Immature reflexes
Immature reflexes are primitive reflexes which have not fully integrated and/or postural reflexes which have not established properly.
We are all born in a very immature, fragile and highly dependent state. The immaturity of our nervous system means that we have not yet developed sufficiently to move in a purposeful way, nor have we the strength in our muscles to support that movement. To ‘get us going’, we rely on a series of primitive reflexes which slowly appear, are ‘integrated’ or absorbed and then are gradually replaced by postural reflexes.
All reflex responses are involuntary and subconscious. Reflexes are triggered by something – a stimulus – and always result in the same response. Primitive and postural reflexes are motor reflexes – they produce movement such that when they are stimulated the same pattern of movement will occur.
In a newborn, primitive reflexes are of enormous benefit. Automatic reactions help the baby respond to its new surroundings and improve its ability to survive. Reflex movements also allow neonates to learn about their bodies and how the different parts operate. Slowly, muscles tone up and the primitive, early reflex patterns are replaced by desired movement.
Gradually too the postural reflexes develop. Postural reflexes, such as sticking your arm out when you fall to one side, remain present and active until late in life, when they may start to fade and become less reliable.
The full integration of primitive reflexes and establishment of postural reflexes takes about three and a half years. However, the nervous system may not be completed myelinated/’wired up’ until a child is eight years old. There is always individual discrepancy in the rate of maturation – for example some young children can appear to be far more physically ‘ahead’ of their peers but, later, that difference may be less marked.
Why immature reflexes matter
The effects of retained primitive reflexes and underdeveloped postural reflexes may manifest themselves in your child in a variety of ways: in the classroom or playground, in the way they behave, communicate and interact with family and friends. Or perhaps the effects are so subtle, – your child has learnt coping strategies to cover up an issue – but you believe something is not quite right.
All children, as they grow, display immature reflexes because their nervous system has not fully matured but, by the time they are seven or eight years old, their neurological development should be robust enough for there to be no sign of immature reflexes. It is when the signs persist beyond the age of seven or eight that neuro-developmental delay (NDD) or neuro-motor immaturity (NMI) is suspected.
Immature reflexes have been found in children with Specific Learning Difficulties (SpLD) and those with diagnoses such as dyslexia, dyspraxia, dyscalculia and ADHD. They have also been found in children with non-specific difficulties such as poor muscle control and coordination, with poor balance and sensory perception problems, inattentiveness, or behavioural issues such as frustration, hyperactivity or over-reaction to certain situations.
Every child has a right to achieve their full potential, in whatever field that might be. The presence of immature reflexes can compromise this potential and will leave the child underperforming, struggling physically and emotionally to keep up with their peers. The unmet academic expectations of both teacher and pupil lead to a frustrating situation for all.
There is also a group of underachievers who are harder to identify. They have not been picked up as having immature reflexes because their coping and conscious compensation strategies have masked their true physical development. These are bright children who are functioning at the ‘normal’ level for their peer group and meeting minimum standards but for whom this standard is personally too low. Only once their issues have been identified and corrected can they truly reach their full potential.
The specific effects of individual immature reflexes
You will find the following information on the Primitive Reflex and the Postural Reflex pages on this website. Here the effects of immaturity for each specific primitive reflex and the postural reflexes is reproduced from the pages above. Until you know exactly which immature reflexes your child has, if indeed this is the cause of their problems, then these lists need to be studied cautiously.
If you are reading this section before looking at the Primitive and Postural reflexes pages, then it is important to understand that all the primitive reflexes mentioned below are normal and desired in a neonate and child up to the age of about one year. Some primitive reflexes are survival reflexes; others help build normal voluntary movement in a child. The postural reflexes are protective and remain with us for life. They should be fully present by three and a half years of age.
It is the retention of primitive reflexes and/or the underdevelopment of postural reflexes which lead to an immature reflex profile. Not all children with this profile will have every immature reflex and they will probably not display every characteristic listed. These lists are added here to demonstrate the issues that have been seen and documented with each immature reflex.
These lists are daunting. You can see that there is over-lap in the signs for some reflexes and this is because they share a stimulus or trigger. Please remember that, if your child does have immature reflexes, he will know no different because his little body has always been like this. He may become aware, as he grows up, that he is slightly (or perhaps markedly) different from his peers. And if his issues are caused by immature reflexes, there is something that can be done for him.
