Primitive Reflexes
Primitive Reflexes: When Foundational Building Blocks Fail to Develop Properly
Primitive reflexes are automatic, stereotypical movement patterns directed by the brainstem that are present at birth. These reflexes should become integrated during the first year of life as higher brain centers develop. When these reflexes persist beyond their typical time frame, they create neurological roadblocks to proper development, often underlying many common childhood challenges.
- Moro Reflex (The “Alarm System” Reflex)
- Fear Paralysis Reflex (The “Freeze” Response)
- Asymmetrical Tonic Neck Reflex (ATNR)
Other Key Reflexes Impacting Development:
- Spinal Galant Reflex
- Tonic Labyrinthine Reflex (TLR)
- Symmetrical Tonic Neck Reflex (STNR)
- Rooting and Suck Reflexes
- Palmar Reflex
MORO REFLEX (THE ``ALARM SYSTEM`` REFLEX)
The Moro reflex is initiated through both vestibular movement (movement of the head) and sensory stimulation. The Moro is, in my opinion, the most important reflex to integrate. When Moro is unintegrated other reflexes will not integrate.
The Moro reflex is seen when a newborn is startled by an unexpected noise or uncomfortable sensory stimulation (cold touch, pain, etc). You will notice the infants upper back arch and both arms open to the side.
This reflex is typically integrated by 4 months of age. The Moro can cause a host of problems when unintegrated, especially sensory processing issues. The reflex triggers our “fight or flight” system placing the child into a state of stress majority of the day (if unintegrated). When the body is in “fight or flight” mode the brain cannot work well (difficulty learning, poor social skills, hypersensitivities to the environment) and the digestive system can be a problem as blood rushes towards our muscles in a stressed state.
Common symptoms in an unintegrated Moro Reflex include:
- Hypersensitive to sensory stimuli
- Overreacts to situations
- Emotional immaturity
- Sensory processing disorder
- Emotional outbursts
- Poor balance and coordination
- Easily distracted
- Poor digestion, food sensitivities
- Motion sickness
- Sensitive to light, sounds, touch
- Withdrawn and/or timid, shy
- Impulsive and/or aggressive
FEAR PARALYSIS REFLEX (THE ``FREEZE`` RESPONSE)
Moro Reflex and Fear Paralysis Reflex (FPR) are interconnected, and often confused. Moro reflex is elicited via head movement. FPR is elicited via sensory information. Many times we see Moro not integrating it is because no one has addressed FPR. If a child’s Moro is unintegrated I almost always will see FPR unintegrated as well – and incorporate the movements to integrate into the routine.
Fear Paralysis Reflex (FPR) is triggered by sensory stimulation from auditory, visual, tactile information. Examples include an unexpected loud noise, a bright light or flash, or uncomfortable tactile sensation such as cold when baby gets his/her diaper changed.
Fear Paralysis response in infants is the withdrawal or “freeze”, when infants withdrawals inwards and flexes their limbs. In contrast to the Moro response of arms & head extending and “fight or flight”.
Fear Paralysis and Moro are deeply connected and can be easily confused or misinterpreted. Children with hypersensitivities to sensory stimuli will always work FPR & Moro at the same time.
Common symptoms of an unintegrated FPR include:
- Hyper-reactive to sound, light, touch
- Dislikes touch
- Low tolerance to stress
- Poor eye contact
- Withdrawals with eye contact or socially
- Extreme shyness
- Meltdowns in sensory overload environment
FPR & Moro are all about feeling safe and bonding with their parents. Preemies and children who were adopted typically have higher incidence of unintegrated FPR. Moro, being the “gateway” reflex is typically needed to integrate other reflexes.
ASYMMETRICAL TONIC NECK REFLEX (ATNR)
The Asymmetrical Tonic Neck Reflex helps us perform cross body motions; connecting the right and left sides through midline. It is also important for visual tracking and binocular vision. Studies have shown ATNR is significantly associated with children having difficulty in reading, spelling, and math; including dyslexia.
Common symptoms of an unintegrated ATNR include:
- Eye tracking difficulties
- Hasn’t chosen dominant hand after 3 years old
- Reading trouble; dyslexia
- Trouble crossing the midline
- Poor behavioral control
- Difficulty following multiple step directions
- Low muscle tone
- Poor balance
ATNR is one of the most implicated reflexes with learning challenges, reading challenges, and difficulty with sports. Without ATNR integration the head turning from side to side will be connected to upper body movement, making it difficult for the child to do most activities with head turn with smooth motor control.
TONIC LABYRINTHINE REFLEX (TLR)
The function of the TLR is for head control and teaching the infant about gravity and balance; finding a link between the vestibular system & proprioceptive system. The TLR is activated in both a flexion and extension pattern. Muscle tone, core stability, coordination, and balance are all responses to TLR integration.
