Retained primitive reflexes - what they are, and how to check if your child has retained their reflexes

What are Retained Primitive Reflexes?

Retained primitive reflexes are, as the name suggests, reflexes that are supposed to be present in babies but have been retained in older children and adults. The ‘primitive’ reference in the name refers to the fact that these retained reflexes are in the primitive brain. This is the part of the brain that newborns use to stay alive, until their brain begins to develop and mature. 

Retained primitive reflexes are also called retained neonatal reflexes, which is technically what I personally was trained in (there happen to be many training programs for both RNR/RPR).

Some of these reflexes are present in the womb, long before baby enters the world. Others are actually not present at birth, but become present as your baby moves through a sequence of brain and body developments. 

Integration of Primitive Reflexes

The important thing about neonatal reflexes is that they really should be ‘integrated’, and if the brain is developing optimally, this will happen naturally. If the brain retains some of these primitive reflexes, this can lead to an overflow of symptoms into their early childhood and adult life. You may not have even noticed your baby had a primitive reflex that was retained until many years later - when they express the side-effects of retaining the reflex. 

Unfortunately, retained primitive reflexes are assumed to have integrated fully after 12 months of age, and don’t often form part of your general examination by your primary health provider. So when trying to find support and answers relating to retained reflexes, it’s best to speak with someone trained in that area. However, it also means that by the time you’ve even heard about these reflexes, your child may have had them unresolved for many years (I’m sure your child is presenting with some kind of symptom or you wouldn’t have read this far!).

What are the signs of a retained primitive reflex in your child?

The easiest way to pick up whether your baby has a retained neonatal reflex is by noting their motor milestones. Movement drives brain development (and integration of neonatal reflexes), and if movement is delayed, or not symmetrical, it may indicate a reflex is being retained, and therefore preventing full motor development. Things to look out for are turning the head one way only (or having a preference), not crawling at all, or asymmetrical crawls such as bum shuffling or using one leg straight and one bent, and finally awkward or clumsy walk/run patterns. While these aren’t always indicative of retained reflexes, if your baby is presenting like this I would question if they were a piece of the puzzle. 

In older children, if you’re concerned with retained primitive reflexes, you might notice particular developmental delays, or things that your mother’s intuition senses is just “not quite right”. Your child may or may not have a diagnosis, including ADHD, ASD, OCD, sensory processing issues or auditory processing issues. Let me be clear when I say these are complex issues, not caused by any one thing, but that children with diagnoses tend to have an increased incidence of retained reflexes (in my personal, clinical experience).

Either way, keep reading. This blog will tell you a LOT!

Types of Neonatal Reflexes and Symptoms of Retention

The Fear Paralysis Reflex (FPR)

Action - This reflex begins early after conception and should integrate before birth. In the womb, it is seen as movement of the head, neck and body in response to threat. 

The FPR is mediated by the parasympathetic nervous system, which is the rest and digest part of the nervous system. It activates the dorsal vagal response in moments of stress, and appears in the moment as complete paralysis. Kinda like faking death, to avoid threat or danger. If this reflex is retained it can be characterised by withdrawal, reticence at being involved in anything new, and fear of different circumstances. The withdrawal is not always quiet -it may be a screaming fear.

Retention is associated with: 

• Withdrawal, shyness, fearfulness

• Screaming/upset when faced with perceived threat - even if it’s clear to everyone else there is no real threat

  • Ie anxiety unrelated to reality

• Poor tolerance to stress, poor adaptability

• Can contribute to hypersensitivity to sensory information

  • Touch, sound, light

• May lead to panic disorders

  • OCD or compulsive traits

• Emotional dysregulation, unable to come back to calm state quickly

  • Temper tantrums

  • Defeatist attitude, negative a lot of the time

• Freeze response - can’t think and move at the same time

• Refusal to try new things

• Dislike of change or surprise

• Breath-holding in times of stress

• Unexplained fatigue

• Fear of social embarrassment - tends to stay on the outskirts of things

• Overly clingy, OR unable to accept or give affection

Retained Moro Reflex

Action - The Moro is an involuntary startle response, linked to the fight or flight response, coming from the sympathetic nervous system. It is set off by excessive information in any of the baby’s senses. For example, a loud noise, bright light, sudden rough touch, sudden stimulation of the balance mechanism such as dropping or tilting. It is the earliest form of adrenal “fight or flight response”. This response prepares for fighting or running and if not integrated leads to hyperactivity. In most instances, the Moro is present at birth, and will have integrated by 3 months or 12 weeks of age. If not integrated beyond 3-6 mths, becomes an automatic overreaction, overriding the higher centre decision making. 

