What are primitive reflexes?
As an infant is born and they leave the protection of their mothers body, they are quickly introduced to millions of new stimuli. Thankfully, they are equipped with primitive reflexes to help adapt to this new environment and survive. Primitive reflexes are the automatic movements directed from the brain stem that infants are born with. Though these reflexes are critical for the infants survival during the first few months of life, they should begin to integrate and disappear largely by 6 months. As higher brain centers begin to inhibit primitive reflexes, more sophisticated neural pathways develop and the infant begins to have more voluntary responses to the many stimuli. This process marks proper neurological organization in the brain. If primitive reflexes remain past 6 months, this marks evidence of immaturity of the central nervous system.
Testing for the presence or absence of primitive reflexes is a harmless and effective way to gauge nervous system development in the pediatric patient. By monitoring the nervous system development of infants we can be sure that the brain is developing appropriately and that the child is meeting her/his milestones. According to Dr. Robert Melillo, author of Disconnected Kids, “Infant reflexes that don’t integrate successfully can lead to developmental delay.” With a growing number of children presenting to our office with neurodevelopmental issues such as ADD, ADHD, ASD, SPD, and communication disorders, we have found testing and remediation of these reflexes in addition to gentle chiropractic adjustments to be very effective in improving function among our pediatric and adolescent patients.
How do they work?
At birth infants function primarily from primitive brain centers, located at the bottom and back of the brain, as well as the brainstem, located at the very top of the neck. Let's examine one of the primitive reflexes, known as the rooting reflex. This reflex is critical in establishing a healthy breastfeeding relationship between mother and infant. As the infants mouth or cheek is stimulated by light touch, such as from the breast or bottle, the infant reflexively turns her head towards the stimulus and opens her mouth to prepare for feeding. As the stimulus is received, the information travels through the peripheral nerves of the face, ascends up the spinal cord to the brainstem and then an automatic and uncontrollable reaction occurs. In this case, the reaction is the head tuning and the mouth opening in preparation for feeding. This new impulse is sent back down the spinal cord, to the peripheral nerves to create the reaction. As the central nervous system matures, the infant starts to access higher brain centers which will inhibit these reflexes. Beyond the first few months of life, the reflex is not needed, as the infant has learned how to suck and swallow successfully. The infant simply no longer needs the automatic brainstem reactions to accomplish the task of feeding. The higher brain centers begin to control more of the infants reactions to stimuli as they age. These centers are responsible for executive functions such as paying attention, organizing, planning, prioritizing, staying focused, self control and regulating emotions.
What happens if primitive reflexes are retained?
A retained reflex means that the specific primitive reflex continues to exist beyond the normal and appropriate age. In the short term this may or may not present an issue. However, in the long term this tells us that the child's brain is not developing appropriately and that they are not able to access a critical portion of their brain. In this case, they will most likely try to accommodate for this lack of development and will exhibit deficiencies in other areas of life such as physically, academically and emotionally.
Common Primitive Reflexes
Listed below are a few of the most common primitive reflexes we test on our pediatric practice members. Remember, the reflex is normal during the first few months of life, but should be integrated by 6 months in most cases. If the reflex is not integrated, various symptoms or responses may begin to be noticed by parents, doctors and teachers.
- Moro: A startle in response to a loud acoustic stimulus, or a startle in response to a falling stimulus. If retained it can lead to hypersensitivity to various sensory stimuli, causing an over-reaction. These children are often in "fight or flight" and have higher levels of stress hormones. Long term retained reflex may lead to vestibular problems such as motion sickness, poor balance and coordination, poor visual perception and poor reaction to lights.
- Rooting: Turning the head and opening the mouth when touched near the mouth. If retained this can lead to hypersensitivity around lips and mouth, difficulty swallowing, drooling, speech problems, and poor manual dexterity.
- Babinski: Infant's foot goes into dorsiflexion and toes splay in response to stroking the bottom of the foot. If retained it may lead to toe walking, balance problems, and coordination issues.
- Spinal Gallant: Spinal muscles contract in response to stroking the back on the same side. If retained this can lead to bedwetting, fidgeting, poor concentration, poor short term memory, and hip rotation when walking.
