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The Importance of Integrating Primitive Reflexes

Primitive or Infant Reflexes are automatic movements that are essential for the development of head control, muscle tone, sensory integration, and overall growth development of the baby. Primitive reflexes become integrated by the central nervous system during the first few months of life. Integrated means they no longer occur involuntarily.

Incomplete integration of primitive reflexes may be a contributing cause of ADD/ADHD, autism, learning challenges, developmental delay, sensory integration disorders, vision and hearing disorders, extreme shyness, behavioral challenges, or lack of confidence.

Primitive reflexes are important as they help develop the brain, which is crucial for learning, behavior, communication, and emotions. Primitive reflexes are the basis of our nervous system and our ability to move. They originate in the brain stem; which is responsible for survival. Non-integrated reflex can lead to speech and language delays, fine and gross motor delays, concentration issues, poor bladder control, breathing difficulties, low muscle tone, muscle weakness, poor endurance, difficulty with balance/coordination, and fatigue.

Possible Causes of Retained Reflexes:

  • Decreased tummy time in infancy

  • Short period or lack crawling

  • Chronic ear infections

  • Head Injuries

  • Vertebral Trauma

  • Exposure to Toxins

  • Traumatic Birth or C-Section

The Most Common Primitive Reflexes:

1) Moro Reflex: This is also known as the infant startle reflex. The purpose of this reflex is the fight or flight response. This reflex appears at birth and should be integrated by 4 months of age. This reflex is triggered if your baby is startled by a loud noise or if their head falls backward.

Response: When the baby’s head is quickly dropped back, their arms open quickly as a response.

Signs of Possible Retention:

  • Poor balance/coordination

  • Poor digestion

  • Hypersensitivity

  • Dislikes loud sounds

  • Distractibility

  • Sensory overload

  • Emotional and social immaturity

Exercises to Integrate the Moro Reflex:

a) Sit on edge of exercise ball while therapist holds down the knees, have child lean back on the ball arms stretched out behind head while breathing in, then breathe out and sit up on ball while crossing arms in front of body and tuck chin. Then this therapist will make a loud clap and child immediately lies back on ball to repeat exercise. Repeat 5-6 times.

b) Bridge pose: Knees bent, hands together in prayer pose, bridge up and hold for 10 seconds, come back down to floor for 10 seconds and then repeat for a total of 5 repetitions.

2) ATNR (Asymmetric Tonic Neck Reflex): This reflex is very important to develop one-sided movements and crossing midline activities. This reflex is important for developing muscle tone and the vestibular system. Once this reflex is integrated, the baby begins to reach and have functional ability within the midline of their body. This reflex develops at birth and is integrated by 6 months.

Response: When the infant turns their head to one side, the arm and leg of that side automatically extends while the opposite side automatically flexes “fencers position”.

Signs of Possible Retention:

  • Poor eye-hand coordination

  • Difficulty with handwriting

  • Trouble crossing midline

  • Poor visual tracking for reading/writing

  • Dyslexia

  • Poor balance/ coordination

  • Poor sense of direction

  • Difficulty catching/throwing.

Assessing to see if ATNR is non-integrated: In a table top position, have the child close their eyes and gently passively turn their head in one direction, wait and then the other. Notice if the opposite elbow bends, even slightly. In standing, have the child put their arms straight out in front of them, close eyes, gently turn their head to one side, wait and then the other. Notice if the opposite arm goes down or if the arms follow the head turn.

Exercises to integrate the ATNR reflex:

a) Babies that are just over 7 months, have them lie on their belly and encourage them to reach for toys held in planes; crossing midline

b) With older children, perform one handed push ups on the wall (standing sideways to the wall) with one hand on the wall and the other on their hip as the child faces away from the wall

c) Arms straight out in front, turn head to the left side and march in place keeping arms straight for 20 reps and then repeat to the other side.

d) Lizard Exercise (same side): First turn head to the left, then bend left arm, then bend left leg. The right limbs are straight. Slowly press palm into floor and slide down left arm to your side and straighten left leg, which should stimulate the turn of the head to the right side. Bend right arm and right leg.

Cross lateral (opposite side): This time the opposite leg is bent when head is turned to the right. When the palm is pressed and the arm straightens, the opposite leg will straighten. Turn head to the left while bending the right arm and leg.

3) Symmetrical Tonic Neck Reflex (STNR): This is not a primitive reflex in the same way as the others in that it is not present before or at birth. This reflex is an important developmental stage that transitions the baby from lying on the floor up to being able to crawl. In this stage, movement of the head is automatically linked to movement of the arms and legs. This reflex appears at 6-9 months and integrates by 11 months.

