Retained Primitive

Reflexes - An
Osteopathic Approach
 My Osteopathic Genealogy

A.T. Still
F.L.Mitchell, Sr.
W.G. Sutherland

G.A. Laughlin

P.E. Greenman P.T. Wilson E.G. Stiles

“Everybody’s right and everybody’s wrong.”

–Ed Stiles, DO, FAAOdist

 Reflex

• In its simplest form, a reflex is an unconscious pattern of

motion that is expected from a certain activating stimulus.
We have certain spots that we test to allow us to “look inside” at the nervous
system and see how certain parts are functioning…or malfunctioning
We have a language that describes whether that automatic response is just what we
expect…or more or less than we expect.
We even have an explanation of how the pattern of motion is supposed to work
 Reflexes

• This exam for reflexes is part of our education and is

supposed to be part of any patients initial exam.

• And its good information to gather…until you recognize

that it is only part of the picture of the patient.
 Reflexes

• In my practice, I did this for a few years, then found my

first patient who had something that seemed to come
before, or be bigger than, the reflex testing.
 Reflexes
• Then I found that:

• I wasn’t taught well enough in school

• I wasn’t asking the right questions

• I wasn’t testing the right things

• The answers in the books didn’t seem osteopathic enough

• The patient had the answers if I was willing to be the

student again…the student of the patient…
 Reflexes

• In the last picture, the author states that tendon organs

monitor tension. Is that 100% true osteopathically?

• Might it also be true that tendons (and ligaments and

maybe even all connective tissues) give a window into the
health of their attached nervous system by showing us
their tension?
 Reflexes

• And thus, a movement pattern that we expect MAY

indicate health, but a movement pattern that we don’t
expect SHOULD lead us to more investigation?

• And that investigation should be osteopathic in nature…

while not leaving behind the allopathy that we know. (this
is where EBM comes in - but remember EBM is ALWAYS
lagging behind the people discovering it (the clinicians))
 Engaging the Ram of Reason

Perhaps this should be the official osteopathic graduation headgear…

 Things that seem to
cloud or hinder accurate
reflex testing
Abnormal tension from C1 to L5
Abnormal tension from T4 to L5
Abnormal tension from L1 to L5
Questionnaires
“The important thing is to
not stop questioning.
Curiosity has its own
reason for existing.”

–Albert Einstein
 Reflex Questionnaire

• These are questions, which is answered affirmatively, can

lead you to suspect primitive reflexes that may still be
present in the patient.
 Part I: Pregnancy & Birth
History
Did the mother have a viral infection in the first trimester of
pregnancy?

Were there any medical problems during pregnancy such as

threatened miscarriage, high blood pressure, or excessive
morning sickness?

Was the mother under severe emotional stress between the

23rd and 28th week of pregnancy?

Were there any complications during pregnancy or delivery;

prolonged labor, fetal distress?
 Part I: Pregnancy & Birth
History
At any time during the pregnancy/delivery was the child said
to be in a breech position?

Was there use of forceps or suction delivery?

Was a caesarian section performed?

Was the child more than 2 weeks pre-mature or 2 weeks

late?

Were excessive ultra sounds performed during pregnancy?

Part II: Family & Health History

Is there any history of learning difficulties in the family or

either parents' family?

Has the child been diagnosed with a learning disability?

Has the child been diagnosed with ADD/ADHD or Autism

Spectrum Disorder?

Did/does the child suffer from chronic ear infections?

Part II: Family & Health History

Did/does the child have a history of allergies, asthma, or

frequent illnesses?

Does the child have chronic digestive disorders?

Is/was the child a bed wetter past the age of 5 years?

Does the child suffer from motion sickness?

Did the child suffer from a head injury?

Part II: Family & Health History
Was your child small for term?

Were there any unusual physical signs? (jaundice, bruising, distorted skull)

Was there any difficulty feeding or keeping it down? Did your child easily
feed off both breasts?

Between 6 to 18 months was your child very active or demanding? Or

particularly quiet and unresponsive?

Did your child develop a violent rocking motion when standing or sitting?

Was your child a ‘head-banger’?

Does your child suffer from travel / motion sickness?

Part II: Family & Health History
Did your child start walking before 10 months or after 16 months?

Did your child bum shuffle or skip the cross crawling stage?

Was your child late when learning to talk (2-3 words by 2 years)?

Did your child experience any serious illness or seizures in the

first 18 months of life?

Does your child suffer from travel / motion sickness?

Did your child have trouble establishing hand dominance or

crossing the midline with objects?
Part II: Family & Health History
Was there any sign of eczema, asthma or allergies?

Did your child have any adverse reactions to childhood vaccinations?

Did your child have difficulty learning to dress his / herself?

Did your child suck their thumb past the age of 5?

Did your child wet the bed regularly past the age of 5?

Does your child suffer from travel / motion sickness?

Did your child have trouble establishing hand dominance or crossing

the midline with objects?
 Part III: Learning &
Developmental History
Was there lack of, or little, creeping or crawling on all fours with this child?

Were there any troubles with feeding or latching on in the first 3 months?

Did/does this child have difficulty distinguishing right from left?

Is, or did, the child have difficulty deciding which hand they would use as
their dominant hand?

Does this child have difficulty catching a ball or have poor hand-eye
coordination?

Does this child seem awkward in P.E.,dance, gymnastics, etc.?

Does the child have difficulties sitting still and/or paying attention?
 Part III: Learning &
Developmental History
Does the child have difficulty tying shoelaces or doing up buttons?

Does the child have reading difficulties?

Does the child occasionally reverse letters when writing?

Does the child have difficulty writing or is their writing very messy?

Does/did the child have difficulty learning to ride a bicycle, swim,

or swing?

Does the child have any speech/articulation difficulties?

 Part IV: At School
Did your child have problems learning to read and / or write
in the early years at school?

Did your child have difficulty telling the time on an analogue

clock?

Did they have difficulty riding a bicycle?

Did they suffer from recurrent sinus or ear infections or

headaches?

Did they have difficulty catching a ball?

 Part IV: At School
Did your child have ‘ants in the pants’?

Did your child make numerous mistakes when copying from the
board?

Does your child occasionally miss letters or write them backwards?

Does your child have an awkward pencil grip?

Has your child ever been diagnosed with any conditions such as
Low Muscle Tone or ADHD?

If there is sudden noise would your child over-react?

Retained Primitive
Reflexes
“All that is valuable in human society depends upon
the opportunity for development accorded the
individual.”

–Albert Einstein
 Retained Reflexes

• Most of the reflexes that we have as babies serve a

purpose during our development.

• When we “outgrow” the need for these reflexes, we

should lose the reflex. (it should integrate)

• However, many of the reflexes remain in us after we

should have outgrown them.
 Retained Reflexes

• This can be anything from an annoyance to actual

pathology.

• We will look at a few of the reflexes and how to test for

them.

• We will cover a principle based way to help integrate

these reflexes.
 Retained Reflexes

• Not all reflexes will be covered due to time constraints

(there are 70).

• Other reflexes can be looked up online.

• The same principles should help to integrate these

reflexes as well.
 Contraindications
• Include anything that can worsen with treatment:
• Bleeding

• Infection/ Inflammation/Fever

• Trauma/Recent Injury/Fracture

• Cardiac Problems/Blood Clots

• Malignancy/Cancer/Pain of Unknown Origin

• Pregnancy

• Menstruation (with excessive bleeding)

• Orthostatic/Postural Hypotension
 Sequence

• Screen/Treat the patient first, paying special attention to

the brain and spinal cord. (to the extent of your education)

• Get a baseline assessment of the brain and spinal cord

before beginning treatment.

• Always recheck that the brain and spinal cord are

completely released after treatment.
 Warnings

• The physical response to the reflex is not always visible.

