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Pediatric Occupational Therapy · Neurodevelopmental Foundations
A complete pediatric OT guide to primitive reflexes — what they are, why retention matters, all major reflexes and their signs, and how Sensory Therapy Place uses integration to help children regulate, learn, and thrive.
Primitive reflexes are automatic, brainstem-mediated movement patterns that emerge in utero and early infancy to support survival and early motor development. They should integrate — meaning fade into voluntary, cortical control — within the first 6 to 12 months of life. When a reflex remains active past its developmental window, it can interfere with posture, coordination, reading, attention, sensory processing, and emotional regulation. Sensory Therapy Place, led by Earl Mamaril, MS, OTR/L, screens for and integrates retained primitive reflexes as part of pediatric occupational therapy in Brewer and Scarborough, Maine.
Imagine a newborn baby lying on their back — tiny hands curling instinctively when touched, legs kicking rhythmically as they explore the world for the first time. These movements, so natural and automatic, are the body's first language. They are how the nervous system learns to exist, to connect, and to feel safe.
As the baby grows, these reflexes should gently fade, making way for refined movements: crawling, walking, writing, balancing. But sometimes the reflexes linger. They hide in the body like echoes of early life, and though unseen, they whisper in ways that can be felt — a child who can't sit still, a body that holds tension without explanation, a mind and body that feel out of sync.
A neurodevelopmental assessment at Sensory Therapy Place examines the foundational systems responsible for emotional regulation, movement, sensory processing, and learning. We go beyond traditional pediatric assessments by examining the brain–body pathways that begin shaping in utero — because the earliest reflexive movements of the fetus are not random. They are the first expressions of the human blueprint, shaping how the nervous system perceives safety, organizes movement, and forms relationship with the world.
Our goal is to understand not only what challenges a child is experiencing, but why those challenges are occurring and how their nervous system arrived at this point. By identifying these patterns, we support the child's natural capacity for integration, self-regulation, and well-being.
Each primitive reflex supports a vital developmental milestone. The most critical reflexes are genetically encoded in our DNA — evolutionarily conserved foundations of human neurodevelopment. They emerge in predictable sequences during fetal and early postnatal life, serving as building blocks for motor control, sensory integration, and central nervous system maturation.
Their presence and timely integration are essential for typical development. As the cortex (the "thinking brain") matures, these reflexes should be replaced by voluntary, sophisticated movement. When they remain active past their expected timeline, they can interfere with everything from handwriting to emotional self-regulation.
When primitive reflexes are retained, children may seem overly reactive, clumsy, anxious, or unable to sit still. Adults may struggle with focus, posture, or chronic stress — unaware that their nervous system is still wired for survival rather than safety. Common patterns include:
Below is a complete reference of the primitive reflexes we assess at Sensory Therapy Place — organized by when they emerge in development.
In Utero Reflexes
Function: Activates the fight-or-flight response and mobilizes survival-based reactions to sensory input. Precursor to bonding and social orientation.
Signs of retention:
Function: Defensive response to overwhelming stimuli; helps the fetus withdraw from danger.
Signs of retention:
Function: Links hand pressure with oral-motor responses; supports feeding, speech, and emotional regulation.
Signs of retention:
Function: Helps the infant locate breast or bottle for feeding.
Signs of retention:
Function: Coordinates rhythmic sucking for nourishment and soothing.
Signs of retention:
Function: Coordinates feeding and breathing.
Signs of retention:
Reflexes Active at Birth
Function: Supports hand–eye coordination and midline development.
Signs of retention:
Function: Adjusts posture in relation to gravity.
Signs of retention:
Function: Stimulates hip movement and spinal mobility.
Signs of retention:
Function: Supports foot arch development and posture.
Signs of retention:
Function: Supports reciprocal movement for walking.
Signs of retention:
3–9 Months
Function: Supports anti-gravity posture.
Signs of retention:
Function: Coordinates head and body during crawling.
