) Tonic Labyrinthine Reflex. Retrieved from https://bloccupationaltherapy.wordpress.com/tonic-labyrinthine-reflex-tlr/
Empower your pOTential. (n.d.). Symmetrical Tonic Neck Reflex (STNR) PDF poster. Retrieved from https://www.teacherspayteachers.com/Product/Symmetrical-Tonic-Neck-Reflex-STNR-PDF-Poster-5882134
Futagi, Y., Toribe, Y., & Suzuki, Y. (2012). The grasp reflex and Moro reflex in infants: Hierarchy of primitive reflex responses. International Journal of Pediatrics.
Gieysztor, E. Z., Choinska, A. M., & Paprocka-Borowiez, M. (2015). Persistence of primitive reflexes and associated motor problems in healthy preschool children. Archives of Medical Science, 14(1), 167-173. https://doi.org/10.5114/aoms.2016.60503
Grigg, T. M. (2018). The influence of a primitive reflex integration programme within the classroom: Teacher/ parent perspectives and student results [Doctoral dissertation, University of Canterbury]. UC Campus Repository. file:///C:/Users/tapla/Downloads/Grigg,%20Tessa_Final%20PhD%20Thesis.pdf
Heidenreich, S. (2021). Landau Reflex. Retrieved from https://www.occupationaltherapy.com/articles/understanding-primitive-reflexes-they-impact-5409-5409
Heidenreich, S. (2021). Moro Reflex. Retrieved from https://www.occupationaltherapy.com/articles/understanding-primitive-reflexes-they-impact-5409-5409
Heidenreich, S. (2021). Palmar Reflex. Retrieved from https://www.occupationaltherapy.com/articles/understanding-primitive-reflexes-they-impact-5409-5409
Heidenreich, S. (2021). Tonic Labyrinthine Reflex. Retrieved from https://www.occupationaltherapy.com/articles/understanding-primitive-reflexes-they-impact-5409-5409
Heidenreich, S. (2021). Understanding primitive reflexes: How they impact child development and intervention strategies for integration. OccupationalTherapy.com, 5409. Available at www.OccupationalTherapy.com
Jackson, A. (2020). The effects of integration therapy on retained primitive reflexes. University of Milligan.
Konicarova, J. & Bob, P. (2013). Asymmetrical tonic reflex and symptoms of attention deficit and hyperactivity disorders in children. International Journal of Neuroscience, 123(11), 766-769. https://doi.org/10.3109/00207454.2013.801471
Marques-de-Moraes, M. V., Dionisio, J., Tan, U., & Tudella, E. (2017). Palmar grasp reflex in human newborns. Pediatrics & Therapeutics, 7(1). https://doi.org/10.4172/2161-0665.1000309
McDonald, K. (2023, June 19). Spinal Galant Reflex. Retrieved from https://www.integratingreflexes.com/benefits-of-the-spinal-galant-reflex/
Melendez, J. N. P. (2019). Effects of reflex integration in autism: An occupational therapy case report. University of Texas Medical Branch.
Melillo, R., Leisman, G., Mualem, R., Ornai, A., & Carmeli, E. (2020). Persistent childhood primitive reflex reduction effects on cognitive, sensorimotor, and academic performance in ADHD. Frontiers In Public Health, 8(431835). https://doi.org/10.3389/fpubh.2020.431835
Melillo, R., Leisman, G., Machado, C., Machado-Ferrer, Y., Chinchilla-Acosta, M., Kamgang, S., Melillo, T., & Carmeli, E. (2022). Retained primitive reflexes and potential for intervention in autistic spectrum disorders. Frontiers in Neurology, 13(922322). https://doi.org/10.3389/fneur.2022.922322
Mihajlovska, M. & Rashikj-Canevska, O. (n.d.). Persistence of primitive reflexes and associated problems in children. Retrieved from http://periodica.fzf.ukim.edu.mk/godzb/GZ72(2019)/GZ72.48.%20Rasic%20Canevska,%20O.%20-%20Persistence%20of%20primitive%20reflexes%20and%20associated%20problems%20in%20children.pdf
Mitchell, R. G. (1962). The Landau Reaction (Reflex). Developmental Medicine & Child Neurology, 4(1), 65-70. https://doi.org/10.1111/j.1469-8749.1962.tb03099.x
Modrell, A. K. & Tadi, P. (2023). Primitive reflexes. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554606/
Story, S. (2007). The importance of integrating reflexes. Move Play Thrive. www.moveplaythrive.com
Taylor, M., Houghton, S., & Chapman, E. (2004). Primitive reflexes and attention deficit/hyperactivity disorder: developmental origins of classroom dysfunction. International Journal of Special Education, 19(1), 23-37.
The Gait Guys. (2021, March 22). Asymmetrical Tonic Neck Reflex. Retrieved from https://www.thegaitguys.com/thedailyblog/2021/3/22/more-on-stretching
Villaneda, A. (2018). Primitive reflexes. Integrated Learning Strategies. (pp. 1-37).
