Retained Neonatal Reflexes

Retained Neonatal Reflexes

NEONATAL REFLEXES

Infants are born with a strongly developed set of reflexes called neonatal or primitive reflexes. Experts believe that the purpose of these reflexes is survival based. Examples of these  include:

  • The suckling reflex- where stimulating the lips or side of the mouth causes the baby to turn toward the stimulus and begin a suckling action
  • The palmar grip reflex – where lightly stroking the palm, or placing a finger in the hand of the infant causes them to close it and grip strongly
  • The Moro reflex – where a sudden backwards tilt causes the infant to throw their arms and legs outward
  • Asymmetric Tonic Neck Reflex- when the baby is on its back, turning its head to the left causes the left arm to straighten and the right arm to bend (& vice versa)
  • Galant Reflex – stroking along the spine causes a twitch in the back muscles on the same side

Around six months of age, many of the reflexes begin to wane (or integrate) and are slowly replaced by postural reflexes, whose purpose is to allow independent movement of limbs from head movement; manipulation of objects by hand, to sit up, crawl and eventually balance on two legs and walk. The chart below (courtesy of Inspiral Paediatric seminars) shows a timeline of the transition from primitive reflexes to postural reflexes.

 

Inspiral-Reflex-Chart

Developmental Delay

 

This transition between primitive, brainstem dominated neurology and advanced, cortex neurology can be interrupted, delayed or even inhibited by many circumstances in an infant’s life. Each of the primitive reflexes influence particular control and movement patterns, behaviour responses to different stimuli, and even perception of space and distance, so if the brainstem retains inappropriate control over these criteria it will block the corresponding development of control in the cortex, leading to abnormalities in coordination, processing and analysis of information. This can manifest in a whole range of learning disorders, poor spatial and time awareness and even abnormal behavioural characteristics, due to the exhaustive attempts by the brain to compensate for the excessive influence of the brainstem on normal function, even in adults, many decades later.

Common causes of these interferences are:

 

  • Assisted delivery during birth:
    • including induction by oxytocin (causes forceful and frequent contractions that jar the skull and spine of the foetus during birth)
    • Caesarean section
    • Forceps delivery
    • Vacuum
  • Excessive amounts of time spend in car seat, prams, bouncers and bassinets leading to poor or little movement
  • Food sensitivities, preservatives, flavourings and colourings and other insults to the infant’s immune system.
  • Severe illnesses or trauma during infancy
  • Genetic predisposition, familial inheritance patterns

Some examples of primitive reflexes and retention patterns:

The Moro Reflex

The Moro reflex represents an alert or danger signal to parents that the infant is in distress. In other words it is the infant equivalent of the fight-flight response to stress.

 

moro

Sudden noises, unexpected stimuli such as a sudden change in body position, lights and touch can evoke this reflex, where the arms and legs snap outwards in a star position, the child inhales, opens its eyes widely. It is then followed often by crying or lesser upset.

 

 

 

 

When this reflex fails to integrate properly, we see the manifestation of a very diverse range of functional disturbances, generally reflecting a hypersensitivity to stimuli (sensory integration disorders) such as the following:

 

  • Motion sickness
  • Balance and coordination problems
  • Timidity in behaviour, low self esteem and insecurity (which may lead to a controlling personality)
  • Poor stamina
  • Hyperactivity followed by fatigue
  • Visual disturbances- not being able to hold their gaze, frequent blinking, not maintaining eye contact, light hypersensitivity (i.e. to brightness),
  • Auditory hypersensitivity
  • Allergies- the continuous stress response results in fatigue of the kidneys, adrenals and liver, which makes one susceptible to infections, skins reactions and respiratory sensitivity
  • Hypoglycaemia
  • Anxiety disorders, separation anxiety, frequent nightmares
  • Mood swings
  • Intellectual challenges (e.g. very challenged by Maths)

 

 

 

The Asymmetric Tonic Neck Reflex (ATNR) reflex

This reflex assists the infant to turn and lift themselves up on the side they turn their head. It is believed that this reflex assists the foetus to move down the birth canal, and that the birth process also reinforces the strength of this reflex. There has been some suggestion that children delivered by assisted means (Caesarian, forceps, vacuum) are at greater risk of developmental delay- partly because of the underactivity of this reflex. When one considers that part of the effect of this reflex is to increase extensor muscle tone of the neck and provide the basic network for reaching movements of the arms, a whole host of activities become dependent on the proper functioning of this reflex in the early development of muscle strength and coordination:

  • atnrIt helps infants become mobile and flip themselves over
  • The relationship between head and limb movement and facilitates kicking movements
  • In 80% of infants sleeping on their side, they will prefer the right side up, and hence influence development dominance (handedness) more solidly
  • It supports development of midline cross neural development, improving auditory and visual processing
  • Reinforces cognitive development of not only spacial and midline orientation, but also more deeply being involved in perception and memory pattern development
  • The hemispheric sidedness that is developed through this reflex stimulates:
    • speech and language development (mostly left side of the brain)
    • learning, exploration and awakening
    • enhances development and then integration of the STNR reflex
    • Forms a basis for the further development of hearing
  • Influences development of the hearing-seeing relationship (or ears-eyes coordination)
  • Important in postural development (coordinating the sensory and balance systems)

 