The effects of retained primitive reflexes
The Moro reflex
A child with a retained Moro is likely to be hypersensitive to sensory input. By the time a child is of school age, all the primitive reflexes should be integrated and the postural reflexes present. This stage of neurological development indicates that the unconscious brainstem- triggered response to all sensory stimulation has been replaced by higher, cognitive responses. The Moro reflex is multisensory – it can be triggered by many or all of the senses – and because of this characteristic, where the Moro is retained, there can be profound motor and physiological effects in a child.
It is unlikely that a child with a retained Moro will be hypersensitive to all sensory stimulation but some may. To ‘protect’ himself from this overload, a child with a retained Moro will be constantly alert and on guard against his little body which can trip him into exaggerated reactions to certain stimuli.
Vestibular hypersensitivity may trigger responses such as motion sickness, intolerance of fairground rides, poor coordination particularly with hand/eye movements and balance insecurity (perhaps compounded by poor postural reflexes).
Hypersensitivity to touch can lead to a child who is startled by unexpected physical contact, tickling or close physical contact and ‘invasion’ of body space.
Visual hypersensitivity can lead to several issues; visual-perceptual problems such as stimulus bound effect (eyes being drawn to the edges of shapes, scenes, pictures to the detriment of understanding of the whole image), poor reaction to light (pupil responses) and tiring under florescent lighting, photosensitivity, immature eye movements and slow reaction to fast-approaching objects such as balls.
Hypersensitivity to auditory input may result in an inability to discriminate sounds or to closing out background noise. Distractibility may be profound due to auditory overload and this can lead to fatigue.
Physiological and emotional effects of a retained Moro in a child result from the constant fight/flight preparedness and, as he matures, the learnt anticipation of his body’s nasty reaction to much of life. As a result, a child may not match his peers in apparent maturity and might develop one of two coping strategies. He may be shy and fearful, poor at peer-group relationships and coping with affection and loathing of sport or he may be aggressive, excitable, unable to read the body language of his peers and be dominating. A child with a retained Moro hates change and is unable to be flexible or adaptable to situations, especially those over which he perceives he has no control.
The biochemical effects of a Moro leads to an over-production of the stress hormones, cortisol and adrenalin. This is a double hit because these hormones are designed to increase sensitivity and reactivity. Thus a Moro child is in a loop of over-reaction to stimuli and a hormonal state which is designed to heighten such a response. Also these hormones assist the body’s defence against infection and allergy but in a child with a retained Moro, there may be a lowering of the efficacy in the immune responses and so the child is more likely to suffer from allergies, to pick up every cold going at school and perhaps have food or additive sensitivities. His glucose metabolism may be fast, also resulting in sudden onset of fatigue and mood swings. All these effects compound an already challenged situation in both the classroom and the child’s academic performance.
The Tonic Labyrinthine Reflex (TLR)
There are two main effects of a retained TLR – a vestibular effect and that on tone.
The vestibular effects may present as motion sickness, poor balance, visual-perception problems (the ability to correctly interpret information received through sight), issues with spatial concepts (complex cognitive skills which allows a child, for example, to know: right from left, up/down, on/in, was from saw, how to fill a sheet of paper with information). Specific visual problems may include a lack of near-point convergence and figure-ground effect (the ability to work out which is the object and which the background). The child may also have poor sequencing skills and a poor concept of time.
The effects on tone are dependent on which TLR is retained. TLR in flexion or forwards may cause hypotonus – lower than normal tone which can manifest as weakness, poor posture and slumping. A retained TLR in extension may cause hypertonus/ increased tone and presents as the lack of smooth movement or toe-walking.
The Asymmetrical Tonic neck Reflex ( ATNR)
A child with a retained ATNR can present with one or more of several issues, most as a result of the interference caused to normal physical development and the subsequent effects on learning. An ATNR child is always being forced into the pattern of the ATNR, albeit in a slight and perhaps unobvious fashion, rather than being able to undertake voluntary movement desired. This can be frustrating for the child and compromises his full physical development.
