Non-Standardized Retained Reflex Assessment


What is Retained Reflex

Retained reflexes are primitive reflexes that are naturally present in infants to help with survival and development. These reflexes typically integrate or fade away as a child grows and their nervous system matures. However, when these reflexes are retained beyond the typical age, they can interfere with a child’s motor skills, learning, behaviour, and emotional development. As parents, it’s important to be aware of the signs of retained reflexes, such as difficulties with balance, coordination, handwriting, and certain behaviours like heightened sensitivity to light and sound. Identifying and addressing retained reflexes early can significantly enhance your child’s ability to learn, improve their coordination, and support their overall development.

Addressing retained reflexes is crucial because they can significantly impact a child’s physical, emotional, and cognitive development, potentially hindering academic achievement and daily functioning.

Cherish’s neurodivergent-centred framework recognizes the inherent value and uniqueness of each person, focusing on the belief that there is nothing inherently wrong with neurodivergent people. However, the retained reflex is a specific fixable issue that can be directly addressed through occupational therapy.

Signs of Retained Reflux
  • Moro Reflex: The Moro reflex acts as a baby’s primitive fight/flight reaction and is typically replaced by the adult startle reflex by four months old. If a child experiences a retained Moro reflex beyond 4 months, he may become over sensitive and over-reactive to sensory stimulus resulting in poor impulse control, sensory overload, anxiety and emotions, and social immaturity. Some additional signs of a retained Moro reflex are motion sickness, poor balance, poor coordination, easily distracted, unable to adapt well to change, and mood swings.
  • Rooting Reflex: The rooting reflex assists in the act of breastfeeding and is activated by stroking a baby’s cheek, causing her to turn and open her mouth. Retention of the rooting reflex beyond four months may result in difficulty with solid foods, poor articulation, and thumb sucking.
  • Palmar Reflex: The palmar reflex is the automatic flexing of fingers to grab an object and should integrate by six months. If the palmer reflex is retained, a child may have difficulty with fine motor skills, stick out tongue while writing and exhibit messy handwriting.
  • ATNR: Asymmetrical tonic neck reflex (ATNR) is initiated when laying babies on their back and turning their head to one side. The arm and leg of the side they’re looking should extend while the opposite side bends. This reflex serves as a precursor to hand-eye coordination and should stop by six months.
  • Spinal Galant Reflex: The spinal galant reflex happens when the skin along the side of an infant’s back is stroked, the infant will swing towards the side that was stroked. This reflex helps with the birthing process and should inhibit between three and nine months. If it persists, it may affect a child’s posture, coordination attention, and ability to sit still. Retention of the spinal galant reflex is also associated with bedwetting.
  • TLR: The tonic labyrinthine reflex (TLR) is the basis for head management and helps prepare an infant for rolling over, creeping, crawling, standing, and walking. This reflex initiates when you tilt an infant’s head backward while placed on the back causing legs to stiffen, straighten, and toes to point. Hands also become fisted and elbows bend. It should integrate gradually as other systems mature and disappear by 3 1/2 years old. If retained, the TLR can lead to poor muscle tone, a tendency to walk on toes, motion sickness, and poor balance.
  • Landau Reflex: The landau reflex assists with posture development and technically is not a primitive reflex as it is not present at birth. It is when a baby lifts his head up causing the entire trunk to flex and typically emerges at around 3 months of age. It is fully integrated by one year. If the landau reflex persists beyond this point, children may experience short-term memory problems, poor motor development, and low muscle tone.
  • STNR: Also known as the crawling reflex, symmetrical tonic neck reflex (STNR) is present briefly after birth and then reappears around six to nine months.  This reflex helps the body divide in half at the midline to assist in crawling – as the head is brought towards chest, the arms bend and legs extend. It should disappear by 11 months. Developmental delays related to poor muscle tone, tendency to slump while sitting, and inability to sit still and concentrate can result if the STNR is retained.

From Brain Balance.

Shay Describes This Non-Standardize Retained Reflex Assessment

Why is it not standardized?

Most pediatric physiotherapists and occupational therapists can offer a standardized retained reflex assessment.  However, pediatric occupational therapy is in short supply in British Columbia and there are many barriers to accessing the services.

