What are Primitive Reflexes?

A reflex is an instinctive, automatic physical reaction to a particular stimulus that occurs without conscious thought. For example, if we trip and fall, we instinctively put our arms and hands out to break our fall; if we touch something hot we instinctively withdraw from the source of contact. We have hundreds of these reflexes.

Babies are born with a set of so-called ‘primitive’ reflexes. These develop in the womb and are essential to the birthing process, help the newborn take its first breath and support its early survival. They instinctively enable us to perform certain tasks such as feeding, grasping and responding to danger. As human babies are born before their brains have fully developed, they rely on these automatic, instinctive reactions to survive. Primitive reflexes are also crucial to our early development, each teaching us a certain function such as rolling over, crawling, standing and walking.

The early survival reflexes are called ‘primitive’ reflexes because they emanate from the lower or ‘primitive’ regions of the central nervous system (i.e. the spinal cord and brain stem). Broadly speaking, the central nervous system develops in stages, “from the bottom up”, starting with the spinal cord and brainstem. The last part of the central nervous system to mature is the cortex , which is responsible for higher cognitive functions, such as thinking, conceptualising and learning.

All being well, the primitive reflexes should serve their purpose during the baby’s first year of life and should then ‘ inhibit’ or ‘switch off’, as the higher centres of the brain begin to mature and take over. They don’t completely disappear but form the foundation for adult postural reflexes which in turn enable the higher more sophisticated centres of the brain to develop.

Whilst all babies are tested for the presence of primitive reflexes shortly after birth, no follow-up testing is generally carried out to ensure that these reflexes have inhibited.

WHAT HAPPENS IF THEY FAIL TO INHIBIT?

If the primitive reflexes fail to inhibit and remain active beyond the baby’s first year of life, they can act as a barrier to normal development of the central nervous system and prevent the higher centres of the brain (the midbrain, limbic brain and cortex) from taking over the ‘running’ of the central nervous system.

As a result, the central nervous system may continue to function at an immature level, causing it to respond inappropriately in certain situations. This can have a significant impact on all aspects of behavioural, emotional, cognitive and physical development. In the case of a retained Moro reflex, it puts the body in constant ‘fight or flight’, leading to over-activity of the sympathetic nervous system which can have adverse consequences for our physical and mental wellbeing.

The reason why the retention of primitive reflexes has such far-reaching implications is that our central nervous system develops in hierarchical stages, with each developmental stage acting as the foundation for the next. The primitive reflexes are the first foundations of the central nervous system and their inhibition is essential to the remainder of the central nervous system being able to develop and function properly.

During typical neurological development, as the primitive reflexes are inhibited, postural reflexes take their place. Postural reflexes are controlled from the midbrain (the area of the brain which connects the cortex to the brainstem) and their development signifies a maturing of the central nervous system. The postural reflexes should be established by the time a child is three and a half and they remain active for the remainder of our lives. They are responsible for the subconscious maintenance of the body’s posture if there is a disturbance in balance and they facilitate normal (fluid) daily movement patterns.

If the primitive reflexes remain active, they prevent full development of the postural reflexes, resulting in poor balance and co-ordination which can have implications socially and in the classroom.

Furthermore, as the postural reflexes form the foundation for subsequent developmental stages of the central nervous system , the absence of postural reflexes, or any weakness in their development, will prevent the higher-level functioning areas of the brain (the limbic brain and cortex) from developing and functioning properly. This can result in behavioural and emotional issues  and have an impact on cognitive functions, such as language, conceptualising and academic learning.

What Causes the Retention of Primitive Reflexes?

Very little is known about the causes of developmental delay but there is speculation and some scientific research to suggest that a combination of factors may be involved, including:
In our experience, based on the families we treat, the retention of primitive reflexes appears also to be largely hereditary, passed down from generation to generation.

Neuro-developmental delay can manifest itself in different ways in different children of the same family. For example, it is not uncommon for one child with neuro-developmental delay to struggle academically whilst its sibling is a high achiever. Personality may also of course have an impact on the way neuro-developmental delay manifests itself, so whereas one child with a retained Moro may be over-anxious and “shy”, his or her sibling might be hyperactive and explosive.

Examples of primitive reflexes

Consequences of their Retention

Moro Reflex

The Moro reflex is the first of the primitive reflexes to emerge and the first to inhibit after birth.  It usually emerges around 9–12 weeks after conception and is normally fully developed at birth. It should switch off around 2- 4 months of age.

The Moro reflex is the baby’s “alarm reflex”. As a newborn baby is incapable of rational thought, it cannot assess whether a threat is real or not. It is therefore protected by the Moro reflex, which is an unconscious, automatic response to a perceived threat. Like the other primitive reflexes, the Moro reflex emanates from the (unconscious) brainstem, the first part of the brain to develop and function.

On startle, the baby will rapidly throw its arms upwards and away from its body with its hands open. This is accompanied by a sharp intake of breath. It is followed by a relaxing of the posture on the out-breath with the baby bringing its arms in across the chest and clenching its fists and may be followed by a cry. These automatic movements are an important survival technique and are a signal to the outside world that the baby is in difficulty and needs parental attention.