Response: When head is in flexion, arms are flexed and legs are extended; when head is in extension, arms are extended and legs are flexed.

Signs of Possible Retention:

  • Poor/slouched posture or falling out of their chair

  • Headaches

  • W-sitting

  • Difficulty sitting still

  • Difficulty reading/writing

  • Visual tracking challenges

  • Difficulty to stay on task

  • Poor muscle tone

  • Poor eye-hand coordination

Exercises to Integrate the STNR:

a) Stretching Cat: Start on hands and knees, sit back on heels slowly with arms straight out and forehead closely touching the floor. With arms straight, move back to starting position while inhaling. Pause for 5 seconds and then repeat for 10-20 repetitions daily.

4) Tonic Labyrinthine Reflex (TLR): This reflex helps a baby learn about gravity and mastering neck and head control. This reflex is important for balance, muscle tone, and proprioception. This reflex is the basis for head management and postural stability with the rest of the body. It appears in utero and should be integrated by 3.5 years old.

Response: Tilting the babies head back while lying on their back causes the back to arch backwards, legs straighten, toes point and arms bend at the elbow and wrists.

Signs of Possible Retention:

  • Poor posture

  • Fatigue

  • Poor muscle tone

  • Difficulty judging distance/depth/space

  • Poor body awareness

  • Speech difficulties

  • Stiff jerky movements

  • Toe walking

  • Difficulty walking up/down stairs

  • Spatial orientation issues

If moro reflex is non-integrated, most likely TLR will be non-integrated as well.

Exercises to integrate the TLR:

a) Lie on back, with knees bent and arms down by side. Then cross arms across chest, come sit up and lift legs up off floor and hold for 15 seconds. Repeat two times.

b) Superman Exercise: Lift arms, chest, and legs off the mat for 15 seconds and repeat two times.

5) The Spinal Galant Reflex: This reflex assists the baby with the birth process. This reflex appears at birth and integrates by 9 months.

Response: This reflex is elicited by touching the sides of the child’s spine to cause the child to rotate their hip to the side that has been touched.

Signs of Possible Retention:

  • Postural issues on one or both sides

  • Fidgeting

  • Bedwetting

  • Poor concentration

  • Poor short term memory

  • Difficulty sitting still

Exercises to integrate the spinal galant reflex:

a) Snow Angel Exercise: Lie on back with arms by side, then open legs and arms and then close very slowly until legs are wide apart and hands touch at the top. Repeat for 5 cycles daily.

6) Fear Paralysis Reflex (FPR): Also known as the withdrawal reflex, is the key to all other reflexes. This is the first reflex to emerge. It develops early in uteri and is integrated by weeks 9-12 in the first trimester.

Response: Illicit a loud sound, bad odor, a shock to the child’s body and observe for screaming, hitting or leaving the scene.

Signs of Possible Retention:

  • Hypersensitivity to touch/sound

  • Dislike of change

  • Chronic phobias

  • Poor adaptability

  • Fatigue

  • Fear or social embarrassment, or insecurity

  • Avoids contact

Exercises to integrate fear paralysis reflex:

a) Child should lay on their back with their arms crossed on their legs and their legs lifted towards their stomach. While playing relaxing/ calming music, have the child perform 10 deep breathes (in and out) and then take a break. Repeat for about 3-5 minutes.

7) Rooting Reflex: This reflex is the babies automatic response to turn towards food. It appears at birth and should be integrated by 3-4 months of age.

Response: touching or gently stroking the corner of a child’s mouth. If the child reflexively turns their head in the direction of your hand and begins to “root”, this reflex may not be integrated yet.

Signs of Possible Retention:

  • Fussy with eating

  • Picky eater

  • Thumb sucking

  • Speech problems

  • Drooling

  • Hypersensitive when face is touched

Exercises to integrate the rooting reflex:

a) Stroke face in horizontal direction from ear to mouth with light pressure. Make 3 consecutive strokes, each a 1/2 inch lower than the previous stroke.

b) Stroke face in a vertical direction from nose to chin with light pressure. Make 3 consecutive strokes, each a 1/2 inch lower than the previous stroke.

Above picture is demonstrating Exercise B

8) Suck Reflex: This reflex appears in utero and integrates by 4 months of age. This works on conjunction with the rooting reflex to feed and get nourishment.

Response: By placing a clean finger, pacifier, or nipple/bottle in the child’s mouth they will place their lips around object and begin sucking.

