This post is all about retained primitive reflexes, what retained reflexes look like, and how they impact child development. You’ll find specific strategies to integrate retained primitive reflexes as well. In a recent blog post, we discussed what are primitive infant reflexes, and why they are so important to infant development. Now, it is time to discuss what can happen if these reflexes hang around for too long. Remember that every case is unique, and if your child matches these characteristics, that does not necessarily mean that they have retained that reflex. If you are concerned about your child’s abilities and how they may relate to retained reflexes, we recommend talking to your pediatrician.
For more information on primitive reflexes and their impact on child development, be sure to check out some of these books on primitive reflexes.
retained Primitive Reflexes
The term “retained primitive reflexes” might be a phrase you’ve heard before. But what does that mean and what do retained reflexes look like in children? Well, there is a lot to cover.
Basically, as infants develop into toddlers, their primitive reflexes should do what health care professionals call “integration”. The response that comes with the primitive reflex should integrate into a more mature or voluntary movement. When primitive reflexes are retained, those instinctive actions, movements will remain past the typical age range…they continue to exist. They are retained.
If primitive reflexes are still present long after they should have integrated, the child will display certain characteristics specific to the retained reflex, many of which limit their development and academic skills.
Just to add some background information, when we say that primitive reflexes are integrated, that means that the movements (or reflexes) are absorbed and contributing to characteristics, actions and neurological responses. To put it in other words, a reflex moves along a neurologic arc and when integration of those reflexes occurs, a process where specific stimulus results in a predictable response (or lack of that predictable response) so that movements are more efficient. This occurs so the neurologic system is connected and communicating efficiently. It’s all part of the nervous system.
The palmar reflex is important for the development of purposeful grasping, something that an infant is learning throughout their first year of life. The palmar reflex can be seen when you place your finger in the palm of an infant’s hand and their reflexive response is to hold on to your finger. What an adorable reflex, right?
This is not something we want to see in an older infant or child, though. While the response is necessary for a newborn to learn how to use their hands, it limits an older infant or child to only using their hands and fingers for a strong grip.
retained palmar reflex
Children with a retained palmer reflex may:
- Get fatigued very easily with handwriting or fine motor tasks, like stringing beads.
- Have a sensitive or “ticklish” palm
- Open and close their mouths while using their hands for tasks like writing or cutting with scissors.
- Have difficulty in speech articulation
The mouth and the hands are connected via neural pathways in infancy, and that connection is still strong in those who have the palmar reflex. This is why the movements of the mouth and speech may be involved in the retained palmar reflex.
How to integrate the Palmar Reflex:
- Tasks that encourage separate use the fingers
- Squeeze a ball with one finger and thumb, alternating fingers to squeeze
- Stringing Beads
- Playing with small Legos or similar toys
The Moro reflex is also called the startle reflex – it can be seen in a frightened infant up to about 4 to 6 months old. The reflex causes a baby to stretch out their arms and legs, and quickly bring them back in, in jerky movements. This is in response to the feeling of falling, a loud sound, or a drastic change in temperature.
Retained Moro Reflex
Children with retained Moro reflexes are often very sensitive to stimuli – sounds, tags on clothing, lights, etc. They tend to lack emotional and self-regulation skills and have a difficult time paying attention in class. Without an integrated Moro reflex, their fight or flight response can be activated very easily causing them to have deficits in many areas of life.
How to integrate the Moro Reflex:
- Starfish Exercise
- While seated, open up into a big “X” shape with straight arms and legs.
- Cross right ankle over left & Cross right arm over left
- Open up to big “X”
- Cross left ankle over right & Cross left arm over right
- This is also how you can test for its presence! If a child has a very difficult time completing these actions, without another known cause, they may have a retained Moro reflex.
TONIC LABYRINTHINE REFLEX
The tonic labyrinthine reflex (TLR) is used for head and postural control. We know that baby has poor control of their head and neck when they are born, and this reflex is part of what helps them gain control over this part of their body.
Retained Tonic LABYRINTHINE reflex
This reflex typically integrates around 4 months old, but if it persists, the following may occur:
- Difficulties judging space, speed, depth, and distance.
- Toe walking
- Discoordination in simultaneous movements, such as walking or swimming.
- Avoiding lying on their stomach.
Children with retained TLRs tend to be perceived as clumsy and often have a difficult time sitting upright and still in their chairs. This can decrease their ability to pay attention in the classroom setting.
How to integrate TONIC LABYRINTHINE REFLEX
- Incorporate activities on their stomachs as much as possible, or for as long as they can manage each day.
- Try reading, watching TV, or playing with a toy while on their tummies
- Daily practice will strengthen their muscles and correct this response.
ASYMMETRICAL TONIC NECK REFLEX
This reflex is important to the initiation of crawling, as the arms and legs move as a baby turns their head while on their belly. While infants are on their bellies, and while crawling, they are exposed to a ton of visual stimulation by looking at their arms moving, looking and grabbing toys, etc. Tummy time is so important for this reason and more!
The ATNR should disappear around the time an infant is gearing up for crawling, around 6 months old.
Retained ASYMMETRICAL TONIC NECK REFLEX
If asymmetrical tonic neck reflex doesn’t integrate, the following may occur:
- Poor Coordination during movements like skipping or riding a bike
- Trouble crossing midline
- Example: Moving right arm to left side of the body to buckle a seat belt.
- Poor visual tracking = academic issues
- Difficulty reading and writing
A quick test for a retained ANTR starts with having the child stand with both arms directly out in front of them. Ask the child to slowly turn their head all the way to the left. Their left arm will remain straight and their right arm will bend if the reflex is still present.
How to integrate the ATNR
- Lizard Crawling Exercise
- Start on the stomach
- Look to your left, and bend your left elbow and left knee
- Look to your right, and bend your right elbow and right knee
There are many more primitive reflexes, as well as postural reflexes, that are important to child development and student success. We have not covered everything here, but we hope to have given you a nice place to start building your understanding of what may happen when primitive reflexes are maintained over time.
Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.