• Always check the brain/spinal cord for responses.

• DO NOT over treat a child’s reflexes.

• They may become overstimulated (won’t listen,

throw a temper tantrum, etc.)
 Age to Begin

• It is suggested to not initially begin working on correcting

the retained reflexes until a child is 5-7 years old.

• As you gain experience, you may choose to work with

younger children.
 The
Symphony of
Reflexes
Bonnie Brandes, MEd

ISBN-10: 150285502X

ISBN-13: 978-1502855022
 Movement is Key
• In a Canadian study of over five hundred students, those
who spent an extra hour each day in gym class scored
markedly better on exams than those who spent less time
in gym class.

• According to Dr. Joseph Mercola, “Exercise encourages

your brain to work at optimum capacity by causing nerve
cells to multiply, while strengthening their
interconnections, and protecting them from damage.
• Brandes, Bonnie. The Symphony of Reflexes: Interventions for Human Development, Autism, ADHD, CP, and Other Neurological Disorders . Kindle Edition.
 Movement is Key

• Movement not only integrates reflexes but also helps

them to remain integrated.

• Lack of movement (watching TV, texting, computer

games, etc.) bring stress to the nervous system and can
lead to brain shrinkage.
• Brandes, Bonnie. The Symphony of Reflexes: Interventions for Human Development, Autism, ADHD, CP, and Other Neurological Disorders . Kindle Edition.
 What You Eat Matters

• Sugar and high-fructose corn syrup suppress BDNF

(which is like “miracle grow” for the brain, allowing higher
brain centers to function optimally), while a low-sugar diet
combined with regular exercise supports brain
development and normal integration of reflexes.
• Brandes, Bonnie. The Symphony of Reflexes: Interventions for Human Development, Autism, ADHD, CP, and Other Neurological Disorders . Kindle Edition.
 Avoid Baby “Fads”
• Siegel and Burton conducted a study of 109 babies, published in the
Journal of Developmental and Behavioral Pediatrics in October of 1999,
and found that those babies using the newest walkers learned to sit
upright, crawl, and walk later than babies who did not use walkers or
who used earlier walkers whose design made it possible for a baby to
see his legs.

• The large tray used on newer walkers prevents the baby from seeing the
legs, blocking the visual feedback that teaches her how to travel through
her surroundings. The tray also prevents the grasping and exploring of
objects that are critical for early development. The unnatural upright
movement of the child in the walkers and jumpers may cause
overdevelopment of the calf muscles, which can lead to walking on toes,
while inadequate development may occur in the hips and upper legs.
• Brandes, Bonnie. The Symphony of Reflexes: Interventions for Human Development, Autism, ADHD, CP, and Other Neurological Disorders . Kindle Edition.
Fear Paralysis Reflex
“If you hold a cat by the tail you learn things you
cannot learn any other way.”

–Mark Twain
 Fear Paralysis Reflex

• This is the first reflex to appear in utero. It occurs from

5-7 weeks

• It is usually integrated by the 12th week of development

• Testing this reflex may stimulate fear in the patient, so

maintain a safe space and therapeutic rapport
 Fear Paralysis Reflex

• It may come about from fear or trauma during pregnancy

• Its purpose is to cause withdraw from any sign of danger.

It triggers a decreased heart rate, decreased respirations,
and decreased muscle tone (playing dead) (this is a
parasympathetic response)

• It is interconnected with the Moro reflex

 Fear Paralysis Reflex

• If it is activated in someone, they tend to have a low

tolerance to stress and be overly sensitive in one or more
of their senses (facilitation???)
 Fear Paralysis Reflex

• OCD/Inflexible

• Easily Distracted

• Difficulty Sleeping

• Separation Anxiety

• Very Attached to Parent

 Fear Paralysis Reflex
• Evaluation:

• Evaluate closed eyes for a blink or response as you tap

the sternum, laterally on both elbows, knees or the
bottoms of the feet

• Sudden noises will also activate

• This activates the patients (and your) sympathetic

nervous system.
 Osteopathic Finding

• Patient twitches during palpation. Nervous system

ramped up. Poor sleep.
Moro Relfex
“Look deep into nature, and then you will
understand everything better.”

–Albert Einstein
 Moro Reflex

• Begins at the 8-9th week in utero and is fully emerged by

the 30th week

• Should integrated by the 4th month of infancy

 Moro Reflex

• It involves three distinct components:

1. Spreading out the arms (abduction)

2. Unspreading the arms (adduction)

3. Crying (usually)
 Moro Reflex

• The Moro reflex may help the infant cling to its mother. If
the infant lost its balance, the reflex caused the infant to
embrace its mother and regain its hold on the mother’s
body
 Moro Reflex

• Is a body defense with activated sympathetics and

adrenals

• Triggers can be:

• Strong unpleasant stimulation with balance, auditory,

visual, tactile or proprioceptive factors
 Moro Reflex
• People who do not have an integrated reflex may have:

• Hypersensitivity to light and sound

• Difficulty blocking out background noise

• Can be reactive in situations to great physical or

emotional stress

• Intolerant of routine changes

• Inflexible
 Moro Reflex

• This startle reflex can lead to:

• ADHD

• Anxiety
 Moro Reflex

• Testing:

• With patient lying supine, gently lift neck with the 2nd
and 3rd fingers

• A stiff neck is a positive test

 Moro Reflex

• Testing:

• With patient lying supine, gently lift the posterior knees

with the 2nd and 3rd fingers

• A stiff leg is a positive test

 Moro Reflex
• Testing (Starfish):

• With patient sitting in a chair with no arms

• Ask the patient to extend both arms and legs to the side

• Then ask them to cross the arms (right over left) and legs (right
over left)

• Then extend both arms and legs again

• Then cross left over right

• Inability to do either is a positive test

Moro Reflex Video Links

• https://commons.wikimedia.org/w/index.php?
title=File%3AMoro_reflex_while_sleeping.ogv

• https://www.parent24.com/Baby/Newborn/The-Moro-
reflex-20150826
 Osteopathic Finding

• Cervical spine relatively rigid. All joints stiffer than normal.

Spinal Galant
“A man should look for what is, and not for what he
thinks should be.”

–Albert Einstein
 Spinal Galant

• Emerges at 20 weeks of development

• Usually integrates by the 3-9 month of infancy

 Spinal Galant

• This sidebend reflex helps in travel down the birth canal

• Helps to develop hip movement

• Develops the vestibular system

 Spinal Galant
• A retained reflex can cause:
• Inability to sit still
• Poor concentration
• Bedwetting and/or poor bladder control
• Clumsy
• Irritated by tucking in a shirt or tight waistbands on
pants
• Lack of focus and attention to a task
• Fidgeting
• Trouble with short term memory
• Frequently making noise (buzzing, humming)
 Spinal Galant
• Can show up in adults as:

• Scoliosis

• Clumsiness in lower half of the body

• ADHD

• Irritable Bowel Syndrome

• Digestive Issues

• Uncomfortable in tight clothing

 Spinal Galant

• Testing:

• Patient is on hands and knees or side lying

• Spine is stimulated gently from T1 to the Sacrum on

one side at at time

• Sidebending, ticklish response or pain are all positive

responses
 Osteopathic Finding

• Paraspinal muscles are abnormally tight.

Spinal Perez
“I am thankful for all of those who said NO to me.
Its because of them I’m doing it myself.”

