MONI LEBON
NEURO-DEVELOPMENTAL THERAPIST
What are Primitive reflexes?
Primitive reflexes are the body’s inborn software, the automatic movement patterns that help us through birth and support survival in the first months of life. They protect, guide, and provide the basic training for all future motor skills. These early reflexes are vital for human development, helping us adapt to life outside the womb and to the new challenge of a gravity-based environment. When primitive reflexes remain active beyond the typical age of integration (usually within the first year), they can interfere with the development of more sophisticated postural reflexes and slow the maturation of the central nervous system. To allow higher brain functions to take charge, these primitive reflexes need to be “put to bed”, integrated, and retired to the brainstem. They should only reappear in response to significant brain injury or degenerative conditions.
What are Postural reflexes?
Postural reflexes are a set of more mature, sophisticated reflexes that support many of our gross motor functions.
They form the foundation for the automatic control of balance (vestibular system), posture (muscle tone), and coordination (movement).
These reflexes begin to emerge during the first year of life, from around six months onward, and must become fully integrated to allow the primitive reflexes to subside.
The two systems work in harmony, with one gradually giving way as the other takes over, creating a smooth transition toward mature movement and motor control.
If postural reflexes are not strong enough to manage our motor functions in a gravity-based environment, the primitive reflexes may remain active, causing ongoing challenges with balance, coordination, and stability.
Learned motor patterns are stored in the cerebellum (the lower brain).
Once established, these patterns become automatic, freeing the cortex, the brain’s executive command centre, to focus on more complex cognitive and emotional tasks.
Key reflexes
Symptoms if retained:
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Over-reactive
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Hyper or hypo-sensitive
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Hyperactive
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Poor balance and coordination
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Visual-perception problems (stimulus-bound)
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Photosensitivity
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Poor auditory discrimination
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Poor impulse control
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Emotional immaturity
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Motion sickness
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Poor immune system (related to allergies, recurring ear, nose and throat problems as well as asthma & eczema)
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Anxiety
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Low self-esteem
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Physical timidity
The Moro reflex
Description:
The Moro reflex helps establish the breathing mechanism before birth and facilitates the baby's first breath. It is an automatic response to a perceived threat and is considered the earliest form of the fight-or-flight response. As a newborn cannot protect itself, the Moro reflex serves as a signal that help is needed.
If the Moro reflex remains active beyond infancy, the nervous system may stay in a constant state of heightened alertness. This can lead to increased sensitivity to sound, touch, movement, smells, changes in temperature and environment, light levels and, in some individuals, certain foods.
Children with a retained Moro reflex generally develop one of two coping styles: flight or fight.
Children who respond through flight tend to be anxious, cautious and easily overwhelmed. They may avoid new situations, dislike change and become socially withdrawn, often preferring their own company.
Children who respond through fight are more likely to be overactive, impulsive, easily frustrated or controlling. They may struggle to read social cues and can overreact to everyday situations.
Despite these differences, both groups are often highly sensitive, perceptive and imaginative. They may, however, appear emotionally immature and find it difficult to regulate their responses to everyday challenges. Many prefer the company of younger children or adults, as navigating peer relationships can be more demanding.
In the classroom, a child with a retained Moro reflex may be restless, easily distracted, noisy, inattentive or find it difficult to remain seated and focused.
Lifespan:
Emerges at around 9 weeks in utero and should be integrated by approximately 4 months after birth.
Tonic labyrinthine reflex TLR
Description: When a baby’s head is tilted forward, chin to chest, the arms and legs will flex, bending and folding into the body.
When the head is tilted back below the level of the spine, the limbs will stretch out and extend.
This reflex assists the birthing process and has a tonic influence over the whole body, straightening it out from a long period of gestation. It is responsible for developing balance and coordination, muscle tone and proprioception as well as stimulating the later postural reflexes.
Symptoms if retained:
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Poor balance and coordination
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Visual perception problems
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Spatial problems
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Poor sequencing skills
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Poor organisation skills
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Poor sense of time
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Motion sickness
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Under or overdeveloped muscle tone
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Poor posture
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Physical timidity (dislike of sports)
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Toe walking
Asymmetrical tonic neck reflex (ATNR)
Description:
When a baby's head turns to one side, the arm and leg on the face side straighten, while the arm and leg on the opposite side bend.
The Asymmetrical Tonic Neck Reflex (ATNR) develops in the womb and helps the baby become comfortable before birth. It is responsible for many of the kicking movements felt during pregnancy and helps stimulate muscle tone and the developing balance system. It also plays an important role during the birth process and in the newborn's early survival.
If the ATNR remains active beyond infancy, it can affect balance, posture and coordination. Children may need to make constant unconscious postural adjustments when carrying out everyday tasks. This often becomes most noticeable at school, where sitting upright, reading and writing place greater demands on the nervous system.
Lifespan:
Emerges at around 18 weeks in utero and should be integrated between 6 and 11 months after birth.
