The Ultimate Guide to Retained Primitive Reflexes
What are Primitive Reflexes

What Are Primitive Reflexes?

By Jessica Hill, COTA/L, CPRCS   |   Reviewed by Rachel Harrington, COTA/L, AC, CPRCS  | Updated on June 22nd, 2023


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.


In this article, we'll cover common primitive reflexes, as well as address retained primitive reflexes.


If you are familiar with primitive reflexes but ready to learn more, then you’re in the right place! As Certified Primitive Reflex Clinical Specialists, we're excited to help you understand primitive reflexes, as well as learn how to integrate retained primitive reflexes. 

Prefer to listen to your content? Check out our podcast episodes where we cover these primitive reflexes in depth!

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Join Harkla's COTA's to learn:

  • What Primitive Reflexes Are
  • Why Integration is Vital for Success
  • How to Identify Retained Primitive Reflexes
  • Next Steps in Your Primitive Reflex Journey


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 - 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 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. 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 Are Retained Primitive Reflexes?

If a primitive reflex is retained - that is, still present - after 12 months of age, challenges may arise. Each primitive reflex comes with its own set of movements and leads to new and different developmental milestones. If a specific reflex is retained, it may affect a specific area of development.


Additionally, many reflexes are directly related to another. Therefore, if one reflex is retained, we can assume that others will be retained.


A study from 2016 found that “Retained primitive reflexes can disturb natural development and involve difficulties in social, educational, and psychomotor development.”


Typical childhood activities such as: playing with peers, running and jumping, learning to read and write, self-care tasks, and many more can be impacted by retained primitive reflexes.


As Certified Primitive Reflex Clinical Specialists, we are trained to test for, assess, and then integrate retained primitive reflexes with clients. We cover more below about assessing retained primitive reflexes, as well as next steps.


How Prevalent Are Retained Primitive Reflexes?

There aren't any massive studies conducted like there are for Autism or ADHD, but there are number of smaller studies we can look at to see how many children may have retained primitive reflexes.


While these numbers may seem high, we believe they are accurate based on our work in the clinic. Once you start testing for retained primitive reflexes, you realize they are way more prevalent than you'd ever expect.


Also, it's important to note that retained primitive reflexes work more on a spectrum. You can have partially integrated primitive reflexes. When testing for retained primitive reflexes, we use a scale of 0 to 4, with 0 being the most integrated and 4 being the most retained.


This one study looked at 21 children in the same pre-school classroom and found that only one child had no signs of retained primitive reflexes. 29% of the students scored a 1 or 2 on the scale, while 50% of the students scored a 3 or 4.


Here are the most prevalent retained primitive reflexes they found:


  • TLR - 95% of subjects
  • ATNR - 86% of subjects
  • Left ATNR - 81% of subjects
  • STNR - 67% of subjects


Another study of similar size involving 35 healthy students of ages 4 to 6 found that 89% of students had at least one retained primitive reflex.


This study was slightly larger, involving 53 students of ages 5 to 7 "found that 100% of the participants had at least one active reflex, with the most common retained reflexes being STNR, ATNR R, and ATNR L."


What was also interesting about this study was they broke down some of the results by gender, and "found statistically significant and moderately strong correlations between ATNR retention and poorer performance in multiple areas of scholastic performance among males. Mixed and inconsistent results were found among females and by grade."


There is not an explanation for why there would be gender differences in retained primitive reflexes, and obviously with only one study of 53 participants, we'd need a lot more research to draw strong conclusions for this.


What Causes Retained Primitive Reflexes?

Not a lot of definitive research has been done to determine exactly why primitive reflexes may be retained. However, there have been some potential factors identified:


  • Trauma during pregnancy
  • Trauma during and/or after birth
  • Exposure to toxins, drugs, tobacco in utero
  • Stroke in utero
  • Caesarean section delivery
  • Premature birth
  • Prolonged jaundice
  • Problems with feeding within the first 6 months of life
  • Developmental motor delays
  • Minimal floor time as an infant

Again, this is not an exhaustive list, but simply some potential factors that have been identified in correlation with retained primitive reflexes. These factors, however, are not a guarantee that a child’s primitive reflexes will be retained.


Oftentimes when a parent begins learning about primitive reflexes, they may feel guilty - like they somehow caused their child’s reflexes to stick around longer than necessary, thus causing challenges as their child ages.

Please do not feel guilty! Retained primitive reflexes are no one’s fault! Yes, there are things we can do during our child’s early years to help promote primitive reflex integration, but there is no “one size fits all,” there is no “cure,” and there is no blame to be had.


What Are The Symptoms Of Retained Primitive Reflexes?