As the adrenal glands are a large part of our immune system; constantly being turned on can lead to adrenal fatigue and therefore asthma, allergies, and chronic illness.

The Moro is due to your baby’s higher centres not being fully developed enough to make a rational decision about a perceived threat. 

Retention of the Moro is associated with: 

• Hypersensitivity to senses that turn the reflex on (light, sound, touch, stress)

• Generalised hyperactivity

• Difficulty with new/stimulating experiences

• Difficulty socialising/giving or receiving affection

• Overactive fight or flight responses (therefore, child could be aggressive/overactive/highly excitable)

• Jumpiness, startling over perceived threats (eg shadows, noises)

• Inability to cope with background noise and drown it out

• Sensitivity to foods or food additives

• Inappropriate behaviour

  • Unsure of social conventions

  • Impulsive behaviour 

  • Participation anxiety - could play up or downright refuse to join in

• Emotional and social immaturity

• Distracted - has to pay attention to everything, can’t prioritise focus

The Babinski Reflex

Action - This reflex is found on the bottom of the feet. It usually disappears fully once your baby becomes a toddler. The Babinski reflex is present when the nervous system hasn’t fully matured, so resolution is a sign used to determine nervous system maturity.

Retention of the Babinski reflex is associated with: 

• Rolling out of foot on the side that the reflex is present

• Toe walking

• Issues with proprioceptive & vestibular system

• Muscles in back of the leg are affected (altered walking patterns)

• Trouble balancing

• Gravitational insecurity - eg swings, slides, climbing

• Trouble with vestibular, visual, sensory systems - such as car sickness, overstimulation, rides making you sick

• External rotation from the hip when standing (ie feet turned outwards)

Palmar Reflex

Normal neonates have an active Palmar, or Grasp, reflex. When the palm of the hand is touched, the three small fingers flex toward the palm to grasp. This reflex must integrate for normal prehension (holding between the thumb and fingers). You know that adorable thing new babies do when you place your finger in their hand and they hold on so tight? I hate to tell you, that’s a reflex response and not a conscious choice. 

Some also say that their reflexive grip is so strong that it can hold their entire body weight! Maybe don’t try this one, but I found that interesting. 

The first readily recognisable fine motor skill that is crucial to normal development is unfisting. This reflex is present at birth, but usually fully integrated by 5 months of age. 

The integration of the palmar reflex is important for developing fine motor skills and enhancing sensory input. 

If retained, these children often have poor handwriting, but more importantly, a poor ability to process their ideas and then write them down. That is, copying words is easy but the task of spelling words is more difficult and messy. Independent movement of the fingers will tend to weaken other muscles. Thus the child may slump during tasks like playing piano or making models.

Retention of the palmar reflex is associated with:

• Poor handwriting, poor ability to process ideas and write them down

• Poor manual dexterity with other activities too 

• Able to copy words, but difficulty in spelling

• Poor pencil grip

• Child may slump when performing fine motor tasks 

• Child may use the breath/tongue or jaw to recruit strength and focus

• In adulthood, back pain when sitting at a computer

  • Also may cause slumping when using the fingers on the keyboard (computer or piano etc)

Asymmetrical Tonic Neck Reflex (ATNR)

Action - Rotation of baby’s head to one side will cause the arms to straighten and extend from the body on the side the head is facing, while the other side will bend and go close to the body. For example, if your baby’s head turns right, their right arm and leg will straighten (like a fencer) and the left arm and leg will bend. 

In utero, the ATNR provides the necessary stimulation for developing muscle tone and the vestibular system. It assists with the birth process, providing one of the means for the baby to "corkscrew" down the birth passage. ATNR also provides training in hand-eye coordination.