The inability to roll over or commando crawl results because the retained ATNR prevents head rotation and flexion/bending on the same side. If you turn your head to the right, you need to be able to bend your right arm and leg to roll over to the right. Commando crawling requires the ability to have the right arm and left leg flexed/bent at the same time and then pushing through to extension/straightening of these limbs to propel oneself forwards. A retained ATNR may result in homologous movement instead – both arms are used together to pull the body forwards and the legs may just drag behind or are used together too. Crawling and creeping, important for cross-pattern development which enhances hand-eye coordination and integration of vestibular information, will be compromised with a retained ATNR.
Balance is affected – in standing a child will feel unstable and insecure unless his head is held still and in the midline. Turning his head will make his leg on the opposite, occipital side (the back of the head side) feel weak due to slight lowering of tone. In all other positions, the effect will be the same, although perhaps not so marked. When walking, the child’s gait may look strange especially if he swings his left arm forward with his left leg (rather than opposite arm and leg) in a homolateral/one sided pattern.
Difficulty crossing the midline causes a series of issues. A child needs to learn, through movement, that both sides of the body, the page, the pathway across the carpet of his car can be traversed through the midline. There may be difficulties in: manipulating an object with both hands and passing the object between hands which may not be learnt properly: writing is compromised, as is reading, because it is necessary for the hand to go to the other side of the page and for eyes to scan and track across a page in unison: cross-laterality or mixed laterality is a consequence – the child does not have a dominant side, so has to consciously think which hand to use rather than automatically using the dominant hand. Visual-perceptual difficulties, such a symmetrical presentation of figures or symbols on a page, may be seen.
Poor visual-motor integration – hand-eye coordination – can be marked in a child with a retained ATNR because, whilst the child may be able to cope with reading by compensating for eye movements alone, writing needs both hand and eye movements to be accurate and controlled. A child may quickly learn coping strategies for reading and writing; he may sit differently with his arm out straight; he may turn the paper or book to an angle which suits him better rather than having these usually aligned; his pen grip may be very tight or unusual to override the desire for his hand to open when the head is turned towards it.
Awkwardness or a slightly different way of moving in comparison to his peers may cause the ATNR child angst. His ball skills may be below par and he might appear clumsy when catching or kicking a ball. In the swimming pool, his backstroke will be fine (his head is kept in the midline) but his front crawl may only be half right – as he turns his head to breathe, the arm on that side will want to move away from his body, not go smoothly towards his ear in line with his body. If he has not developed dominance, he may be fractionally slower than his peers in various school situations while he has to actively choose between right or left. His motor planning skills – the desired intent from a movement – and the reaction of his body will be poorly matched because the ATNR kicks in following his turning/rotation of his head before he has time to think.
Cognitive effects may be seen. The subconscious effect required to override a retained ATNR is energy-sapping. A child with an ATNR may be very capable orally in the classroom but, when writing is required or under stress such as in an exam, he may well appear to ‘let himself down’ or perform below the level expected of him. The fluency required to think and write at the same time seems to be blocked. This is frustrating for all concerned but is a true effect of a retained ATNR and is not the child’s ‘fault’.
The Symmetrical Tonic Reflex ( STNR)
One of the more obvious signs of a retained STNR is seen in the posture, both active and static. If the STNR pattern has not been inhibited, head position will still affect the tone of the upper and lower body differently. When walking, the gait may have simian/monkey-like quality. In standing, the posture is slouched with shoulders rounded and the chin forward. In sitting on the floor, a child may adopt a ‘W’ position. Sitting cross-legged on the floor is almost impossible if the STNR is strong because, with the head flexed/bent, the legs want to be extended/straight. Sitting on a chair at a desk also causes problems because again, if the arms are flexed/bent and the chin down, the legs want to be straight. The child may end up lying on his desk when writing. He may also tuck his feet under his bottom or hook his feet round the legs of the chair to lock his legs and keep them ‘under control’.
As a result of the issues caused by posture, a STNR child may have problems with concentration and attention. He may appear to be fidgety and unable to sit still, all because it is too uncomfortable to be so.
A retained STNR will have affects on vision – on accommodation and also on vertical tracking. The child may find actions like catching a ball difficult, as his ability to focus correctly on a moving object (especially one moving towards him) may be compromised. He will also find it awkward to copy from a blackboard or white board, as switching from far to near vision quickly will be slower for him than that of his peer group. Vertical tracking, where the eyes move from top to bottom, has been shown to be impaired in STNR children. This affects tasks such as lining up information or numbers in columns and can lead to trouble assessing height, such as walking onto a descending escalator or when standing on the edge of a diving board or cliff.
