At OTFC we always trying to work with children and families in a holistic manner. While we strive to apply Sensory Integration and Play in our work, we are always keep Neurodevelopmental approaches involved. These include addressing developmental reflexes known as Primitive Reflexes.
What is a Primitive Reflex?
For those with some understanding of neuroanatomy, reflexes are commonly understood as movements that ‘bypass’ cortical areas of the brain. This ensures they are ‘fast’ reactions and don’t require cortical processing. Primitive Reflexes are automatic, involuntary movements controlled from the brain stem and executed without cortical involvement. These types of reflexes have survived evolutionary changes in humans, as they work on enhancing the chances of survival, growth or development and protect a child’s body from its external environment.
Primitive reflexes are so named, as they should have a short lifespan and are evolutionary reflexes important in the early years of life. Their main purpose is to support baby survival in the first few months of life. Inhibition, though involvement of higher cortical centres, will ensure more mature neural structures to develop. As mentioned above, if primitive reflexes are retained beyond 12 months of life, they suggest evidence of a structural weakness or immaturity of the central Nervous System (CNS).
Common Primitive Reflexes observed in the OTFC clinic
- Moro Reflex: The Moro reflex acts as a baby’s fight/flight reaction. A child with a retained Moro reflex past 4 months, may become over sensitive and over reactive to sensory stimulus. Functionally this can appear as poor impulse control, emotional lability, sensory overload, anxiety and immaturity, motion sickness and difficulties with balance and coordination.
- ATNR: This reflexes emerges 18 weeks in utero, and is elicited when the baby moves its head to one side, causing reflexive extension (straightening) of the arm and leg on the side in which the head is turned, and flexion (bending) of the opposite limbs. During the birthing process, it is one of the reflexes responsible for helping babies to ‘unscrew’ themselves down the birth canal. The ATNR should be inhibited by the age of 6 months. A retained ATNR can include difficulty crossing the midline from one side of the body to the other (including eye movements, such as tracking words across a page), poor bilateral coordination, affected balance when the head is turned, and lack of dominant sides (e.g. Dominant hand for writing). In the classroom, a child with a retained ATNR will usually struggle with handwriting.
- Spinal Galant Reflex: The Spinal Galant Reflex happens when the skin along the side of an infant’s back is stroked. The reflex response occurs when the infant moves towards the stroked side. This in an important reflex in the birthing process and should inhibited between by nine months. Retention can impact postural control (particularly seated posture), coordination and sustained attention.
- TLR: The Tonic Labyrinthine Reflex (TLR) is essential for head management and movement helping prepare a child for rolling , crawling, standing and eventually walking. This reflex initiates in two ways: Supine –when you tilt an infant’s head backwards when they are on their back, making the legs stiffen, straighten and toes point. Prone – as shown in the photo on the left, when the head is tilted forward and the hands turn more fisted with elbow flexion. This reflex should gradually integrate, with other systems maturing and disappearing by about the age of 3-3.5 years. Retention can lead to reduced muscle tone, balance difficulties, motion sickness and has been linked to a tendency to toe-walk.
- STNR: The Symmetrical Tonic Neck Reflex (STNR) is generally present between 6 to 11 months of age. This reflex is designed to help the infant defy gravity in order to help them get up from lying on their tummy and into a crawling position. Children who retain the STNR may have not crawled or instead walked on hands and feet, bum shuffled or pulled themselves to stand then walk. Crawling is an essential skill which helps train the child’s eyes to cross midline and learn eye-hand coordination. A retained STNR reflex can present as poor muscle tone, particularly a tendency to slump while sitting, impact concentration, reading and basic ball skills.
So my child has had an assessment which states they have some retained reflexes.
Why are they retained?
Reflex retention can be due to a number of factors. For example, retention can be caused by a baby not requiring that specific reflex at the appropriate time of development or function. Alternatively, stress (e.g. that of childbirth itself) that the baby faces can increase the chances of primitive reflexes being retained. As such, the birth process is a key an important consideration in these reflexes, and a traumatic birth experience or birth by c-section could possibly contribute to retained reflexes. Other factors can include trauma (e.g. falls, had trauma, vertebral damage), lack of tummy time and delays in gross motor developmental milestones of crawling.
What does retention of primitive reflexes mean?
Primitive Reflexes should only remain active for the first few months of life. There have been links identified between the inhibition of primary reflexes and the attainment of gross-motor milestones. As such, reflexes are often utilised as a form of measurement for CNS maturity. They play a vital role in survival for crucial periods but should then undergo inhibition or transformation. A number primitive reflexes are important for child birth, and in typical development, these reflexes naturally inhibit during the first year, and are replaced by postural reflexes. Postural reflexes are more mature patterns of response that control balance, coordination and sensory motor development. This graph shows how developmentally, primitive reflexes decline as postural and definitive motor actions are gained.
Does it matter if these primitive reflexes are retained?
If primitive reflexes are retained beyond 6-12 months of life, they suggest evidence of a structural weakness or immaturity of the central Nervous System (CNS). This presence of primitive reflexes is often found in combination with an absence or under-developed set of postural reflexes (above 3.5 years of age), as shown in the above graph. As mentioned, retention of a reflex may impact the development of postural reflexes, which are required to support child maturation and gross motor development to effectively engage with their surroundings.
What do retained primitive reflexes look like (apart from arms and legs in different places)?
Despite the obvious ‘reflex actions’, as described above, functionally retained primitive reflexes can have a wide range of implications, particularly noticeable for children in a school and classroom environment. Signs of CNS immaturities due to retained primitive reflexes can include:
- Difficulty with impulse control
- Some learning difficulties
- Emotionally labile
- Attention and Concentration issues
- Reduced Postural Control (particularly seated posture at mat time and at the table)
- Challenges with Balance and Gross Motor Confidence
- Difficulty with Reading and Scanning across a page
- Challenges with Repeated Copying from the board
How do we ‘integrate’ primitive reflexes?
To ensure these reflexes are inhibited, we must work on integrating the reflexes. The integration of these reflexes essentially aims to maturate the CNS. Programs such a Rhythmic Movement Training and the Move to Learn Program aim to integrate and inhibit primitive reflexes through specific movements that help integrate and maturate the CNS. In clinic, we often use techniques from the Move to Learn and Rhythmic Movement programs to support integration of primitive reflexes.
For more information about primitive reflexes, follow the below resources.
Information from: OTFC clinical observations, Move to Learn Program (http://movetolearn.com.au/move-learn-movement-program.html) Brain Balance Centres – Primitive reflexes (http://www.brainbalancecenters.com/blog/2014/09/retained-primitive-reflexes-sign-brain-imbalance/), Goddard, S. 2005 ‘Reflexes, Learning and Behaviour: A Window Into the Child’s Mind: 2nd ed.’ Fern Ridge Press, Eugene, OR, and Rhythmic Movement Training (http://www.rhythmicmovement.com/en/primitive-reflexes/the-importance-of-integrating-primitive-reflexes)