–Albert Einstein
 Spinal Perez

• Emerges at birth

• Usually integrates by the 2-3 month of infancy

 Spinal Perez

• The sidebend reflex helps in travel down the birth canal

• Helps to develop hip movement

• Develops the vestibular system

 Spinal Perez
• A retained reflex can cause:
• Inability to sit still
• Poor concentration
• Bedwetting and/or poor bladder control
• Clumsy
• Irritated by tucking in a shirt or tight waistbands on
pants
• Lack of focus and attention to a task
• Fidgeting
• Trouble with short term memory
• Frequently making noise (buzzing, humming)
 Spinal Perez
• Can show up in adults as:

• Scoliosis

• Clumsiness in lower half of the body

• ADHD

• Irritable Bowel Syndrome

• Digestive Issues

• Uncomfortable in tight clothing

 Spinal Perez
• Testing:

• Patient is prone

• Spine is stimulated gently from Sacrum to the T1 on

one side at at time (opposite the spinal galant)

• Lifting movement of the buttocks or hips, backward

arch of the torso, lifting of the head, flexion of the upper
or lower limbs is positive test
 Osteopathic Finding

• Paraspinal muscles are abnormally tight. Findings are

worse near the sacrum.
Asymmetrical Tonic Neck
Reflex
(ATNR)
“Education is what remains after one has forgotten
what one has learned in school.”

–Albert Einstein
 Asymmetrical Tonic Neck
Reflex

• Begins at the 13th week in utero

• Should integrated by the 6th to 9th month of infancy

 Asymmetrical Tonic Neck
Reflex

• The ATNR manifests when the baby’s head is turned to

one side. The infant’s arm and leg on the side to which
the head is turned will extend and the opposite limbs will
flex (curl inward) so that the child appears to be in what
has been called a “fencer’s pose”
 Asymmetrical Tonic Neck
Reflex

• The purpose of the ATNR is to provide stimulation

for developing muscle tone and the vestibular
system whilst in the womb before birth. It also assist with
the birthing process by inhibiting limb movement and
slowing it down so that the baby uses a "corkscrew"
movement through the birth passage.
 Asymmetrical Tonic Neck
Reflex
• It is linked with corpus callosum development

• ATNR helps with eye-hand co-ordination and serves as a

precursor to this skill

• A retained ATNR can have a significant impact on a

child's development and it is often thought to have a
major effect on the child's physical, cognitive, social and
emotional progress, thus affecting their ability to function
well in school
 Asymmetrical Tonic Neck
Reflex

• The retained reflex will continue to influence limb

movement every time the head is turned and will have
physical influences that impact all other areas.

• The ATNR can cause the spine to curve (scoliosis)

• Both the ATNR and TLR can cause subluxation of the

femoral head or dislocation of the femoral head as it
completely moves out of the hip socket
 Asymmetrical Tonic Neck
Reflex
• This retained reflex can lead to:

• Movement/Coordination difficulties

• Vision problems (dyslexia, long distance vision issues,

binocularity problems)

• Difficulty walking

• Joint alignment issues (scoliosis)

 Asymmetrical Tonic Neck
Reflex
• This retained reflex can lead to:

• Poor balance when moving head side to side

• Homolateral (same side) rather than cross pattern

movements when walking, skipping, or marching

• Difficulty crossing the imaginary midline between the

two sides of the body with the arms or legs

• Poor smooth eye movements

 Asymmetrical Tonic Neck
Reflex
• This retained reflex can lead to:

• Difficulty shifting focus from distance to near

• Difficulty keeping place when copying from the board

• Mixed laterality (use right and left hands

interchangeably)

• Poor handwriting

• Poor expression of ideas on paper

 Asymmetrical Tonic Neck
Reflex
• This retained reflex can lead to:

• Difficulty learning to ride a bicycle

• ADD and ADHD characteristics

• Difficulty throwing and catching a ball

• Learning problems

• Difficulty with multitasking

 Asymmetrical Tonic Neck
Reflex

• This retained reflex can lead to:

• Writing with the arm crossed over the midline (curled

wrist)

• Shows up when eating with utensils

• They will drop something when the head is turned away

 Asymmetrical Tonic Neck
Reflex

• Testing:

• Standing test - Patient stands with arms outstretched

• Operator turns patients head to one side (left)

• Positive test - patients arm on right will move medially

or right leg will bend
 Asymmetrical Tonic Neck
Reflex

• Testing:

• Patient is on all fours

• “I am going to turn your head from side to side and I

want your arms to remain as still as possible”

• Any arm movement is a positive test

 Osteopathic Finding

• Upper cervical muscles are tight (C1-C3).

Symmetrical Tonic Neck
Reflex
(STNR)
“It is the supreme art of the teacher to awaken joy
in creative expression and knowledge.
–Albert Einstein
 Symmetrical Tonic Neck
Reflex

• The STNR is normally fully developed by 6–8 months and

significantly diminished by 2–3 years.

• If this reflex is retained beyond 2–3 years to such a

degree that it "modifies voluntary movement", the child is
considered to have "immature and abnormal reflex
development", and this can have broad effects on the
child's later development
 Symmetrical Tonic Neck
Reflex

• This reflex consists of two phases: flexion (inward

movement) and extension (outward movement). When the
child is positioned on their hands and knees, flexion or
lowering of the head causes the arms to bend and the
legs to extend. When the head is extended or raised, the
arms extend and the legs bend.
 Symmetrical Tonic Neck
Reflex

• It is a bridging or transitional brainstem reflex that is an

important developmental stage and is necessary for a
baby to transition from lying on the floor to quadruped
crawling or walking. In order to be able to do this the
[2]

baby needs to have been successful in unlinking the

automatic movement of the head from the automatic
movement of the arms and legs to progress beyond this
development stage
 Symmetrical Tonic Neck
Reflex

• Whereas the ATNR divides the body in half vertically – the

left and right sides, the STNR divides the body in half
horizontally – the upper and lower body.

• This is a short-lived reflex that primarily helps the baby to

learn to get up off the floor and onto their hands and
knees. However, if this reflex is retained, the baby will not
be able to move forward by crawling or creeping but will
do a “bear walk”, scoot on their bottoms, or skip
crawling, and just stand up and walk.
 Symmetrical Tonic Neck
Reflex

• The STNR is often retained in children that have suffered

environmental deprivation such as children adopted from
orphanages overseas who did not have the space or
opportunity to creep and crawl at the appropriate time.
 Symmetrical Tonic Neck
Reflex
• This retained reflex can lead to:

• Poor posture

• Tendency to slump when sitting, especially at a desk or table

• Simian (ape-like) walk

• Poor eye-hand coordination

• Difficulty tracking or catching a ball

• Messy eater

• Difficulty adjusting binocular vision from distance to near

 Symmetrical Tonic Neck
Reflex
• This retained reflex can lead to:

• Difficulty learning to swim

• ADD and ADHD tendencies

• Poor learning abilities

• Poor balance

• Poor depth perception

• Difficulty recognizing social cues

• Poor space and time awareness

• Anchors feet behind chair legs while sitting

 Symmetrical Tonic Neck
Reflex
• This retained reflex can lead to:

• “W” position when sitting on floor

• Reading and writing are easily lying on the floor with the
legs extended

• Discomfort when sitting up straight with both legs and

arms flexed

• Difficulty aligning numbers for math calculations

 Symmetrical Tonic Neck
Reflex

• The proper integration of the STNR is very important in

visual development. If a child does not creep and crawl,
they do not get the experience of visually tracking their
hands as they move forward in space which helps to
develop the ability of the eyes to cross the midline when
tracking.
 Symmetrical Tonic Neck
Reflex
• Testing:

• Patient is on all fours

• Passively flex the head forward and then extend it

backwards. The expected response would be forward
head flexion producing flexion of the upper extremities
and extension of the lower extremities while extension
of the head will produce extension of the upper
extremities and flexion of the lower extremities.
 Osteopathic Finding

• Lower cervicals (C5-C7) are abnormally tight.

• Potential dental link to posterior molars.