Use this quick symptom checker to identify if your child may have retained primitive reflexes.


Please note, this is not a symptom checker to diagnose. This is simply to assess whether your child may or may not have one or more retained primitive reflexes.


Symptoms:

  • Anxiety
  • Motion sickness/car sickness
  • Clumsy
  • Poor hand-eye coordination
  • Poor right / left discrimination after the age of 8
  • Challenges with reading at age level
  • Poor handwriting at age level
  • Low muscle tone

  • Picky eating and/or oral motor challenges
  • Challenges with fine motor tasks at age level
  • Diagnosis of Autism
  • Early Diagnosis of ADHD

If you checked off half or more of the above items, your child may have one or more retained primitive reflexes.


When Retained Primitive Reflexes are assessed, then worked on to integrate, symptoms associated with them may go away all together!


One study from 2020 focused on integrating retained primitive reflexes in 2,175 students with ADHD over a 12 week period. Along with a decrease in the retained primitive reflexes, the students saw:


  • Increase on Cognitive Measures
  • Increase on Motor Skill Tests
  • Increase in Listening Comprehension
  • Increase on Mathematical Problem Solving

As you can see, integrating retained primitive reflexes can have major school and life improvements for children!


Want an Engaging Way to Learn About Primitive Reflexes?

Join Harkla's in-house Occupational Therapy Assistants for a free hour-long webinar that covers will get you quickly up to speed on the basics of primitive reflexes.


Click the button below learn more!

What's Next If Your Child Might Have Retained Primitive Reflexes?

So what do you do if you suspect that your child may have retained primitive reflexes?


First, remember that there is NOTHING wrong with your child! This may just be something that they struggle with and your job is to help them as they grow.


Next, keep reading! We are about to dive into the main eight primitive reflexes that are addressed in occupational therapy and give you some simple ideas that you can use to help your child.


Then, if you are ready to help your child even further, seek out a trained Occupational Therapist in your area who can test your child’s primitive reflexes and guide you with primitive reflex integration!

Assessing For Retained Primitive Reflexes


8 Retained Primitive Reflexes Seen In Children 

Occupational Therapists (OT), and other professionals such as Physical Therapists and pediatric chiropractors, are often the go-to when learning about and integrating primitive reflexes. Typically, this is due to the broad range of areas that OTs address.


Specifically, when working with children, OTs address self-care tasks, social skills, motor development, sensory integration, and more. All of these areas can be affected by retained primitive reflexes.


The eight primitive reflexes that are most commonly addressed in Occupational Therapy are:

1) Moro Reflex
2) Tonic Labyrinthine Reflex (TLR)
3) Landaue Reflex
4) Palmar Grasp Reflex
5) The Rooting Reflex
6) Asymmetrical Tonic Neck Reflex (ATNR)
7) Spinal Galant 
8) Symmetrical Tonic Neck Reflex (STNR)

1) The Moro Reflex

The Moro Reflex is present at birth - it is an involuntary movement in response to sudden stimuli. A report from 2020 reported that the Moro Reflex can be seen as early as 25 weeks postconceptional age and usually is present by 30 weeks postconceptional age. You’ve heard of the startle reflex, right? That’s the Moro Reflex!


The Moro Reflex should be integrated - not present - by six months after birth, at the latest.


Some potential symptoms of a retained Moro Reflex in older children are:

Want To Dive Deeper On The Moro Reflex?

We have a deep dive article and podcast on the Moro Reflex, which you can see by clicking the button below!

2) Tonic Labyrinthine Reflex (TLR)

The TLR is closely linked to the Moro Reflex and is seen with movement of the head forwards or backwards - providing a method of response to gravity (an infant experiences gravity for the first time after birth, so this reflex is a direct response to this newfound challenge). The TLR develops in utero and has a direct influence on the development of muscle tone throughout the body.


The TLR should be integrated - not present - by as late as 3 years old. However, it can be integrated as early as six months (note, this is the approximate age when the Moro Reflex should be integrated - quite the connection!).


Some potential symptoms of a retained TLR in toddlers and older children are:

  • Challenges with crawling
  • Poor posture, low muscle tone
  • Vision challenges
  • Auditory processing challenges
  • Poor sense of space, time, and organization
  • Challenges with sports

Want To Dive Deeper On The Tonic Labyrinthine Reflex?

We have a deep dive article and podcast on the Tonic Labyrinthine Reflex, which you can see by clicking the button below!

3) The Landaue 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 4-6 months of age. This reflex is often noted as the 'swimming' reflex, as the baby often has all 4 extremities off the floor, held against gravity, when laying on their stomach. The Landau Reflex contributes to vestibular processing, ocular motor skills, and postural control.