When the Moro reflex is triggered , the baby’s  ‘fight or flight’ response is activated, releasing adrenaline and cortisol ( the ‘stress hormones’) into its bloodstream .This results in an increase in the baby’s rate of breathing and heart rate, as well as a rise in blood pressure and reddening of the skin.

The Moro is multisensory and can be triggered by any or all of the senses, including an unexpected or loud noise, an unexpected change in light levels, an unexpected or intense touch, pain, a sudden change in temperature and a sudden movement of the body or in the visual field.

If the Moro reflex remains active beyond 6 months, it becomes an automatic, involuntary (over)reaction, which is strong enough to override the higher, decision- making, centres of the brain.

Once the Moro is triggered and our ‘fight or flight’ response is activated, we tend to perceive everything in our environment as a potential threat to our survival. Our fear is exaggerated; we see everyone and everything as a possible enemy. Our system will be in a constant state of over-stimulation, making it even more sensitive to sound, touch, movement and visual information. We find ourselves in constant ‘flight or flight’ and the excess levels of stress hormones in our system can have far-reaching implications, not only impacting on our physical and emotional wellbeing but also affecting our behaviour.

POSSIBLE SYMPTOMS OF A RETAINED MORO REFLEX INCLUDE

BEHAVIOURAL AND EMOTIONAL

Anxiety and fearfulness
Low self-esteem and lack of confidence
Dislike of change or surprise
Shy and withdrawn behaviour
Fear of separation from loved ones
Difficulty accepting and giving affection
Mood swings
Depressive feelings and behaviours
Defiant behaviours
OCD type behaviours
Panic attacks
Impulsivity
Emotional immaturity
Aggressive outbursts, both verbal and physical
Frequent meltdowns
Hyperactivity
Oversensitivity to sensory stimuli
Avoidance of certain places and situations
Excessive daydreaming and fantasising
Inability to relax
Distractibility
Fussy eating
Controlling behaviour

PHYSIOLOGICAL

Lowered immune system - frequent ear, nose and throat infections
Digestive problems
Allergies - asthma, eczema as well as food allergies
Adverse reactions to medication
Fluctuating blood sugar levels ( minor hypoglycaemia)
High blood pressure
Sleep problems
Headaches
Neck and shoulder pain
Reduced or increased appetite

ATNR

The Asymmetrical Tonic Neck Reflex usually emerges around 18 weeks after conception. It should be fully present at birth and should switch off around 6  months after birth.

When a baby’s head is turned to the side, the jaw limbs extend and the occipital  (opposite) limbs flex. So when the baby’s head it turned to the right, its right arm and leg will extend and its left arm and leg will flex, and vice versa.

The ATNR stimulates muscle tone and balance mechanisms in the womb and is crucial to the birthing process. The ATNR not only assists the birthing process but is activated and reinforced by it which may explain why babies born by Caesarean or with use of forceps are at higher risk of neuro-developmental delay.

The ATNR is also crucial to survival of the newborn after birth and should ensure a free passage of air when baby is placed on its tummy by helping it turn its head to one side.  Furthermore, as well as increasing muscle tone in the extended limbs, it aids in the baby’s ability to reach out for things and provides the first opportunity for baby to use its eyes to shift focus and establish hand-eye coordination.

POSSIBLE SYMPTOMS OF A RETAINED ATNR INCLUDE

Poor balance and coordination
Difficulty establishing laterality ( i.e dominant  hand , eye or ear)
Difficulty crossing the midline ( e.g a right handed child may find it difficult to write on the left side of the page)
Discrepancy between oral and written performance
Issues with smooth tracking of the eyes (necessary for reading and writing)
Poor hand-eye coordination (e.g difficulty catching a ball)
Poor fine motor skills ( i.e handwriting)
Difficulty learning to ride a bicycle and swim
Sideways writing – with paper on an angle

Spinal Galant Reflex

The Spinal Galant Reflex emerges 20 weeks after conception. It should be actively present at birth and should inhibit by 3 to 9 months of age.

If you stroke a baby to either side of its spine, it will cause the hip on that side to flex or rotate.

Like the ATNR , the Spinal Galant Reflexes important in the birthing process as it facilitates movement of the hips as the baby works its way down the birth canal.

POSSIBLE SYMPTOMS OF A RETAINED SPINAL GALANT REFLEX INCLUDE

Inability to sit still and fidgeting (‘ants in the pants’)
Poor concentration and short -term memory
Poor posture
Bedwetting beyond the age of 5
Possible scoliosis ( if the reflex remains present on one side only)
Hip rotation to one side when walking
Hypersensitivity to fabrics and labels and generally fussy about clothing

TLR

The Tonic Labyrinthine Reflex has 2 separate patterns, the TLR forwards and the TLR backwards. Each has its origin in the vestibular system ( which is responsible for balance) and is elicited by movement of the baby’s head.