Postural Reflexes
“Get your facts first, then
you can distort them as
you please.”

–Mark Twain
 Postural Reflexes

• Postural reflexes are responsible for the subconscious

maintenance of the body’s posture when movement and
position is altered and they ensure that the body remains
upright and aligned. It is the effects of gravity on the body
which triggers their response and so these reflexes do not
begin to develop until after the baby is born.
 Postural Reflexes

• All but one of the postural reflexes arise from/are found in

the midbrain. This means they are mediated from a higher
center than the primitive reflexes and so their appearance
signifies a maturation of the nervous system. The shift
from primitive to postural reflexes is gradual and there will
be overlap while both are present but the postural reflexes
should be established by the time a child is three and a
half. They should remain for life but with age they may
decay, allowing the primitive reflexes to reappear.
 Postural Reflexes
• The postural reflexes are divided into two groups – the
righting reflexes and the equilibrium reactions. The
primitive reflexes have formed the foundation for
conscious movement and the postural reflexes allow
subconscious control of posture, balance and
coordination in the active and static individual. They help
the baby develop from a passive little mass to an active
being who can roll, sit, crawl, stand, walk and run and
their contribution leads to an individual who can respond,
at every stage, to a loss of balance and weight change in
order to maintain body alignment or posture in space.
Neck Righting Reflex
“He who can no longer pause to wonder and stand rapt
in awe, is as good as dead; his eyes are closed.”

–Albert Einstein
 Segmental Neck Righting
Reflex

• Develops in the infant - 6 mo supine to prone, 8-10 mo

prone to supine

• Is essential to assist in changing positions & to provide

flexibility to movements such a swimming, dancing,
gymnastics, etc
 Neck Righting Reflex

• The first of the righting reflexes to appear is the neck

righting reflex. It is present at birth in a normal full term
baby and strongest at about three months of age. It is
triggered by stretching of the neck muscles when there is
rotation of the head or movement of the cervical/neck
spine. With the baby in supine/on his back, if the head is
turned to one side, the whole body will follow, in what is
called a log roll, until it is brought into alignment with the
head.
 Neck Righting Reflex
• Testing:

• Patient is supine (perhaps on floor)

• Neck is slightly stretched cephalad and head is slowly

rotated to one side

• Patient should roll to the side, tucking in lower arm to

follow head

• Positive test is lack of rolling motion or lack of tucking

arm
 Osteopathic Finding

• Tight SCM’s, scalene’s and thoracic outlet.

Labyrinthine Righting
Reflex
 “I have no special
talent. I am only
passionately
curious.”

–Albert Einstein
Labyrinthine Righting Reflex

• Emerges at birth

• Should be inhibited at 2-4 months of age

Labyrinthine Righting Reflex

• The labyrinthine head righting reflex is stimulated by tilting

of the body or stimulation of cilia hair cells of the inner ear
which detect movement of the head in space. The LHRR
compensates body motion with a contraction of the neck
muscles to keep the head level.
Labyrinthine Righting Reflex

• Children with underdeveloped labyrinthine-head righting

reflexes often struggle with balance and coordination
issues so they may appear to be clumsy or uncoordinated
when they play sports.

• In addition, they may also have trouble with their

vestibular and proprioceptive systems, which makes it
difficult for them to pay attention in school and they often
get motion sickness or experience dizziness.
Labyrinthine Righting Reflex
• If these head righting reflexes are not developed properly,
you may start to see your child struggle with listening to
the teacher, underdeveloped auditory processing, poor
handwriting and trouble with gross and fine motor skills.

• A child with poor proprioception may have difficulty with

motor planning and often has sensory seeking behavior
(plays rough, chews, bites, likes tight clothes, pushes).
Because these head righting reflexes are also closely
related to lifting the head (postural reflexes) you may
notice your child slouching in their chair, laying on their
desk or struggling to lift their head to view the chalkboard.
Labyrinthine Righting Reflex

• Testing:

• Patient is seated with eyes closed

• Operator moves the patients torso right, left, anterior

and posterior

• Head should stay upright

• A positive test is when he head tilts with the body

 Osteopathic Finding

• Tight SCM’s, scalene’s and thoracic outlet.

• Lateral motion of the neck is restricted at the thorax.

Ocular Head Righting
Reflex
“All religions, arts and sciences are branches of the
same tree.”

–Albert Einstein
 Ocular Head Righting
Reflex

• Should be inhibited at 2-4 months of age

 Ocular Head Righting
Reflex

• The ocular head righting reflex keeps the head stable and
the eyes stationary on visual objects in spite of other
movements of the body. Since the OHRR is dependent
for functioning on the cerebral cortex, visual perception
can be impaired if underdeveloped. This can affect
reading, comprehension and spelling in a developing
brain.
 Ocular Head Righting
Reflex

• The OHRR responds to visual cues and it maintains the

head in a stable position while the eyes are fixed on visual
targets. This all occurs despite other movements of the
body and head. This is a necessity to build the visual
fixation skill, which is used to maintain visual attention
when the body is in motion. It is also imperative for eye
tracking when looking away from something and then
looking back, which helps a child track words on a page
and prevents them from skipping lines or words.
 Ocular Head Righting
Reflex
• Children who struggle with the OHRR often have difficulty
with their visual systems and tracking with the eyes. This
often causes them to skip words, write their letters
backward, and they can’t copy notes from the
chalkboard, has poor handwriting, struggles with spacing
their letters and words and has difficulty with long-term or
short-term visual memory. The constant struggle to
refocus and readjust their eyes makes simple tasks like
copying notes from the chalkboard very difficult. Parents
may mistake their child for having Dyslexia because they
can’t tell their visual system hasn’t developed properly.
 Ocular Head Righting
Reflex
• Testing:

• Patient is seated with eyes open

• Operator moves the patients torso right, left, anterior

and posterior

• Head should stay upright

• A positive test is when he head tilts with the body

 Osteopathic Finding

• Tight SCM’s, scalene’s and thoracic outlet.

• Anterior/Posterior motion of the neck is restricted at the

thorax.
Landau Reflex
“What is right is not always popular, and what is
popular is not always right.”

–Albert Einstein
 Landau Reflex

• Should be emerges at 3-10 weeks during infancy and

should be absent between 1-2 years of age

• It helps to break the general flexion patten seen at birth

 Landau Reflex

• The landau reflex stimulates extension throughout the

body in the prone position if a baby is lifted in the air with
support under his stomach. Landau reflex increases
muscle tone and aids in inhibiting the tonic labyrinthine
reflex in the forward position. It also increases a child’s
head righting proficiency & torso muscle tone
 Landau Reflex

• It is poor in those with floppy infant syndrome and

exaggerated in hypertonic and opisthotonic infants
 Landau Reflex
• Low muscle tone

• Poor posture

• Poor motor development

• Short term memory difficulty

• Tension in the back of legs, toe walker

• Lack of stimulation in the pre frontal cortex causing attention, organization and
concentration problems

• Weak upper body

• Difficulty swimming the breast stroke

• Struggles to do a summersault. Knees buckle when head tucks under

 Landau Reflex
• If the Landau reflex does not adequately develop or
integrate in the infant within the normal timeframe, they
may develop poor muscle tone throughout the back of
the body. This could cause insufficient stimulation of the
prefrontal cortex of the brain, which is responsible for
functions like concentration, social decision making,
attention and organization.

