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.
PALMAR REFLEX
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
MORO REFLEX
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
- Repeat
- 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. When posture exercises in kids don’t work, sometimes it’s easy for teachers or parents to wonder what is going on, when a look at retained reflexes may be in order. In some cases, integrating the TLR reflex can support posture.
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.
Want to learn more about primitive reflexes, what to do when reflexes are retained, and how to know there might be an issue? Check out the primitive reflexes course below. (affiliate link)
Assessment And Integration Of Primitive Reflexes For Improved Independence In Daily Activities is a course on primitive reflexes where you’ll learn how to, screen, test and integrate retained primitive reflexes and find tools to help your client or child improve motor, social and daily functioning skills by implementing fun, therapeutic, and functional activities!
In this primitive reflexes course, created by two occupational therapists, you’ll find modules and functional intervention activities for:
- Moro reflex
- The Tonic Labyrinthine (TLR) & Landau Reflex
- The Rooting Reflex
- The Asymmetrical Tonic Neck Reflex (ATNR)
- The Spinal Galant Reflex
- The Palmar Grasp Reflex
- The Symmetric Tonic Neck Reflex (STNR)
- Support for kids who push back
- Printable handouts, screening tools, and checklists
- Information on postural reflexes, yoga, sensory diets, and more
- Case studies
- Research
- AOTA continuing education: 1.05 AOTA CEUs
If your child has retained primitive reflexes, learning to integrate them could lead to improved development in many areas:
- Social Skills
- Learning
- Motor Skills
- Executive
- Functioning
- Coordination
- Reading & Writing
Primitive Reflexes and Occupational Therapy
This article was originally published in 2021. While reflexes have not changed since then, there is new research and resources available on primitive reflexes. This is important to keep up to date with as an occupational therapist working with children. Inevitably, we will see a child who has retained reflexes impacting daily functional skills.
When it comes to primitive reflexes and occupational therapy, there is a lot of connection because of the motor and sensory components that impact function.
This article talks about the link between retained primitive reflexes and autism spectrum disorder. The authors go on to say that this connection is due to a brain imbalance and connectivity. They offer a specific set of exercises, with EEG testing done at the beginning and end of treatment to show progress.
The research is limited on the efficacy of integrating reflexes thus far, however there is plenty of evidence on reflexes. Reflexes are important for survival in infancy and early childhood. They need to be integrated so we can produce smooth movements, which later might impact motor planning and body awareness. Without this integration we often see uncoordinated movements, an increased startle reflex, difficulty with frontal lobe maturation.
Because the research about the “integration of reflexes” is not there, the AOTA is suggesting using exercises and activities to improve coordination and performance in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), rather than calling it the integration of reflexes.
A Therapist’s Perspective on Reflex Integration in OT
Whenever I have parents or other professionals questioning the validity of certain treatment ideas such as sensory integration, therapeutic listening, vibration, astronaut training, and more, I try the “what can it hurt” approach.
“What can it hurt”, is a worthwhile approach to life and taking risks. I am much more willing to take risks if the reward is greater than the potential drawbacks. This holds true for a lot of what we teach as OTs. This includes primitive reflex “integration” therapy. Whether you believe in integration/retained reflexes or not, think about the treatment methods provided.
Treatment methods for reflex retention include strengthening, coordination, and stretching exercises. Whether the cause of incoordination is reflex retention or something else, practicing strengthening and coordination exercises can help either way. While finding the “why” during treatment is helpful, it is not always available. There are times we may never know the cause of a disorder. In this case we treat the symptoms we see.
According to Samantha Heidenreich, OTD, MOT of occupational therapy .com, There are theories as to the cause of primitive reflex retention including:
- the birth method, like Cesarean section versus vaginal delivery
- Trauma during pregnancy, birth, or shortly after
- exposure to toxins
- Anesthetics during pregnancy/birth
- medications
Additionally, other possible causes for retained primitive reflexes are decreased tummy time in infancy, a lack of crawling, early walking, head injuries, or chronic ear infections. In the OT world, we are always looking at decreased tummy time and that lack of crawling during our intakes and assessments.
Based on what we do know, the back to sleep program and container baby syndrome, are having an effect on development that needs to be counteracted. When we take a step forward for safety, innovation, and technology, there are often consequences if not used in moderation or with caution. (Being a “tech-wise” family means having an awareness of this from the start. Its something that we as OTs can educate our families on, even when working with children of a very young age.)
Education and early intervention are the keys to success. Whether you are talking about retained primitive reflexes, or another difficulty seen in children, we can do more by letting people know how to care for young children, and intervening early.
How can you add to your OT Toolbox to better educate yourself about reflexes and treatment? Check out some of our resources!
- Exercises for focus and attention
- Finger dexterity exercises
- Oral motor exercises
- Cross crawl exercises
- Eye hand coordination
- Heavy Work Activities
- Core strength through music and movement
The resources at the OT Toolbox are endless. Want to find an easier way to locate resources instead of clicking and scrolling? Become a member today! One of the perks of being a member is access to restricted content, and easy search categories.
Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.
