My Baby May Have Persistent Tonic Labyrinthine Reflex (TLR)
The short answer
The tonic labyrinthine reflex (TLR) causes your baby to extend when their head tilts backward and flex when tilted forward. It normally integrates by 6 months. Persistence can affect head control, balance, posture, and muscle tone. If you notice your baby consistently stiffening or extending when their head tilts backward past 6 months, discuss it with your pediatrician.
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By Age
What to expect by age
TLR is normal at this age. Your baby may stiffen and extend when you tilt them backward or when their head falls back. This is part of normal neurological development and will integrate as your baby develops head control.
TLR should be weakening as head control develops. Your baby should be gaining the ability to hold their head steady in different positions without the reflex overpowering them.
TLR should be integrated. If your baby still extends strongly when their head tilts backward, it may affect sitting balance, rolling, and transitional movements. Evaluation is recommended.
Persistent TLR at this age warrants thorough evaluation and likely physical therapy intervention. It can significantly affect motor development including balance, posture, and movement transitions.
What Should You Do?
When to take action
- Your baby is under 6 months and TLR is gradually weakening.
- Your baby has good head control and the reflex does not affect function.
- Brief extension when startled or position changes.
- TLR persists strongly beyond 6 months.
- Your baby stiffens and extends whenever their head tilts backward.
- The reflex affects sitting balance or head control.
- TLR is getting stronger.
- Your baby has other persistent reflexes alongside TLR.
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
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Related Physical Concerns
My Baby's Primitive Reflexes Are Not Integrating
Primitive reflexes are automatic movements present at birth that should gradually integrate (disappear) during the first year as your baby develops voluntary movement control. If reflexes persist beyond their expected timeframe, it may indicate neurological immaturity or developmental concerns. Your pediatrician checks reflexes at well visits.
My Baby Arches Their Back
Back arching is very common in babies and usually a normal way of expressing frustration, discomfort, or just stretching and moving. Most babies arch their backs when upset, tired, or trying to see something. However, persistent arching with crying, especially during feeding, can be a sign of reflux or discomfort that should be discussed with your pediatrician.
Poor Trunk Control
Trunk control - the ability to hold the torso upright and stable - develops progressively throughout the first year. It is essential for sitting, crawling, standing, and walking. Babies build trunk control through tummy time, supported sitting, and active play. If your baby seems unusually floppy in the trunk or slumps significantly when sitting, your pediatrician can assess whether their core strength is developing as expected.
My Baby Seems to Use One Side More Than the Other
Babies should use both sides of their body fairly equally during the first 18 months of life. While slight preferences can be normal, a consistent pattern of favoring one side - using one arm much more than the other, crawling with one leg dragging, or turning the head predominantly one way - should always be discussed with your pediatrician. Early identification of asymmetry leads to the best outcomes.
My Baby Only Army Crawls
Army crawling (also called commando crawling) is a completely valid and normal way for babies to move. Many babies army crawl for weeks or even months before transitioning to hands-and-knees crawling, and some skip hands-and-knees crawling entirely. What matters is that your baby is independently mobile and exploring their environment.
One Side of My Baby's Body Moves Differently
Babies should generally use both sides of their body equally. If one side consistently moves differently, is weaker, stiffer, or less coordinated, this warrants evaluation. Asymmetric movement can indicate hemiplegia (cerebral palsy affecting one side), brachial plexus injury, or other neurological conditions that benefit from early therapy.