Signs of Possible Retention:

  • Thumb sucking

  • Difficulty chewing

  • Articulation delays

  • Poor dexterity

  • Difficulty swallowing

Exercises to help integrate the sucking reflex:

a) Instruct child to voluntarily suck on either an object (lollipop, pacifier or clean finger etc) vigorously and swallow in unison for about 30 seconds straight. Repeat this activity 2-3 times a day.

9) Landau Reflex: This reflex assists with posture development. It appears around 4-5 months and integrates by 24 months of age.

Response: elicited by supporting the child horizontally in the air while in a prone (stomach towards the floor) position. If present, the child will raise head and arch his back upwards.

Signs of Possible Retention:

  • Clumsy

  • Difficulty with movement exercises (jumping, skipping, hopping, etc)

  • Poor concentration

  • Toe Walking

  • Knees extend slightly backwards

Exercises to help integrate the landau reflex:

a) Instruct the child to lift their upper body and arms off the floor while keeping their feet on the ground. Hold that position for 15 seconds and repeat 10 times. This should be performed 1x per day.

10) Palmar Reflex: This reflex is automatic grabbing of fingers to a touch at the palm. This reflex appears at birth and should be integrated by 5-6 months of age.

Response: When applying pressure or touching a child’s palm, they will instantly close their fingers with a tight grasp.

Signs of Possible Retention:

  • Handwriting

  • Poor pencil grip

  • Sensitive palms

  • Tactile Sensitivities

  • Poor dexterity

  • Articulation challenges

Exercises to help integrate the palmar reflex: Have the child hold their hands open and out with straight, flat palms. Brush with a pencil along the crease between their index and thumb finger and the across their palm towards their wrist. Perform this three to four times to both hands, 2-3 times per day. Watch for any finger or elbow twitching.

11) Plantar Reflex: This reflex is when you place your thumb below the infant toes and their toes will curl around your thumb/finger. This reflex appears at birth and is integrated by 9 months.

Response: When thumb is pressed below the child’s toes their toes will curl around your thumb or fingers.

Signs of Possible Retention:

  • Toe Walking

  • Motor planning problems

  • Difficulty balancing

  • Walking in an uncoordinated way

Exercises to integrate the plantar reflex: apply pressure with your thumb to the center of the child's foot for 10-15 seconds. Perform this on both feet about 3-4 times.

12) Babinski Reflex: This reflex develops during the first month after birth and is integrated by 24 months of age. A non-integrated babinski reflex at 2 years of age and above can be a sign of a brain or nervous system disorder (Lou Gehrigs disease (ALS), brain tumor, meningitis, multiple sclerosis, spinal cord injury, or stroke).

Response: Stimulation to the lateral side of the of the foot with a normal response will present with flexion of the toes downward. A positive Babinski reflex will present as fanning of the toes upwards when presented with a stimulus to the lateral side of the foot.

Signs of Possible Retention:

  • Poor balance/coordination

  • Weak hand/eye coordination

  • Sensory Sensitivities

  • Toe Walking

  • Visual Tracking challenges

Exercises to help integrate the Babinski reflex: Instruct the child to lay down a flat surface and prop their foot on an inclined surface so that their toes are positioned upwards toward the ceiling. You may utilize the end of a pencil or the smooth side of a feeding utensil to draw a line from the outermost portion of the heel to the big toe. Perform this on both feet about 10 times.

13) Amphibian Reflex: This reflex develops between 4-6 months of age. This reflex must develop before a child starts crawling. This reflex helps a child bend their legs and get up on hands and knees. If this reflex fails to develop it means that the spinal galant, TLR and possibly the ATNR have not been integrated. This reflex is essential for rolling, crawling, and marching in place. It allows you to make cross pattern movements.

Response: When stroking a line down the child’s back the child should lift up one side of their body while bending one of their legs on the same side.

Signs of Possible Retention:

  • Delayed crawling/ creeping

  • Poor muscle coordination

  • Clumsiness

Exercises to help integrate the amphibian reflex:

a) Cat Arches: Instruct child to assume quadruped position on their hands and knees. First, the child will curl their head under and hold for 10 seconds and then they will lift their head up and look straight ahead for 10 seconds. Continue this activity about 10 times in both positions.


The content in this blog should not be used in place of medical advice/treatment and is solely for informational purposes. All activities/exercises posted in this blog should be performed with adult supervision, caution, and at your own risk. Big Leaps, LLC is not responsible for any injury while performing an activity/exercise that has been posted on this blog. If you have any information on the content of our blog, feel free to contact us at


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