Everything You Need to Know About Infant Reflexes

by Jessica Hill, COTA/L November 17, 2022

Everything You Need to Know About Infant Reflexes

You may have heard the term “primitive reflexes” thrown around before but do you know and understand what they are and why they’re important? If not, that’s ok! Many people have no idea what primitive reflexes are, much less why they are so important to childhood development.

If you are familiar with primitive reflexes but ready to learn more, then you’re in the right place!

We are all born with primitive reflexes

At birth, primitive reflexes are present to assist in survival - most develop in utero. These involuntary movement patterns are designed to keep the newborn alive and help with development throughout infancy. They are essentially the foundation for higher-level learning and development. The kicker here is that these primitive reflexes do not stay forever; they should integrate - go away or develop - typically around 12 months of age, some closer to two or three years old.

When a primitive reflex integrates, it makes way for new, more mature, voluntary movement patterns and higher-level learning to develop.

To be more scientific, when a new movement pattern is developed, it creates new neural pathways in the brain, thus prompting higher-level skill development - it’s a sequential process. For example, an infant must first develop head and neck control before learning to sit upright independently. If the infant does not develop head and neck control, he/she will be unable to sit upright without assistance.

If a reflex does not integrate, development may be hindered, and the infant may not gain higher-level skills.

What reflexes should a newborn have?

Infant reflexes

There are MANY newborn primitive reflexes, but for the purpose of this article we will cover 8 of them. These 8 primitive reflexes are often associated with challenges later in life (if not integrated) and are often addressed in occupational and/or physical therapy services.

Moro Reflex

“The Moro reflex is an involuntary protective motor response against abrupt disruption of body balance or extremely sudden stimulation.” (NCBI) When you’re holding your infant and then place them down, they will often have a physical reaction - the arms and legs will move outward and the fingers will extend. Additionally your infant may cry when this reflex is elicited. The moro reflex may also be elicited by a loud or sudden noise or any type of sudden movement. It can also be seen while the infant is sleeping - if they jerk suddenly in their sleep or are startled by sound or movement while sleeping.

The Moro reflex can be seen as early as 25 weeks gestation, should be fully present at birth, and should integrate by 6 months of age.

Some research has shown that the Moro reflex is a form of nonverbal communication between the infant and the caregiver (NCBI PubMed). When the infant’s Moro reflex is activated and they cry, the caregiver will react to soothe the infant, thus developing a bond and communicating that it’s ok.

Tonic Labyrinthine Reflex (TLR)

The Tonic Labyrinthine Reflex (TLR) has two movement patterns - flexion and extension. Flexion occurs when the infant’s head moves forward and facilitates movement of the arms and legs in towards the body. Extension occurs when the infant’s head moves backward and facilitates movement of the arms and legs away from the body. This is thought to help with the infant’s newfound challenge of gravity and has a direct impact on muscle tone. These movements of the head are typically facilitated by the caregiver during transitions - picking up babe, laying babe down, etc. Additionally, due to the head movement associated with the TLR, it is directly related to the moro reflex.

The TLR flexion pattern can be seen in utero as early as 12 weeks gestation, should be fully developed at birth, and should integrate between 4-6 months of age. This is also around the same time that the infant should develop good head control and begin establishing balance throughout the head, neck, and trunk. Additionally, an infant can begin rolling as early as 4 months and crawling by 6 months. See the connection here?!

The TLR extension pattern should develop at birth (full term) and should integrate anywhere between 6 weeks to 3 years (reference).

Landau Reflex

The Landau Reflex is considered a secondary reflex due to the fact that it appears after birth. In fact, it should appear AFTER the TLR has integrated - around 4 months of age. At this time, the infant should begin lifting his/her arms up off the ground (and likely their legs as well!) while in tummy time. The landau reflex should fully integrate by the age of 3 years (similar to the TLR extension pattern).

The TLR and the Landau Reflex assist the infant in developing muscle tone throughout the neck, back, and core.

Rooting and Suck Reflexes

The rooting reflex is essential for survival and growth, as it assists the newborn in finding food and initiating feeding (NCBI). When the corner of the infant’s mouth is stimulated, the infant will turn his/her head towards the stimulus and open their mouth with tongue thrusting (getting ready for the suck reflex to be stimulated). The rooting reflex appears at approximately 28 weeks gestation and should be integrated no later than 6 months after birth.

The suck reflex is also essential for survival and growth, as it allows the infant to coordinate breathing with swallowing. The suck reflex initiates when the roof of the mouth is stimulated (after the rooting reflex has activated to locate the bottle or breast) and begins the process of feeding. The suck reflex appears at approximately 30 weeks gestation but is not fully developed until 36 weeks gestation. This reflex can integrate as early as 3 months.

