On this page Maxine regularly shares her knowledge of health issues that may affect your baby or toddler.
RETAINED REFLEX SYNDROME (RRS)
For the next few months this page will be dedicated to some of my favourite patients – the babies – and with particular reference to the increasingly recognisable problems that can arise as a result of a medical condition known as RETAINED REFLEX SYNDROME (RRS). To understand the physiological effects RRS can have on child, and later, adolescent development, we need to first look at PRIMITIVE (newborn) REFLEXES and understand not only their short-term purpose, but also the reason why they need be replaced by more sophisticated mechanical responses within the first years of life.
Reflexes are predictable but involuntary reactions which originate in the nervous system when the body is subjected to a certain stimulus e.g. we shiver when we are cold because heat is generated by muscular activity, and we produce adrenalin at times of stress to help us face-up to the perceived danger (commonly known as the “fight-or-flight” response). For this reason, reflexes have ensured our survival as a species over hundreds of years and are with us from the beginnings of the birth process (the PRIMITIVE REFLEXES) when they lay the important pathway for neural integration and movement pattern in the more mature nervous system. Health and lifestyle issues during pregnancy and labour can often hamper your baby’s primitive reflex responses, but with elective C-sections on the increase, this is often a primary cause for RRS.
So, to kick-off, next month I will be addressing two well-known PRIMITIVE REFLEXES i.e. the MORO reflex and the ROOTING reflex, explaining what happens, why they are necessary, and the disadvantages they may cause to your child if -for whatever reason – they do not inhibit.
RETAINED "MORO" REFLEX
The Moro reflex is one of the earliest and most well-known of the primitive reflexes as it is the precursor to the stress response, commonly called the “fight-or-flight” reaction. Whenever a new-born is subjected to a sudden sensory change – it could be anything from a change in temperature, light, sound, or even body position – it will throw back its head with eyes wide-open, extend both arms and fingers, and take in a breath. Seconds later, it curls legs and arms in the foetal position and wails loudly – the whole response is to warn the parent of potential danger threatening the vulnerable offspring.
The Moro reflex initiates in utero after the first wave of contractions and usually inhibits within the first few months of life. It is a vital part of the birth process, as it stimulates the production of adrenalin to prepare the foetus for its active journey down the birth canal. The contractions also force the baby’s diaphragm to move which changes the balance of blood gases and prepares the baby for its first independent breath.
However, if the reflex does not inhibit within an acceptable time after birth, the baby will be locked into a permanent state of irrational excitability - unable to concentrate and demonstrating poor vision, impulsive behaviour and extreme mood swings. This will impact on his/her social integration throughout life both physically, emotionally and psychologically.
If your baby or toddler shows classic signs of over-adrenalisation i.e. irregular sleeping/feeding patterns, inconsolable fits of wailing, and red, hot skin flushes, consider the possibility of a still-active Moro.
RETAINED “ROOTING” & “SUCK” REFLEX
Also, two of the earliest reflexes which are at their strongest straight after the birth process are the Rooting and Suck reflexes, which encourage the new-born to latch on to the breast and feed. Stroke a cheek or lip and the baby will turn its head towards the stimulus and open its mouth ready to suck and swallow.
Naturally, these reflexes are not only vital for the infant to thrive, but also the muscular action of feeding helps jaw development and precedes hand/mouth co-ordination.
Failure of inhibition can cause articulatory problems, a constant need for oral gratification, fussy eating habits and poor manual dexterity. If your toddler displays these worrying traits it could be that he/she has a retained Rooting and Suck reflex, and could be caused by something as simple as a delayed skin-to-skin moment, or a temporarily undetected tongue-tie in the first weeks of life.
RETAINED SPINAL GALANT AND RETAINED PALMER REFLEXES.
RETAINED SPINAL GALANT REFLEX
When you lightly stroke the low back of a new born to the the right or left side of the spine, the hip and torso should automatically rotate to the same side. The Spinal Galant as this reflex is known is present at 20 weeks gestation and is an important part of the birth process as it helps the baby to wriggle its way down the birth canal. As the child develops, the same reflex will prompt it to turn onto its stomach and creep commando-style, before it progresses to crawling on hands and knees with the limbs co-ordinated in opposition. The 3 stages of the reflex are necessary for the “figure-of-eight” pattern that is the basis for most adult movement. If, however, the reflex does not inhibit within the first 9 months of life, the potential symptoms cannot only be demonstrated in clumsy mobility and gait due to lack of cross-lateral coordination, but also poor concentration and fidgeting due to the oversensitivity of the spine. Well after the child has been potty-trained, the issue of bedwetting may still arise because the child has no voluntary control over stimulation of the kidney area whilst asleep. As you can imagine, any child with these sensitivity and coordination problems can quickly lose self-esteem because he/she gets labelled as a “problem” child displaying all the signs of ADHD.
RETAINED PALMAR REFLEX
Probably one of the most endearing primitive reflexes, the infant will grasp with a strong fist any object that touches his/her palm. The reflex has 2 purposes – to stimulate the baby to cling to its mother in times of danger, and to knead the breast whilst suckling – hence there is a strong relationship with mouth movement. The Palmar Reflex should quickly be replaced by the more sophisticated “pincer” grip that is enabled by opposition of the thumb to the fingers – it is this feature which distinguishes us from our closest primates and has endowed humankind with the manual dexterity to achieve all kinds of feats. If this reflex does not inhibit within 3 months, it can affect both hand and mouth function, leading to poor handwriting and grip, and speech difficulties. A common sign of a retained Palmar is the involuntary movement of the mouth during hand activities such as drawing, writing, cutting with scissors etc.
RETAINED ASYMMETRICAL TONIC NECK REFLEX (ATNR)
RETAINED ASYMMETRICAL TONIC NECK REFLEX (ATNR)
The ATNR reflex is present from birth to about 4months and is a precursor to hand/eye co-ordination. When the child’s head is turned to the right the right arm will straighten whilst the left will bend, and vice versa when the head is turned to the left. The reflex stimulates the vestibular system (the part of the nervous system which co-ordinates physical balance and spatial awareness), so as well as developing shoulder and arm muscle tone, it trains one side of the body at a time. A retained ATNR can lead to poor motor problems especially linked eye-hand activities like driving and writing, and the consequent failure to establish a dominant side can affect an individual’s ability to filter left and right brain tasks.
RETAINED TONIC LABYRINTHINE REFLEXES (TLR)
If you hold a new-born under the tummy with your hand and push its head gently downwards, the arms and legs should automatically curl into the foetal position.
Similarly, in the same position tilt the baby’s head backwards and the opposite should happen – the back will arch, the legs will straighten and stiffen, the toes point, and the hands become fisted.
These 2 reflexes are present at birth and pave the way for controlled head movement, limb co-ordination, and balance through the vestibular system. Like a retained ATNR, if these reflexes do not inhibit within the first 6 months, the result will be jerky leg movements and odd postures due to the head-leg connection and lack of spatial judgement.