Retained Primitive Reflexes

Primitive reflexes serve as a child’s foundation for movement and development. This set of reflexes appears in utero or at birth as automatic responses to specific movements such as flexing or extending the neck. At different points of a child’s development, these reflexes go away or “integrate”. They become skilled movements rather than automatic responses. For example, in a newborn baby we see a strong startle response when they hear a loud noise or experience a sudden movement. Over the next several months, we begin to see less and less of that big startle as the reflex begins to integrate into the body. 

MORO reflex

The MORO reflex is the earliest primitive reflex that emerges and is present from birth. It is an infant’s response to sudden change in stimuli, such as change in position, presence of touch, sound, light, etc. This is seen when an infant quickly extends and then flexes all limbs. The Moro reflex is the infant’s attempt to protect itself from harm. It helps with infant self-organization. It is the only primitive reflex that is connected to all of the sensory senses. 

Signs of non-integrated reflex: 

• Hypersensitivity to sensory stimuli/heightened awareness of the surrounding environment
• Light sensitivity 
• Sound sensitivity 
• Clothing sensitivities
• Dislikes hair brushing 
• Exaggerated startle response 
• Anxiety
• Emotional and social immaturity; dislikes change and/or surprises 
• Impulsive; emotional outbursts; “mood swings”  
• Motion sensitivity 
• Over-reactive 
• Difficulty with friendships
• Poor balance and coordination 

ATNR 

The asymmetrical tonic neck reflex (ATNR) is a reflex that is present before birth, and is responsible for developing the visual and vestibular systems. ATNR is responsible for the “fencing pose” seen when infants turn their heads to one side or the other. ATNR is important for early development of eye-hand coordination and typically integrates around 6 months of age.

Signs of non-integrated reflex: 

• Difficulty crossing midline
• Difficulty reading and following a line of text
• Poor listening and attention skills
• Poor handwriting 
• Difficulty with spelling
• Poor eye-hand coordination
• Poor sense of direction
• Difficulty catching and throwing
• Poor gross motor coordination and balance
• Difficulty discriminating left/right, lack of handedness
• Poor short term memory and difficulty following verbal instructions
• Impulsive and emotionally immature for age

STNR 

The symmetrical tonic neck reflex (STNR) is a reflex that presents at 6-9 months and integrates around 9-11 months. This reflex assists with development of bilateral body movements (both sides of the body). It helps children move against gravity and get onto their hands and knees. If this reflex is not integrated, it can interfere with crawling and positional changes. 

Signs of non-integrated reflex: 

• Decreased strength and balance 
• Poor standing posture
• Difficulty sitting in chairs or desks 
• Low muscle tone 
• ADHD-like behaviors 
• Fidgety 
• “W” sitting 
• Toe walking 
• Little to no crawling 
• Writing or reading difficulties 
• Poor depth perception and difficulty looking between near and far objects 
• Immature ball handling skills and eye-hand coordination
• Sloppy eaters
• Difficulty with social cues 
• Poor space and time awareness 

Why are reflexes retained? 

Primitive reflexes can be retained for a variety of reasons. Primitive reflexes may be retained due to a difficult or traumatic birth experience, experiencing a brain injury, not enough “tummy time”, spending extended periods of time in containers (i.e., car seat, infant swing, highchair), or displaying little to no crawling. Sometimes we are not sure what the reasoning is for retained reflexes.

What can therapy do to help? 

Our occupational therapists can test your child to see if they are demonstrating any retained reflexes during their initial evaluation or during a subsequent treatment session. If your child does have retained reflexes, your occupational therapist can help explain what this means and will add integration of reflexes to your child’s occupational therapy plan of care. Your child will participate in reflex integration exercises as a part of their occupational therapy sessions and the therapist will teach you exercises to perform at home as well. Reflexes serve as our foundation. As these begin to integrate, we can then see progress in other concern areas such as sensory processing, emotional regulation, coordination, and more! Call today to get more information on the topic or to schedule an occupational therapy evaluation!