• A retained Landau reflex is also commonly linked to the

Spinal Galant Reflex, which is also another reflex
responsible for attention and focus issues in the
classroom.
 Landau Reflex

• Testing:

• Have the child lie flat on the floor, face down with arms
straight out in front. Have the child lift their upper body
and arms off the ground while keeping the top of their
feet on the floor. If they struggle with keeping both feet
flat on the floor, the Landau Reflex is most likely still
present.
 Landau Reflex

• Testing:

• Have the child lie flat on the floor, face down with arms
straight out in front. Have the child lift their upper body
and arms off the ground and both legs off the ground. If
they are not strong to resistance in this position, the
Landau Reflex is most likely still present.
 Osteopathic Finding

• Extension head…

• Flexed posture that is linked with tight bowstring.

Amphibian Reflex
“In the middle of difficulty
lies opportunity.”

–Albert Einstein
 Amphibian Reflex

• Should be emerges at 4-6 months of age

• Its development depends on the reflexes that come

before it, such as the ATNR and Spinal Galant
 Amphibian Reflex

• In the amphibian reflex, raising of the pelvis causes an

automatic flexion of one leg from the hip regardless the
the child’s head position. This reflex aids in the inhibition
of the asymmetrical tonic neck reflex which increases
mobility and independent movement of the legs and arms
essential for crawling, creeping and gross muscle
coordination.
 Amphibian Reflex

• This reflex allows the infant to have more automatic

flexion of the arm, hip and knee on the same side of the
body when the hip is raised. In this way, the infant can be
ready to roll over, creep and crawl, and eventually walk.
 Amphibian Reflex
• In school, this reflex is important in developing motor
coordination and whole brain thinking.

• It is crucial for developing cross lateral movements or

movements that cross the midline of the body.

• It helps to balance both sides of the brain hemispheres

and activates more nerve stimulation across the corpus
callosum for whole brain activity, necessary for creative
thinking and overall cognition.
 Amphibian Reflex

• Testing:

• Patient is prone or supine. Raising of the pelvis to

about 45 degrees causes an automatic flexion of the
ipsilateral leg, regardless of the patients head position

• Lack of this response indicates a retained reflex

 Osteopathic Finding

• Possible tight psoas or hamstring (haven’t played with

this much).
Stepping Reflex
“Whenever you find yourself on the side of the
majority, it is time to pause and reflect.”

–Mark Twain
 Stepping Reflex

• Should be present at birth

• It should disappear by 2 months of age

 Stepping Reflex
• Retained Reflex can lead to:

• Toe walking – ‘running like an ostrich’

• Tight calf muscles

• Poor balance and muscle control

• Feet and ankle problems with pain and dysfunction

• Recurring hamstring injuries and mid-low back strains

• Visual problems due to an altered perception of the horizon –

head tilts forward and eyes look upward
 Stepping Reflex

• “If you hold a newborn upright and place the soles of his
feet on a table, he will begin to take steps,” Wible says.
Although newborns can’t support their own weight, they’ll
place one foot in front of the other and appear to walk.
“The stepping reflex is ingrained in our primitive instincts
to move,” Wible says. The purpose of this baby reflex is
to prepare a child to walk, and it recurs around 12
months. As a newborn reflex, however, it usually
disappears by the second month.
 Stepping Reflex

• Testing:

• If you hold a newborn upright and place the soles of his

feet on a table, he will begin to take steps

• Lack of this response indicates a retained reflex

 Stepping Reflex

• Testing (adult):

• Look for tight calf muscles and more weight placed on

the toes than the heels

• Visual problems due to an altered perception of the

horizon – head tilts forward and eyes look upward

• Lack of this response indicates a retained reflex

 Osteopathic Finding

• Restricted cephalad motion of forefoot to palpation.

Heel Reflex
“Education is not the learning of facts, it’s rather the
training of the mind to think.”

–Albert Einstein
 Heel Reflex

• Not much information available

• Many people want to correlate it with the achilles deep

tendon reflex
 Heel Reflex
• Retained Reflex can lead to:

• Heavy heel walking – ‘walking like a baby elephant’

• Heel pain

• Achilles Tendonitis

• Shin Splints

• Poor core stability

• Balance problems

• Visual problems due to an altered perception of the horizon – head tilts

back and eyes look down
 Heel Reflex

• Testing (adult):

• Look for loose calf muscles and more weight placed on

the heels than the toes.

• Visual problems due to an altered perception of the

horizon – head tilts back and eyes look down

• Lack of this response indicates a retained reflex

 Osteopathic Finding

• Restricted cehpalad heel movement.

Babinski Reflex
“Any intelligent fool can make things bigger and
more complex… It takes a touch of genius—
and a lot of courage—to move in the opposite
direction.”

–Albert Einstein
 Babinski Reflex
• It assists in the development of joint rotation, especially in the
feet, ankles, knees, and hips.

• It also helps develop muscle tone in the lower part of the

body and supports overall freedom of movement.

• It helps to develop gross motor coordination, which, in turn,

prepares the child for crawling, standing, walking, and
running.

• Because of its connection to the vestibular system, it plays an

important role in the development of balance, coordination,
speech development, and higher-level cognitive skills.
 Babinski Reflex
• Conditions associated with a retained Babinski include:

• Autism,

• Cerebral palsy,

• Foot problems as an adult (bunions, flat arches, etc.),

• Stroke

• Parkinson’s disease.
 Babinski Reflex
• Retained Reflex can lead to:

• Later in life, the Babinski sign can reemerge in multiple

sclerosis and other neurological diseases including
Parkinson’s, ALS, brain tumors, meningitis, and some
forms of polio.

• It may also be present in head injuries, spinal cord injuries,

spinal cord tumors, stroke, and spinal tuberculosis.

• It may also appear briefly after a seizure, a marathon or

long walk, or in conjunction with the use of alcohol or
drugs.
 Babinski Reflex
• Testing:

• To elicit the Babinski reflex, one should stimulate the outside

edge of the foot from the heel to the base of the toes.

• When the Babinski SIGN is present, the large toe extends

upward and the other toes fan out. The full response is also
accompanied by dorsiflexion of the ankle (movement of the
toes toward the shin) and flexion of the hip and knee joint.

• In addition, there may even be a slight contraction or an

abduction of the thigh, leading to withdrawal of the leg. The
spinal cord segments involved in the reflex arc are lumbar 4
and 5 and sacral 1 and 2.
 Osteopathic Finding

• Foot will not evert, but will invert.

Crossed Extensor
Reflex
“Live as if you were to die tomorrow. Learn as if you
were to live forever.”

–Mahatma Gandhi
Crossed Extensor Reflex

• Emerges at 28 weeks in utero

• Usually integrates by the 1-2 month of infancy

Crossed Extensor Reflex

• It allows the individual to develop the concept of having

two legs.

• It is essential in developing the Thomas automatic gait

reflex.

• Integration of the CER indicates that the medulla

oblongata is matured and communicating with higher
brain centers.
Crossed Extensor Reflex

• Young children and students may have difficulty with the

following: handwriting and other fine motor skills such as
buttoning shirts and tying shoes; math (dyscalculia),
especially story problems and multiplication tables;
reading, notably related to phonemic awareness; and
saccades.
• Brandes, Bonnie. The Symphony of Reflexes: Interventions for Human Development, Autism, ADHD, CP, and Other Neurological Disorders . Kindle Edition.
Crossed Extensor Reflex

• Testing:

• To elicit the crossed extensor reflex in the infant, firmly

press the center of the sole of the upper foot (the inside
of the ball of the foot on K1, acupuncture point). As a
“contralateral” reflex, a response occurs in the leg
opposite to the stimulated leg. The opposite leg will
flex, adduct, and then extend again.
 Osteopathic Finding

• Tension slightly anterior to 2nd and 3rd cuneiforms.

Primitive Tactile
Reflexes
Palmar Grasp Reflex
“We must not allow other people’s limited
perceptions to define us.”

