What are primitive reflexes:
By: Julia Sherman
They are essential involuntary movements that occur in response to stimuli to aid newborns in survival. Most of these primitive reflexes start in utero and end leading up to 12 months however, some may stay until 2-3 years of life. It is important for these reflexes to become integrated so that more mature motor patterns and advanced learning can develop. If the primitive reflexes are not properly integrated, it can negatively impact development and ability to reach developmental milestones. This is where occupational therapy can come in. By understanding the signs of these reflexes not being integrated, we can then work with the client to integrate them which over time will likely reduce the symptoms caused by these primitive reflexes.
Prevalence:
Gieysztor et al., (2016) conducted a study with 35 children and found 89% of children to have at least one retained primitive reflex in this study. Feldhacker et al., (2021) conducted a study on 53 children aged 5-7 and found that 100% had at lead one retained primitive reflex. Many other studies have been conducted that show similar values.
What do the primitive reflexes consist of:
There are 8 common reflexes discussed in occupational therapy. There is ATNR, STNR, Landau, Moro, Rooting, Palmar, Spinal Galant, and TLR. These reflexes will be further discussed below.
Moro Reflex:
This primitive reflex occurs at birth and integrates by 6 months. The purpose of this reflex is to create a fight or flight reaction brought on by the sympathetic nervous system. This reflex is also known as the startle response as its causes all limbs to fully extend and then quickly bring them back in.
Potential symptoms of retained Moro Reflex:
- Motion sickness
- Decreased eye contact
- Light and sound sensitivity
- Allergies and/or poor immune system
- Anxiety and mood swings
- Decreased hand eye coordination skills
How to test for it:
Testing for this is the same as the exercise to integrate it. To start, they are in a “starfish” position with arms and legs extended out wide. Then slowly bring the right arm over the left arm and the right leg over the left leg and tuck chin to chest, hold for a few sends and release again into “starfish” then repeat on the opposite side. The reflex will likely be present if the child has a hard time doing the same side of the body for arms and legs.
How to Integrate it:
Position the child the same as before and repeat this action 10 times.
Rooting Reflex:
This primitive reflex occurs at birth and should be integrated by 6 months. This reflex is when stimuli’s presents at the infant’s cheek and the infant will turn to the stimuli and suck for nutrients. This reflex is most powerful at birth and if nutrients is not supplied, it will weaken.
Potential symptoms of retained rooting reflex:
- Thumb sucking
- Anterior tongue tie
- Hypersensitive oral cavity
- Feeding challenges
- Drooling more normal for age
- Chewing and swallowing deficits
- Speech and articulation delays/challenges
How to test for it:
Stroke from nose to chin around mouth 3 times on each side and if child’s mouth moves or twitches towards sides of hand the reflex may be retained.
How to integrate it:
Stroke from ear to mouth 3 times and nose to chin around mouth 3 times on each side then repeat 5 times.
Palmar Grasp Reflex:
This primitive reflex occurs at birth and should be integrated by 6 months. This reflex is when the fingers flex creating a fist when the palm is stimulated.
Potential Symptoms of Retained Palmar Reflex:
- Problems with proper pencil grip
- Poor writing skills
- Poor posture with writing activities
- Poor manual dexterity
- Deficits in correlated speech and hand movements
- Dysfunction of tactile and proprioceptive systems
How to test for it:
Have child hold hand out and flat, stroke along lifeline crease 3-5 times, observe if fingers or elbow twitch or slightly bend. If the movement in present, then the reflex may be retained.
How to integrate it:
Squeeze putty with all fingers then squeeze each finger to thumb starting with index finger ending with pinky then going the other way starting with pinky and ending with index finger. Repeat this action 10 times, 1-2 times a day.
Asymmetrical Tonic Neck Reflex (ATNR):
This primitive reflex occurs at birth and should be integrated by 6 months. This reflex is used to exit the birth canal and for cross pattern movements.
Potential symptoms of retained ATNR:
- Poor Handwriting
- Decreased hand-eye coordination
- Poor balance
- Uncoordinated gait
- Problems with math or reading
- Poor visual-motor skills and tracking
- Difficulty crossing midline
How to test for it:
Have child stand and put their arms out straight in front of them. Have the child look left and to the right, if the if the elbow bends or shoulder rotates then the reflex is likely retained.
