What are primitive reflexes?

Reflexes are involuntary and adaptive responses to stimuli and have varying levels of complexity. Primitive reflexes originate in the brainstem and facilitate survival in early child development. These reflexes are either suppressed or inhibited (integrated) in typically developing children and adults as they age but may still be present due to various reasons including trauma or skipped developmental milestones.

Primitive reflexes are the building blocks for more complex movement and aid in the development of other skills. These reflexes are important when assessing a child and the integration of them are important for everyday functioning including play, school performance, mobility, etc.

When looking at primitive reflexes, there are specific ways for healthcare professionals to elicit each one to determine if they are still present. Additionally, there are associations with certain primitive reflexes that can indicate the presence of unintegrated reflexes.

Primitive Reflexes Flyer

Here are some of the most common unintegrated reflexes and associations seen with each:

  • The moro reflex is a fight or flight reaction of the sympathetic nervous system that is developed around 28 weeks in-utero and is typically integrated around 4-6 months old.

    This response consists of extension of the arms and opening of the hands quickly followed by retraction of the arms and hands along with an audible cry.

    Associations or signs or retentions of this reflex include: hypersensitivity, hyper-reactivity, poor impulse control, social/emotional immaturity, poor coordination and balance, oculomotor and visual-perceptual problems.

  • The spinal galant reflex aids in the birthing process by facilitating movement of the hips through the birthing canal, it is developed around 20 weeks in utero and typically integrates around 3-9 months old.

    This reflex consists of twitching, movement, or incurvation on the side of the spine that is stroked or pressure is applied.

    Associations or signs of retention of this reflex include: postural issues (scoliosis, misaligned or rotated pelvis, pain in lower back), bedwetting, hyperactivity, attention/concentration issues, decreased endurance, chronic digestion issues, and decreased coordination or pain in the lower body

  • The ATNR or asymmetric tonic neck reflex allows a child to roll over or perform cross pattern movements (reaching), it is developed around 18 weeks in utero and is typically integrated around 4-6 months.

    This response consists of extension of the extremities on the side which the child's head is turned and flexion of those opposite.

    Associations or signs of retention of this reflex include: difficulty crossing midline, poor hand-eye coordination, poor handwriting, difficulty crawling, poor balance and uncoordinated gait

  • The STNR or symmetric tonic neck reflex is a foundational component for crawling that is developed around 6 months old and is typically integrated around 10-11 months.

    This reflex consists of twitching of the back, a huge arch in the back, bending of the arms, or weight-shifting backward towards the legs when looking up and down in quadruped.

    Associations or signs of retention of this reflex include: poor posture standing or seated, low muscle tone, W sitting, messy eater, or "ape-like" (rounded back) walk.

  • The TLR or tonic labyrinth reflex is foundational for postural stability in large muscle groups and aids in the birthing process, it is developed as early as 12 weeks in utero and is typically integrated around 3 years old.

    This reflex consists of difficulty keeping extremities straight when lifting their head/chest off the ground from laying flat.

    Associations or signs of retention of this reflex include: decreased balance, toe walking, hyper-mobile joints, poor spatial awareness, poor posture, weak muscles, or tilted head position.

  • The rooting reflex is an autonomic response to locate food (bottle or breast) that is developed around 24-28 weeks in utero and is typically integrated around 2-4 months.

    This response consists of the head turning with the opening of the mouth, toward a stimulus on the cheek.

    Associations or signs of retention of this reflex include: drooling, picky eating, oral hypersensitivity, speech/articulation problems, and thumb sucking.

  • The palmar grasp reflex allows for voluntary grasping, it is developed around 27 weeks in utero and is typically integrated around 3-6 months old.

    This reflex consists of flexion of the fingers when the palm is stimulated.

    Associations or signs of retention of this reflex include: poor fine motor skills or manual dexterity, poor handwriting, deficits with pencil grip, poor visual coordination, and correlated speech and hand movements.