Neonatal reflexes or primitive reflexes are the inborn behavioral patterns
that develop during uterine life. They should be fully present at birth
and are gradually inhibited by higher centers in the brain during the
first three to 12 months of postnatal life. These reflexes, which are
essential for a newborn's survival immediately
after birth, include sucking, swallowing, blinking, urinating,
hiccupping, and defecating. These typical reflexes are not learned; they
are involuntary and necessary for survival.
A normal birth is considered full term if the delivery occurs during the
thirty-seventh to fortieth week after conception. Developmentally, the
baby is considered a neonate for the first 28 days of life. At birth, the
neonate must immediately make five major adjustments:
Under normal developmental conditions, these neonatal reflexes represent
important reactions of the nervous system and are only observable within a
specific period of time over the first few months of life. The following
reflexes are normally present from birth and are part of a normal newborn
The presence and strength of a reflex is an important indication of
neurological functioning. Within the first 24 hours after birth, a
healthcare provider evaluates an infant's neurological functioning
and development by testing and observing these reflexes. If a reflex is
absent or abnormal in an infant, this may suggest significant neurological
problems. In normal development, the primary reflex system is inhibited or
transformed in the first year of life and a secondary or postural reflex
system emerges. The secondary system forms the basis for later adult
coordinated movement. Absence or presence of a reflex is a symptom, not a
Severe persistence of primary reflexes indicates predominantly persistent
physical problems. Relatively milder persistence, however, is associated
with less severe disorders that include specific reading difficulties.
The process of inhibition of these reflexes in the earliest months of life
remains unknown but it has been assumed that this process cannot occur
after early childhood because neonatal movement is largely stereotypical
and follows the patterns of the primary reflex system. Thus, the early
movements of the fetus and newborn were previously viewed as passive
byproducts of the central nervous system. They are viewed as interactive
and having a reciprocal effect on the underlying central nervous system
structure and functioning. This implies that the actual rehearsal and
repetition of primary reflex movements play a role in the inhibition
An evaluation of neonatal reflexes is performed during well-baby
examinations. The abnormal presence of infantile reflexes in an older
child can be discovered during a neurological examination.
of neonatal reflexes is a screening tool for at-risk children with
neurological difficulties. Primary reflexes may persist for certain
children beyond their normal time span causing a disruption in subsequent
development. Children with neurological damage will have a common
of prolonged neonatal reflexes. Since recent studies have demonstrated
that repetition of these reflexes seems to eventually inhibit them,
parents can work with the infant by assisting with the repetition of
—Referring to the palm of the hand.
—Relating to the sole of the foot.
—Pertaining to the position of the head, neck, trunk and lower
limbs in relation to the ground and the vertical.
—Lying on the stomach with the face downward.
—Lying on the back with the face upward.
—Pertaining to the perception of visual stimuli.
The Role of the Primitive Asymmetrical Tonic Neck Reflex (ATNR) in
Balance, Co-ordination Problems and Specific Learning Difficulties,
Chester, UK: INPP, Monograph 2002.
Reflexes, Learning and Behavior.
Eugene, OR: Fern Ridge Press, 2002.
Seidel, Henry M., Rosenstein, et al.
Primary Care of the Newborn,
3rd ed. St. Louis, MO: Mosby, 2001.
Bein-Wierzbinski, W. "Persistent Primitive Reflexes in Elementary
Presented at the 13th European Conference of Neuro-Developmental Delay
in Children with Specific Learning Difficulties
Chester, UK (2001).
Blythe, Sally G. "Neurological Dysfunction, a Developmental
Movement Programme used in Schools and the Effect upon Education."
The Bangor Dyslexia Conference, University of Bangor, North Wales
American Academy of Pediatrics.
141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098. (847)
434-4000. Web site: http://www.aap.org..
The International Dyslexia Association.
Chester Building, Suite 382;8600 LaSalle Road; Baltimore, MD 21286-2044.
(410) 296-0232 or (800) 222-3123. Web site:
Primary Movement 2004.
Available online at http://www.primarymovement.org.
Primitive and Postural Reflexes—The Theory.
Available online at http://www.inpp.org.uk/htm.