When I talk to people about primitive reflexes it blows my mind that these concepts are literally the backbone of everything I do now in the clinic. I can remember what feels like yesterday sitting in graduate school and diligently memorizing how to test for them, listening to lectures for hours on end for the entire pediatric semester with little to no understanding of what this all actually meant for a child’s development.

While I am thankful I had a professor who recognized the significance of primitive reflexes and put them on my radar, I was still left with so many questions.

How do these relate to developmental milestones?

What does integration mean?

What is a child tests positive? How do we treat this?

How do you explain this concept to parents?

Is this a priority for OT’s to focus on?

Having studied on them for quite a while now, I wish this was knowledge that not just every pediatric therapist had, but every parent as well.

Primitive reflexes are like the background music in a child’s developmental journey. They complement the child’s progress, sustain the child’s ability to engage in their environment as the child grows, but when played too loudly or for too long, they tend to dominate the child’s development and hold them back.

Simply put primitive reflexes are involuntary movements we are all inherently born with for survival. As we move and grow these involuntary patterns are replaced with more coordinated, voluntary movements. If you meet a child who is uncoordinated, they most likely have retained primitive reflexes, or visual processing issues… or both.

Ask me how I know (clumsy 90s kid 🙋🏻‍♀️).

So How Do Primitive Reflexes Work?

Primitive reflexes work in patterns and clusters. There are some clusters (Moro, Palmar and Rooting for example) that are the lowest brain primitive reflexes. When these are present past their time (which we will get to in a moment), they should also be the priority in treatment.

When the child has the palmar reflex retained there is usually an oral motor issue involved. The palms and the mouth are neurologically woven together. It is absolutely fascinating. That is why OT’s are especially equipped to address primitive reflexes, because our training is fundamentally well-rounded and encourages us to see the “whole” child.

Primitive reflexes also work on a timeline. They have points of noted integration, based on research as seen in this chart.

This is a timeline that I created based on several resources that show integration points in a child’s life. (Source available on Etsy)

When the child demonstrates a reflex past the typical integration period it is likely it will cause some kind of developmental delay or learning challenge. We call these retained primitive reflexes.

When the child no longer demonstrates primitive reflexes we call them integrated primitive reflexes.

Using Primitive Reflex Integration to Drive Progress

As an OT we have to be cautious that our goal writing is on par with OT Practice Guidelines.

That being said, it is within our scope to address these in treatment.

Can you write a primitive reflex integration goal? Probably best not to… but you can most certainly use integration techniques to address a fine motor goal.

I am a firm believer that we are always evaluating our patients and not relying on an evaluation from 6 months ago or longer in some cases to drive today’s treatment. With that mentality it is conceivable that we can be testing for these reflexes during our treatment sessions, as the results can demonstrate where the child is functioning at a neurological level.

For example if I have a child who is working on a writing goal at age 6 but his grasp is poor (maybe inconsistently using tripod grasp), has poor hand strength, poor fine motor endurance and spends his free time playing Roblox, it would be wise to look into testing his palmar reflex.

The reflexes are integrated through movement and play, and if the child has had little exposure to things like crawling, climbing toys, manipulative toys, different textures like dirt, leaves, tree bark, etc., it is reasonable that his palmar reflex is likely still present and this could be impacting his tolerance for holding something in his hand.

I could list so many more examples but the important takeaway is that primitive reflexes matter.

As a parent, ask your child’s therapist if they are open to addressing them in treatment. You can also look into resources like these books below: