Let’s Talk About… Retained Primitive Reflexes

Does your child have:

• Hypersensitivity? 

• Poor coordination and balance? 

• Weak muscles/low muscle tone?

• Poor posture?

• Oral hypersensitivity? 

• Poor manual dexterity? 

• Poor eye-hand coordination? 

• Poor handwriting? 

• Difficulty with math and reading?

• Difficulty crossing midline?

• Hyperactivity? Attention/Concentration issues?

• Bedwetting after potty training?

• Poor spatial awareness?

• Toe walking?

• Motion sickness?

• Delayed motor development?

The cause could be Retained Primitive Reflexes (RPR). 

What are Primitive Reflexes?

Reflexes are automatic and involuntary movements. An example of a reflex is when the doctor bumps the front of your knee, and your leg automatically kicks.  Primitive Reflexes are the first part of the brain to develop.  Eight specific primitive reflexes develop between the time a baby is a fetus to 9 months of age: the Moro Reflex, Rooting Reflex, Palmar Grasp Reflex, Asymmetric Tonic Neck Reflex (ATNR), Spinal Galant Reflex, Tonic Labyrinthine Reflex (TLR), Landau Reflex, and Symmetric Tonic Neck Reflex (STNR).  These reflexes are fundamental for developing muscle tone, sensory integration, head control, and overall development. 

As the brain develops, these reflexes integrate and disappear as more mature patterns of response/reflexes develop.  The primitive reflexes integrate at different times but should be fully integrated by 3 ½ years of age. (See chart below)  Sometimes, the reflexes do not integrate. 

Causes of Retained Primitive Reflexes

There are a variety of reasons the reflexes may persist, including a Cesarean section, trauma at birth or shortly after, exposure to toxins, medications, decreased tummy time in infancy, short period or lack of crawling, walking early, chronic ear infections, or head injuries.

What happens when the Primitive Reflexes do not integrate?

When a child’s primitive reflexes continue beyond the usual age of integration, they are considered retained primitive reflexes (RPR). It could be only one reflex or multiple reflexes that do not integrate.  RPRs can lead to developmental delays and are frequently seen in disorders like ADHD, sensory processing disorder, Autism, and learning disabilities. The persistence of the primitive reflexes contributes to issues such as coordination, balance, sensory perceptions, fine motor skills, sleep, immunity, energy levels, impulse control, concentration, social skills, emotional regulation, and academic learning. Retained Primitive Reflexes can profoundly affect a child's education and social well-being.

The Primitive Reflexes

Moro Reflex: This is the “startle reflex.” It begins our “Fight, Flight, or Freeze” reaction. By 4 months of age, the Moro Reflex should be integrated. When the reflex does not integrate, common diagnoses and health problems include ADD, ADHD, Autism, allergies, asthma, and adrenal fatigue. Because they have an exaggerated startle reflex, the child's stress level and increased anxiety can affect how they interact with their peers. Also, this retained reflex can make children more sensitive to sensory information and lead to sensory overload. Symptoms of retention include:

Exaggerated startle reflex Often in “Fight or Flight” mode Eye movement and visual processing problems Light sensitivity/poor pupillary reactions to light Difficulty with black print on white paper Frequent infections/Inner ear problems Poor auditory discrimination Hyperactivity/easily distracted Poor impulse control

Poor coordination Poor balance Motion sickness Poor stamina Tense muscle tone Biochemical and nutritional imbalances Low self-esteem Social immaturity

Rooting Reflex: This reflex is the automatic response to locate food or the breast in infants. It is activated by stroking a baby’s cheek, causing the baby to turn and open their mouth. Retention of this reflex beyond 4 months of age causes deficits with speech, writing, eating, thyroid issues, autoimmune diseases, and hormone imbalance. Signs of retention include:

Anterior tongue-tie Thumb sucking Oral hypersensitivity Speech and articulation problems

Poor eating Swallowing and chewing difficulties Dribbling/Drooling

Palmar Reflex: This reflex causes the fingers to close automatically (flexing) to grab an object when the palm is stimulated. The Palmar Reflex should be integrated by 6 months of age. When it does not integrate, common diagnoses include dysgraphia and speech and language problems. Symptoms of retention include:

Poor fine motor skills Poor manual dexterity Deficits with pencil grip Poor posture during handwriting Messy handwriting Stick out tongue while writing

Poor visual coordination Correlated speech and hand movements Dysfunction of the tactile sensory system Dysfunction of the  proprioceptive sensory system

