Primitive Reflexes in Child Development - Part 2
We’ve discussed Primitive Reflexes in previous blogs, today I’m going to get a bit more in depth. Before we talk about Primitive Reflexes, let's go back to neuro 101. The brain has different parts called the brain stem (kind of like the stem of a flower), the cerebellum, and the cortex (the large part). The lower structures develop first (brain stem), then the higher structures (cerebellum and cortex). When a baby is born, the brain is immature. The brainstem is the most mature, and regulates most of the baby’s functioning with almost automatic functions. This includes breathing, heart rate, and primitive reflexes. It’s like the baby’s functioning is on auto-pilot early on. As the baby learns about his or her environment and develops during the first year; the brain stem starts relinquishing more and more control to the other parts of the brain. Within the first year, the brain stem fully matures.
Movement!
The prefrontal cortex matures much later, not until a person is in their mid 20’s does it fully mature through movement and interaction with the environment. It’s also a use it or lose it type phenomenon; which makes it so important for children to receive information from the environment to their senses to react and move. This exchange of information creates changes in the brain and in the body systems. As your baby learns how to be in control of their bodies, the brain stem gives up some control to higher parts of your brain (cerebellum and cortex).
Think of your brain as a theater:
The upper level of the brain is the stage. You only notice what’s on stage during a performance; similar to your learning, planning, rational thinking.
The brain stem and cerebellum is like the backstage crew. Working behind the scene to make sure everything runs smoothly.
Primitive Reflexes
Develop in utero
Assist the birth process
Disappear (typically) within the first year, and replaced by adult reflexes
Are a test to the maturity of your central nervous system
Are strong, may interfere with development and function of the rest of the brain
Children have these reflexes for a reason, to help them through the birth canal and to help them adjust to a totally new environment (outside the womb). Reflexes are for survival until they learn to adjust. Unfortunately, they can interfere with development and function of the rest of the brain past a certain age.
We’ll go through each Primitive Reflex, starting with...
Moro
The Moro reflex is one of the more common, and have a large affect on child development. It has to do with when the baby or child loses head support, they go into fight-or-flight mode. This helps for the baby to take their first breath, protecting their airway, and alerts caregiver to a possible danger. The downfall to this is that if the stimulation to the nervous system continues upon the change in head position, releasing stress hormones, cortisol and adrenaline; it affects their arousal, sensory, immune and digestive system. With this adrenaline rush, it might present as that their really excited but that’s what happens when this reflex gets elicited. They might be at their stress limit more than usual due to this reflex that still persists. Result: This might be the child that has a hard time tuning out irrelevant information to continue their school work. They also may react more sensitively to auditory information.
Symptoms include: overreactive, hypersensitive, anxiety, hyperactive, visual-perceptual problems, poor impulse control, emotional immaturity, motion sickness, immune issues, stimulus bound, controlling behavior, dislike of changes.
Asymmetric Tonic Neck Reflex (ATNR)
This is a reflex that gets elicited when a child’s head turns right or left, and their limbs flex/extend in response. This reflex is for encouraging movement in the womb, assists with the birth, helps keep baby’s airway clear, early visual hand-eye training, and helps break up the two sides of the body. If not integrated, it makes it difficult for kids to coordinate both sides of the body, especially for reading and visual motor development.
Symptoms: poor balance and coordination, avoiding crossing midline, poor hand-eye coordination, difficulty with visual tracking, difficulty with reading and writing.
Tonic-Labyrinthine Reflex (TLR)
This is elicited when the neck is extended or flexed. This is another reflex that helps the baby get into a good position for birth, helps develop muscle tone, elicited by the vestibular system.
Symptoms: poor balance and coordination, visual perceptual problems, motion sickness, over or underdeveloped muscle tone, poor posture, toe walking, poor spatial skills, vestibular problems.
Spinal Galant Reflex
This is when a baby’s hips rotate towards stimulated side. It increases movement and flexibility in the womb, and promotes hip flexibility. As children get older with this retained reflex, sitting in a chair may be uncomfortable.
Symptoms: difficulty sitting still, hypersensitivity in the lumbar region (tags, waisbands), some connection to bedwetting.
Symmetric Tonic Neck Reflex (STNR)
STNR helps babies move from crawling on the floor to standing, spine alignment, and visual skills that allow them to focus on things close up and alternate to something far away. This might be the reason your child is uncomfortable sitting in a chair, needs to move in different positions to copy from the board, they may even sit on their feet. It may present as though they are students that don’t want to do their work, but it’s the difficulty they have with an immature postural system that is preventing them from sitting comfortably. This may also affect their attention and concentration, as well as hand-eye coordination.
Symptoms: helps the infant defy gravity (move from floor to standing), helps spine alignment, and visual accommodation (alternating visual focus for something close to something far).
Reasons for Retained Primitive Reflexes
This might be due to damage to higher levels of the brain, Pathology (Alzheimer’s and Parkinson’s), or maybe they never properly developed or withdrew during pregnancy, birth and infancy. In pediatrics, it’s usually the third case. This includes; complications with pregnancy, complications with labor and birth, or problems in infancy. It could also have to do with complications with pregnancy; medical problems, sickness, injury requiring bed rest, extreme stress, or alcohol/drug use. These are just risk factors, and it doesn’t mean that if one of these cases relates to your family- that your child will end up with a retained primitive reflex.
Treatment through Occupational Therapy
The way we treat a person with neurodevelopmental delay (retained primitive reflexes), is through movement and interaction with the environment. Special exercises are performed that stimulate the nervous system, and different parts of the brain stem. This is not a quick fix, it requires months of the program, but it is made manageable with the help of family and an Occupational Therapist to make an individualized and tailored treatment plan for your child’s needs.
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