OT Month: Primitive Reflexes

We all have reflexes; fast, automatic movements our bodies make without us even thinking. Some reflexes stay with us for life, helping us stay safe and respond to the world around us. Others are meant only for infancy. They support early survival and movement, then fade as children gain more control of their bodies. When those early reflexes don’t integrate on schedule, they can influence how a child experiences their body and how they interact with their environment. These are known collectively as primitive reflexes.

What’s funny is that most parents (in non health-related fields) don’t even know what these are. Newborns have such weird movements when they are learning body control that you can get through the first six months without even realizing the reflexes at work.

FYI: This post has a lot of definitions and lists, so feel free to bookmark and save.

Primitive reflexes (aka neonatal/infant reflexes) are involuntary, brainstem‑driven movement patterns that newborns are born with. They are designed to support early survival by helping babies feed, orient to caregivers, and protect themselves. These involuntary responses are normal in infancy and gradually fade as the brain, especially the frontal lobes, matures and takes over with voluntary, controlled movement.

When integration happens on schedule, children build:

Postural control
Bilateral coordination
Hand–eye coordination
Sensory processing foundations
Emotional regulation pathways

When these reflexes do not integrate on time, the brain continues to rely on lower‑level motor patterns instead of more mature systems. This forces children to use extra mental energy just to manage basic movement, often keeping their nervous system in a fight‑or‑flight mode.

With so much energy going toward staying organized and feeling safe, there is less available for attention, learning, and fully engaging with their environment. Over time, this creates developmental “traffic jams” that can show up as behavioral challenges, attention difficulties, or motor delays — even in bright, motivated kids.

Ode to the Unintegrated

When primitive reflexes stay active, the body struggles to move parts independently, and even small movements can trigger automatic reactions. This creates confusion in the neuro‑sensory‑motor system and disrupts early motor, sensory, emotional, and learning foundations. Active reflexes can also cause muscle tension, weak tone, fatigue, and extra effort for everyday tasks.

Over time, children compensate without realizing it. This drains their energy because skills that should be automatic require constant conscious control. When reflexes don’t integrate on time, they can interfere with participation at home, at school, and in the community.

These retained reflexes can disrupt development across multiple domains, like:

Motor development – difficulties sitting upright during meals or in class; constantly fidgeting; relying on W-sitting or awkward positions to stabilize their body
Fine‑motor and academic skills – trouble with handwriting; difficulties with bilateral coordinated activities (cutting with scissors, shoe-tying); avoiding drawing/writing tasks
Sensory processing and modulation – overreaction to light, sound, or movement; clumsiness due to challenges in body/spatial awareness
Emotional and behavioral regulation – big reactions to small stressors; difficulty calming after being upset
Attention and learning – impulsivity or distractibility; fatigue during schoolwork; trouble copying from the board

The Usual Suspects

These are the primitive reflexes consistently highlighted as having the strongest impact on daily function when retained:

Moro reflex – often linked to emotional reactivity, sensory sensitivity, and fight‑or‑flight overactivation. Also known as the Startle Reflex.
Palmer grasp reflex – retention can affect grasp development, handwriting, utensil use, and fine‑motor control; persistent palmar grasp limits purposeful grasping and efficient hand use
ATNR (Asymmetrical Tonic Neck Reflex) – strongly associated with handwriting challenges, crossing midline, reading, and bilateral coordination
Spinal galant reflex – often associated to fidgeting, bedwetting, difficulty sitting still, and sensitivity to clothing at the waistline
STNR (Symmetrical Tonic Neck Reflex) – affects posture, sitting at a desk, copying from the board, and transitioning between positions
TLR (Tonic Labyrinthine Reflex) – influences balance, spatial awareness, gravitational security, and overall body organization

Reasons for Retainment

Primitive reflexes fail to integrate when something disrupts the combination of brain maturation, movement experiences, and sensory processing that normally helps them diminish. Anything that interferes with early brain development, sensory regulation, or opportunities for natural infant movement can delay this process and keep these reflexes active longer than expected.

Neurological immaturity. Factors such as prematurity, birth trauma, lack of oxygen at birth, early medical complications, and developmental delays all increase the likelihood that the brainstem remains “in charge” instead of handing off control to higher brain centers.
Limited movement opportunities in infancy. Not enough tummy time, too much time in containers like car seats or swings, delayed or skipped crawling, reduced floor play, or medical conditions that restrict movement can all interfere with integration. Because movement is the cue that tells the brain it’s ready to advance, too little of it can keep these reflexes active longer than they should be.
Sensory processing challenges. When a child’s sensory system is overwhelmed, under‑responsive, or inconsistent, the brain may maintain these reflexes as a protective strategy. This is often seen in children with sensory processing disorder, chronic stress, trauma histories, or highly sensitive nervous systems. The Moro reflex, in particular, is closely tied to fight‑or‑flight activation, making sensory instability even more impactful on reflex integration.
Developmental or neurological conditions. They can affect muscle tone, coordination, or communication between the brain and body. Conditions such as ADHD, autism, cerebral palsy, genetic disorders, and traumatic brain injury do not always lead to retained reflexes, but they do increase the likelihood by altering how the nervous system organizes movement and processes information.
Stress and emotional factors. These can keep the nervous system in a protective mode, making it harder for primitive reflexes to integrate. This can occur with prolonged medical procedures, early separation from caregivers, inconsistent caregiving, or trauma. In these situations, the nervous system prioritizes survival over development, which can delay the natural fading of reflexes.
Re–emergence after injury. After a concussion, brain injury, or neurological disease, early reflexes may return because higher brain centers are no longer fully inhibiting them. This reappearance is known as frontal release and reflects a loss of cortical control over automatic brainstem patterns.

