By Francesca Reurreccion PT, DPT
Do you feel as if your child has challenges with:
- Balance
- Handwriting
- hand-eye coordination
- Focusing in class
- Reading & writing
- Anxiety/emotional regulation
- Spatial awareness
- Fidgeting
This could be due to retained primitive reflexes. This is not an extensive list; however, these are the common signs and symptoms of retained primitive reflexes.
What are Primitive Reflexes
Primitive reflexes are involuntary movement reactions that develop while your little one is still in the womb. These reflexes are present at birth and help with survival, they keep newborns alive and create the foundation for gross motor and fine motor development throughout infancy. Once an infant reaches a movement milestone such as rolling, crawling, or sitting the primitive reflex associated with that specific motor milestone has fulfilled their function and the reflex is integrated. Primitive reflexes are then replaced by a mature and voluntary movement pattern. Integration of primitive reflexes lays the foundation for good balance, posture, and coordination. Additionally, integration of primitive reflexes helps children achieve higher-level cognitive skills such as problem solving, being able to focus in class, and reading/writing skills (Pecuch et al. 2021). Primitive reflexes are integrated within the first 3 years of life.
Retained Primitive Reflexes in Physical Therapy
Did you know that both physical therapist and occupational therapist can address primitive reflex integration during their sessions? A primitive reflex that I commonly work on integrating during my physical therapy sessions is the Moro reflex. The Moro Reflex is “an involuntary response against abrupt disruption of body balance or extremely sudden stimulation” (l Khalili, Edwards, 2023). Sudden movements like being picked up quickly, loud noises, or tipping their head back to look up elicit this reflex. When the Moro Reflex is elicited, a baby will fling their arms out to their sides with their palms facing up. This reflex is typically integrated when a baby is around 6 months old. Signs of a retained Moro Reflex seen in school age children are motion sickness, coordination and balance challenges, impulsivity, poor tolerance to change. In children that I treat in the clinic, I often see that they may be hesitant to look up while walking—oftentimes they are slightly hunched while they walk which causes them toe walk because they shift their weight onto the balls of their feet. This type of posture may lead to muscular imbalance and could cause possible injuries in the future. After several sessions of integrating the Moro Reflex and working on gait mechanics, I’ve seen the children I work with start to normalize their gait mechanics.
I’ve seen retained Moro Reflex or children under 1 year old as well. I commonly see retained Moro in the children that are learning to sit independently. Babies become independent sitters by 9 months old—keep in mind that Moro Reflex is integrated by 6 months. When a child is learning how to sit independently around 7-9 months, I will always check their Moro Reflex especially if I notice that they fall backwards often. I used to treat a child who was sitting independently but had a tendency to fall backwards when I checked for their Moro Reflex, 3 out of 4 times. At the end of the session, after focusing on integrating this reflex, the child fell backwards 1 out of 4 times when I rechecked the reflex.
Retained Primitive Reflexes in Occupational Therapy
A common reflex that my occupational therapist colleagues work on during their session is the Palmar Grasp Reflex. This reflex is an involuntary response that occurs when you place your finger on an infant’s palm (Anekar, Bordoni, 2024). When you place your finger on their palm, the baby will then grab and cling onto your finger. This reflex is typically integrated by 6 months old which is when our little ones are exploring different textured toys. When babies play with toys with different textures like teether toys or crinkle books, that sensation in the palm of their hand helps with replacing the involuntary response to a more refined voluntary movement. Signs of unintegrated Palmar Grasp Reflex in school aged children are: challenges with fine motor tasks such as grabbing small objects, handwriting, self-feeding, and manipulation of clothing fasteners.
There was a school aged child that was receiving weekly occupational therapy sessions specifically for their handwriting. Their occupational therapist observed that the child was holding their pencil with a Palmar Supinate Grasp, a grasp typically seen in 12–15-month-olds even though this child was well over 15 months old. Their occupational therapist assessed the child’s Palmar Grasp Reflex and sure enough, the primitive reflex was present. Their occupational therapist saw good progress with this child’s handwriting skills after several treatment sessions focusing on integrating this reflex and working on their handwriting.
Retained Primitive Reflexes
If you notice that your child may be struggling in the school setting and are curious whether your child has a retained primitive reflex, we offer Primitive Reflex Assessments here at Uplift Therapy Center. Schedule a consultation call with one of our therapists to discuss your concerns to see if a Primitive Reflex Integration Program is the right fit for your child.
Reference:
Anekar AA, Bordoni B. Palmar Grasp Reflex(Archived) [Updated 2024 Sep 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553133/
Edwards CW, Al Khalili Y. Moro Reflex. [Updated 2023 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542173/
Hill, Jessica. “What Is the Moro Reflex?” Harkla, harkla.co/blogs/special-needs/moro-reflex?srsltid=AfmBOoqG6jcsTwNzrh86QzdQt2ruwqBBog2mHcqJ6TmvgRfMQ8u0ZVkC. Accessed 6 Feb. 2025.
Pecuch A, Gieysztor E, Wolańska E, Telenga M, Paprocka-Borowicz M. Primitive Reflex Activity in Relation to Motor Skills in Healthy Preschool Children. Brain Sci. 2021 Jul 23;11(8):967. doi: 10.3390/brainsci11080967. PMID: 34439585; PMCID: PMC8394673.