Signs of failure to integrate this reflex

  • Mixed or poorly established dominance (e.g. right hand but left foot dominant; ambidextrous)
  • Parents will note the child prefers left side up when side sleeping.
  • Difficulty crossing arms and legs over midline in a coordinated exercise such as touching the opposite toes or shoulders. This is particularly relevant in terms of eye movement and visual tracking of objects across the midline. Reading will become a problem as they eyes need to rapidly track up and down as well as left and right to track words and sentences
  • Poor coordination of arms and legs (e.g. marching or skipping); balance.
  • Poor hand writing, reversal of letters
  • Dyslexia, dysgraphia, dyscalculia: as the head turns toward to the hand, there will be a reflex increase in tone of the extensor muscles of the hand,
  • Effects on handwriting result in the child attempting to increase grip strength (with resulting strain and fatigue of the fingers)
  • Visual disturbances such as convergence (board-book focus challenges)
  • Delayed speech and language development
  • Social and Behavioural dysfunction
    • ADHD: inattentive, hyperactive or combined types
    • Autism characteristics
    • Emotional and anxiety related issues

 

 

Tonic Labyrinthine Reflex (TLR)

 

The TLR is a survival reflex that serves to direct the activation of muscles into the direction of head movement. Think of a cat falling from a tree. As it falls forward, the limbs tuck in and forward to contact the ground and protect it from impacting its abdomen. This response is mediated by the vestibular (balance and spatial awareness) system, which involves the semicircular canals of the inner ear. There are two main groups of reflexes: the sagittal (or front back plane), and the lateral (or side to side plane). When the head is lifted above the level of the spine, the body and limbs move into extension; when the head drops below the level of the spine, the body and limbs move into flexion. These movements all help the infant develop an ability to eventually focus and pay attention.

 

Signs of failure to integrate this reflex

Most affected children will have a failure of integration predominantly of the flexion (forward) reflex, which results in excessive and chronic tightness in the flexor muscles relative to the extensor muscles of the body. In the arms, flexor muscles include the biceps and palm-side forearm muscles; while in the lower limb the flexors include the hamstrings, hip flexors, groin and calf muscles. In the trunk the flexor muscles include the front of the neck and chest muscles.

An important comment here is that there is also usually some tension in the diaphragm muscle in these children- which can lead to respiratory as well as digestive dysfunction. The stooped or hunched posture disrupts the normal descent of the diaphragm and lower rib cage expansion during breathing, which has a multitude of consequences such as:

  • Upper chest breathing, resulting in:
    • spasms of the neck, wry neck or torticollis
    • Barrel chest
    • A tendency to breathe through panting or mouth breathing leading to dental and jaw problems
    • Lower oxygenation leading to an acid physiological profile (lethargy, hypersensitivity, joint and muscle aches, mood disturbances, body odour)
  • Decreased rhythmic descent pressure into the abdominal cavity resulting in:
    • Hiatus hernias
    • Poor acid production and churning of food in the stomach
    • Poor secretion of enzymes
    • Poor peristalsis (waves of bowel contraction that pushes food along)- leading to:
      • Constipation
      • abdominal distension
      • Fermentation and putrefaction of food
      • Foul smelling stools and excess wind
      • Parasites and unbalanced gut bacteria
      • Inflammatory gut conditions and increased tendency to food allergies
      • Skin conditions such as eczema
    • Stasis of circulation to abdominal organs including the liver, kidneys, adrenal glands, bladder and spleen leading to loss of vitality, energy and immune function.
  • Behaviourally, there is often a tendency to lateness; a need to be helped or rescued by others

 

The extensor group of muscles, which oppose the flexors and are usually weak involve the triceps and back of forearm muscles; the shins and arches of the feet. They also involve well as the trunk core muscles such as the back, top of shoulders and the abdominal corset muscles (transversalis, oblique muscles).

Because of the unchecked and unbalanced function of the flexor group in particular, these children often exhibit a stooped posture, with rolled shoulders, slouchy forward head position and upper back weakness. At the same time, they will have very tight hamstring and calf muscles, pronated (collapsed) foot arches, often resulting in reactive toe walking, hip and back pain. Schoolwork can cause discomfort and learning impact due to the seated, head-forward desk position that is the tradition educational model. These children often move around and fuss in their chairs because of discomfort and can often be incorrectly labelled as disruptive or even ADD.

While the extensor group dominance is less common, in these children you will often find a stiff posture with rigid, jerky movements; toe walking; motion sickness, poor organisational skills

In children where both of these groups are poorly integrated, you often observe a floppiness and weakness that can have a substantial impact through delayed crawling and walking; delayed speech and learning.

The lateral TLR group is not as diagnostically obvious as the other two, but typically you might notice a left-right asymmetry, most noticeable in the form of a developing scoliosis. As most scoliosis tend to have some degree of torsion, not just sideways curve, this group is often associated with the sagittal group, again, more particularly with the flexion dominant subgroup. Parents might notice clothes not falling evenly over the shoulders, or pants not fitting correctly. The child may favour standing on one leg more than the other and when observed standing up, will tend to have a more side-to-side sway, though a forward – back sway is also characteristic.

Thus, TLR retained children often develop poorer spatial awareness than normal, commonly showing up as:

  • Poor posture, hunching or slouching
  • Toe walking
  • Weak extensor muscle tone, scrawny or skinny appearance
  • Poor balance, clumsiness (dyspraxia)
  • A dislike of sports
  • Visual problems such as convergence difficulties (or “board-to-book” challenges) due to difficulties in shifting their focus from long distance to close distance focus
  • When writing they tend to cram words into the end of the page or into a corner.
  • The special awareness challenges also manifest into poor sequencing skills, such as a sense of time and its use (yesterday-tomorrow), time management (lateness) etc.

 

 To check for retention of these and other reflexes not shown above, and for additional resources and exercises please call the clinic and speak with Dr. Allan Kalamir. He can examine your child and discuss any adverse findings with you as well as help you set up a program to improve your child’s development.

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