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  • Lyndsey Ryburn, MOT, OTR/L

What are Primitive Reflexes? Why Are They Important for Development?

What are primitive reflexes?

Primitive reflexes are involuntary motor responses to sensory stimulation that originate in the brainstem. These reflexes originate in utero and are present for a period of time after birth into early childhood to facilitate survival.

Why is it important to integrate primitive reflexes?

It is important to integrate primitive reflexes to permit voluntary movements, that is so that the reflex motor patterns do not take over, interfering with our activities of daily living.

What are the 8 primitive reflexes?

  1. The Rooting Reflex- This reflex is in response to having their cheek stroked, a baby will turn and open their mouth to this stimulus, this allows them to successfully feed and/or breast feed. This reflex is typically integrated (not present any longer) by around three to four months old.

  2. The Sucking Reflex- The reflex is elicited with a breast nipple, the nipple of a bottle, or even a finger on their lips to help with feeding. This reflex is integrated (or becomes voluntary at three months old.

  3. The Moro Reflex- This reflex is present at birth and is usually elicited when the infant is startled by a movement or a loud noise. The Moro reflex is called a "protective response" reflex and can happen when holding the baby (tummy up) and rapidly lowering them four to eight inches (for example when placing baby in their crib for sleep). The reflex presents as the infant extending their arms and hands/fingers in response to the stimuli and then curling up or "giving themselves a hug" shortly after that to protect themselves. This reflex should disappear by five to six months.

  4. Palmar (or grasp) Reflex- This reflex is elicited by pressing a finger or object into an infant's hand. In response, the infant should close their fingers around the object. This reflex is typically present until around six months of age.

  5. Babinski Reflex- The Babinski Reflex is elicited when the side of the sole of the foot is stroked. In response, the infant's toes will spread out. It typically disappears by nine to twelve months of age.

  6. Tonic Neck Reflex- (Asymmetric Tonic Neck Reflex- ATNR) With their head turned gently to one side, the infant will extend the arm on the side their head is turned (opposite elbow will be bent). This response will typically not persist past four to six months). (Symmetric Tonic Neck Reflex- STNR) With their head extended (looking up), their arms will extend and legs will flex with their head looking down towards the floor, the ams will bend and the legs will extend. This response should not persist past eight to twelve months.

  7. Tonic Labyrinthine Reflex- In a "belly down" position, the infant will flex their head, arms and legs in towards their body. In a "belly up" position, everything will extend. This is in response to the head moving in space. The TL reflex will typically disappear by six months.

  8. Spinal Galant Reflex- This reflex is elicited by holding the baby face down and stroking the back on either side of the spine, the response will be a curvature of the trunk on the side being stroked. This should disappear between two to six months old.

What can be affected if these reflexes are not integrated?

- If the rooting/sucking reflexes are not integrated, it can cause sensitivity in the mouth, challenges with food textures, messy eating, and poor speech articulation.

- If the Moro reflex is not integrated, it can present as an overactive "fight or flight" response, sensitivity to light, sound, touch, poor emotional regulation, poor attention to task, fatigue, and/or frequent illness due to a stressed immune system.

- If the Palmar (grasp) reflex is not integrated, it can present as the child's mouth moving while performing cutting, writing or coloring, chewing on objects, biting, difficulty with grasp and speech due to tension in the hands and mouth.

-If the Babinski reflex is not integrated fully, it can result in toe walking, poor balance/coordination, difficulty with proprioceptive and vestibular sensory processing, gravitational insecurity, difficulty with visual system.

- If ATNR is not integrated fully, it can cause poor balance, difficulty with coordinated eye movements needed for reading and writing, challenges crossing midline and separating the upper and lower body.

-If STNR is not fully integrated, it can present as difficulty crawling on all fours, poor balance, clumsiness, difficulty with activities in midline, poor sitting position, "W" sitting.

- If the Tonic Labyrinthine Reflex is not integrated, this can result in difficulty coordinating body and eye movements, motion sickness, poor balance/posture, and poor timing/sequencing.

- If the Spinal Galant Reflex is not integrated, this can present as difficulty maintaining a seated posture, constant fidgeting, bed-wetting, sensitivity to touch and certain clothing textures, challenges in following directions and with short term memory.

While the physical nature of a retained reflex may not seem obvious, you should discuss with an occupational therapist or practitioner who has training in this topic if any of these signs of a retained reflex align with your child. An occupational therapist trained in primitive reflex integration will be able to help with integration and strategies to improve quality of life and engagement in daily occupations despite these challenges.


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