–Virginia Satir
 Palmar Grasp Reflex
• Emerges at 11weeks in utero and should be present at
birth

• It is a reflex of two parts – the grasp and the response to

traction or the effect of pulling. If an object such as a
finger is placed in the palm, the fingers close round the
object (the grasp). If the fingers are then drawn gently
upwards, the grip is reinforced (the traction effect) and it
would appear that the baby could support its own weight
if so suspended. If the baby’s head is not in the midline,
the grasp will be strongest on the occiput side/the side
nearest the back of the head.
 Palmar Grasp Reflex

• The purpose of the palmar reflex is deep-rooted; it helps

the neonate cling to his/her mother for safety. In the first
post-natal months, there is a connection between the
palmar reflex and sucking and vice versa, such that there
is reciprocal elicitation of these reflexes.
 Palmar Grasp Reflex
• This connection between the palmar reflex and sucking
is known as the Babkin reflex – the palmar-mandibular
response. When pressure is applied to the palms, the
neonate may flex and/or rotate his head and open his
mouth. The Babkin response demonstrates the hand-
mouth sensorimotor links which are present in the early
months.
• An exceptionally strong palmar reflex may be found in
an infant with kernicterus and hypertonic cerebral
palsy. It will be unilateral in hemiplegia.
 Palmar Grasp Reflex

• The palmar reflex should be inhibited in the first three to

six months of life. A baby losing his palmar reflex will
drive his parents mad by his incessant dropping of an
object and the resultant demands that this is retrieved
and handed back – only for it to be dropped again. The
child is learning to ‘let go’ of an object previously held in
an uncontrolled fashion because the reflex dictated it be
so. Once he learns to release the object, a child can start
to develop more mature hand movements, the most
important and useful of which is opposition.
 Palmar Grasp Reflex

• If a child has not learned 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.
 Palmar Grasp Reflex

• 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.
 Palmar Grasp Reflex

• 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.
 Palmar Grasp Reflex

• Testing:

• Patients open hand is stroked from MCP to wrist and

from thenar to hypothenar eminance

• A positive test results in finger movement

 Palmar Grasp Reflex
• Testing:

• Have patient grasp two of operators fingers

• Operator tests the grip strength against gentle traction

(you can add rotation as well)

• Patients thumb should be outside their fingers

(naturally)

• A positive test results in increase in patients grip

 Osteopathic Finding

• All of the grasp reflexes have similar findings - tight

scapulas that will not compress and tight rhomboids.
 Hands-Supporting
Reflex, Parachute Reflex
“I’ve learned that people will forget what you said,
people will forget what you did, but people will
never forget how you made them feel.”

–Maya Angelou
 Parachute Reflex

• This reflex supports the coordination of a wide array of

functions, including both gross and fine motor skills. It
helps the infant to develop the ability to move comfortably
and safely through her environment; and it lends its
support as the child learns to differentiate between her
hands, arms, and shoulders.

• This differentiation will be particularly important in the

development of handwriting.
 Parachute Reflex

• A very basic function of the hands-supporting reflex that

should not be overlooked is the protection of the child
when falling. A child with a retained hands-supporting
reflex may not extend her hands to avoid an injury when
she falls.

• This, in fact, forms the basis of the test for this reflex.
 Parachute Reflex
• To elicit the response, one should hold the baby under the armpits in a
prone position and then lower her a short distance toward a horizontal
surface.

• If the infant’s motor nerve development is normal, at about 6 months, she

will extend her arms, hands, and fingers on both sides of the body in a
movement of survival and protection. Such a response would protect
against injuries to the brain and internal organs, sometimes at the
expense of the arms.

• The effect of the lowering motion on the baby’s vestibular system, as well
as on her vision, is important in eliciting the response. Children with a
retained hands-supporting reflex may not use their hands and arms to
protect themselves: they may bump into objects or people, display a
generally undeveloped spatial awareness, and lack coordination and
gross motor skills.
 Parachute Reflex
• The hands-supporting reflex contributes to the establishment of physical
boundaries and helps to create a sense of “personal space.”

• Thus, when the reflex is retained, we see unexpected reactions to someone

who enters the child’s personal boundaries or “gets in her space.”

• In these cases, the child may bite, pinch, or hit in response. This type of
reaction is also frequently reported in children or adults with autism.

• This sensitivity of personal space and lack of healthy boundaries may result
in a tendency toward isolation—choosing to retreat into one’s own world.

• Such a person may become uncommunicative and socially distant or

immature.
 Parachute Reflex

• Testing in an Adult:

• Enter their personal space while palpating for a brain

response. If a response is noted, the reflex is retained.
 Osteopathic Finding

• All of the grasp reflexes have similar findings - tight

scapulas that will not compress and tight rhomboids.

• Consider how this would appear with the fear paralysis

reflex also retained.
Babkin Reflex
“Believe you can and you’re halfway there.”
–Theodore Roosevelt
 Babkin Reflex

• The Babkin Reflex emerges around 9 weeks in utero, is

active during the first 3 months after birth, and should be
integrated at about 4 months.
 Babkin Reflex

• This reflex helps the baby to stimulate the breast causing

breast milk to flow while breastfeeding. The pattern of the
Plantar Reflex in the feet is very similar to the Babkin
Reflex in mammals when they stimulate the breast with
their paws.
 Babkin Reflex
• When infants suck, there is not only involuntary
movement of their hands, but many times their toes
and feet curl. When a child with an active Babkin Reflex
writes or does other fine motor work, like playing an
instrument or using scissors, there will be involuntary
movements of the mouth and tongue.
• Harald Blomberg (2012) has found that the Babkin
Reflex may influence the movements of the sphenoid
and temporal bones, and directly impacts speech,
articulation, and even phonological ability.
 Babkin Reflex
• Some symptoms of a nonintegrated Babkin Reflex

• Low muscle tone in the hands

• Poor handwriting; impaired fine motor skills

• Challenges with speech and articulation; speech delay

• Tensions of the jaw; grinding or clenching of teeth; tensions in the body,

especially tightly clenched fists (TMJ issues)

• Can affect reflexes responsible for eating, therefore can be seen in eating
disorders and excessive nail biting

• Retention of long-term sucking, such as biting or sucking on ones

clothes or objects in the hands
 Babkin Reflex

• Testing:

• Patient tries to both open and close hands against the

operator’s resistance

• A positive test is displayed by weakness or lack of

coordination in either movement
 Osteopathic Finding

• All of the grasp reflexes have similar findings - tight

scapulas that will not compress and tight rhomboids.

• Tight buccinators.

• Possible restricted premaxilla.

Plantar Grasp Reflex
(Feet)
“The person who says it cannot be done should not
interrupt the person who is doing it.”

–Chinese Proverb
 Plantar Grasp Reflex

• The plantar reflex, like the palmar grasp reflex, emerges at

11 weeks in utero but it is inhibited a little later, usually by
the time the infant learns to stand.
 Plantar Grasp Reflex

• The plantar reflex is a grasp reflex but in the human infant

only weakly so. Its purpose is to complement the palmar
reflex and assist the neonate in grasping onto his mother.
Its presence allows for movements of the toes and foot
and helps stimulate movement of the whole leg.

• One of its most important roles is to inhibit the Babinski

reflex within the first year of life.
Plantar Grasp Reflex
• This connection between the palmar reflex and sucking
is known as the Babkin reflex – the palmar-mandibular
response. When pressure is applied to the palms, the
neonate may flex and/or rotate his head and open his
mouth. The Babkin response demonstrates the hand-
mouth sensorimotor links which are present in the early
months.
• An exceptionally strong palmar reflex may be found in
an infant with kernicterus and hypertonic cerebral
palsy. It will be unilateral in hemiplegia.
 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.
 Plantar Grasp Reflex

• If a child has not learned 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.
 Plantar Grasp Reflex

• 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.
 Plantar Grasp Reflex

• Testing:

• The reflex is tested by gently stroking the sole of the

foot behind the toes (ball of the foot)

• The toes will curl/flex downwards towards the

stimulation and the foot will plantar flex/moves away
from the shin in a positive test
 Osteopathic Finding

• Toes curled down, tension on the plantar surface proximal

to the toes.

