Tag: bed wetting


Primitive Reflexes

Primative Reflexes- The Good, The Bad, The Better!

Have you ever tripped and simultaneously reached out your hands to stop the fall? That is your primitive reflexes at work! They are essential as the first line of defense to protect ourselves but they can also be detrimental to our development.

What are primitive reflexes? 

Primitive reflexes are involuntary motor responses present at infancy that facilitate survival. Pediatricians check these reflexes at wellness visits to ensure the nervous system is working properly. It is important that these reflexes are present but it is just as important that these reflexes mature or integrate in early childhood. 

The Good: 



Moro Reflex

The startle reflex

A fear response to sudden movements or noise
Hands PullingHead control reflex and the ability to contract our muscles to sit up
Hands SupportingOur falling reflex. Ability to reach out and catch yourself.
Tonic Labyrinthine (TLR)Develops balance and spatial awareness
STNRHead, limbs and balance system connection
Asymmetrical Tonic Neck Reflex (ATNR):  Differentiates our left and right side.
Spinal GalantConnects the trunk and lower body
AmphibianActivates nerves between both hemispheres of the brain
Babinski:Supports mature walking and balance
BabkinTongue and mouth coordination for eating and speaking
PlantarProtective response to provide stability
PalmarAdvances fine motor movements of fingers.
Landau Promotes ability to control head in tummy time

Why do reflexes need to integrate?

We unconsciously use these reflexes everyday, but what happens when we are unable to consciously control them? That’s what happens when reflexes don’t integrate. It’s like being in a self driving car and not being able to take control of the wheel, which can be very scary. Sometimes our reflexes do not mature because of abnormal movement patterns in utero or infancy, neurological deficits, or just unknown reasons. These primitive neuro connections are powerful and can inhibit our ability to voluntarily control our body and mind if they are retained.

How do reflexes affect development?

A retained reflex can present in strange ways causing possible behavioral, emotional, sensory and physical deficts. Not all reflexes present the same way in every person but they do have common patterns. The infant’s movements work together in sequence during development. If one reflex does not integrate it can cause others to also be retained. It is not uncommon to see two, three, or almost all the reflexes present during a primitive reflex evaluation. The following are common traits you might see if reflexes are retained.   

The Bad- Unintegrated Primative Reflexes




Moro Reflex

The startle reflex

A fear response to sudden movements or noise
  • Anxiety
  • Difficulty sleeping
  • Insecure
  • Sensitive to light
  • Sound and/or touch
  • Emotional
  • Common in toe walkers 
Hands PullingHead control reflex and the ability to contract our muscles to sit up
  • Poor muscle tone
  • Poor hand, eye, and mouth coordination
  • Delayed gross and fine motor movements 
Hands SupportingOur falling reflex. Ability to reach out and catch yourself.
  • Clumsy
  • Poor personal boundaries
  • Aggressive
  • Avoids interactions
  • Difficulty processing information
Tonic Labyrinthine (TLR)Develops balance and spatial awareness
  • Motion sickness
  • Poor sense of time and organizational skills
  • Coordination difficulty
  • Spatial and balance problem
STNRHead, limbs and balance system connection
  • Crawling difficulty
  • Low muscle tone
  • Slumps while seated
  • Difficulty copying tasks
  • Poor attention
  • W sits 
Asymmetrical Tonic Neck Reflex (ATNR):  Differentiates our left and right side.
  • Challenged with crossing midline
  • Difficulty catching
  • Focus and memory difficulty
  • Auditory challenges
  • Dyslexia
Spinal GalantConnects the trunk and lower body
  • Postural deficits
  • Hip rotation effecting gait
  • Hyperactive
  • Fatigues with cognitive functions
  • Bed wetting
AmphibianActivates nerves between both hemispheres of the brain
  • Rigid movements
  • Limited stride length
  • Poor coordination
  • No rotational movement
  • No hand dominance
Babinski:Supports mature walking and balance
  • Tripping
  • Stabilizes with tongue
  • Oral motor and articulation deficits
  • Flat feet
  • Walks on toes or sides of feet 
BabkinTongue and mouth coordination for eating and speaking
  • Open mouth posture
  • Poor mouth coordination
  • Lacks facial expression
  • Speech delay
  • Sensory chewer 
PlantarProtective response to provide stability
  • Grasping hands
  • Poor running/jumping
  • One sided crawl
  • Standing delay
  • Fight/flight response to loss of balance.
PalmarAdvances fine motor movements of fingers. 
Landau Promotes ability to control head in tummy time
  • Poor posture
  • Clumsy
  • High tone in legs
  • Visual challenges
  • Depression and fears
  • Poor focus and balance


The Better: 

It is extremely common to have one or more reflexes present and you might even identify some of these traits in yourself. That does not mean it needs to be treated unless the reflex is so dominant that it interferes with the ability to learn, be safe and thrive. Reflex therapy helps to identify and create an individualized reflex exercise program to promote integration. The brain responds by taking the wheel and improves control over it’s own mind and body. Now that’s better!


If you think your child may have primitive reflexes present we can help! Free primitive reflex screenings are available via Zoom or in person at our Orland Park or Naperville/Aurora locations. 

