Depending on how old your child is, this article may take some remembering. Think back to when your child was an infant. Did he or she tightly grasp your index finger in their hand? Did they find the bottle with their mouth when it was placed by their cheek? Did they look like a "fencer" when you found them sleeping on their back in their crib (arm extended in the direction that the head is turned)? Each infant is born with a set of reflexes, similar to the reflex test you receive at the doctor's office when she hits your kneecap with that triangular looking rubber hammer. A reflex is defined as "an involuntary response to a stimulus and the entire physiological process activating it." (Goddard, 2002). These reflexes serve as a foundational set of motor movements which come hardwired in our central nervous system. Beginning in utero, they help infants begin to understand their bodies and to develop through the various motor milestones. When a baby begins to learn volitional movement patterns these reflexes are then integrated. But what happens when they don't integrate? Research shows that primitive reflexes have been linked to problems with development, academic success, motor control and bilateral coordination, visual-spatial tasks like reading, writing and more (Goddard, 2002).

These primitive sets of reflexes are directed from the brainstem without the involvement of the cortex. With that being said, when reflexes don't integrate they are disruptive to cortical learning and processing because the brainstem is cotinuing to elicit reflexes that are no longer needed. Retained reflexes impact the fluidity of higher-level brain functioning because the child's neurological foundation is somewhat immature or inefficient.

Many of our reflexes begin to develop in the womb, and one of the first reflexes to develop is the Moro reflex. Picture a windy day, when suddenly the wind blows the door shut and the baby starts to wail. This is a hallmark involuntary startle response (the Moro reflex); a baby responding to a sudden noise. This reflex is a survival instinct, as it is an alerting call for help during times of threat, a baby's "fight or flight" response. If the Moro reflex doesn't integrate properly, it can cause a child to be hyper vigilant - always on the edge of a "fight or flight" response. This can be seen in a child who is fearful and cautious or a child who is overly excitable and controlling. A retained Moro reflex is correlated with movement challenges, including motion sickness, poor balance and coordination, physical timidity, difficulty tuning out peripheral vision, difficulty shutting out background noise, poor immune system and a dislike of change in routine or surprises. This reflex is a major primitive reflex due to the fact it it is connected to all of our senses and it has a strong tie to our state of arousal and emotional stability.

Now picture older children who are sitting in class, trying to focus on a teacher's lesson. They are bothered by fluorescent lighting. They can't tune out the child sitting next to them making noise. They are startled by a book that is dropped and this sends a rush of adrenaline causing them to become overly excited and unable to focus. For children with this retained Moro reflex, life can be a constant battle of trying to remain regulated and attentive in a world where sensory input is overwhelming.

Primitive reflexes help infants navigate out of the womb during the birthing process. It is this process where these reflexes are called upon and also established for use after birth during development. A few reflexes are thought to assist in the birthing process. They include the Asymmetrical Tonic Neck reflex (ATNR) and the Spinal Galant reflex. In utero, the ATNR facilitates a baby's ability to kick, increases muscle tone and facilitates the development of the vestibular (movement) system. This reflex is the beginning of eye-hand coordination. It elicits the extension of the arm and leg in the direction that the baby turns his head. Additionally, opposing limbs flex at the same time when the head is turned. This reflex resembles a "fencer" like position. A retained ATNR can result in poor balance, difficulty with reciprocal movement patterns like skipping, trouble with midline crossing, mixed dominance or hand preference, the lack of ocular motor skills needed for writing, reading and visual-motor sports, poor handwriting and expression of ideas in written composition.

The Spinal Galant is a reflex that results in side to side trunk flexion to a touch response on the side of an infant's spine. A retained Spinal Galant can result in fidgeting and difficulty remaining in a seated position, bedwetting past the age of five, as well as poor concentration and short term memory. This occurs because if this reflex is being elicited by tactile input (whether it is clothing, the back of a seat, etc.) it causes postural instability and wiggling similar to a child who looks like they have "ants in their pants."

These are only a few of the many reflexes that every one of us has in the foundation of our nervous systems. They are neurological in nature, unconscious, and develop and integrate in a somewhat sequential order. There are different reasons why reflexes may not integrate as naturally for some children. It could be lack of time spent in certain milestones (crawling, tummy time) or trauma during pregnancy, during birth or even during infancy. Despite the reason, there are many implications that a retained reflex can have on neurological brain development and a child's ability to learn and succeed in their daily activities whether it be school related, self help or extracurricular. If you are concerned that your child is struggling with issues that may be related to retained reflexes and immaturity within his nervous system, support and treatment is available. As when any question or concern arises regarding a child's health and development, parents should seek the advice of their family pediatrician. She may make the recommendation for an Occupational Therapy evaluation, as well as additional assessments to rule out any other health problems.

Brittany White M.S., OTR/L, is an Occupational Therapist at The Treatment and Learning Centers