How Do You Test for Primitive Reflexes? A Pediatric OT Explains 8 Key Reflexes
by Earl Mamaril, MS, OTR/L
Pediatric Occupational Therapy · Neurodevelopmental Assessment
What are primitive reflexes — and how do you test for them?
When a child constantly struggles with transitions, emotional regulation, clumsiness, or focus, it is easy to read it as a behavior problem. In the clinic, we look deeper — straight into the central nervous system. This guide breaks down what primitive reflexes are and how a pediatric OT tests for eight of the most important ones.
Watch: primitive reflexes & how we test them
In this video, Earl Mamaril, MS, OTR/L, founder of Sensory Therapy Place, answers the two questions parents ask most: What are primitive reflexes, and how do you test for them? He walks through what these foundational survival reflexes are, how we assess them in the clinic, and how they act as neurological roadblocks when they are not fully integrated. The written guide below mirrors the video, reflex by reflex.
What are primitive reflexes, and how do you test for them?
Primitive reflexes are automatic, brainstem-mediated movement patterns that emerge in utero and early infancy to support survival, feeding, and early motor development. They are meant to integrate — to fade into voluntary, cortical control — within roughly the first 6 to 12 months of life. A pediatric occupational therapist tests for them with specific hands-on positional and head-turn assessments, observing whether the reflex pattern still fires when it should be quiet. When a reflex is retained past its developmental window, it can interfere with posture, coordination, attention, sensory processing, and emotional regulation. At Sensory Therapy Place, reflex screening is part of every neurodevelopmental evaluation in Brewer and Scarborough, Maine, led by Earl Mamaril, MS, OTR/L.
Behavior, or biology?
A child who melts down at transitions, refuses to sit still, writes with their tongue out, or trips over their own feet is often described as difficult, impulsive, or distracted. But behavior is the surface. Underneath it is a nervous system that is either organized and feeling safe — or still wired for survival.
Retained primitive reflexes are one of the most overlooked reasons a capable child keeps hitting the same walls. They are not a character flaw and not something a child can simply try harder to overcome. They are unfinished developmental business, and they respond to the right kind of input. We fundamentally believe that therapeutic progress only begins when the nervous system feels safe.
A quick note on naming
Reflex terminology varies across clinical frameworks, and several reflexes go by more than one name. Throughout this guide we use the names from our own clinical database and link them to the terms you may have heard elsewhere. For example, the Crossed Extension Reflex appears in our framework as the Leg Cross Flexion/Extension Reflex, and the Automatic Gait Reflex is also called the Stepping Reflex. Where a reflex has an alias, we flag it.
For the complete A-to-Z reference, see our full Pediatric OT Guide to Primitive Reflexes and Types of Primitive Reflexes.
The 8 reflexes in this video — function, testing & signs
Each reflex below includes what it does, how a clinician tests for it, and the functional signs that suggest it has been retained. Testing is described for education — in practice, reflex assessment is performed and interpreted by a trained occupational therapist alongside posture, vision, and functional goals, never in isolation.
In Utero Reflexes
Fear Paralysis Reflex (FPR) — The Freeze Response
Function: The earliest withdrawal-and-freeze response to overwhelming stimuli. Closely related to the Moro reflex, it lays the groundwork for how the nervous system perceives threat and safety.
Signs of retention:
- Persistent anxiety; a system that stays flooded with cortisol
- Difficulty feeling safe or trusting others
- Freezing or shutting down under stress; extreme shyness
- Heightened sensitivity to unexpected stimuli; trouble relaxing
Supportive at home: calming deep-pressure input through a compression tunnel or sensory swing can help signal safety — alongside clinician-led integration.
Babkin Reflex — The Palm–Mouth Connector aka Palmo-Mental
Function: Links pressure in the hands with movement of the mouth. This hand-to-mouth wiring underpins feeding, oral-motor control, fine-motor skill, and speech.
Signs of retention (often seen in older children):
- Sticking the tongue out while writing or concentrating
- Poor or immature pencil grip
- Speech and articulation delays
- Hand fidgeting or mouthing under stress
Supportive at home: graded hand and fine-motor work with therapy putty supports the hand side of this pattern.