Reflex Integration

Reflex Integration

What are reflexes?

Reflexes are automatic responses that occur out of someone’s control in response to an external stimulus or facilitated movement.  Reflexes are necessary automatic movements that are essential for survival as a baby and are what helps a baby develop movement. 

Each reflex is present and integrated at different parts of development.  An example is the rooting reflex, when the baby’s cheek is stroked the baby will turn their head in the direction of the stimulus and open their mouth automatically. This reflex allows the baby to find their mother’s breast and is essential for feeding.  This reflex will usually integrate around 4 months of age once the infant starts to develop volitional control and has learned how to respond IND when they smell, feel and see mother’s breast.  

Unintegrated Reflexes

Reflexes can become problematic when they are delayed or unintegrated. In the case of the rooting reflex, if it is not present at birth it can impact IND feeding response or if present after feeding can impact speech, eating, and response to facial touching.  Common things you might see in your child if this reflex is not integrated include trouble pronouncing words, difficult breaking thumb sucking, messy eatering, or has poor tolerance to kissing or touching their face. 

Unintegrated Reflex Red Flags

There are many reflexes and each has a vital role and can have a huge impact on development if delayed or not integrated at the right time.  Some of the red flags to look for include

  • difficulty or delayed gross motor skills
  • difficulty or delayed fine motor skills
  • emotional lability
  • poor tolerance to new situations
  • difficulty with learning/writing
  • poor vision
  • poor attention
  • bed wetting
  • difficulty with potty training
  • abnormal muscle tone
  • poor tolerance to certain movements.

Next Steps

If you have any of these concerns you should try physical and/or occupational therapy to perform movements that are designed to help with reflex integration.  In addition, your therapist will be able to work on the functional or emotional skills your child is having difficulty with to improve their IND and participation.

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Pediatric Incontinence
& Pelvic Floor Health

  • cutout incontinence

  • Toddler Incontinence

  • teenage incontinence

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what is pediatric incontinence therapy?

Pediatric incontinence occurs when children over the age of 4 have difficulty controlling their urine and have leakage. It can occur at night or during the daytime. This can add additional stress to the child, their parents, and impact participation in social events. Physical therapy and occupational therapy can help with this in a variety of ways.  

What could be involved?

Common symptoms associated with pediatric incontinence:

  • Bedwetting (Enuresis): 

Urination during the nighttime can be caused from constipation, increased production of urine at night, and/or intake of bladder irritants prior to bed.

  • Overactive bladder: 

This is a sudden and uncontrollable urge to urinate. Children may have accidents from not making it to the bathroom on time, and may often sprint to the bathroom to avoid an accident. 

  • Dysfunctional voiding: 

Children may have difficulty fully emptying their bladder and may be contracting the muscles that need to relax during urination. This leads to less emptying with occasional leaking.

  • Urinary urgency: 

Child may feel like they need to use the restroom frequently and without much warning.

  • Voiding postponement: 

Often associated with a low number of voids per day. A typical child voids 4-5 times a day. This can be related to low awareness of need to void as well as purposeful withholding.

  • Stress incontinence: 

This occurs when a small amount of urine leaks with exertion such as with playground activities. 

  • Giggle incontinence: 

A complete void occurs during or immediately after laughing with normal bladder function when not laughing.

What does a treatment session look like?

Physical or occupational therapists with pediatric incontinence training will meet with the child and their parent(s) and/or guardian to get a history of the current concerns. A physical examination is then completed to look at the muscles of the abdomen, legs, and back. The parent or guardian is present throughout the exam and the exam occurs over clothing. The findings of the exam are then sent to the referring physician to determine the most appropriate treatment plan for that child. Treatment sessions are one therapist to one child. They occur in a private treatment room with the children dressed and caregiver present. Our therapists incorporate a holistic approach that includes diet, sleep patterns, and other behavioral conditions that could be impacting the child’s continence. Our multidisciplinary team is able to collaborate to determine the best strategies for each child. These strategies may include:

  • Core strengthening
  • Biofeedback
  • Bladder re-training
  • Behavior and diet strategies
  • Body awareness to help realize the urge to go
  • Posture training
  • Sensory strategies to assist with tolerance for public bathrooms and toileting
  • Review of bathroom setup
  • Bowel and bladder logs
  • Increasing variety of foods and limiting bladder irritants
  • Modified O’Regan Protocol

What is biofeedback?

Biofeedback is a little machine that helps children learn to relax and contract their muscles that help them use the bathroom more efficiently. Little stickers are attached to their muscles and give feedback to a computer. This feedback is connected to a game that responds to the child’s relaxation or contraction of specific muscles. Biofeedback is commonly used for pediatric incontinence, but can also be used for body awareness to help strengthen specific muscles. Biofeedback sessions occur in a private treatment room with an adult caregiver present. 

Modified O’Regan Protocol (M.O.P.)

We have a M.O.P. ( Modified O’Regan Protocol) specialist, Andrea Turnell, PT, DPT, on staff that can support your child’s M.O.P journey and assist in interpreting your process!

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