Primitive Reflexes and Exercises to Help with Integration

What are primitive reflexes?

Primitive reflexes are automatic responses that ensure infants are kept safe and healthy. These automatic movements are elicited by proprioceptive, tactile, and vestibular stimulation. Primitive reflexes occur without voluntary control from the infant.

When do primitive reflexes start and how long do they last?

Primitive reflexes can be seen starting in the third semester of pregnancy and most are expected to stop presenting themselves in an infant within his or her first year. If these reflexes persist after the first year and are not integrated, it can affect performance of daily activities in the future.

Primitive Reflexes – Onset and Integration

Rooting Reflex

Onset: Birth
Integration: 3-4 months
Stimulus: While laying supine (or on back), infant receives light touch on the side of their face near mouth
Automatic response: Infant opens mouth and turns in the direction of touch
If onset or integration does not occur: If reflex persists, infant can become orally fixated and lead to thumb sucking. It can also interfere with exploration of objects and head control.

Activities that can help with integration:

Facial massage from ears to mouth
Using chewy necklaces

2. Sucking/Swallowing Reflex

Onset: Birth
Integration: 2-5 months
Stimulus: While laying supine, infant receives light touch on oral cavity
Automatic response: Infant closes mouth, sucks, and swallows to draw liquid into mouth and take in nutrition
If onset or integration does not occur: It interferes with development of coordination of sucking, swallowing, and breathing

3. Moro’s Reflex

Onset: Birth

Integration: 2-4 months
Stimulus: While supine and head midline, dropping head in more than 30 degrees of extension. Other stimulus includes loud noises or being startled.
Automatic response: Infant arms extend and hands open, followed by arms flexing and hands closing; Infant usually cries.
If onset or integration does not occur: Interferes with head control and protective reactions.

Activities that can help with integration:

Deep flexion activities such as the ‘Starfish’ exercise
- While lying supine, begin with arms and legs extended out away from body and then bring knees to chest and cross arms over legs

Starfish exercise (start position)

4. Palmar grasp Reflex

Onset: Birth
Integration: 5-6 months
Stimulus: Pressure placed on ulnar side of palm
Automatic response: Infant flexes fingers around object
If onset or integration does not occur: If not integrated, can interfere with letting go of objects.

Activities that can help with integration:

Small ball or putty squeezes using one finger to squeeze at a time
Playing an instrument such as toy piano

4. Plantar Reflex

Berkeley CA Nine-day-old baby illustrating plantar grasp reflex

Onset: Birth
Integration: 4-9 months
Stimulus: While supine, firm pressure given on ball of foot
Automatic response: Infant flexes toes
If onset or integration does not occur: Can interfere with putting shoes on and cause problems with standing and walking. Can lead to toe walking.

Activities that can help with integration:

Picking up objects with toes
Sensory bins for feet (Ex: filled with water beads or sand) to encourage flexion of toes

5. Positive support Reflex

Onset: Birth
Integration: 1-2 months
Stimulus: Proprioceptive input from being bounced several times on soles of feet
Automatic response: Infant extends legs and plantar flexion occurs
If onset or integration does not occur: Interferes with walking patterns and causes walking on toes

6. ATNR (Asymmetrical Tonic Neck Reflex)

Onset: Birth
Integration: 4-6 months
Stimulus: While supine, infant turns head to one side.
Automatic response: Arm and leg extend on side face is turned towards; Arm and leg on opposite side flex.
If onset or integration does not occur: Can interfere with reaching for and grasping objects as well as with bilateral hand use or using both hands together to perform a task. Can also result in poor hand-eye coordination.

Activities that can help with integration:

Incorporating crossing midline during play activities

7. STNR (Symmetric Tonic Neck Reflex)

Onset: Birth
Integration: 9-11 months
Stimulus: While in quadruped position, two separate responses occur when head is flexed and extended.
Automatic response: When head is flexed, infant’s arms flex and legs extend. When head is extended, infant’s arms extend and legs flex.
If onset or integration does not occur: Can result in impaired coordination that affect crawling or swimming. Can also contribute to poor posture and low muscle tone.

Activities that can help with integration:

Yoga poses (Cat/cow stretch)
Crawling in tunnel
Rolling pull toy in front of infant while crawling to promote child looking down at toy. Promotes neck flexion while arms are in extension.

8. TLR (Tonic Labyrinthine Reflex)

Onset: Birth
Integration: 5 years
Stimulus: Two different responses when infant head flexes (looks down) or extends (looks up)
Automatic response: When head flexes, arms and legs move into flexion. When head extends, arms and legs move into extension.
If onset or integration does not occur: Interferes with turning on side, rolling over, and crawling

Activities than can help with integration: