What is the Palmar Grasp Reflex?

by Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC June 29, 2021

What is the Palmar Grasp Reflex?

The Palmar Grasp reflex is one of many infant primitive reflexes - an involuntary movement pattern that we are all born with. You know how infants basically have a death grip - they can grab your finger, your hair, your clothes - that’s the palmar reflex at work!

The Palmar reflex is elicited by pressure to the infant’s palm, resulting in the fingers closing around the object that provided pressure, as well as gripping or holding on - that death grip! Remember, this is an involuntary movement - it happens before the infant has control over his/her hands. One study from 2020 stated that,

“The palmar reflex probably serves to create a basic motor pattern that lays the foundation for obtaining this voluntary ability. Furthermore, this reflection creates interaction and bond between the infant and the adult.”

In infancy, the hands and the mouth are directly linked which means that the Palmar reflex is also activated when the infant is nursing/drinking from a bottle. You can see this connection as the infant sucks - the hands will reflexively clench in coordination with the sucking.

The Palmar reflex emerges at around 11 weeks in utero and should only remain active until 3-6 months of age. This is around the same time that the infant begins to gain control over his/her hands and intentionally begins reaching for objects.

How does the Palmar reflex integrate?

Although there is no one scientific method to ensure full primitive reflex integration, there are some things to take into consideration when discussing the integration of the Palmar reflex.

Sensory Play with baby

Let’s talk about sensory integration. By providing an infant with different types of sensory stimulation, new neural pathways will be developed in the brain, thus stimulating new movement and cognitive development. An article on sensory integration discussed that the engagement in sensorimotor activities promoted adaptive behaviors via neuroplastic changes - simply put, by experiencing different types of sensory activities, our brains can change and thus promote new behaviors.

So what types of sensory activities should you provide to your newborn infant? Keep it simple!

  • Natural movement is always a fantastic option - instead of carrying your newborn in a carrier or stroller, use a wrap to carry your newborn on your body in order to provide more natural movement.
  • Tummy time. We’ve all heard it over and over again - tummy time is a must! A systematic review from 2020 identified that tummy time was positively associated with gross motor and total development. But how do you start tummy time with a newborn? Simply laying your newborn on your chest, on their tummy, is a great place to start. Then incorporating tummy time into everyday, waking play will begin to establish a routine and improve tolerance in the long run.
  • Provide plenty of tactile stimulation to the hands, face, and feet. This can include gentle massage, helping your infant touch different textures within their environment, and completing messy play activities (with supervision, of course!).
  • A variety of sights, sounds, smells, and tactile experiences. The more variety and the more frequent, the better!

Because every newborn is different and every experience is different, there’s no one way to guarantee that the Palmar reflex will be successfully integrated by 3-6 months of age. However, by using the above strategies you can feel more confident that your baby is getting the sensory experiences necessary for potential primitive reflex integration.

What factors can contribute to an unintegrated Palmar reflex?

An article from the International Journal of Pediatrics stated that the palmar reflex may be retained longer, compared to “normal” infants, “in infants with spastic hemiplegia or quadriplegia, whereas it is very weak in infants with cerebral palsy (CP) of the athetoid type.”

Additionally, a study looking at the persistence of primitive reflexes and associated problems in children identified these potential factors for unintegrated primitive reflexes:

  • Stress during pregnancy
  • Substance abuse during pregnancy
  • Caesarean section birth
  • Brain damage during labor
  • Premature and low birth weight
  • Significant illness during the first year of life
  • Insufficient stimulation and tummy positioning
  • Lack of free movement time on the floor
  • Stressful environment
  • Not enough nourishment / insufficient weight gain
Additionally, if a child has successfully integrated their primitive reflexes, a sudden or chronic bout of trauma, stress, or injury can re-activate these reflexes.

While there is no guarantee for reflex integration, there are contributing factors to take into consideration if your child has an unintegrated Palmar reflex.

What an unintegrated Palmar reflex looks like

Symptoms related to an unintegrated Palmar reflex in older children are:

  • Challenges with fine motor tasks, including grasp on small objects, handwriting, self-feeding, and manipulation of clothing fasteners
  • Potential challenges with speech and articulation
  • Overflow into the mouth during fine motor tasks (sticking tongue out, etc. )
  • Tactile hypersensitivity - specifically to hands
  • Challenges with directionality (left vs right)
  • Dysgraphia

What can I do if my child has an unintegrated Palmar reflex?

If your child exhibits any of the above symptoms / challenges, the first step is going to be to talk with your pediatrician. Discuss your concerns - if your pediatrician is familiar with primitive reflex integration, they may already have a plan of action ready. If your pediatrician is unfamiliar with primitive reflex integration, feel free to share what you've learned! If you ever feel uncomfortable or that your concerns are being pushed to the side, don’t be afraid to seek out a new pediatrician.