Signs of retention:
Postural & Adaptive Reflexes
Function: Full-body flexion in response to stress.
Signs of retention:
Function: Supports foot-ground stability.
Signs of retention:
Function: Aids balance and posture.
Signs of retention:
Function: Supports upright posture and torso control.
Signs of retention:
Function: Builds cross-lateral coordination through crawling.
Signs of retention:
Function: Aligns head with body and gravity.
Signs of retention:
Primitive reflex integration is not about fixing the body — it's about helping it remember. At Sensory Therapy Place, every pediatric OT plan combines four clinical pillars:
Each evaluation includes hands-on reflex testing for ATNR, Moro, STNR, TLR, Spinal Galant, and others — interpreted alongside functional goals, not in isolation.
Quiet, attuned connection that signals safety to the nervous system — the prerequisite for any reflex pattern to release.
Simple, natural motions that mirror how we first learned to roll, reach, and crawl — completing the developmental sequence the body started.
Regulation doesn't end in the therapy room. Caregivers learn protocols and home tools they can use every day. Parents are part of the clinical team.
For families and clinicians who want the full clinical picture: read our peer-reviewed-style article on ATNR retention, oculomotor function, and pediatric OT intervention — with citations from PubMed, NCBI, and AOTA sources.
Read the ATNR Clinical Review →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, ATNR, STNR, TLR, Spinal Galant, and Babinski reflex. Primitive reflexes should integrate into voluntary motor control by 6 to 12 months of age, allowing higher cortical skills like crawling, walking, and writing to develop.
Retained primitive reflexes interfere with the developmental sequence required for posture, coordination, focus, learning, and emotional regulation. A child with a retained Moro reflex may overreact to sensory input; a child with a retained ATNR may struggle with handwriting and reading. At Sensory Therapy Place, integrating retained reflexes is a foundational layer of pediatric occupational therapy in Brewer and Scarborough, Maine.
Common signs of retained primitive reflexes include W-sitting, toe-walking, poor handwriting, trouble crossing the midline, fidgeting, meltdowns over sensory input, and difficulty with reading endurance. A pediatric occupational therapist can perform specific reflex screening tests during a neurodevelopmental evaluation. Sensory Therapy Place offers a free 3-minute Sensory Profile Screener and a free 15-minute consultation to help you decide whether a full evaluation is appropriate.
Yes. Adults can carry retained primitive reflexes that were never fully integrated in infancy, contributing to chronic tension, postural difficulty, anxiety, attention struggles, and emotional dysregulation. Reflex integration in adults uses the same developmental movement principles as in children, with intervention adjusted for adult learning and body awareness. Sensory Therapy Place accepts select adult cases for reflex integration alongside our primary pediatric occupational therapy practice.
Earl Mamaril, MS, OTR/L, and the Sensory Therapy Place clinical team perform hands-on reflex testing as part of every neurodevelopmental evaluation. Testing includes specific positional and head-turn assessments for ATNR, Moro, STNR, TLR, Spinal Galant, and other major reflexes. Findings are interpreted alongside posture, midline crossing, oculomotor skills, and parent-reported functional goals — never in isolation.
Most families notice measurable shifts in posture, regulation, and motor coordination within 8 to 12 weeks of consistent pediatric occupational therapy at Sensory Therapy Place. Full integration of multiple retained reflexes typically takes 6 to 9 months of weekly or biweekly care, paired with daily home programs. Sensory Therapy Place reviews each child's reflex profile every 12 weeks against measurable functional outcomes.
Schedule a neurodevelopmental evaluation at our Brewer or Scarborough Maine clinics — or start with a parent coaching telehealth call. Reflex screening is included in every pediatric OT evaluation at Sensory Therapy Place.
(207) 300-7598 · service@sensorytherapyplace.com · Brewer & Scarborough, Maine
Your sensory & nervous system guide
Hi! I'm BrainMax — your sensory & nervous system guide. Which sensory system are we supporting today? 🧠