A retained ATNR can look like: 

• Child/adult easily distracted by anything attention grabbing

• Difficulty with tasks involving both sides of body (eyes, ears, limbs)

• Difficulty establishing dominant hand, leg or ear

• Turning the head may cause parts of visual field to be missed

• Difficulty bike riding (turning the head may result in arms turning to the same side, resulting in steering problems)

• Swimming strokes requiring head turning may be difficult

• Issues with visual tracking/judgement - such as reading

Tonic Labyrinthine Reflex (TLR)

Action - The TLR involves the vestibular system, and how the body uses it’s senses to work out where it is in space (and if it is safe!). If your baby’s head is moved backwards, their arms will straighten, and if their head is moved forward, their limbs will bend. 

The Tonic Labyrinthine Reflex helps with stability; it helps us develop muscle tone, balance, posture, and coordination throughout the whole body. It also helps with the development of neck and head control, and develops the proprioceptive and balance senses.

The TLR is present at birth, and integrates around 5 months of age. 

A retained TLR can look like: 

• Difficulty with auditory processing (listening skills)

• Vestibular system is disturbed, and its interaction with other sensory systems - may be a sensory seeker or a sensory avoider

• If head control is lacking, eye functioning will also be impaired due to their interconnectedness

• May suffer motion sickness

• When starting to walk, cannot acquire true standing and walking security / may experience difficulty judging space, distance, depth and speed

• Clumsiness - always falling over or bumping into things

Juvenile Suck Thrust Reflex

Action - Projection of the tongue forward, to suck a nipple, often stimulated by the nipple touching the roof of the mouth during feeding. Useful for establishing breastfeeding, and learning how to swallow milk. In an adult, the tongue moves backwards to push bolus of food down the throat.

Retained suck thrust reflex is associated with: 

• Tongue projects forwards before moving backwards in the normal swallow 

• This tongue thrust pushes the front teeth forwards, altering the shape of the maxillary arch towards an overbite

• Speech and articulation problems

• Difficulty swallowing and chewing

• Difficulty speaking and doing manual tasks at the same time

• Involuntary tongue or mouth movements when writing or drawing

• Poor hand dexterity when eating or speaking

• Test - when you swallow, does your tongue touch the back of your teeth, or the roof of your mouth? (the second one is correct)

Rooting Reflex

Action - If your baby’s cheek or mouth is stimulated, they will turn their head towards the stimulation and open their mouth in preparation for suckling. The combination of the rooting and the suck reflex ensures baby’s head turns towards the source of food and the mouth opens wide enough to accommodate the nipple for efficient feeding. 

The Rooting Reflex is present and birth and should integrate around 4 months of age. 

Retention of the rooting reflex can appear like: 

• Hypersensitivity around lips and mouth

• Tongue may remain too far forward (as if ready to suck), resulting in speech and articulation problems, dribbling, difficulty swallowing and chewing

• May be fussy eater or thumb sucker

• Poor manual dexterity may be experienced - A neurological link between the hand and the mouth seen as kneading movements of the hand associated with suckling. 

  • This is a two-way response; hand movement may affect speech, chewing or speech may affect manual dexterity

Landau Reflex 

Action - The Landau reflex is when your baby tries to lift their head, back and legs if laying on their belly. It is often best elicited by holding your baby up (on their belly), and their arms, legs and head will appear like an aeroplane. The Landau’s purpose is to begin coordination between the upper and lower parts of the body. 

The Landau appears around 3 months of age and fully integrates by 12 months of age. 

A retained Landau reflex may look like: 

• Insufficient stimulation of the prefrontal cortex (which might look like decreased emotional regulation, ability to focus, and learning ability)

• Concentration

• Social decision making

• Attention/focus

• Short term memory

• Poor sleep patterns

• Decreased pain regulation (ie they feel more pain in general, and often in a wider spread, eg if they kick their toe they may feel it all over their leg rather than just in their toe)

Symmetrical Tonic Neck Reflex (STNR)

Action - Bending your baby’s head forward causes arms to bend, and legs to straighten. This allows your baby to get into a position where they can push their upper body off the floor, and get onto all fours position. As the STNR reflex helps your baby get onto their hands and knees, it's sometimes referred to as the crawling reflex, however it is not directly related to crawling (only getting them on all 4s). The STNR reflex develops around 6-8 months of age (right in time for crawling!). 