Many Occupational Therapists (OT) are trained in primitive reflex integration techniques. Seek one out! Talk with friends and family members to see if they know anyone specific. Use Facebook groups and Instagram to find someone who has training. Physical Therapists (PT), cranio-sacral therapists, and chiropractors may also have knowledge of primitive reflex integration. It can take some time to locate the right professional, so don’t give up!

Meanwhile, there are some different exercises and play activities that you can incorporate into your child’s daily routine that can help promote the integration of the Palmar reflex.

For babies, decreasing the amount of waking time spent in containers is the best way to integrate the Palmar reflex. Specifically spending time each day in tummy time to provide tactile stimulation to the hands, face, and feet! Try placing your baby on different surfaces for tummy time: different textured blankets, grass, etc.

If your child is young, under 3 years old, focus on developing fine motor skills:

  • Provide opportunities to explore different textured and different sized objects - small objects to help with developing a pincer grasp but also larger objects to provide opportunity to successfully grasp.
  • Complete lots of container play tasks - placing toys into a container. Try shape sorting containers, coin banks, etc.
  • Crawling activities that require the whole hand to be placed on the ground, fingers splayed open. Regular crawling, bear walks, etc.
  • Climbing activities that require the use of the entire hand, such as rock climbing, holding onto bars, etc.
  • Sensory bins with different tactile mediums such as beans / rice, shaving cream, playdough, etc.

If your child is older, you can still focus on the same above activities, just make them more challenging! As well as try these activities:

  • Sequential finger touching - touch the tip of your thumb to the tip of each finger, tapping gently and making an O shape. Complete with both hands!
  • Try playing with Chinese Baoding Balls.
  • Crumple and uncrumple a piece of paper with one hand at a time.
  • Multisensory processing tasks using hands and mouth simultaneously (crawling while blowing a cotton ball along a path / to a target)

If your child is struggling with some of the signs / symptoms associated with an unintegrated Palmar reflex, try some of these strategies:

  • Challenges with speech and articulation:
    • Seek out a trained Speech-Language Pathologist.
    • Practice slowing down while speaking to form sounds more accurately and allow your child to watch your movements and imitate them.
    • Play sound games - make different sounds with your mouth and imitate them for each other.
  • Overflow into the mouth during fine motor tasks:
    • Chew gum or suck on hard candy during fine motor tasks to help dissociate the movements.
  • Tactile hypersensitivity:
    • Complete messy play activities as often as possible. Use different dry and wet tactile mediums such as rice or shaving cream, even try pureed food items.
      • Don’t force it. Model for your child and they will imitate you if you do it consistently and show how fun it can be.
      • Use preferred toys with the messy tactile medium - get the toys messy, then give them a bath!
  • Challenges with directionality (knowing left vs right after the age of 8 years):
    • Practice! Use real life activities to point in a specific direction, during walks outside, etc.
    • During handwriting or eating tasks when your child is using their dominant hand, identify it! See if they can identify your dominant hand.
    • Play Simon Says games to touch various body parts and using left / right instructions. For example, “touch your left ear with your right hand.”
    • We love this game, called Right Turn, Left Turn!
  • Dysgraphia:
    • Provide a visual model of what the child is supposed to write. This can help to decrease letter reversals.
    • Use highlighter to help with orientation of where to start writing and to assist with letter size.
    • Use a multi-sensory approach when practicing writing. Try using index finger of dominant hand to write letters in sand, shaving cream, etc.

One last note

As you continue on your path through primitive reflex integration, keep in mind that your child is unique and there's nothing wrong with them! Even if they have an unintegrated Palmar reflex and seem to be struggling more than other children, your job is simply to help guide them along the way and provide as much support as possible.

You and your child are doing the best you can with what you have so keep researching and keep trying new things until you find what works. Even then, keep searching because what works now might not work forever. Especially as your child grows and develops through different seasons of life!

 

Resources

All Things Sensory by Harkla Podcast

Be sure to check out our Primitive Reflexes digital course on Harkla.co!

Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC
Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC

Rachel Harrington, COTA/L, AC and Jessica Hill, COTA/L both Certified Occupational Therapy Assistants (COTA). They have been working with children for over 6 years in outpatient settings. Rachel and Jessica specialize in creating easy-to-digest, actionable content that families can use to help their child's progress at home. Rachel and Jessica are the in-house experts, content creators, and podcast hosts at Harkla! To learn more about Rachel and Jessica, visit the Harkla About Us Page. Make sure to listen to their weekly podcast, All Things Sensory by Harkla for actionable, fun advice on child development.


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