Even though Neuro-Developmental Delay (NDD) is not something that is diagnosed until the child reaches four years of age. There are several signs which can be be evident earlier on which can affect a child’s confidence and behaviour, ability to focus and retain information, social development, fine and gross motor development, co-ordination issues and postural tone.
Reflexes put simply are “predicable and unconscious motor reactions that occur in response to stimuli which are mostly protective in nature”. Most of us can relate to putting our hand on something hot and finding that within a split second our hand withdraws. This is a useful and safe reflex we have to avoid burning.
Retained Neonatal Reflexes:
Dysfunction Affecting the Hemispheres
The left and right brain have differing functions. Generally, one hemisphere will give signals to, and receive information from the opposite side of the body. ie moving your right arm is controlled and signalled by the left hemisphere, and touching the left arm is interpreted by the right side of the brain.
The left brain (known for being the logical hemisphere): is involved with tasks such as;
|Language||Mathematics||Writing and Reasoning|
The Right brain (more the creative hemisphere);
|Music||Philosophy||Facial recognition and imagination|
Hemispheric dysfunction may lead to any of the following;
- Handedness – a clear preference for one hand over the other
- Sidedness – one ear, eye or side of the body dominates the other
- One sided weakness results in poor coordination (dyspraxia)
- Poor coordination between both sides of the body affecting sport, dance, play etc
- Difficulty processing school tasks ie adding numbers
- Reluctance to hum tunes
- Lack of creative ability
Fear Paralysis Reflex - FPR
This reflex is one which is generally presents only within the womb. It involves the opposite of “fight or flight” and can be seen even as early as soon after conception.
Retention symptoms present with:
- Low tolerance to stress
- Dislike of change or surprise
- Fear of social embarrassment
- Temper tantrums
- Hypersensitive to touch, sound, change in visual field
The Moro Reflex is present at 9-12 weeks after conception and is normally fully developed at birth. It is the baby’s “danger signal”. The baby is ill-equipped to determine whether a signal is threatening or not, and will undergo instantaneous arousal. This may be due to sudden unexpected occurrences such as change in head position, noise, sudden movement or change of light or even pain or temperature change. This activates the stress response system of “fight or flight”.
If the Moro Reflex is present after 6 months of age, the following signs may be present:
- Reaction to foods
- Poor regulation of blood sugar
- Fatigues easily, if adrenalin stores have been depleted
- Mood swings, tense muscles and tone, inability to accept criticism
- Low self-esteem and insecurity
Juvenile Suck Reflex
This is active together with the “Rooting Reflex” which allows the baby to feed and suck. If this reflex is not sufficiently integrated, the baby will continue to thrust their tongue forward, pushing on the upper jaw and causing an overbite. This by nature affects the jaw and bite position.
This may affect:
- Difficulties with solid foods
- Speech and articulation problems
- Overbite of upper jaw, requiring dental intervention
Light touch around the mouth and cheek causes the babies head to turn to the stimulation, the mouth to open and tongue extended in preparation for feeding. It is present from birth usually to 4 months.
Some of the signs present if retained are:
- Fussy eating and possibly difficulty swallowing
- Thumb-sucking, chewing on nails, collars etc
- Tongue sitting too far forward in the mouth
- Speech and articulation problems
- Hormonal imbalances
This reflex is present from 18 weeks in utero, together with the Plantar Reflex, and is strongly active during the first 12 weeks of life. It should be transformed by 4-6 months to a pincer grip. This is commonly seen as the “grip response” from stimulation of the palm. There is also a direct link with the “Babkin Response” which is associated with feeding (neck flexed, mouth open and eyes closed). Andre Thomas (1954) found that by stimulating the “Palmer/Grasp Reflex”, the “Moro Reflex” may be inhibited. Placing an object in the hand inhibited arm movement.
Retention following 3 months of age include:
- Problems with fine muscle co-ordination
- Difficulty with speech and articulation
- Difficulty with pencil grip and poor handwriting
- Jumbling letters, spelling and writing
- Poor posture and or back pain when working at a desk or PC
- Difficulty processing ideas on to paper or computer
The Plantar Reflex, similar to the Palmer Reflex, is used for grasp and emerges in utero being fully present at birth. It is normally integrated by 6-9 months of age. It is elicited by stroking the baby’s foot from the heel up to towards the ball of the foot causing the toes to spread and foot to turn slightly inward. It has involvement with balance, walking and co-ordination, especially if this is retained.
If the Plantar Reflex is retained, there may be issues with:
- Balance and walking
- Plantar strains and shin splints
- Recurrent ankle injuries
- For adults, this may play a role with chronic low back pain and dysfunction
Palmomental and Plantomental Reflex - PMR
This is a primitive reflex which consists of movement of the mouth muscles when the thumb or big toe is stimulated. This reflex appears at 9 weeks in utero and is usually integrated at 3 months of age. The Plantomental Reflex is related to the “Stepping Reflex” which aids in crawling and locomotion.