• Poor balance.
Rooting Reflex
“Great minds discuss ideas; average minds discuss
events; small minds discuss people.”

–Eleanor Roosevelt
 Rooting Reflex

• The rooting (searching) reflex is one of many oral reflexes,

which gradually appear from about twelve weeks in utero
and should be present at birth.

• The rooting reflex emerges at about 24 weeks post-

conception and is seen in utero when stimulation of the
side of the mouth or cheek results in turning of the head
towards the stimulus.
 Rooting Reflex
• The rooting reflex is strongest immediately after birth and it
is important that the neonate’s earliest attempts are
gratified. The newborn will root or search and the reflex is
triggered on contact or touch at the side of the mouth,
cheek or nose. The baby turns his head towards the
stimulus, opens his mouth and extends his tongue.

• The nipple or teat in his mouth makes contact with the roof
of the mouth and this contact sets off rhythmic suckling
movements – thus the ‘feeding reflex’ is put into action. If,
for medical reasons, the baby is not able to feed orally
immediately after birth, he may go on to have difficulties
feeding at a later stage.
 Rooting Reflex

• The purpose of the rooting reflex is obvious. There is a

need for an innate pattern to search for food before
vision is developed. As the baby grows, his responses
become conditioned and the sight of the breast or
bottle will have him turn his head to the necessary
position and he will open his mouth with no physical
contact.
 Rooting Reflex
• A retained reflex can cause:

• Hypersensitivity around 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.
 Rooting Reflex
• A retained reflex can cause:

• Tongue lies too far forward

• Hyper sensitivity around mouth

• Difficulty with textures and solid foods

• Thumb sucking

• Speech and articulation problems

 Rooting Reflex
• A retained reflex can cause:

• Difficulty swallowing and chewing

• Dribbling

• Hormone imbalance

• Thyroid problems and autoimmune tendency

• Dexterity problems when talking

 Rooting Reflex

• Testing:

• The reflex is tested by gently stroking the from the

mouth outward in the 4 cardinal compass directions
three times each

• Look for their mouth or hands to twitch on either side.

This is a positive test
 Osteopathic Finding

• Tension in the low back - dental connection

• Sensitivity around the mouth

• Poor speech

• Poor tongue function

Sucking Reflex
“The only thing worse than being blind is having
sight but no vision.”

–Helen Keller
 Sucking Reflex

• The sucking reflex is essential for feeding. Babies begin

practicing it in the womb and it becomes fully developed
by 36 weeks. This is why you may have caught a glimpse
of your baby sucking his thumb or hand on the
ultrasound. It's kind of like a warm-up exercise for the real
world.
 Sucking Reflex

• Babies who are born prematurely may not have a strong

sucking reflex at birth. They may also not have the
endurance to complete a feeding session. Premature
babies sometimes need some extra help getting nutrients
via a feeding tube that’s inserted through the nose into
the stomach. It may take weeks for a premature baby to
coordinate both sucking and swallowing, but many figure
it out by the time of their original due dates.
 Sucking Reflex
• The sucking reflex actually happens in two stages.
When a nipple — either from a breast or bottle — is
placed in the baby’s mouth, they’ll automatically start
sucking. With breastfeeding, the baby will place their
lips over the areola and squeeze the nipple between
their tongue and roof of the mouth. They’ll use a similar
movement when nursing on a bottle.
• The next stage happens when the baby moves their
tongue to the nipple to suck, essentially milking the
breast. This action is also called expression. Suction
helps keep the breast in the baby’s mouth during the
process through negative pressure.
 Sucking Reflex
• Premature babies may have a weak or immature sucking ability
because the reflex has not fully developed. You may notice a
combination of sucking issues, including:

• Disorganized or inefficient sucking patterns

• Weakened lip seal

• Impaired tongue shaping or movement

• Weakened stability of the inner cheek

• Trouble synchronizing the suck and swallow with breathing

 Sucking Reflex
• A retained reflex can cause:

• Speech and articulation problems

• Difficulty swallowing and chewing

• Difficulty speaking and doing manual tasks at the same time

• Involuntary tongue or mouth movements when writing or drawing

• Poor manual dexterity, especially when chewing or speaking

• Class II dental occlusion requiring dental intervention

 Sucking Reflex
• Testing:

• The baby’s swallowing reflex projects the tongue forward

which allows the baby to wrap their tongue around a
nipple. This reflex matures to the adult swallow reflex
whereby the tongue moves backwards to push a bolus of
food down the throat.

• If a Juvenile Suck Thrust is not adequately integrated, the

tongue projects forwards before moving backward in the
normal swallow. This tongue thrust continually pushes
against the back of the front teeth.
 Sucking Reflex
• We swallow thousands of times each day just for saliva
and this continual pressure can push the front teeth
forward. This causes a ‘class 2 occlusion’ otherwise
known as an overbite, one of the common problems
requiring orthodontics or orofacial orthopedics. It is a
huge problem for dentists and their patients.

• The correction for retention of this reflex can be at any

time of life however correction as early as possible is of
course preferable. It may save the formation of buck
teeth, an overbite and narrow upper palate, or recurrence
of the overbite after orthodontic intervention.
 Osteopathic Finding

• Tension in the low back - dental connection

• Poor speech

• Poor tongue function

• Class II malocclusion
Snout Reflex
 “Anyone who stops learning is old, whether at
twenty or eighty. Anyone who keeps learning stays
young. The greatest thing in life is to keep your
mind young.”
–Henry Ford
 Snout Reflex

• Emerges in Utero.

• Normally integrates by one year of age.

 Snout Reflex

• In a typical infant, the snout reflex is related to sucking

behavior.

• When retained, it may indicate a myriad of cerebral

disorders that affect the frontal lobes and pyramidal
tracks.

• This reflex is often retained in children with autism.

 Sucking Reflex

• Testing:

• The snout reflex is elicited by lightly tapping the baby’s

upper lip.

• Muscle contraction around the mouth and base of the

nose causes the mouth to pucker, creating the
resemblance to a snout.
 Osteopathic Finding

• Restriction of the premaxilla

Glabellar Reflex
“It is the mark of an educated mind to be able to
entertain a thought without accepting it.”

– Aristotle
 Glabellar Reflex

• Emerges at birth.

• Normally integrates by the fourth month.

 Glabellar Reflex
• Testing:

• It can be elicited by repetitive tapping on the forehead.

• Typically, once integrated, the subject will blink in

response to the first several taps and then become
habituated to the stimulus.

• If the subject continues blinking, it is called Myerson’s

sign. Persistence of blinking is abnormal and is an
indicator of cerebral pathologies such as Parkinson’s
disease, cerebral palsy, tumors, and head injury.
 Osteopathic Finding

• Look for tension in the falx and scalp fascia.