How to Integrate it:
Start in prone with the child’s head facing one direction with arms and legs straight down, then bend arm and leg on the side the head is turned 90 degrees, then repeat on other side. Repeat this action 10-15 times 1-2 times a day.
Spinal Galant Reflex:
This primitive reflex has an onset at birth and integrates by 9 months. This reflex helps to facilitate movement of hips when going through the birth canal.
Potential symptoms of retained spinal Galant reflex:
- Challenge with focus, sitting still and attention
- Challenge with developmental milestones
- Bedwetting beyond age of 5-6
- Tactile hypersensitivity (especially with clothing)
- Challenges with natural gain – could develop scoliosis
How to test for it:
In quadruped position, stroke down one side of the spine/low back with an eraser, if body tightens, twitches or exhibits jerky movements on corresponding side of the body then the reflex may be retained.
How to integrate it:
Have the child do a slow snow angel through the count of 10 then bring it back in and repeat 10 times, 1-2 times a day.
Tonic Labyrinthine Reflex (TLR):
Onset occurs in utero and integrates by 3.5 years. This reflex is foundational for postural stability in large muscle groups.
Potential symptoms of retained TLR:
- Poor posture, low muscle tone
- Challenge with sports
- Vision deficits
- Auditory deficits
- Challenge with crawling
How to test for it:
In prone have child keep arms by their side and lift their legs and chest off the ground, if their limbs bend they may have retained TLR.
How to integrate it:
Have the child get in a superman position with arms and legs extended for 15 seconds. Repeat this 10-15 times, 1-2 times a day.
Landau Reflex:
This reflex presents around 4-5 months and integrates by 1 years old. This reflex is necessary for postural development. Holding the child in prone it the child will lift their head, convex their back and their legs will be slightly flexed.
Potential problems of retained Landau:
- Delayed motor development
- Poor coordination of upper and lower body
- Poor posture and muscle tone
- Rotated pelvis
- Often skips crawling
How to test for it:
Have the child lay in prone and lift their upper body and arms off the ground. If their feet and legs rise they may have the reflex retained.
How to integrate it:
Have the child just lift the upper part of the body and arms to a point where they can keep their feet on the ground and hold for 15 seconds repeating 10 times, 1-2 times a day.
Symmetric Tonic Neck Reflex (STNR):
This reflex is the foundation for crawling and occurs around 6-9 months and should be integrated by 11 months. This reflex divides the body into upper and lower halves, which allows for different movement between the upper and lower body. When the child’s head is tilted forward their arms bend and legs stretch.
Potential problems of retained STNR:
- Poor posture, low muscle tone
- Challenges with crawling
- W-sitting
- Poor sustained attention
- Clumsiness
- Challenges with reading or writing
How to Test for it:
In a quadruped position have the child tuck their chin to their chest and arch their back and hold for 8-10 seconds. Then lift the head and concave the back and hold for 8-10 seconds. If the child is observed to twitch their back, bend their arms, weight shift back towards legs when shifting up, this reflex may still be present.
How to integrate it:
The same position as above is used, however, have the child hold each position for 10-15 seconds, then repeat this 10-15 times.
References:
Feldhacker, D. R., Cosgrove, R., Feiten, B., Schmidt, K., & Stewart, M. (2021). The Correlation between Retained Primitive Reflexes and Scholastic Performance among Early Elementary Students. Journal of Occupational Therapy, Schools, & Early Intervention, 15(3), 288–301. https://doi-org.sacredheart.idm.oclc.org/10.1080/19411243.2021.1959482
Gieysztor, E. Z., Choińska, A. M., & Paprocka-Borowicz, M. (2018). Persistence of primitive reflexes and associated motor problems in healthy preschool children. Archives of medical science : AMS, 14(1), 167–173. https://doi.org/10.5114/aoms.2016.60503
Heidenreich, S. (2021, May 6). Understanding primitive reflexes: How they impact child development and intervention strategies for integration -article 5409. OccupationalTherapy.com. https://www.occupationaltherapy.com/articles/understanding-primitive-reflexes-they-impact-5409-5409
Hill, J. (2023, June 22). The Primitive Reflex Guide: What are they and why do they retain?. Harkla. https://harkla.co/pages/primitive-reflexes
