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Primitive Reflexes – Development and Significance

Primitive reflexes are innate, involuntary movement patterns present in newborns and infants that indicate neurological maturity and gradually disappear as the brain develops.

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Primitive reflexes are innate, involuntary movement patterns present in newborns and infants that indicate neurological maturity and gradually disappear as the brain develops.

What Are Primitive Reflexes?

Primitive reflexes – also referred to as primary reflexes or infantile reflexes – are involuntary, automatic movement responses that develop in the womb and are present at birth. They are controlled by the brainstem and serve as important indicators of a newborn´s neurological health and maturity. As the brain matures, higher cortical centers gradually inhibit these reflexes, and they typically disappear within the first months of life.

Importance for Child Development

Primitive reflexes play critical roles in early survival and development. They support essential functions such as feeding, breathing, and protection from harm. When these reflexes persist beyond the expected developmental window – known as retained or persistent primitive reflexes – they may indicate delayed neurological maturation or other developmental concerns.

Key Primitive Reflexes

Rooting Reflex

When the cheek of a newborn is stroked, the infant turns its head toward the stimulus and opens its mouth. This reflex supports breastfeeding by helping the baby locate the nipple. It typically disappears by 3 to 4 months of age.

Sucking Reflex

When an object touches the roof of the mouth, the infant begins to suck automatically. This reflex is essential for feeding and gradually becomes a voluntary action between 2 and 4 months of age.

Moro Reflex

In response to a sudden stimulus – such as a loud noise or abrupt change in position – the newborn extends both arms, spreads the fingers, then quickly draws the arms back toward the body. This startle reflex serves a protective function and typically disappears between 4 and 6 months of age.

Palmar Grasp Reflex

Placing a finger in the palm of an infant causes the hand to close firmly around it. This reflex is replaced by intentional grasping at around 5 to 6 months of age.

Babinski Reflex

Stroking the sole of the foot causes the toes to fan outward. While this response is considered abnormal in adults (suggesting neurological pathology), it is completely normal in infants and typically resolves by the second year of life.

Stepping Reflex

When held upright with feet touching a surface, newborns make automatic stepping movements. This reflex is considered a precursor to walking and disappears at around 2 months of age.

Asymmetrical Tonic Neck Reflex (ATNR)

When the head is turned to one side, the arm on the side the face is turned toward extends, while the opposite arm bends – often described as a fencer position. This reflex is normal up to around 6 months and plays a role in the development of hand-eye coordination.

Symmetrical Tonic Neck Reflex (STNR)

When the head is bent forward, the arms flex and the legs extend. When the head is tilted back, the opposite occurs. This reflex supports the development of crawling and resolves within the first year of life.

Tonic Labyrinthine Reflex (TLR)

This reflex influences muscle tone based on the position of the head in space. It is important for developing balance and coordination and should gradually diminish during the first months of life.

Retained Primitive Reflexes

When primitive reflexes remain active beyond the typical developmental age, they are referred to as retained primitive reflexes. Their persistence may interfere with motor, sensory, and cognitive development and has been associated with a range of developmental challenges, including:

Difficulties with coordination and balance
Reading and writing difficulties (e.g., dyslexia)
Attention Deficit Hyperactivity Disorder (ADHD)
Delays in fine and gross motor skills
Emotional regulation difficulties

Diagnosis and Assessment

Assessment of primitive reflexes is a standard part of pediatric well-child examinations. A pediatrician evaluates whether reflexes are present, appropriately inhibited, or abnormally retained through targeted tactile and positional stimuli. If reflexes persist longer than expected or are absent when they should be present, further neurological evaluation may be recommended.

Treatment Approaches for Retained Reflexes

Several therapeutic approaches are available for children with suspected retained primitive reflexes:

Physiotherapy: Targeted movement exercises to support neurological maturation
Occupational therapy: Support for daily functioning and fine motor skills
Neurodevelopmental movement programs (e.g., the INPP method): Structured exercise programs designed to inhibit retained reflexes
Speech therapy: For speech or swallowing difficulties related to oral reflexes

References

Goddard Blythe, S. (2012): Assessing Neuromotor Readiness for Learning – The INPP Developmental Screening Test and School Intervention Programme. Wiley-Blackwell.
Prechtl, H. F. R. (1977): The Neurological Examination of the Full-Term Newborn Infant. Clinics in Developmental Medicine. Spastics International Medical Publications.
Lissauer, T. & Carroll, W. (2018): Illustrated Textbook of Paediatrics. 5th Edition. Elsevier.

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