A retained STNR reflex may appear like: 

• Delayed crawling

• Poor posture due to a full body decrease in muscle tone 

• Tendency to slump or hand difficulty sitting at a desk

• Poor hand/eye coordination

• Poor sensory integration

• Slowness with copying tasks (due to vergence difficulties or poor muscle tone)

  • Eyes fatigue sooner than normal with near-to-far focus - for example copying something off the board

  • Leads to information lost in class due to speed rather than intelligence

• Poor organisational and planning skills

• Long sightedness

• Walking like an ape

Stepping Reflex 

Action - The stepping reflex is elicited when your baby’s feet touch a flat surface, and your baby responds by attempting to walk. It is thought that this reflex is to allow your baby to push it’s way up your chest after birth to find the breast, and then also to develop coordination for ambulation later in life. The stepping reflex disappears around 2 months of age. 

Retention of the stepping reflex can appear as:

• Toe walking

• Asymmetrical muscle tone in the lower limbs if one-sided issue

• Poor balance and motor control

• Feet and ankle problems, pain and dysfunction due to muscle and joint changes from lowered tone

• Tight calf muscles

• Recurrent hamstring injuries and upper lumbar strain

• Occasionally bladder problems such as day or night wetting

• Visual disturbance - you might find them with their head tilted forward and their eyes looking upward (kind of like peering over the top of your glasses)

Heel Reflex

Action - tapping the heel of your baby will cause the leg to straighten quickly. It is thought to prevent the baby from falling backwards whilst being supported at the feet.

Our bodies alter our postural muscles depending if we are standing with our weight over our toes or our heels. The Stepping Reflex and Heel Reflex work using this mechanism, allowing increased ankle movement and establishing ideal posture that is integrated with our vision. 

If our head and vision feels we are falling forwards, the stepping reflex kicks in to support our body (and prevent falling). If our head and vision feels we are falling backwards, the heel reflex kicks in to prevent falling backwards. 

Retained heel reflex might present as: 

• Heel pain

• Heavy heel walking - those kids who walk like an elephant

• Balance problems

• Poor core stability

• Forward body lean when running

• Shin splints - acute pain in the shin and lower leg caused by prolonged running, typically on hard surfaces

• Achilles tendonitis

• Visual issues - may be seen tilting their head backwards and eyes looking down

Suprapubic Reflex

Action - when the public bone is touched, the baby straightens both legs. It is thought to support the birth process and the development into crawling and walking. 

Retained suprapublic reflex has been associated with: 

• Bladder problems

• Pelvic floor problems

• Asymmetry of posture

• Asymmetrical walking pattern

Spinal Galant Reflex

Action - This reflex takes an active role in the birth process, as the contractions of the vaginal wall stimulate the Galant reflex. As the side of the body is stimulated, your baby bends towards that same side, helping your baby work it’s way down the birth canal. The Galants reflex is present at birth, and usually integrates around 6 months of age. 

Stimulation down both sides of the spine at the same time will activate a related reflex, which causes urination (handy tip to remember if you need to get a urine sample for your baby!)

The stimulation of bedsheets may activate the related urination reflex, causing bedwetting long after toilet training.

A retained spinal galant may appear as: 

• ‘Ants in the pants’ child who wriggles, squirms and constantly changes body position - activated by the child's belt or waistband or leaning against the back of a chair. 

• This constant irritant affects concentration and short term memory (often getting them into trouble)

• Poor bladder control (low back region stimulated by bed sheets can trigger the reflex)

  • Bedwetting is common - long after day time toilet training

• If on one side, may affect posture and walking gait, giving the illusion of a limp

• Infant may not be able to maintain sitting position

• Clumsiness while trying to manipulate objects - eg in sporting games

• May interfere with the full development of the later occurring postural reflexes, affecting mobility in physical activities or sports

Well, this might seem like a lot of information, and some of the expressions can be due to many things. These are simply noted associations that primitive reflex experts have collated over the years. If your child is having some struggles with development or in school, and you’re looking for answers, retained primitive reflexes is one area to delve into. 

Want to learn more about Primitive Reflexes?

The Primitive Reflexes Course is for Mums looking to learn all about primitive reflexes and how they affect their child’s development - you’ll probably learn a thing or two about yourself too!

Learn how to support your child’s development, their ability to handle stress, and optimise their brain development.