Posterior Chapman’s Reflexes
and their Relationship to the
Primitive Reflexes
Occur bilaterally unless otherwise noted
 C1 - Cerebral Congestion,
Cerebral Congestion, Otitis C2 -Cerebral Congestion,
Media, Nose, Tonsillitis Pharyngitis, Tongue,
ASTNR Laryngitis, Sinusitis
C3,4,6,7 - Torticollis ASTNR
Moro
 These points relate to the grasp reflexes of the palm

Neuresthenia Dupuytren’s Contracture

These points relate to the righting reflexes and the STNR

T2 - Thyroiditis, Bronchitis,
Ribs1-3 - Arms
Esophagitis, Myocarditis

T3 -Upper Lung, Neuritis T4 -Lower Lung

of the Upper Limb
 These points relate to the spinal Gallant and Perez reflexes

T5 L - Gastric Hyperacidity T5 R - Torpid Liver

T6 L - Gastric Hypercongestion T6 R - Liver and Gall Bladder

T7 L - Splenitis T7 R - Pancreas
These points relate to the spinal Gallant and Perez reflexes

T8 - Small Intestine (Upper) T9 - Ovary (Inner), Small

Intestine (Middle)

T10 - Ovary (Outer),

Small Intestine (Lower) Rib10 - Pyloric
Stenosis (R side)

T12 - Kidneys T11 - Appendix, Atonic

Constipation, Adrenals
 L2 - Abdominal Tension,
Urethra, Spastic
Constipation or Colitis,
L3 - Spastic Cystitis
Constipation or Colitis
L4 - Spastic
Constipation or Colitis
L5 - Uterine Fibroma,
Neoplasm

These points relate to the spinal Gallant and Perez reflexes and the
reflexes that involve the foot
 These points relate to the spinal Gallant and Perez reflexes
and the reflexes that involve the foot and the reflexes that
involve the tongue.
Iliac Crest - Spastic
Constipation or Colitis

Sacral Base - Salpingitis

(F), Vesiculitis (M),
Leucorrhea, Prostate,
Uterus, Broad Ligament Sacrum - Hemorrhoids,
Sciatic Neuritis,
Rectum, Groin Glands,
Cauda Equina

Coccyx - Irritated Clitoris

and Vaginismus, Cauda
Equina
 Primi ve Refle es Cheat Sheet
Refle Na e De c Age Age Sg a dS f Re e
De e I h b ed

M Refle Considered the “fight or flight” response ‐ ac va on of the Begins to develop 2‐4 months of Hypersensi ve/reac ve
sympathe c nervous system weeks in utero life Poor impulse control
Triggered by sudden unexpected occurrence of any kind Ves bular related problems such as mo on sickness, poor coordina on
Arms and legs move outwards with quick inhala on, then (no ceable in ball games)
freeze momentarily and then arms and legs tuck back in Physically mid
and the child exhales Oculomotor and visual percep on problems
Accompanied by a possible outburst of cries Poor pupillary control (sensi vity to light) likely caused by adrenal fa gue
Poor auditory discrimina on
Dislike of change or surprise

Pa a Refle Light touch or pressure in the palm of the hand will cause Begins to develop 2‐3 months of Poor manual dexterity/fine motor skills
the fingers to close 11 weeks in utero life Poor wri ng skills (messy wri ng or pressing too hard)
Speech difficul es (hand and mouth rela onship via the Babkin response)

A e ica T ic Movement of baby’s head to one side will result in Begins to develop Approx. Balance may be affected as a result of head movement to either side
Neck Refle ATNR extension of the arm and leg to the side that the head is 1 weeks in utero months of life Homolateral, instead of normal cross‐lateral movements when walking,
turned and bending of the limbs on the other side of the marching, skipping etc.
body Difficulty crossing the mid‐line
ATNR assists in a vaginal birth Poor ocular pursuit movements (eye tracking)
Difficul es with hand eye coordina on
Poor handwri ng and poor expression of ideas on paper

R g Refle Searching, sucking and swallowing reflex Begins to develop 3‐4 months of Hypersensi vity around lips and mouth
G a Refle Light touch of the cheek or s mula on of the edge of the 24‐2 weeks in life Tongue may remain too far forward in the mouth (makes swallowing and chewing
mouth will cause the baby to turn the head toward the utero of certain foods difficult)
s mulus and open the mouth in prepara on for sucking Speech and ar cula on problems
Poor manual dexterity (Babkin response)

S i a Ga a Refle Assists in the birthing process Begins to develop 3‐ months of Fidge ng

While the child in in the prone posi on, s mula on of the 20 weeks in utero life Bedwe ng
back on one side of the spine will result in hip flexion Poor concentra on
(rota on) to 45 degrees towards the side of the s mulus Poor short term memory
Unilateral or bilateral postural issues
 Refle Na e De c Age Age Sg a dS f Re e
De e I h b ed

Tonic Lab in hine ● Two parts to this reflex: flexion (forward) and extension Flexion: Begins to Flexion: ● Poor posture ‐ stoop (Flexion) walk on toes (Extension)
Refle TLR (backwards) develop in utero Approx. 4 ● Hypotonus ‐weak muscle tone (Flexion), s ff jerky movements (Extension)
● Basis for head management and postural stability using Extension: months of life ● Ves bular problems (poor sense of balance, mo on sickness) ‐ ( Flexion and
major muscle groups Present at birth Extension: Extension)
● Reflex is elicited by either moving the head forward Up to 3 years ● Oculomotor dysfunc ons ‐ visual‐perceptual difficul es and spacial percep on
(flexion) or backwards (extension), either above or below old problems ( Flexion and Extension)
the spine ● Poor sequencing ( Flexion and Extension)
● TLR exerts a tonic influence on the distribu on of muscle ● Dislike of spor ng ac vi es (Flexion)
tone throughout the body ‐ helping the baby “straighten ● Poor sense of me (Flexion)
out” from the flexed posi on in the womb ● Poor organiza onal skills (Extension)
● Balance, muscle tone (balance between flexor and
extensor muscles) and propriocep on are all trained
during this process

S mme ical Tonic ● Two parts to this reflex: flexion (forward) and extension Both flexion and Both flexion ● Poor posture
Neck Refle STNR (backwards) extension and extension ● Tendency to “slump” when si ng especially at desk/table
● When child is prone res ng on all four limbs, flexion of the emerges 6‐9 9‐11 months ● Simian (ape like) walk
head causes the arms to bend and the legs to extend months of life of life ● Poor hand‐eye coordina on such as copying from the board
● Head extension, on the other hand, causes the legs to flex ● Inability to sit s ll and concentrate
and the arms to straighten.
● Helps the child to defy gravity by ge ng up off the floor
onto hands and knees from the prone posi on
● Helps to inhibit the TLR and forms the bridge to the next
stage of development

Landa Refle ● Helps to inhibit the TLR and forms the bridge to the next Emerges 4‐5 3.5 years of ● Affects the development of balance and muscle tone in rapidly changing
stage of development months of life life condi ons
● Engages the extensor tone throughout the body in the ● Runs with s ff awkward movement
prone posi on if the baby is suspended in the air with ● Find hopping , skipping and jumping difficult
support under the stomach
● To assist with posture development

de ed a b dge efle be ee ea d a
Refe e ce
Di connec ed Kid D Robe Melillo Peng in G o p Inc
Refle e Lea ning and Beha io A Windo In o he Child Mind Sall Godda d Fe n Ridge P e
 Links
• https://brainbrighttherapy.com/wp-content/uploads/
2019/01/Primitive-Reflex-Handout_symptoms.pdf

• https://masgutovamethod.com/about-the-method/how-
mnri-method-works

• https://masgutovamethod.com/articles#dv.i58

• https://reflexintegration.net/quantum-reflex-integration/

• https://www.moveplaythrive.com/images/pdf/
integrating_reflexes.pdf
 Links
• https://www.minnesotavisiontherapy.com/primitive-reflexes

• https://ilslearningcorner.com/2018-04-how-retained-primitive-
reflexes-are-holding-my-child-back-in-learning-and-motor-
development/

• https://www.completeeyecare.net/featured-articles/primitive-
reflexes-an-unbalanced-neurological-system/

• https://skillsforaction.com/ptmate/retained-primitive-reflexes-fact-
or-fallacy

• https://catalog.pesi.com/sales/
rh_001301_primitivereflex_organic-64947