Rooting Reflex — The Feeding Seeker
Function: A turn-and-open response to touch near the cheek or mouth that helps a newborn find the breast or bottle. It is a foundational feeding reflex with lasting links to oral-motor development and speech.
Signs of retention:
- Hypersensitivity around the cheeks and mouth
- Difficulty tolerating food textures; picky eating
- Ongoing oral-motor and speech challenges
- Emotional reactivity to touch or change
Reflexes Active at Birth
Tonic Labyrinthine Reflex (TLR) — The Gravity Reflex
Function: Ties head position to whole-body muscle tone, helping the infant respond to gravity. It is strongly linked to the vestibular system and shapes muscle tone, posture, and spatial awareness.
Signs of retention:
- Poor posture and balance; low or high muscle tone
- Weak spatial awareness and judging of distance
- Motion sensitivity or disorientation
- Fatigue from holding an upright position
Supportive at home: graded vestibular and core input via a peanut therapy ball, mini trampoline, or sensory swing.
Automatic Gait Reflex — The Blueprint for Walking aka Stepping Reflex
Function: Held upright with the feet touching a surface, a newborn makes alternating stepping movements. This early pattern helps build the vestibular system and spatial orientation.
Signs of retention:
- Gait irregularities and frequent tripping
- Motor delays and poor balance
- Inefficient, effortful walking or running
Supportive at home: rhythmic, weight-bearing movement on a mini trampoline or indoor climbing gym.
Leg Cross Flexion/Extension Reflex — The Postural Balancer aka Crossed Extension
Function: A reciprocal leg pattern — as one leg flexes, the other extends. This spinal-level reflex develops the reciprocal, weight-bearing leg movement needed for balance, crawling, and walking.
Signs of retention:
- Altered or poorly coordinated reciprocal leg movement
- Reduced weight-bearing on one or both legs
- Difficulty with balance, crawling, and walking
Supportive at home: reciprocal crawling and climbing on a climbing gym or soft-play climbing set.
3–9 Months
Landau Reflex — The Anti-Gravity Developer
Function: A postural reflex in which the head, trunk, and legs extend when the baby is held in ventral suspension. It builds core extension and the anti-gravity strength needed to sit and stand comfortably.
Signs of an absent or unintegrated reflex:
- Poor core extension and a tendency to lean or collapse
- Difficulty sitting upright comfortably
- Low postural endurance and energy
Supportive at home: prone and core-extension play over a peanut therapy ball.
Symmetrical Tonic Neck Reflex (STNR) — The Transition Reflex
Function: Neck flexion drives arm flexion with leg extension; neck extension drives arm extension with leg flexion. The STNR bridges the gap into hands-and-knees crawling and helps the eyes shift focus between near and far.
Signs of retention:
- Slouching and W-sitting on the floor
- Difficulty with hand-eye coordination
- Trouble shifting visual focus from desk to classroom board
- Fidgeting and an inability to sit still at a table
Supportive at home: active, posture-supporting seating such as the FocusFlex active stool or a vestibular swivel chair.
How reflex testing actually works at Sensory Therapy Place
Testing for a single reflex is quick. Interpreting what it means for a particular child is where clinical training matters. Our process has four parts:
1. History & functional goals
We start with what you are seeing at home and school — the meltdowns, the handwriting, the W-sitting — so testing is anchored to real life, not a checklist.
2. Hands-on reflex screening
Specific positional and head-turn tests for Moro, FPR, ATNR, STNR, TLR, Spinal Galant, and the reflexes above, scored for whether and how strongly each still fires.
3. Whole-system interpretation
Reflex findings are read alongside posture, muscle tone, vision and oculomotor skill, balance, and sensory processing — never in isolation.
4. A plan & home program
Integration happens through rhythmic developmental movement in the clinic and a daily home program. Parents are part of the clinical team.
OT-recommended tools that support regulation at home
Tools support a nervous system between sessions; they do not replace clinician-led reflex integration. A few that pair well with the reflexes above:
- Sensory Compression Tunnel — calming deep pressure for an over-alarmed system (Moro / FPR).