The Landau Reflex emerges after birth around 4-6 months as TLR forward (flexion) is integrating.


The Landau Reflex should be fully integrated by the age of 3 years.

Some potential symptoms of a retained Landau Reflex in toddlers and older children are:

  • Poor posture and muscle tone
  • Delayed motor development
  • Rotated pelvis
  • Often skips crawling in infancy
  • Poor coordination for activities that require upper and lower body coordinated movements, such as somersaults

Want To Dive Deeper On The Landau Reflex?

We have a YouTube video we created that covers the Landau Reflex you can learn more with.

4) Palmar Grasp Reflex

The Palmar Grasp Reflex is an involuntary response to stimuli on the palm of the hand. This assists a newborn with grasping objects before they actually do so on purpose. A report from 2020 also found that this reflex can help create interaction and bond between the infant and the adult. The Palmar Grasp Reflex develops roughly between 11-16 weeks in utero.


The Palmar Grasp Reflex should be integrated - not present - by no later than six months of age - the age when an infant begins to intentionally grasp objects.


Some potential symptoms of a retained Palmar Grasp Reflex in older children are:

  • Delayed fine motor skills - poor grasp on objects
  • Challenges with handwriting
  • Challenges with self-care such as self-feeding and dressing
  • Potential challenges with speech
  • Tactile hypersensitivity

Want To Dive Deeper On The Palmer Grasp Reflex?

We have a deep dive article and podcast on the Palmer Grasp Reflex, which you can see by clicking the button below!

5) The Rooting Reflex

The Rooting Reflex is essential for survival and growth, as it assists the newborn in finding food and initiating feeding. 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). It has been stated that the Rooting Reflex is strongest at birth, specifically within the first few hours. If the baby does not receive gratification for 'rooting' or go through the motion of rooting to find the breast, the reflex will weaken.


Connected to the Rooting Reflex is the Suck Reflex:


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. Because of the connection between the Rooting Reflex and the Sucking Reflex, if one is significantly retained, it's likely that the other will also be retained.


The Rooting Reflex is developed in utero. It appears at approximately 28 weeks gestation. The Rooting Reflex should be integrated by no later than six months of age/after birth.


Some potential symptoms of a retained Rooting Reflex in older children are:

  • Anterior tongue tie
  • Thumb sucking
  • Hypersensitivity of oral cavities
  • Drooling / dribbling beyond a normal age
  • Feeding challenges
  • Speech and articulation delays / challenges
  • Chewing and swallowing deficits

Want To Dive Deeper On The Asymmetrical Tonic Neck Reflex?

We have a deep dive article and podcast on the Asymmetrical Tonic Neck Reflex, which you can see by clicking the button below!

6) Asymmetrical Tonic Neck Reflex (ATNR)

The ATNR has been associated with assisting during the birthing process as well as it also facilitates the kicks felt in utero. Movement of the head to one side causes movement of the arms and legs and therefore helps to build muscle tone, skills on each side of the body, and hand-eye coordination. The ATNR develops at around 18 weeks in utero.


The ATNR should be integrated - not present - by no later than nine months of age.


Some potential symptoms of a retained ATNR in toddlers and children are:

  • Challenges with crawling
  • Poor handwriting
  • Challenges with visual tracking
  • Poor establishment of hand dominance after age 7
  • Consistent left / right confusion after age 8
  • Challenges with age-appropriate gross motor skills such as skipping

Want To Dive Deeper On The Asymmetrical Tonic Neck Reflex?

We have a deep dive article and podcast on the Asymmetrical Tonic Neck Reflex, which you can see by clicking the button below!

7) Symmetrical Tonic Neck Reflex (STNR)

The STNR is directly related to the TLR - because the STNR assists the infant with moving from prone (laying on belly) into quad (on all 4s - pre crawling position), it additionally assists with integrating the TLR. According to a report from 2020, the STNR develops between 6-9 months after birth.


The STNR should be integrated - not present - by 9-11 months of age (a very short life span compared to some of the other Primitive Reflexes).


Some potential symptoms of a retained STNR in toddlers and children are:

  • Challenges with crawling
  • Poor posture, low muscle tone
  • W-sitting
  • Clumsiness
  • Poor sustained attention
  • Challenges with reading and writing

Want To Dive Deeper On The Symmetrical Tonic Neck Reflex?

We have a deep dive article and podcast on the Symmetrical Tonic Neck Reflex, which you can see by clicking the button below!

