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Pediatric Occupational Therapy Clinic

2) As an occupational therapist, how does testing for retained reflexes help you do your job?


Reflex Activity – appropriate or inappropriate -  is a window into which brain connections have grown, and how they have grown, what they connected to. It tells me, as a therapist, what brain pathways are dominating and determining the behavior of the client. This “testing” can reveal whether reflexes are functioning as they should be.

All reflexes are retained in the sense that we should all be able to access the movement pattern when we need it – like baseball pitchers who use an ATNR to get the speed on their ball. This ability to access a movement plan, without the need for thought or planning, is most often seen in protective responses. Standing on a tac is an example. You need to be able lift your leg fast, without thought, so that the tac does not enter too far.
But you also need the choice to not respond in an obligatory manner to a stimulus. So if lifting your leg suddenly when you stand on that tac  (to avoid the tac going in further) means you spill the boiling water you are carrying, on yourself you need to be able to choose NOT to lift your leg  - if you would rather not have the burn. 

So testing for appropriately functioning reflexes tells me, as a therapist, how much choice this person has in their life, how many options they can access and how well they will adapt. It tells me how much effort they have to expend to perform whatever task they are attempting – be it reading or writing at school, or climbing or playing, and can be a predictor of the way the person relates to others – manipulative, domineering, compliant or acquiescing.

 3) What are ways babies can skip integrating reflexes? (For instance, not crawling)


There are several crucial points in development at which this can happen:

1. Initially babies skip a huge component when they born by C section. Normal vaginal birth is responsible for the initiation of rotational reflexes – rooting, ATNR, Spinal Galant and Babinksi.
The appropriate thing to do when there has been an emergency c section – which does happen appropriately for saving lives etc – is to advise the parents that will need to ensure that the child’s reflexes are initiated by going to a trained therapist  immediately. If I see a baby within the first week after birth, I can absolutely correct the inappropriate reflex activity. It is really easy and saves years of struggle.
If the C section is elective, it would ethical to discuss this effect with the parents before the proceedure.

2. The next piece that is often skipped, is eye contact while feeding. And then feeding from both sides – even if a bottle is used. This is again a marketing thing… fake breasts that hold the feeding bottle  - so mom can be on Facebook. 
Eye contact is necessary for the baby to establish attachment and to understand social referencing. The most common fallout is seen in poor Moro and Grasp reflex integration.

3. Developmentally the next crucial point where reflex integration can be linited, is when they skip lying on the floor.  Again a marketing thing where babies are sat up in supportive seats before they can do so themselves. Babies should not sit if they are not strong enough to sit on their own - even if they have reflux or GERD. The developmentally appropriate thing to do is hold the baby in your arms if they need the upright position - do NOT use devices. 
This includes the jolly jumpers, the rings that hold the child, the foam seats and a whole range of commercially available items.
The effects of sitting up supported when the musculature is not ready to do so is that there is a firing of pathways in an order that skips the skills and connections in brain areas that affect reading and writing.

The most common response to being placed inappropriatly in ring sitting/jumper activity seats the full straightening of the legs and back. The child then does not learn to extend against gravity in lying, nor does it go through the process of mixing flexion and extension in crawling. This process of learning to bend legs and straighten arms at the same time, will allow for many other kinds of movement as well as the ability to change visual focus. If skipped, what we see is there is often the jump straight to walking from lying. The mixed flexion/extension piece is missing. And then the child has to work extra hard for reading and writing and several acedemic tasks which have there biggest fallout in 3rd grade.

This will usually be evident in inappropriately active Moro, Tonic labyrinthine reflexes, Landau, STNR, often ATNR is also in the mix. Many times Babinski was not given the time needed to develop and it becomes enmeshed with grasp reflexes. The fallout is just complicated and accumalative. 


These are the most crucial points of dysfunction that we see in our practice.

 

Frequently Asked Questions about Primitive Reflex Integration

1) Do you think that if we encourage parents to allow babies (and children) to hit milestones at their own pace that they will be able to integrate all those reflexes and gain the strength they need. Does this approach make sense? Would you agree?


No I would very definitely disagree. The approach of letting children grow on their own, no longer makes sense in today’s world. We have environmental, and marketing driven child rearing practices that are detrimental to child development. We have laws and recommendations that have been put in place to protect children but in the long run have detrimentally changed child rearing. Old practices have been disgaurded as uninformed - but what they have been replaced with is untested and creating unintended consequences.

The back-to-sleep program has changed how babies sleep – in the effort to reduce SIDS. (Sudden Infant Death Syndrome). This practice now produces children with deformed skulls and  late development of the ability to raise their heads against gravity so much so that the CDC has changed the norms for our current generation. This is producing several unintended consequences not the least of which is poor head control in a very large sections of the population. This in turn is resulting in a large number of children with uncontrolled Moro reflex responses and I am seeing clinically, that the anxiety rates directly related to poor head control are rising. I know this because when we establish head control in therapy, anxiety drops.
The need for car seats has produced a host of car seat carriers that mean that babies never have to be taken out and held. They can just be moved from the house to the car, to the shopping cart, to the restaurant table, to the car and back  to the house – no change in position or human contact needed unless diapered. This is not good. Kids again end up with poor head control and poor pelvic control and stablility, and poor social skills.

The point is this: to just let a child reach its milestones naturally is a misconception. Milestones are reached through environmental influences. This can be seen very clearly in the extreme cases of adoption from orphanages where the kids are left in their cribs for 3-4 years, taken out only to diaper change. And this is why therapy works – we re-establish optimal environmental structure, we re-educate families about what is needed to grow humans. Knowledge that has been lost.