Palmar Grasp Reflex

The palmar grasp reflex is stimulated by stimulation or pressure to the palm of the infant’s hand. This stimuli or pressure causes the fingers to flex and grasp whatever is in their palm - you know that “death grip” your infant has on your hair or your finger? That’s the palmar grasp reflex! It is completely involuntary, but very strong! This reflex likely serves as a precursor to voluntary grasping as well as a way for the infant to bond with caregivers (NCBI).

The palmar grasp reflex develops around 16 weeks gestation and should be fully integrated by 6 months after birth. This lays the foundation for the infant to begin intentional reaching and grasping (and letting go) of objects - toys, a bottle or self feeding items, etc. - which is usually seen by 6 months of age.

Asymmetrical Tonic Neck Reflex (ATNR)

The asymmetrical tonic neck reflex (ATNR) is also known as the “fencing reflex” due to the movement of the arms during the reflex. The ATNR can best be seen when the infant is laying on his/her back and their head is turned to one side - if the head is turned to the right, the right arm will extend out while the left arm will flex in towards the body. The same happens if the head is turned to the left - the left arm will extend and the right arm will flex.

The ATNR typically appears at 18 weeks in utero. When a baby is kicking in the womb, it is likely due to the ATNR! Additionally, the ATNR assists with a vaginal delivery by helping the newborn “corkscrew” down the birth canal. In infancy, the ATNR assists with development of muscle tone, hand-eye coordination, and the developmental milestone of rolling. The ATNR should be integrated around 6 months and no later than 9 months of age. Simultaneously, the Moro and Palmar Grasp reflexes are also integrated by 6 months.

Spinal Galant Reflex

The spinal galant reflexis seen when the infant is laying on their stomach or being held on their stomach. Stimulation to the lower back, along either side of the spine, will produce movement throughout the trunk and the hips. This is the spinal galant in action! If both sides of the spine are stimulated at the same time, movement in the arms and legs can be seen and will often result in urination (resource).

The spinal galant reflex is developed around 20 weeks gestation and, along with the ATNR, helps assist with a vaginal delivery - while the baby is moving through the birth canal, they are receiving stimulation to their lower back thus causing hip movements and assisting with movement through the birth canal! This reflex additionally helps an infant prepare for crawling, as the hip movements help develop the range of motion necessary for crawling (and eventually walking) (resource). The spinal galant reflex should be integrated anywhere between 3-9 months of age. An infant typically begins crawling around 5-7 months as well!

Symmetrical Tonic Neck Reflex (STNR)

Last but not least for this article is the Symmetrical Tonic Neck Reflex (STNR). This is considered a secondary reflex, just like the landau reflex, due to the appearance after birth (versus in the womb). The STNR develops as the TLR integrates - around 6 months of age. However, depending on the TLR, the STNR may appear earlier or later.

The STNR can be seen when the infant is in tummy time and then later, in a quad position - that is, on all fours, hands and knees. Similar to the TLR, the STNR has two movement patterns - flexion and extension. During neck flexion (when the infant looks down), the arms will flex, or bend, while the legs will extend, or straighten (think of a modified down-dog position). When the infant moves into neck extension (looking up), the arms will extend, or straighten, while the legs will flex, or bend.

Think about an infant who has just figured out how to move from tummy time into a hands and knees crawling position (before they begin the actual act of crawling). Oftentimes, we’ll see a baby go into a fun little down-dog position, or rock back and forth, or even drop back down onto their tummy into a cobra-yoga position. These are all signs of the STNR!

Because the STNR assists with coordination of the arms, legs, and head which helps to facilitate crawling, it should integrate around 9-11 months of age.

Integration through infancy

As mentioned in each section above, primitive reflexes should integrate as the child grows and develops. This integration process moves along similar to developmental milestones - and as we’ve seen, are directly connected to developmental milestones!

baby playtime

How do you help your infant integrate their primitive reflexes, meet developmental milestones, and develop higher level movement skills? Through play! Through natural movement! Let’s talk about 5 things you can do, starting immediately after birth, to help your infant grow and develop!

Tummy time

Yes, tummy time is talked about over and over and over, but that’s because it is ESSENTIAL to primitive reflex integration! Tummy time is an integral part of integrating the moro reflex, the TLR, the landau reflex, the palmar grasp reflex, the ATNR, and the STNR. Tummy time develops neck, core, back, and shoulder musculature that is required later on for crawling, walking, climbing, and more!

What if your infant dislikes tummy time? That’s normal! It’s hard, especially for a newborn who hasn’t developed the muscles yet! It takes time and consistency. Placing your infant in tummy time several times throughout the day is required for your infant to develop these muscles. To this when they are awake, happy, and fed - although immediately after feeding may not be the best time, as their belly is full and it may be uncomfortable until some of the food has been digested!

Try these different tummy time variations to mix it up and make it more fun!