What Parents Can Do

Parents can support reflex integration by giving kids slow, repeated, playful movement experiences that mimic early developmental patterns and strengthen brain–body connections. These activities don’t replace professional OT when needed, but they do give the nervous system the “second chance” that research describes for integrating retained reflexes.

Research shows that when children engage in reflex-pattern movements, the brain can re‑sequence developmental stages that were missed the first time. This supports motor, sensory, emotional, and visual‑perceptual development.

While these activities do support reflex integration, they also build self‑regulation, strength, coordination, and focus. So, feel free to incorporate them throughout your child’s day:

Crawl. Crawling is one of the most powerful, accessible ways to support integration because it recreates early developmental sequencing. Incorporate crawling whenever possible and have fun with it. Forward and backward crawling to retrieve an object rather walk, “silly crawls” with the head turned, and playful variations like tunnel play, obstacle courses, and animal walks all mimic reflex patterns. These kinds of movements strengthen brain–body connections and give kids the repeated motor experiences their nervous system needs to mature.
Break the pattern. Primitive reflexes fire in predictable, hard‑wired movement patterns. To integrate the active reflex, OTs will use movements that either follow the reflex’s natural pattern or gently do the opposite of what the reflex “wants” the body to do. That mismatch is what signals the brain: “This movement doesn’t need to be automatic anymore. I can take over.” By repeating these experiences, the cortex gradually learns to override the brainstem’s reflexive response. Over time, the brain becomes more efficient at choosing purposeful movement instead of defaulting to reflexive patterns. Movements like Superman the meatball/dead bug or starfish motions, all work because they recreate the same extension–flexion patterns reflexes use.
Slow and controlled movement. Slow, intentional, balanced movement is what helps the nervous system quiet reflexes and build more mature motor control. Gentle yoga poses or even just regular stretching gives the brain time to notice the movement, organize it, and take charge of it. This kind of pacing helps kids shift from reflexive, automatic reactions to more purposeful, coordinated movement.
Make it quick. Short “brain break” moments sprinkled throughout the day give kids the repetition their nervous system needs for reflex integration. Wall push‑ups, cross‑body tapping, chair push‑ups, and slow toe touches or reaching up are easy to fit into classroom or home routines. These quick, kid‑friendly activities also help improve focus, coordination, and overall readiness for learning.
Play like a baby. Activities that mirror early infancy give the brain an opportunity to move through the milestones that support reflex integration. Rolling games, rocking on hands and knees, tummy‑time variations while reading/writing, and simple pushing or pulling play all recreate the sensory‑motor experiences babies rely on in their first year. These kinds of movements help the nervous system revisit and strengthen the patterns reflexes are built on, making it easier for kids to develop more mature, coordinated control.
Support sensory regulation. Kids integrate reflexes best when their nervous system feels calm and organized enough to learn new motor patterns. Supportive strategies like deep pressure (through hugs, squeezes, or a weighted lap pad), predictable routines, and slow, steady breathing can help settle the body and reduce the fight‑or‑flight responses often linked to retained reflexes such as the Moro.

Keeping things playful and consistent makes the biggest difference. Progress comes from repetition over time, so short, fun movement moments woven into daily routines are far more effective than long, occasional sessions. When kids enjoy the activities and do them regularly, their brains get the steady practice they need to build more mature, coordinated movement patterns.

While these strategies certainly help, confirming whether a primitive reflex is truly retained is best done by an OT. Reflex testing is subtle, and many behaviors that look “reflexy” can come from sensory needs, posture, strength, vision, or attention—not the reflex itself. Parents play an important role by observing everyday challenges while an OT provides the formal assessment and guidance.

If your child has significant challenges with posture, coordination, emotional regulation, or school tasks, a pediatric OT can assess if it is a reflex, which reflexes are still present, and create a customized program to help.

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Sources:
Janine Wiskind: Primitive Reflexes Online Webinar
Retained Primitive Reflexes as a Sign of Brain Imbalance
yourtherapysource.com-Signs-of-Retained-Primitive-Reflexes-in-Everyday-Skills-FINAL.pdf