The TLR forwards emerges in the womb ( at around 3-4 months) and should be inhibited by 4 months of age.

When baby’s head is tilted forwards chin to chest, its arms and legs flex. Its arms bend into its body and as its knees bend, its legs are drawn into its tummy.

The TLR backwards emerges at birth and its inhibition is a gradual process involving the maturation of other ‘systems’. It should be inhibited by three and a half years.

When a baby’s head is tilted backwards below the level of its spine, its arms and legs extend. The baby’s back may stiffen and even arch upwards.

The TLR is responsible for helping the brain and senses develop a correct relationship with gravity, allowing us to know where we are in time and space.

It also stimulates and strengthens baby’s muscles and is important for the later development of postural reflexes.

POSSIBLE SYMPTOMS OF A RETAINED TLR INCLUDE

Retained TLR forwards

Poor posture
Weak muscle tone
Poor sense of balance and tendency to car sickness
Dislike of sports
Poor sequencing skills, including poor sense of time
Visual-perception issues and spatial problems
Poor tracking skills

Retained TLR backwards

Poor posture- toe walking
Poor balance and coordination
Hypertonus resulting in stiff jerky movements
Poor sense of balance and tendency to car sickness
Visual-perception issues and spatial problems
Poor sequencing skills
Poor organisation skills

STNR

The Symmetrical Tonic Neck Reflex usually emerges around 6 -9 months after birth and should inhibit when baby is around 9-11 months.

It is not regarded as a primitive reflex but rather as an infant or transitional reflex, being an extension or adaptation of the TLR. Its primary purpose is to help the baby rise up on its hands and knees and prepare it for crawling.

The STNR is a two phase reflex:

When the baby’s head is tilted forwards, its arms flex and its legs extend.

When the baby’s head is tilted backwards, its legs flex and its arms extend.

Children who retain the STNR rarely crawl on their hands and knees. Instead they might “bear walk” on their hands and feet or “bottom shuffle “.

POSSIBLE SYMPTOMS OF A RETAINED STNR INCLUDE

Poor posture
Simian (ape-like) walk
Tendency to “slump” when sitting, particularly at a desk or table
Poor hand-eye coordination
Messy eating
Clumsiness
Difficulties with adjusting focus from distance to near , eg blackboard to desk
Difficulty learning to swim
“W” leg position when sitting on the floor
Problems with concentration and attention ( as a result of issues caused by posture)

FPR

The FPR is a withdrawal reflex, rather than a ‘primitive’ reflex, which emerges very early after conception. It is expected to inhibit with the emergence of the Moro reflex at 12 weeks after conception.

The FPR is thought to be the first response to stress and is a protective response. During the early stages of its development, the embryo responds to stress and stimulation by withdrawing and ‘freezing’.

When the FPR is retained beyond birth, it results in limited stress tolerance and hypersensitivity to sensory stimuli. Its persistence beyond birth can also result in difficulties with attachment and issues with understanding the social world around us.

It can be characterised by withdrawal, both mentally and physically. The child may be withdrawn, ‘internalised’, extremely shy and reticent to be involved in anything new. Withdrawal does not necessarily mean quiet withdrawal as the child may scream loudly when faced with a new or uncomfortable situation.

POSSIBLE SYMPTOMS OF A RETAINED FEAR PARALYSIS REFLEX:

Constant state of anxiety
Low tolerance to stress
Difficulty making eye contact
Shallow breathing; breath holding when angry or upset
Over- or under attachment to adults and peers; fear of separation
Tendency to ‘freeze’ under stress (rather than ‘fight or flight’);  ‘Rabbit in the headlights’ response
Extreme “shyness”
Constant feelings of overwhelm
Excessive fear of embarrassment
Fear of social environments
Difficulty giving and receiving affection
Hypersensitivity to sensory stimuli (sound, light, touch, smell and possibly taste)
Extreme fear of failure
Reluctance to try new activities
Intolerant to sudden change (physical and emotional)
Selective mutism
Negativity and defeatist attitude
Compulsive traits and phobias
Lack of confidence and low self esteem
Fear of change of any kind 
Feeling stuck - not moving forwards in life, metaphorically or physically
Panic disorders
Sleep and eating disorders

As it is the first reflex to emerge and is normally the first to integrate, the FPR will affect the integration of all the primitive reflexes and generally goes hand-in-hand with an unintegrated Moro reflex and TLR.

Diagnosing Neuro-Developmental Delay Testing for Primitive Reflexes

At the initial consultation, we discuss with you the issues you or your child are experiencing. This information is complemented by completion of a detailed questionnaire.

A set of standard non-invasive neurological tests is then carried out to determine whether primitive reflexes are still active and to what extent. We also test for the presence (or lack) of adult postural reflexes. Balance, coordination, pupillary response, eye-tracking and other visual functions are all examined as part of this assessment.

The information gained enables us to measure the existence and extent of neuro-developmental delay in order to build up a detailed profile, allowing us to formulate a specifically tailored treatment plan.
Treatment programme