Understanding the unique challenges and needs of children, especially those with Pathological Demand Avoidance (PDA), requires an approach that respects their individuality and comfort. At Cherish, we recognize that the traditional, standardized methods for assessing retained reflexes, commonly employed by pediatric physiotherapists and occupational therapists, may not be suitable or accessible for every child. Cherish’s short-term assessment is defined with PDA children in mind and tailored to provide a comprehensive understanding of your child’s needs while ensuring a comfortable and supportive environment for both the child and parents.  Families can skip long waits or travelling restrictions by accessing this one-off service.

By concentrating on a specific, concrete issue, we aim to provide actionable insights and strategies that can make a real difference in a child’s life without committing to costly long-term therapy programs.

Children with PDA, who may resist conventional testing methods, need an assessment approach that is adaptable, understanding, and non-threatening. This is where Cherish’s non-standardized assessment for retained reflexes comes into play. Unlike standardized assessments that follow a rigid protocol, our method is flexible and designed with the well-being of PDA children at the forefront. We aim to create a supportive environment that minimizes stress and avoids triggering a child’s avoidance behaviours.

Our non-standardized approach can be likened to the way scientists infer the presence of black holes: not by observing the black holes directly, but by noting the effects they have on their surroundings. Similarly, we assess retained reflexes not by forcing children into specific, potentially distressing testing scenarios, but by observing and interacting with them in ways that naturally reveal the presence of these reflexes. Through play, conversation, and gentle engagement, we gather insights into your child’s developmental stage, identifying retained reflexes through their reactions and behaviours in a variety of situations.

This approach allows us to tailor our assessment to each child’s specific needs and comfort level, providing a comprehensive understanding of their developmental profile without the need for standard testing environments that may cause discomfort or resistance. By prioritizing the child’s comfort and readiness, Cherish’s assessment fosters a positive experience for both the child and their parents, ensuring that the path forward is clear, collaborative, and centered on the child’s well-being.

Limitation for This Service

  • There will be no formal diagnosis of retained reflex. Retained reflexes are recognized as a condition but are typically assessed and diagnosed within broader neurological or developmental evaluations, not as an isolated diagnosis.
  • Shay will not attend IEP.
  • The client would not have access to Shay’s regular ongoing services, outside the scope of this service.  However, we can put the client on the waitlist. 

Parent Support

As with all of our assessment service, we provide comprehensive parent support to ensure that families are fully engaged and empowered throughout the process. Our Google Classroom offers a treasure trove of resources, including step-by-step guides, educational materials, visuals, and videos, all designed to cater to the unique needs and preferences of your child. Continuous communication with Shay ensures that parents receive personalized guidance and support, enabling them to actively participate in their child’s development and progress. This tailored approach ensures that each family’s journey is informed, supported, and aligned with their child’s specific needs, fostering an environment of collaboration and understanding.

Consultation Process

Step 1

Contact us for an intake

We will email the client with consent forms payment arrangement, scheduling. 

This parent consult, in-person session, team meeting must be completed within 8 weeks.


Step 2

Parent Session

(online, 1 hour)

The child Will not attend this session.


Step 3

Planning and Prep

Shay will take some time to create a plan and source necessary material for the child sessions coming up.



Step 4

Child Observation

(inperson, a hour, 3 sessions)

This is a play-based approach or casual peer conversation for older teens. Parents are welcomed to stay. This session has to be in person. For older, cooperative and motivated teens, we can consider online.


Step 5

Team Meeting

(online, 1 hour) 

To discuss the result and recommendations.  Child involvement is optional.


Step 6

Follow Ups

(online, 1 hour, 2 sessions) 

The follow up sessions would be one month apart to check-in on progress and troubleshoot.


Fee Schedule

Services Duration Cost Info
Case Management Fee 1 year $100 This is the intake fee and is non-refundable. This includes access to Cherish Google Classroom for one year
Parent Consult 1 hour $200 Parent Session Online via Zoom
Planning and Prep 1 hour $200 Planning and sourcing materials
Child sessions 3 x 1-hour sessions $600 At Cherish Clinic (Burnaby) In-person only
Team Meeting 1 hour $200 Parent session Online via Zoom
Follow-up Meeting 2 x 1 hour sessions $400 Parent session One month apart
Report Writing (optional) 1 hour $200 Communication report
  • The minimum cost of this service is $1700. For Shay’s ongoing clients, the parent consult fee can be waived. 
  • If necessary, additional follow-up meetings would be charged at Shay’s regular hourly rates of $200.
  • Shay can sign a justification for equipment (JFE) for purchases related to the scope of this service for a fee.
  • We require an approved third-party contract or for private payment, we require a non-refundable deposit of $500 before scheduling.

Cherish Clinic Payment Policies

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