A child with a retained STNR may be a messy eater and end up wearing his food rather than getting it into his mouth. He may also find swimming a challenge – whenever he raises his head above the water his lower limbs will bend, so this is a child who likes to swim under water.
The Palmar Grasp Reflex
If a child has not learnt how to release objects, his manual dexterity and fine motor use of his hand will be compromised. He will use a pencil, feeding tools and items such as scissors inappropriately. This leads to the need for increased effort to perform tasks and the likelihood that these tasks are performed inefficiently and with reduced accuracy.
There may be overflow and lack of separation of hand/mouth movements so that the child uses his mouth when he writes or overuses his arms and hands when he talks. In severe cases, the development of speech may be affected because articulation is affected by a continuing Babkin response.
Hypersensitivity in the palm of the hand and intense dislike of touch in the hand is a nuisance and can prevent correct use of implements.
The Plantar Grasp Reflex
Gravitational insecurity in standing is a major casualty of a retained plantar reflex. If foot placement when walking, or foot position in standing, is incorrect, the child will feel unstable and will not like being upright.
A child may suffer from hypersensitivity to touch on the soles of the feet and find uneven surfaces impossible to negotiate.
If balance is shifted away from the soles of the feet to the balls of the feet, the child may be a toe-walker.
The Spinal Galant Reflex
A child with a Spinal Galant reflex beyond the age of one will be unable to sit still and may appear to have ‘ants in his pants’. He will fidget, squirm and not remain quietly in one position. He may dislike labels in his clothes, belts, anything round his waist and be hypersensitive to all clothing round his middle.
Distractibility, as a result of the unwanted sensations above, means that this child may have a poor attention and concentration span. As he dislikes sitting, he may prefer to work on the floor on his tummy.
Nocturnal enuresis or bed-wetting may be associated with a school aged child with a retained Spinal Galant reflex. Poor bladder control might be as a result of motor developmental delay and may also be triggered by the Spinal Galant reflex or the Perez reflex, which can be triggered when the child lies on his back or rolls over in bed.
The Rooting Reflex
Hypersensitivity round the mouth area may be an issue with a retained rooting reflex.
Poor fine muscle control of the internal and external mouth area may lead to problems with correct and full articulation needed for speech.
The tongue position may be too far forward making, swallowing and chewing difficult resulting in poor control of food in the mouth and dribbling.
The Suck and Swallow Reflexes
The sucking of fingers, thumb and clothes may continue if these reflexes are retained because there is a need for oral stimulation.
An immature swallow pattern may lead to problems will the correct development of the palate.
Poor control of muscles around the mouth may result in speech and articulation issues.
There may be a retained links with hand and mouth movement, especially if the palmar or Babkin response is also present.
The Babinski Reflex
A retained Babinski in older children and adults is considered pathological and is a sign of neurological abnormality, which merits immediate investigation.
It is possible to see a temporary Babinski in sever hypoglycaemia/low blood sugar. This will be reversible on administration of intravenous glucose.
The effects of underdeveloped postural reflexes
The purpose of the postural reflexes is to maintain static and dynamic balance, posture and correct alignment of the head and body. Underdeveloped postural reflexes mean that balance and coordination will be poor. This not only has the obvious effect of lack of protection from falling but has wider implications socially and in the classroom.
The effects of immature postural reflexes are not well documented but will include;
- Poor postural control, body alignment and postural tone
- Poor coordination, bilateral integration and motor control of fine movements
- Weak head control and/or associated head movement
- Compromised gaze control
- Reduced visual-motor/hand eye integration and fixation
- Difficulties with reading and writing
- Inadequate sensory integration
- Gravitational insecurity and increased anxiety
- Problems with adaptation, sequencing, multi-processing, information overload
- Retained or partially integrated primitive reflexes
Righting reflexes and equilibrium reactions are more complicated than the primitive reflexes and their functions are mediated in more developed areas of the brain. If postural reflexes are underdeveloped, under stress a ‘lower’ level of response is triggered and this may be a result in a primitive reflex pattern emerging.