8) Spinal Galant Reflex

The Spinal Galant Reflex is associated with assisting during a vaginal birth, along with the ATNR, according to one research study. In infants, stimuli provided to the lower back will produce movement of the spine and hip away from the stimuli. Therefore during the birthing process, contractions stimulate this reflex to help the baby move through the birth canal. The Spinal Galant Reflex develops around 20 weeks in utero.


The Spinal Galant Reflex should be integrated - not present - by around six months of age.


Some potential symptoms with a retained Spinal Galant Reflex in infants and children are:

  • Challenges with developmental milestones such as rolling
  • Challenges with natural gain - can have an effect on developing scoliosis
  • Challenges with focus, attention, and sitting still (ADHD symptoms)
  • Bedwetting beyond the age of 5 or 6 years
  • Tactile hypersensitivity, specifically with clothing

Want To Dive Deeper On The Spinal Galant Reflex?

We have a deep dive article and podcast on the Spinal Galant Reflex, which you can see by clicking the button below!


Want an Engaging Way to Learn About Primitive Reflexes?

Join Harkla's in-house Occupational Therapy Assistants for a free hour-long webinar that covers will get you quickly up to speed on the basics of primitive reflexes.


Click the button below learn more!

Activities That Could Help Your Child

Now that you know a little more about the 8 Primitive Reflexes that are typically addressed in Occupational Therapy, let’s dive into a few ideas that you can use right away!


Multi-Sensory activities can help integrate retained primitive reflexes. We highly recommend working directly with an Occupational Therapist, but we do run through some multi-sensory activities in this podcast episode.


If you want even more ideas, we have a 30 Day Multi-Sensory Activity Course. You get a video of a multi-sensory activity each day to try out.


We also have activities directly for Retained Primitive Reflexes in our Retained Primitive Reflexes Digital Course.


1. Climbing activities - rock walls, climbing gyms, etc.
This will not only help to strengthen your child’s muscles, but it also requires coordination of the arms and legs, as well as the left and right sides of the body.

2. Ball games - rolling, throwing, bouncing, etc.
If your child struggles with ball games, use a larger ball and try rolling the ball instead of throwing.

Ball games are great for improving visual tracking, hand-eye coordination, and bilateral integration (using both hands together for a task).

3. Superman exercise
This exercise is specific for the TLR and Landau Reflex.

laying on your stomach, lift both arms and legs up off the ground simultaneously, maintaining them straight. Hold this position for as long as possible. If this is extremely challenging, try turning it into a game!

4. Crawling activities - crawling through tunnels, over obstacles, animal walks, etc.
Because retained Primitive Reflexes can have such a profound effect on crawling, incorporating more crawling into your child’s day can be very beneficial (even if your child is older!).

5. Cat-Cow exercise
If you’re familiar with yoga, you may already know this exercise. This exercise is specifically for the STNR.

On all 4s, slowly bend your neck to look down at your knees while simultaneously arching your back up.

Then, slowly bend your neck to look up at the ceiling while simultaneously arching your back down.

Complete slowly and with good control. If your child has retained Primitive Reflexes, you may notice extra movements throughout the arms, legs, and trunk.

6. Obstacle courses
If you’re familiar with OT, you may already be familiar with obstacle courses. These are great opportunities to provide movement, incorporate bilateral integration activities, crawling and climbing, etc.

Setting up an obstacle course is easier than it sounds - keep it simple!

Example obstacle course:
Step 1: Log roll across 3 couch cushions
Step 2: Crawl through a tunnel
Step 3: Bounce and catch a ball 5 times
Step 4: Complete a Superman 2 times
Step 5: Bear walk back to the beginning

You can make the steps more complex for an older, higher functioning child. You can also incorporate other sensory systems and fine motor skills. Get creative!


Final Thoughts

We are all born with primitive reflexes and they should, ideally, naturally integrate in order to promote higher level learning and motor development. Sometimes, they don’t. And this can potentially cause problems for children.


If you suspect that your child may have retained primitive reflexes, use the ideas provided here. Additionally, talk with your pediatrician and seek out an Occupational Therapist who is trained in primitive reflex integration. Advocate for your child’s development! It may not be easy, but it will be worth it.


Be sure to check out our Primitive Reflex Integration Training on Harkla!


JESSICA HILL, COTA/L  RACHEL HARRINGTON, COTA/L, AC

Rachel Harrington & Jessica Hill

COTA / L , AC, CPRCS  |  COTA/L, CPRCS

Rachel Harrington, COTA/L, AC and Jessica Hill, COTA/L both Certified Occupational Therapy Assistants (COTA). They are also both Certified Primitive Reflex Clinical Specialist.  They have been working with children for over 7 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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