- Sensory Peanut Therapy Ball — core extension and vestibular input (TLR / Landau).
- Sensory Mini Trampoline — rhythmic, organizing movement (gait / vestibular).
- Indoor Climbing Gym & Soft-Play Climbing Set — reciprocal crawling and weight-bearing (Crossed Extension).
- FocusFlex Active Stool & Sensory Swivel Chair — posture and near-far focus support (STNR).
Frequently asked questions
What are primitive reflexes?
Primitive reflexes are automatic, brainstem-mediated movement patterns that emerge in utero and early infancy to support survival, feeding, and early motor development. They include the Moro reflex, Fear Paralysis Reflex, ATNR, STNR, TLR, Babkin, and Rooting reflexes. They are meant to integrate into voluntary motor control within roughly the first 6 to 12 months of life so that higher skills like crawling, walking, and writing can develop.
How do you test for primitive reflexes?
A pediatric occupational therapist tests for primitive reflexes using specific hands-on positional and head-turn assessments — for example, head flexion and extension in a hands-and-knees position for the STNR, or palm pressure for the Babkin reflex. The therapist observes whether the reflex pattern still fires when it should be quiet, then interprets the result alongside posture, vision, balance, and the child's functional goals. At Sensory Therapy Place, reflex screening is included in every neurodevelopmental evaluation.
Can I test my child's reflexes at home?
Parents can absolutely notice the functional signs — W-sitting, toe-walking, tongue-out writing, trouble shifting focus from desk to board, meltdowns over sensory input. Those observations are valuable. Formal reflex testing and, more importantly, the interpretation of what a finding means for your child, should be done by a trained occupational therapist. A free 3-minute Sensory Profile Screener is a good first step before booking an evaluation.
What is the difference between the Fear Paralysis Reflex and the Moro reflex?
The Fear Paralysis Reflex (FPR) is the earlier, deeper freeze response that develops before the Moro reflex and matures into it. Where the Moro is an outward startle-and-embrace response, the FPR is an inward freeze. A retained FPR can keep a child's system flooded with cortisol, making it hard to feel safe, trust others, or move through stress. The two are assessed together.
Why does my child stick their tongue out when writing?
Tongue movement during writing is a classic functional sign of a retained Babkin reflex (also called the palmo-mental reflex), which links pressure in the hands with movement of the mouth. When this hand-to-mouth wiring has not fully integrated, effortful hand activity like writing can pull the mouth along with it. It often appears alongside an immature pencil grip or speech and articulation delays.
Do you offer primitive reflex testing near me in Maine?
Yes. Sensory Therapy Place provides pediatric occupational therapy with primitive reflex screening at our clinic in Brewer, Maine (serving Greater Bangor) and our location in Scarborough, Maine (serving Southern Maine). Reflex screening is part of every neurodevelopmental evaluation. You can schedule an evaluation or start with our free Sensory Profile Screener.
Primitive reflex testing in Brewer & Scarborough, Maine
Our clinical team assesses and integrates primitive reflexes every single day to help children find true emotional and physical regulation.
Brewer, Maine — Greater Bangor
Pediatric OT evaluations and reflex integration for families across Greater Bangor and Eastern Maine. Learn about our Brewer clinic →
Scarborough, Maine — Southern Maine
Our newest location, serving families throughout Southern Maine and Greater Portland. Learn about our Scarborough clinic →
Wondering if a retained reflex is part of your child's picture?
Reflex screening is included in every pediatric OT evaluation at Sensory Therapy Place. Book at our Brewer or Scarborough clinic — or start with the free screener.
(207) 300-7598 · service@sensorytherapyplace.com · Brewer & Scarborough, Maine
This article is for educational purposes and reflects the neurodevelopmental and sensory-integration framework used at Sensory Therapy Place. Reflex terminology and integration timelines vary across the clinical literature. It is not medical advice and does not replace an individualized evaluation by a licensed occupational therapist or physician. If you have concerns about your child's development, please consult a qualified professional.
