Primitive Reflexes
Emily Hartney, MOT, OTR/L
Primitive reflexes are normal, involuntary movements present at birth and fade
away or become “integrated” before the child turns about 12 months old. The
reflexes promote motor learning (a neurological process of acquiring new
movement skills through practice) and sensory integration (how the mind
perceives and processes internal and external information through the senses).
These senses include sight, hearing, taste, smell, touch, vestibular (sense of
movement and balance), and proprioceptive input (body awareness). The most
common reflexes we will discuss include Moro Reflex, Asymmetrical Tonic Neck
Reflex (ATNR), Symmetrical Tonic Neck Reflex (STNR), Tonic Labyrinthine Reflex
(TLR), and Spinal Galant Reflex (McDonald, 2019).
Primitive reflexes are necessary for the birthing process and survival of the
infant’s first year. They can be retained or “fail to integrate” if there is a traumatic
event during birth (premature births, breach positions, cesarean births, etc.), the
child doesn’t spend enough time on their stomach, or they lack space during
creeping and crawling stages (Villaneda, 2018). Other potential reasons a reflex
may still be present may include genetic abnormalities, chorionic illnesses, or
developmental delays (McDonald, 2019).
Exercise Frequency:
Why do we engage in these exercises? The brain stem controls primitive reflexes, which integrate or assimilate into higher functioning development around 12 months old for voluntary and purposeful movements. The reflexes are beneficial for survival and how the infant perceives the world via senses.
However, when they do not integrate on their own through play and development, there could
be maladaptive movement patterns, behaviors, or reactions to specific stimuli. We perform
these exercises to recreate activities that the child typically would have performed to integrate
the reflexes. It is important to note that repetition and consistency are critical elements in integrating retained reflexes, as repetition is needed to rewire the brain-body connection (McDonald, 2019).
Various exercises can be performed at home to assist in integrating the reflex.
It is recommended that you incorporate exercises for at least 5-10 minutes, four to five days per
week. You can make the exercises into fun games or movement breaks. Please ask your
therapist if you have any exercise questions, and if there are no noticeable changes within 6-8
weeks with frequent exercise, please get in touch with your occupational therapist.
Be careful not to frustrate your child by demanding an exercise that is too difficult to do.
Moro Reflex:
“Startle Reflex” or “Fight or Flight reaction”
The Moro reflex is “an involuntary reaction to what's perceived as an outside threat.
The threatening stimuli can come in via touch, sound, or the feeling of being dropped, which creates a sense of falling” (i.e sudden, loud noises, sudden change or movement in visual field) (McDonald, 2019).
Child’s response: clenching fingers, spreading/extending extremities followed by quick flexion of extremities, crying and/or anger, startling or freezing, increased HR, BP, breathing, stress response (adrenaline/cortisol release)
Potential signs of retention:
Motion sickness, poor eye contact, light/sound sensitivity, poor tolerance to change, anxiety, mood swings, difficulty with ball games, stressful birth, challenges communicating feelings, poor impulse control, frequent headaches, and fatigues easily (Harkla, 2023).
The Moro reflex is connected to all other senses and is the foundation of all other reflexes and overall development because of the impact on the sympathetic nervous system. It is termed the stress response reflex because it can affect the emotional and physical state of the child, as they are constantly exhibiting fight or flight responses, which can fatigue their body and immune system (McDonald, 2019).
Activities to incorporate into daily routine:
Somersault
Rocking on a therapy ball
A sensory box with different textures
Hanging on monkey bars for 5-10 seconds or until they get tired.
Calming Tools: quiet corner, dim lights, weighted blankets, and deep pressure.
Exercises:
2. ATNR: Asymmetrical Tonic Neck Reflex
The ATNR reflex, also known as the learning reflex, impacts early life experiences and developmental skills. It becomes triggered when the head turns to the right or left side.
It is present at birth to assist with preparation for the birthing stage to pass through the birth canal (McDonald, 2020). It affects a child’s ability to cross midline (reach the opposite side of the body with arms & legs), vision, hearing, and vestibular system. Crossing midline is essential for developing spatial awareness and cognitive development.
Examples of movement patterns include “crawling, walking, brushing teeth, dressing,
combing hair, reading, writing, sports, and more” (McDonald, 2020, p. 12).
Child’s response: Bow and arrow - extension of arm and leg that the head turns forward and flexion of the opposite leg from which head turns away.
Potential signs of retention:
Difficulty rolling, difficulty crawling, lack of balance, clumsy gross motor skills, mixed laterality (no
left/right side dominance), poor handwriting, eye tracking difficulty, difficulty crossing midline,
spelling/reading skills, poor attention/concentration (McDonald, 2020 & Harkla, 2023).
The ATNR reflex affects the child’s fine motor/gross motor development, auditory, visual, vestibular processing, focus, and attention skills.