Symptoms if retained:
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Poor balance and coordination
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Poor hand-eye coordination
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Difficulty in crossing the midline
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Inability to have smooth pursuit of eye tracking movement
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Difficulty writing
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Difficulty reading
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Homolateral movement instead of cross-patterned in activities such as walking and marching
Symptoms if retained:
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Difficulty developing an efficient crawling pattern (may bear walk or bottom shuffle)
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Poor posture
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Poor postural control or frequent W-sitting
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Messy eating
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Clumsiness or poor motor coordination
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Difficulty with attention and concentration
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Swimming is difficult but better doing it underwater (gravity-free)
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Difficulty with vertical tracking
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Poor hand-eye coordination
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Poor accommodation in vision (readjusting from near to far)
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Slow at copying tasks
Symmetrical tonic neck reflex (STNR)
Description:
When a baby is on their hands and knees and lifts their head, the arms straighten while the legs bend. When the head lowers, the arms bend and the legs straighten.
The Symmetrical Tonic Neck Reflex (STNR) is not a true primitive reflex but a transitional reflex. It develops after the Tonic Labyrinthine Reflex (TLR) and also relies on information from the vestibular (balance) system. Its role is to help inhibit the TLR and build the strength and stability needed to get onto hands and knees. The STNR must then integrate before a baby can crawl forwards efficiently.
One of its key functions is to separate the movement of the upper and lower body, allowing them to work independently. This "breaks" the horizontal body axis and prepares the child for more mature movement patterns.
The STNR also helps develop visual accommodation — the ability to adjust focus smoothly between near and far objects, an important skill for reading and classroom learning.
Crawling is one of the most important stages of early development. It promotes smooth, cross-patterned movement, midline crossing, hand-eye coordination and postural control. During crawling, the vestibular (balance), proprioceptive (body awareness) and visual systems begin working together for the first time. This stage also supports the development of spatial awareness, depth perception and cognitive skills such as object permanence.
Lifespan:
The STNR emerges between approximately 6 and 9 months of age and should be integrated by around 9 to 11 months.
Spinal Galant reflex
Description: When the baby's back is stroked down either side of the spine or in the lumbar region, the hip on that side will flex or rotate.
The spinal Galant reflex helps the infant to move down the birth canal. It also helps the baby urinate after birth.
Lifespan: emerges at approximately 20 weeks in utero, is present at birth, and is usually integrated between 3 and 9 months
Symptoms if retained:
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Fidgeting or hyperactivity, particularly when clothing or a chair touches the back.
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If active down only one side, it may cause scoliosis, rotated pelvis, and lower back pain.
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Poor concentration and short-term memory
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Attention problems
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Bedwetting long after potty training
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Fidgeting, difficulty sitting still -“ants in the pants”
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Posture problems
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Hip rotation on one side when walking
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Hypersensitivity to fabrics and labels
Palmar Reflex
Description: When placing an object into the palm of a newborn baby’s hand, it will curl its fingers around the object, usually with the thumb nestling underneath the index finger. This reflex is strong enough to support the baby’s weight if suspended.
Lifespan: emerges 11 weeks in utero, inhibited by 2-3 months of age
Symptoms if retained:
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Difficulty with writing grip
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Poor dexterity
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Tactile hypersensitivity of the hands
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Speech difficulties - possibly linked with reduced separation of hand and mouth movements
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Overflow or lack of separation of hand/mouth movements (Babkin response)
Plantar Reflex
Description: Similar to the palmar reflex, it assists the neonate in grasping onto his mother. Its presence allows for movements of the toes and foot and helps stimulate movement of the whole leg.
Lifespan: Emerges at 11 weeks in utero, inhibited by the time the infant learns to stand
Symptoms if retained:
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Gravitational insecurity in standing
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Hypersensitivity to touch on the soles of the feet
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Clumsy in walking on uneven surfaces
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If balance is shifted away from the soles of the feet to the balls of the feet, the child may be a toe-walker.
Rooting Reflex
Description: Stimulation to the side of the mouth or cheek will cause the baby to turn the head towards the stimulus. It is strongest immediately after birth, and it is important that the neonate’s earliest attempts are gratified or the reflex will weaken after a couple of days and may lead to difficulties in feeding and the reflex having never been satiated.
Lifespan: emerges 24-28 weeks in utero, present at birth, inhibited by 3-4 months of age
Symptoms if retained:
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Tongue lies too far forward
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Difficulty swallowing and chewing certain foods
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Hypersensitive around the mouth
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Immature control of the lips leading to speech and articulation problems
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hand/mouth still linked, affecting independent movements
Suck Reflex
Description: When the nipple or teat enters the mouth and makes contact with the roof of the mouth, the suck reflex will be triggered; thus, the ‘feeding reflex’ is put into action. If the baby is not able to latch on immediately after birth, he may have difficulties feeding at a later stage.
Lifespan: emerges 24-28 weeks in utero, present at birth, inhibited by 3-4 months of age
Symptoms if retained:
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Immature swallow pattern may lead to problems with the correct development of the palate
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Hyper-sensitive around mouth
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Difficulty with textures and solid foods
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Thumb sucking
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Speech and articulation problems
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Links with hand and mouth movement
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Dribbling