Common symptoms of an unintegrated TLR include:
- “W” leg position when floor sitting
- Poor posture
- Poor balance
- Poor head and neck control – head may lean forward or to side
- Toe walking
- Difficulty catching a ball
- Balance and coordination problems
- Fatigues easily
- Poor articulation
- Problems with orientation in space
- Low muscle tone; over-flexible joints
TLR has two components, flexion and extension. A child may be unintegrated in only one direction. If you find this the case, then you will only need to work on that direction.
SYMMETRICAL TONIC NECK REFLEX (STNR)
STNR is an important reflex to help strengthen muscle tone in the back body, preparing the infant for later upright posture. The reflex affects the child’s eye tracking, cross-body movements, auditory processing, and eye-hand coordination. If an infant did not crawl, crawled for a short period, or crawled in an awkward fashion (ie, one leg dragging); it is likely the child would benefit from working the reflex.
A retained STNR can affect school work, as the student will have trouble sitting in a chair for long periods.
Common symptoms of an unintegrated STNR include:
- Difficulty copying off blackboard
- SSlouched position when at a desk/table, or lying over the desk/table
- Sits in a “W” position
- Difficulty with binocular vision
- Poor eye, hand coordination; difficulty with ball games
- Tires quickly when reading
- Complains of blurry text when reading
- Muscle tension in legs or shoulders; tension headaches
- Child supports head with hands
- Skipped crawling, or had an altered pattern
We use the STNR position (shown in picture above) for horizontal eye tracking. We’ll discuss this in Module Four.
ROOTING REFLEX
The rooting reflex is important for feeding and survival. The infants head will turn towards the stroke of a cheek, responding to the stimulus for feeding. The rooting and grasping reflex are linked during infancy. Sometimes you will notice a child’s mouth moving while writing or performing other fine motor tasks.
Common symptoms of an unintegrated Rooting Reflex include:
- Excessive drooling
- Speech delay
- TMJ
- Movement of mouth while writing or using hands
- Difficulty in social situations
- Trouble with tongue movements
Stimulation throughout the face is helpful for all Oral-Facial Reflexes. Facial reflexes are highly correlated to hand reflexes and both to speech.
PALMAR (GRASP) REFLEX
You will notice the grasp reflex in infants when they wrap their fingers around yours when placed in their palm. Crawling helps to integrate the palmar reflex by forcing the child’s hand to open with weight bearing. The hand and mouth reflexes are uniquely intertwined and both need to be integrated for the other to work well. The palmar reflex is the foundation for all fine motor tasks.
Common symptoms of an unintegrated Palmar Reflex include:
- Poor handwriting
- Delayed fine motor skills (trouble with buttons, zippers, laces, etc)
- Movement of mouth/tongue while writing or doing fine motor tasks
- Speech or articulation difficulties
- Delayed grasp
- Too tight or too loose pencil grip
BABINSKI REFLEX
Babinski reflex is our plantar reflex that helps with balance and gait. It is active upon birth and integrates around two years of age.
Babinski is stimulated by a stroke on the lateral side of the foot. In response the big toe will extend, ankle will turn slightly inwards and other toes with fan open.
Common symptoms of an unintegrated Babinski:
- Poor stability and balance
- Challenges with oral motor skills
- Challenges with articulation
- Poor bilateral integration
- Poor postural control
- Delay in gross motor skills
- Possible toe walking
Babinski can also be related to speech and language. The feet and hands are important sensory areas of our body.
SPINAL GALANT REFLEX
The Spinal Galant helps move the baby down the birth canal by wiggling the body side-to-side. Spinal Galant is considered to be connected to tactile hypersensitivity especially with clothing and tags against the back.
Common symptoms of an unintegrated Spinal Galant Reflex include:
- Restless and hyperactive
- Dislikes tight clothing, or clothing tags; prefers loose clothing
- Hip rotation, to one side
- Scoliosis
- Bedwetting, or soiling past the age of 5
- Fidgeting, inability to sit still
Spinal Galant and Spinal Perez are closely associated and both work on whole body coordination, developing the understanding between right and left halves of the body. When retained, spinal galant can interfere with integration of amphibian reflex (crawling) and segmental rolling (log rolls).
LANDAU REFLEX
The Landau Reflex also helps improve muscle tone in the back body for later upright posture. It is important to help in integrating TLR as well; if Landau does not integrate, TLR will not integrate. Lifting the body off the floor against gravity is an important skill that helps to develop near vision. Landau is also known as the “joy” reflex — it improves our posture and outlook on the world, bringing us joy and happiness.
Common symptoms of an unintegrated Landau Reflex include:
- Low muscle tone in the back and neck
- Disliked tummy time; dislikes being on belly
- Poor attention and concentration
- Difficulty with near vision; and three-dimensional vision
- Poor posture
- Possible hyperextension of knees
- Tension in legs; may cause toe walking
- Depression, anxiety, low self-esteem