Primitive Reflexes

Primitive reflexes are a group of reflexes that govern movement that are found in new-born babies. These reflexes develop in utero and are present at birth in a full-term, healthy baby.

Primitive reflexes are guided by the brainstem, one of the first parts of the brain to develop and these reflexes should only remain active for the first couple of months of life.

In normal development during the first year of life these reflexes naturally become integrated into normal function. This happens in a sequential order after which further reflexes called ‘postural reflexes’ emerge.

Postural reflexes are more mature patterns of motor development that control balance, coordination and sensory motor development.

If primitive reflexes are not integrated into normal function they remain active in what are termed ‘primitive retained reflexes’. The continued presence of these primitive retained reflexes can contribute to developmental delays. Their continued presence also prevents the development of higher level fine motor skills such as those required for handwriting, fine motor coordination and balance.

Continued presence of these reflexes can be found in such conditions as ADHD, sensory processing disorders and autistic spectrum. They can also be found in patients with learning disabilities such as dyslexia and dyspraxia as well as patients with balance and coordination problems.

The continued presence of these reflexes can result in reduced balance, untidy hand writing, a reduced attention span and reduced fine motor coordination such as being to dress oneself, tie shoelaces or manipulate cutlery.

Causes of Retained Primitive Reflexes

Primitive reflexes can be retained due to a number of factors. The birth process is a key factor in the integration of these reflexes. Therefore a traumatic birth experience, a rapid delivery or birth by c-section is more likely to lead to primitive retained reflexes being retained.

Additional causes include maternal stress during pregnancy, the baby not spending enough time on their tummy, the baby being early to walk or the baby or toddler not making enough appropriate body movements at that stage of their life.

Also implicated is the child delaying or not going through a creeping and crawling phase in their development. Other possible causes include chronic ear infections, falls or head trauma.

Types of Primitive Reflexes

Moro Reflex:

The Moro reflex acts as the baby’s primitive fight or flight reaction and is typically replaced by the adult startle reflex by the age of four months. If a child experiences a retained Moro reflex beyond the age of four months, they may become over sensitive and over reactive to sensory stimuli.

This will result in reduced impulse control and a tendency to experience sensory overload. The child may also easily become anxious.

They may also easily become emotional and show emotional immaturity.

Additional signs of a retained Moro reflex include motion sickness, reduced balance, reduced coordination, being easily distracted, being unable to adapt easily to change, not liking any change in their routine as well as experiencing mood swings.

Rooting Reflex:

The Rooting reflex assists in the act of breastfeeding and is activated by stroking the baby’s cheek. Activation of the reflex causes them to turn and open their mouth.

Retention of the rooting reflex beyond the age of four months may result in a difficulty in eating solid foods, a reduced articulation of the mouth, a tendency to keep the mouth open and a tendency to suck their thumb.

Palmar Reflex: The Palmar reflex is the automatic flexing of the fingers to grab an object and should be integrated by the age of six months. If the Palmar reflex is retained, a child may have difficulty with fine motor skills, may stick their tongue out when writing and may have messy handwriting.

Asymmetric Tonic Neck Reflex (ATNR): The ATNR is initiated when babies are laid on their back and their head is turned to one side. As the reflex is activated, the arm and leg on the side to which they are looking extends whilst the limbs on the opposite side bend. This reflex helps guide hand-eye coordination as the reflex turns the head in the direction that the eyes are already looking.

This means that if the hand touches any object, the eyes are already looking in that direction.

This reflex is usually integrated into normal function by the age of six months. If retained this reflex can cause issues with balance, handwriting and hand eye coordination.

In terms of the child writing, as their head turns towards the page, if still present the reflex is activated and acts to move the hand in the direction of their gaze away from the page. The other arm away from their direction will bend upwards.

The child has to work against the reflex to keep their hand on the page and in doing so will tighten their hand so making it more challenging to write. This may result in their fingers gripping the pen tightly so that writing becomes tiring and challenging as well as not tidy.

Spinal Galant Reflex:

The Spinal Galant reflex is initiated when either side of an infant’s lower back is stroked. Activation of the reflex causing the infant’s body to move towards the side that has been stroked.

This reflex helps with the birth process as touch to the one side of the baby’s back causes the baby to twitch causing the baby to move along the birth canal.

This reflex should integrate into normal movement between the ages of three and nine months. If the reflex remains it can affect a child’s posture, coordination, attention and ability to sit still. The continued presence of this reflex can also be associated with bedwetting.

TLR: The Tonic Labyrinthine Reflex (TLR): The TLR helps control the position of the head and prepares an infant for rolling over, creeping, crawling, standing and walking. The reflex is initiated when an infant has been placed on their back and their head is tilted backwards.

The reflex causes the infant’s legs to stiffen and straighten. Their toes point, their hands form into fists and their elbows bend.

This reflex gradually integrates as other systems mature. The reflex is expected to be fully integrated by the age of three and a half. If this does not happen the TLR can cause reduced muscle tone, a tendency to toe walk, can cause motion sickness as well as result in a reduced sense of balance.

Landau Reflex: Technically this is not a primitive reflex as it is not present at birth though the Landau reflex assists with posture development.

The reflex is initiated when the baby lifts its head and this movement will cause the entire trunk to flex. The reflex typically emerges at around 3 months of age and is fully integrated by the age of one. If the Landau reflex persists beyond this time children may experience reduced motor development and low muscle tone.

Symmetrical Tonic Neck Reflex (STNR): The STNR is present briefly after birth and then reappears around six to nine months of age.

The STNR helps the body divide in half at the midline in terms of motor development so helps prepare the body for crawling.

As the head moves down towards the chest, the arms bend and the legs extend. This reflex is expected to fully integrate by 11 months of age. If retained, the STNR can contribute to developmental delays that relate to reduced muscle tone, a tendency to slump forward whilst sitting, an inability to sit still or an inability to be able to concentrate.