  • Tummy time on a therapy/yoga ball
  • Tummy time in front of a mirror
  • Tummy time on different blanket textures or the grass
  • Tummy time in a supportive swing
  • Tummy time on your chest (perfect for newborns!)
  • Tummy time propped on a small cushion or rolled up towel
  • Tummy time on your legs, while you are laying on your back and lifting your legs up, with knees and hips bent at 90 degrees to create a “platform” for your infant

If your infant seems to be in distress and is unable to tolerate tummy time, despite consistent trials, discuss your concerns with your pediatrician. There may be an underlying reason.

Open floor play

Sounds simple, because it is! Playing your baby on the floor and allowing them to move freely in an open environment is the BEST way to promote primitive reflex integration. It allows them to move their arms and legs and head in every possible direction! Unfortunately, containers are often used excessively and reduce the baby’s ability to move freely. While containers can be very helpful for a variety of situations, the goal is to place your baby on the floor for open, free play during MOST waking hours. Use containers only when necessary.

Try these ideas to make floor play more exciting, especially as your infant gets a little older:

  • Get on the floor with them!
  • Use mirrors
  • Use a floor gym and rotate the different items that hang
  • Get outside for new visual and auditory stimulation
  • Use books with high contrasting colors - prop them up at eye level

Pivot floor play

As your infant is growing and beginning to reach for toys and is tolerating tummy time for longer periods of time, set up some fun activities that will encourage them to look and reach in different directions. This can be as simple as setting up 3 different toys while your infant is in tummy time - one directly in front of them, one to the left, and one to the right - all slightly out of arm’s reach. This will encourage them to turn their head, reach, and potentially move in different directions which will work towards primitive reflex integration (do you remember which reflex is activated with head turns?!).

Also try this - fill several large ziplock bags with different materials. Try feathers, glitter water, shaving cream, gel, and tissue paper. Grab some painter’s tape and tape these large bags on the floor, in a semicircle (place the tape along the 4 edges of the bags so they are flat on the floor). Place your infant in tummy time within the semicircle and engage them in touching and reaching for the different bags!

Tunnel play

As your infant begins attempting to crawl forward - maybe they are just starting to army crawl or push themselves forward, or maybe they are already up and crawling - set up tunnels for some fun crawling opportunities. You can purchase a pop-up tunnel or create your own, using chairs and blankets! Place preferred toys on either end of the tunnels to encourage crawling / moving through! If your child is already walking, make the tunnel small enough that they HAVE to crawl through!

Obstacle courses

Obstacle courses are typically used in occupational therapy to help children learn motor planning skills (among others). However, you can set up simple 1-2 step obstacle courses for your infant! This can include pivot play activities or tunnel play activities as previously mentioned. However, as your child ages and begins crawling and walking, you can then begin to set up more complex obstacle courses to move through!

Use items you already have to complete obstacle courses - chairs and blankets for tunnels, pillows for hopping paths, couch cushions for crawling over or jumping on, rolled up blankets for balance beams, etc. Incorporate a simple cause-and-effect toy, such as a shape sorter. Place one shape at the end of the tunnel or the end of the cushions and the sorter on the other side. Help your child move through the obstacle course to grab the shape, then back to place the shape in the sorter!

At this young of an age, you can expect your child to move through a simple obstacle course one, maybe two times at first! The more you do this, the more they will engage and learn how to sequence and motor plan the course! Additionally, with all of the crawling and jumping and balancing, you’ll also be providing them with the necessary movements to promote primitive reflex integration!

For a more in-depth discussion on primitive reflex integration, check out our Primitive Reflex digital course

Final thoughts on newborn reflexes

Primitive reflexes are vital for newborn survival and development. They are a key factor in hitting developmental milestones and higher level skills in the future. Primitive reflexes are necessary for newborn survival, and abnormal reflexes can be a sign of central nervous system dysfunction (NCBI). As your infant is developing, if you notice signs of abnormal primitive reflexes or you’re concerned that a reflex has not integrated correctly, chat with your pediatrician and ask for an occupational therapy evaluation.

Check out our YouTube video about Primitive Reflex Integration in Infancy

Check out our video about the Rooting Reflex

Jessica Hill, COTA/L
Jessica Hill, COTA/L

Jessica Hill, COTA/L, CPRCS is Harkla's in-house Certified Occupational Therapy Assistant (COTA) and Certified Primitive Reflex Clinical Specialist. She has been working with children for over 6 years in outpatient settings. Jessica specializes in creating easy-to-digest, actionable content that families can use to help their child's progress at home. Jessica is the in-house expert, content creator, and one of the podcast hosts at Harkla! To learn more about Jessica, visit the Harkla About Us Page. Make sure to listen to her weekly podcast, All Things Sensory by Harkla for actionable, fun advice on child development.

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