- ATNR: When the head is turned to one side, the extremities on the same side extend as the extremities on the other side go into flexion. If retained this may lead to balance problems associated with rotating of the head; difficulty walking, skipping, marching; difficulty crossing the midline; mixed laterality; poor handwriting; visual perception difficulties.
- Palmer: Infant grasps (and does not let go) in response to touching or stroking of the palm. If retained it can lead to poor manual dexterity, lack of pincer grasp and decreased ability to hold a pencil, speech difficulties, hypersensitive hand, and a child that moves their mouth when trying to write or draw.
- TLR: Straightening of the arms when the baby looks up, and flexing of the arms when the baby looks down. If retained this can lead to poor posture, hypotonus/hypertonus, vestibular problems (poor balance, motion sickness), dislike of physical activity, oculomotor dysfunctions (visual perception disorder, spatial problems), poor sequencing skills, poor sense of time, and poor organization skills.
- STNR: Flexion of the head causes arms to bend, extension of the head causes legs to bend. If retained it can lead to poor posture, slumping at desk, "W" sitting, poor hand-eye coordination (messy eating, clumsy child), difficulty with binocular vision, difficulty copying, difficulty swimming, and attention disorders.
What causes retained primitive reflexes?
This question could be a full length article or book in itself. Many of our modern conveniences may cause these reflexes to be retained. Traumatic births, sympathetic (fight or flight) activation, interference to the nervous system, lack of movement, lack of being touched, poor nutrition, among others are all contributors to a lack of proper nervous system development. If the nervous system is not given the chance to develop as nature intends, there will be consequences to the child.
Since many of these reflexes are subtle, they may be missed by the untrained parent or even pediatrician. Still, many parents bring their children in to be checked because they can tell that something is just not right. They notice that their child seems to be trapped or unable to perform a task in the same way as other children the same age. Unfortunately, a large number of parents are not aware that their child has missed an important step in development until they reach school age. Once we begin to ask children to sit in chairs, concentrate, read and write, etc., it becomes clear that some children have a harder time than others. This may be an indication for primitive reflex testing and evaluation.
At our office we always start with a conversation about your child, starting from conception and pregnancy through current age. We search for all possible factors that may have led to an immaturity of the central nervous system. Often parents come to us with the answers themselves. They may have seen that their child is developing differently than other children or they may notice their child is sensitive to particular stimuli.
The next step in our practice is to evaluate the child. Once we ensure that both the parent and child are comfortable with us, we utilize very gentle and safe testing methods to determine the maturity of the nervous system. Many infants and children actually like the testing procedures as they involve gentle stroking of the skin and gentle movements. Parents can often notice the response themselves making the testing itself a valuable learning experience.
Our assessment and evaluation is discussed with each parent. If any primitive reflex testing has been positive, indicating that the reflexes are retained, specific exercises or movements are prescribed to help in the maturity of the child's nervous system. When combined with our gentle and specific chiropractic adjustments, many parents begin to notice changes very soon after beginning care.
Combining gentle chiropractic adjustments with specific exercises
Gentle chiropractic adjustments help to remove interference to the nervous system, so it can work more efficiently. The adjustment also provides a valuable mechanical stimulus to the brain stem which can further help to integrate some of these reflexes. In particular, the upper cervical spine is very important as this is the area of the spine that houses the brain stem. Optimal function structurally is essential for optimal neurological function in this area. By caring for both optimal function of the spine and nervous system and utilization of very specific movement patterns or exercises to help mature the nervous system, we are able to provide your child with the best opportunity for growth and maturation. We encourage you to reach out to our office via phone or email if you have specific questions or concerns about your child.
It may be a good idea to have your child’s spine and nervous system checked if:
- They are missing milestones such as rolling over, creeping, crawling, walking or talking
- They have low tone or a "slouching" posture
- The child startles easily
- You are having latching issues/ difficulty breastfeeding
- Your child “W” sits
- The child scoots, or is unable to crawl with the proper cross crawl patterning
- Your child is clumsy
- They have difficulty reading or writing
- They have difficulty controlling emotions or impulses
- They are a picky eater
- They are sensitive to particular stimuli (noises, smells, lights, motion, touch, taste)
Drs Jessica & Josh Burckhard
Goddard, Sally. Reflexes, Learning and Behavior: A Window Into the Child's Mind.
Melillo, Robert. Disconnected Kids.