Common signs of a Retained Reflex include:
- Movement of the tongue and mouth when writing
- Difficulty eating with a knife and fork
- Difficulty with facial expression
- Tension in the jaw and neck when concentrating
- History of biting
- Tight pencil grip
- Clenching the jaw whilst gripping the steering wheel.
Often an improvement of speech, hand and facial mobility is noted when this reflex is integrated.
Tonic Labyrithinine Reflex - TLR
This reflex is linked with the “Moro Reflex”. The TLR begins around 12 weeks in utero. It is mostly involved with balance perception and body in space awareness. It aids in maintaining foetal position within the womb and also assists the baby during the birthing process. It allows the infant with a primitive method of responding to gravity. There are two parts to this reflex – forwards and backwards. Head flexion or down will cause the limbs to fold and is mostly integrated by 4 months. Head extension or backwards will lead to extension or straightening of the limbs and is integrated gradually from 6 weeks up to 3 years.
Retention of this reflex will produce:
- Stooped posture
- Tendency for children to walk on their toes
- Fatigue while writing or sitting to study at a desk
- Difficulty judging distance, speed, depth and space
- Motion sickness
- Poor balance
- Can also be associated with auditory processing disorders
Sagittal Labyrithine Reflex - SLR
The SLR is known to be involved with poor concentration and posture whilst sitting. It is associated with TLR and STNR Reflexes and plays a role in the integration of these reflexes.
This reflex is commonly seen with the child who prefers to slump or sit in what appears to be a lazy position. They have their chair pushed back, leaning forward and are proped by the hands resting on the table.
Retention of this reflex can lead to:
- Tiredness at the end of the school day
- Poor concentration in the classroom
- Poor posture
- Prefer reading or doing homework laying on stomach
Asymmetrical Tonic Neck Reflex - ATNR
This reflex begins 18 weeks after conception and should be present at birth. Rotation of the infant’s head to one side will lead to extension/straightening of the arm on that side and bending of the arm on the opposite side. This aids in development of muscle tone and during the birthing process, together with the “Spinal Galant Reflex”. It also assists the newborn free passage of air when laying on their tummy. It also aids in development of hand-eye co-ordination, increasing extensor tone of the body.
Retention of this reflex will affect:
- Normal crawl pattern
- Balance when walking, as arms will want to extend on head rotation
- Hand-eye co-ordination
- Inability to cross over the midline of the body
- Problems with written performance (expression of ideas on paper) and ease with oral expression
- Visual tracking problems, especially at the midline, which can affect reading
- Ambidexterity (inability to determine a dominant hand past the correct age)
- Kicking and catching can be difficult
A retained ATNR in an adult can also lead to shoulder, elbow and wrist problems.
Spinal Galant Reflex
The Spinal Galant Reflex begins about 18 weeks after conception and is usually integrated by age one. This reflex plays an important role during the birthing process, by activating the ATNR Reflex. Stimulation of the side of the trunk causes the trunk to side-bend; hip is flexed and the knee extended. The head also turns to the side of trunk flexion. Stimulation by bed sheets or pyjamas may activate the related urinary reflex, creating bed wetting long after toilet training has been established.
Common retention symptoms include:
- Children who have inability to sit still (ants in their pants kids who wriggle and constantly change their position)
- Attention and concentration problems
- Bladder problems (predominantly bedwetting)
- Postural problems which may lead to scoliosis due to the muscular contraction on one side of the spine
- Clumsiness while trying to manipulate objects
- Difficulty coordinating normal walking movement
Symmetrical Tonic Neck Reflex - STNR
This reflex tends to emerge after birth at around 6-9 months and are inhibited by 9-11 months. It should be integrated by the age of one, getting the infant ready for crawling. Capute (1986) suggested that it is not a separate reflex, but a stage of the TLR. There are two parts to this reflex; flexion of the head causes the arms to flex and legs to extend (this prepares the eyes to move to near distance vision), whereas head extension causes the arms to extend and legs to flex (this prepares the eyes for far distance vision).
Common retention symptoms include:
- Injury-prone and clumsy children
- Difficult to co-ordinate upper and lower body
- Poor hand-eye co-ordination
- Slouched posture
- Eye tracking problems
- Poor sensory integration
Stepping and Heel Reflexes
If our body position changes, we have postural muscles that fire according to change were we hold ourselves under gravity. These may vary according to whether our weight is over our heels, toes or mid foot.
Stepping reflex retention may lead to;
- Toe walking
- Tight calf muscles
- Poor balance and muscle control
- Feet and ankle problems with pain and dysfunction
- Reoccurring hamstring injuries and mid lower back
Heel Reflex retention may lead to;
- Heavy heel walking ie walking like a baby elephant
- Poor core stability
- Balance problems
- Visual problems doe to an altered perception of the horizon – head tilts back and eyes look down.
- Shin splints, heel pain, achilles tendonitis