Activities to incorporate into daily routine:
Ball/Balloon toss
Catch
Sports
Climbing
Rock climbing
Monkey bars
Bilateral movements (jumping jacks, scissor jumps, cross crawls)
Hopscotch
Dancing
Exercises:
3. STNR: Symmetrical Tonic Neck Reflex
The STNR Reflex is also known as the learning reflex; however, unlike the ATNR reflex, it becomes triggered when the head moves up or down. It helps the body go against gravity and differentiates the upper and lower body. The STNR reflex enables a child to learn to crawl, pull themselves up from sitting to standing, and achieve other developmental milestones such as eye-hand coordination, visual fixation, auditory processing, posture, muscle tone, and FM/GM development (McDonald, 2021).
Child’s response: The STNR has two different positions and reactions. When the head flexes, the lower body extends, and the upper body flexes (i.e., the upper body drops to the floor). When the head extends, the lower body extends, and the upper body extends (i.e., the upper body straightens and moves away from the floor).
Potential signs of retention:
Lays head on desk while writing, decreased ball skills, messy eater, decreased attention, difficulty copying from the board, skipped crawling, lack of balance instability, difficulty coordinating upper and lower body together (Harkla 2023).
Key Facts:
The STNR reflex contributes to fine motor/gross motor skills, auditory processing, visual processing, vestibular, focus and attention skills. It also contributes to speech and language development. It is key in the ability to train the eyes to shift foKecus on near vs far objects.
Activities to incorporate into daily routine:
Animal walks (bear, crab, inchworm)
Jump rope
Rowing
Crab soccer
Exercises:
4. TLR: Tonic Labyrinthine Reflex
The TLR Reflex assists in developing muscle control of the head and neck, which allows for correct head alignment for balance, coordination, and visual tracking. It prepares the body for rolling, crawling, standing, and walking. (Villaneda, 2018).
Child’s response: The TLR has two different positions and reactions. When the head flexes (moves in front of the spine), the trunk, upper, and lower body flex. When the head extends (moves behind the spine), the back, upper, and lower body extend (McDonald, 2022).
Potential signs of retention:
Poor balance, difficulty with ball games, visual-perception challenges, decreased organizational and sequencing skills, and spatial awareness difficulties (Harkla 2023). Other symptoms may include mixed dominance (interchanges of l/r hand, foot, eye, ear), dyspraxia tendencies, poor posture, auditory processing (multiple instructions/verbal learning), frustration, lack of self-esteem
Key Facts:
The TLR reflex contributes to fine motor/gross motor skills, auditory processing, visual processing, vestibular skills, proprioception, focus, and attention skills.
Activities to incorporate into daily routine:
Work in a variety of positions (standing at a desk, lying on the floor to read, slanted board)
Break down instructions into small steps
Rainbow breathing
Balance walk
Superwoman/superman
Swimming on the floor
Riding on scooter board
5. Spinal Galant Reflex:
The spinal Galant reflex works together with other primitive reflexes to facilitate the infant through the birth canal and directly influences posture (spinal and pelvic mobility/flexibility) and the maturation of the vestibular system (hearing and balance) (McDonald, 2023).
Child’s response: Spinal Galant Reflex is an automatic response to tactile stimulation on both sides of the back. When one side of the back is stroked from top to bottom, it causes the body to bend toward the direction of the stimulus. If both sides are stroked, it can cause urination, which may correlate with bedwetting or accidents past the age of 5. This can also affect concentration and attention as children may be more prone to fidgeting or have decreased posture as the TLR reflex may be activated, causing wiggles or decreased posture (Villaneda, 2018).
Potential signs of retention:
Fidgeting, decreased concentration, bed wetting beyond age 5, sensory sensitivities (tactile, auditory, visual), reading difficulties (Harkla 2023), slouched posture, and difficulty maintaining balance.
KEY FACTS:
The Spinal Galant reflex contributes to fine motor/gross motor skills, bladder control, pelvic stability/mobility,
auditory processing, vestibular skills, proprioception, focus and attention skills.
Activities to incorporate into daily routine:
Army crawl
Hula hoop
Snow angel
Fire hydrant
Exercises:
References
Harkla. (2023). Primitive reflex screening checklist for parents.
https://harkla.co/products/primitive-reflexes-course?_pos=1&_sid=d18ce83f0&_ss=r
Integrating primitive reflexes through play and exercise: An
interactive guide to the Moro reflex for parents, teachers, and service providers.
Polaris Therapy.
McDonald, K. G. (2020). Integrating primitive reflexes through play and exercise: An
interactive guide to the asymmetrical tonic neck reflex (ATNR). Polaris Therapy.
McDonald, K. G. (2021). Integrating primitive reflexes through play and exercise: An
interactive guide to the symmetrical tonic neck reflex (STNR). Polaris Therapy.
McDonald, K. G. (2022). Integrating primitive reflexes through play and exercise: An
interactive guide to the tonic labyrinthine reflex (TLR). Polaris Therapy.
McDonald, K. G. (2023). Integrating primitive reflexes through play and exercise: An
interactive guide to the spinal galant reflex. Polaris Therapy.
Villaneda, A. (2018). Primitive Reflexes. Integrated Learning Strategies.