Asymmetrical Tonic Neck Reflex (ATNR): Also known as the “Fencer’s Pose.”  This reflex assists with movement through the birth canal at delivery. It is initiated when laying a baby on its back and turning its head to one side. The arm and leg of the side they are looking at should extend while the opposite side bends (flexes). This reflex is a precursor to hand-eye coordination and should be integrated by 6 months of age.  ATNR affects midline issues, eye tracking, balance, handwriting, and laterality. If this reflex is retained, children can have difficulties with visual tracking, crossing midline, and poor eye-hand coordination. Most tasks in the educational environment require visual tracking, including reading and writing. When the ATNR is retained, symptoms include:

ADD/ADHD characteristics Poor balance when moving head from side to side Poor pursuits (smooth eye movements) Focusing problems (especially when switching from near to distance) Difficulty keeping place when copying Poor expression of ideas on paper Poor handwriting

Decreased hand-eye coordination Difficulty learning to ride a bicycle Difficulty crossing the midline Mixed laterality (uses right foot, left hand, or uses right or left hand interchangeably) Difficulty catching a ball Uncoordinated gait (walking) Problems with math and reading

Spinal Galant Reflex: This reflex also helps with the birthing process. The Spinal Galant Reflex affects the ability to sit still, short-term memory, and concentration. Continued bedwetting past successful toilet training is a common symptom of this retained reflex.  Retention symptoms also include:

Fidgety or wiggly (especially when sitting) Sensory issues with food texture or tags or waistbands in clothing Postural issues like scoliosis, misaligned or rotated pelvis Pain in the lower back Pain and tension in the legs Chronic digestive issues

Poor short-term memory Decreased endurance Decreased lower body coordination ADHD characteristics  Hyperactivity Attention and concentration issues W-sitting is common when on the floor Anchors feet behind legs of the chair while sitting Difficulty catching and/or tracking a ball

Tonic Labyrinthine Reflex (TLR): This reflex is the foundation for postural stability and head control. It helps prepare infants for rolling over, crawling, standing, and walking. TLR affects vision, motor, balance, muscle tone, and auditory discrimination. When children have issues controlling eye movements, copying and writing sentences and reading are difficult. The reflex should fully integrate and disappear by 3 ½ years of age. Retention of this reflex is commonly seen in children with ADHD.  Symptoms of retention include:

Poor posture and/or stooping Weak muscle tone Hypermobile joints Stiff or jerky movements Toe walking Dislike of sports Fear of heights Poor ability to climb Atypical head position (forward or to the side)

Eye movement, spatial and visual perceptual problems Motion sickness Poor balance Poor spatial awareness Poor organization skills Poor sequencing skills Poor coordination Poor sense of time

Landau Reflex: Also known as “The Superman” because when the baby is held in the air with support under its stomach, the reflex initiates, causing the baby’s head to extend upright and the back to arch with the legs slightly flexed (like Superman flying through the air).  This reflex is not technically a primitive reflex because it is not present at birth. The Landau Reflex typically emerges at 4 to 5 months of age and should be integrated by 1 year of age. It is necessary for postural development.  Symptoms of retention include:

Low muscle tone Poor motor development Poor coordination for activities that require the upper and lower body move together

Poor posture Delayed motor development Child commonly skips crawling in infancy Short-term memory problems

Symmetrical Tonic Neck Reflex (STNR): This reflex is the foundation for crawling and is also known as the “Crawling Reflex.” It is present briefly at birth and reappears around 6 to 9 months but should be integrated by 11 months of age. This reflex helps divide the body in half at the midline to assist with crawling. STNR affects visual fixation, focusing from far to near, and crossing midline. When this reflex is retained, a child will struggle with postural control and attention. The educational setting requires a student to have good posture and maintain attention. Additional symptoms include:

ADHD characteristics Poor posture in standing  Poor seated posture W-sitting is common when on the floor Anchors feet behind legs of the chair while sitting Difficulty catching and/or tracking a ball Ape-like position in walking Low muscle tone Poor hand-eye coordination Difficulty catching and/or tracking a ball

Messy eating Poor depth perception and balance Difficulties with adjusting focus from far to near Poor swimming skills Learning problems Difficulty aligning numbers for math problems Difficulty recognizing social cues

The following chart from Brain Balance is a helpful quick reference.

Now that you understand how retained primitive reflexes can affect learning and what it can look like in the educational environment let's talk about treatment.

The good news...

The brain can change, the reflexes can be integrated, and symptoms can improve!  Several types of therapy can help with retained primitive reflexes.  

• Occupational Therapy

• Vision Therapy

• Chiropractic Care

• Rhythmic Movement Therapy

Before you pick a therapy or provider, ensure it is a qualified professional experienced in primitive reflex integration who can provide appropriate assessment and treatment.  Also, be ready to follow through with exercises at home.