Retained neonatal reflexes... What should we know?

The body is a complex system. In the womb and during early life the body’s brainstem has several reflexes called ‘primitive’ or ‘neonatal’ reflexes. In fact there are 70 known primary reflexes. These reflexes occur during the life stages when the decision making process has not fully developed. In simple terms, a baby's initial movements will be reflex-based and those movements are predictable, repetitive, and subject to specific incoming stimulus.These reflexes help us grow properly and safely. As one matures, these reflexes are no longer needed and the higher brain takes control. It is an essential stage for normal development allowing one to perform more complex tasks.

However, as a result of developmental restrictions or trauma at birth these reflexes may remain dominant. This means that the nervous system will react inappropriately in certain situations. This in turn may then affect development, learning and behaviour.

What are the primary retained reflexes that affect educational progress and learning in the classroom?

Asymmetric Tonic Neck Reflex (ATNR):

This is seen when babies turn their head to one side and the limbs on that side straighten while the limbs on the other side bend. This reflex should disappear at 6 months.

The retention of this reflex causes the most interface with a child’s learning process. Problems that can occur may include:

Handwriting: Each time a child turns their head to look at the page, their arm will want to extend and the fingers will want to open. Holding and working a pen or pencil for any length of time will require enormous effort.

Reading: Eye tracking difficulties can occur when reading as the eyes do not move smoothly from one side of the page to the other. This can result in loosing your place, loss of accuracy and loss of comprehension.

Mixed Laterality: This means that the child may use left and right hands interchangeably for the same task. The effect of mixed laterality can be failure to send information to the most efficient centre of the brain for that skill.

Symmetrical Tonic Neck Reflex (STNR):

This reflex allows the baby to straighten its arms and bend its legs when it looks up. The STNR reflex is normally lost at 8 months after birth. If it is not lost, it can affect a child’s ability to crawl on hands and knees.

This in turn may affect development of hand-eye co-ordination

as this is facilitated during the crawling phase.

Other symptoms of retained STNR include:

• Poor posture

• Tendency to slump when sitting, particularly at a desk

• Poor hand-eye coordination

• Messy eating

• Clumsy

• Difficulty with catching balls

• Slow at copying from the blackboard

Tonic Labyrinthine Reflex (TLR):

The TLR is the opposite of STNR. When a baby looks up TLR causes the baby to straighten it’s legs and arms, likewise when the head goes down the limbs fold in. This reflex should be fully present from the time of birth to 4 months old. It is linked to balance and muscle tone. If this reflex persists it will disrupt balance and gross motor skills.

Symptoms of this retained reflex can include:

• Poor posture

• Tendency to walk forward on toes

• Weak at ball skills

• Poor articulation – due to an extension of the tongue in the mouth.

Moro Reflex:

The Moro reflex is a response to unexpected changes within the infant’s environment and acts as the infants’ “fight of flight” response. The Moro Reflex should disappear at 2-4 months and should be replaced by the adult “Startle” reflex. The prolonged retention of this reflex can be highly

disruptive to a child’s development.

Symptoms of a retained Moro Reflex include:

• Balance problems

• Motion sickness

• Sensitivity to bright lights

• Difficulty reading black print on white paper

• Dislike of loud noises

• Easily distracted

• Dislike of change- child may be clingy or shy

• Poor coordination (particularly during ball games) – which leads to poor sequencing and memory skills

Spinal Galant Reflex:

This reflex is present at birth, and should disappear by the time the baby is 9 months old. In the newborn, stroking the low back to one side of the spine will result in side flexion of the lumbar spine (low back) away from that side, with raising of the hip on the same side.

If it persists, the child experiences :

• Restlessness

• Fidgeting

• Inability to sit still.

• Bedwetting is sometimes associated with this reflex

• A tendency to dislike tight clothing around the waist.

• Poor concentration and short term memory, making it

difficult to take in and process information.

Palmar Grasp Reflex:

The palmar grasp reflex refers to a baby closing it’s fist around anything that is placed in it’s palm. The purpose of the grasping reflex is believed to be to prepare the baby’s hand muscles for developing voluntary grasping in the months to come.

This reflex should disappear at 3 months after birth.

Symptoms of this retained reflex may include:

• Poor handwriting.

• Poor pencil grip.

• Poor Fine Muscle Control.

• Poor dexterity.

• Poor fine motor skills.

• Poor vision coordination.

• Slumped posture when using hands.

• Back aches when sitting.

How to help your child overcome retained reflexes:

1. Seek a functional neurologist or an Occupational Therapist to perform an assessment to determine if your child has retained reflexes and which ones are inhibiting their development

2. Work with a practitioner to complete a rehabilitation program. This program will consist of strategies to rework the neural pathways in the brain and improve the child's learning. The practitioner can also provide strategies to implement within the home and school environment.

3. Fine motor activities including play dough, posting, peg art, threading and lacing can be attended in some of the positions illustrated below.

4. Fun activities can be completed at home or in the child's environment to assist with the challenges experienced by the child. Some of these activities may include: Commando crawling on the floor, crawling, balance activities, passing a bean bag around the body and ball activities.

References:

Yasuyuki Futagi, Yasuhisa Toribe, and Yasuhiro Suzuki, “The Grasp Reflex and Moro Reflex in Infants: Hierarchy of Primitive Reflex Responses,” International Journal of Pediatrics, vol. 2012, Article ID 191562, 10 pages, 2012. doi:10.1155/2012/191562

Konicarova, J. & Bob, P. Act Nerv Super (2012) 54: 135. https://doi.org/10.1007/BF03379591

Photo credits: ATNR, STNR, TLR & Intervention positions- Toolstogrowot.com

Spinal galant -MasgutovaMethod.com

Palmar grasp & Moro reflex- Premed.org