Medical Conditions

Missing Primitive Reflexes in Newborns

Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist

Content reviewed against published AAP, NIH guidelines

Editorial policy

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If your baby has been diagnosed with or you suspect missing primitive reflexes in newborns, here is what the evidence says.

The short answer

Primitive reflexes (Moro, rooting, sucking, grasp, stepping) are expected in all healthy newborns and are tested as part of the newborn neurological exam. Absent or significantly diminished reflexes may indicate a neurological concern, prematurity-related immaturity, or the effects of medication and should be evaluated by your pediatrician.

Key takeaways

  • Primitive reflexes (Moro, rooting, sucking, grasp, stepping) are expected in all healthy newborns and are tested as part of the newborn neurological exam. Absent or significantly diminished reflexes may indicate a neurological concern, prematurity-related immaturity, or the effects of medication and should be evaluated by your pediatrician.
  • Usually normal when: All primitive reflexes present at birth and during the newborn period
  • Call your doctor if: Complete absence of primitive reflexes in a newborn, which may indicate significant neurological depression or injury
  • Varies by age — see the age-by-age breakdown below
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What Parents Should Know

According to AAP, NIH guidelines, primitive reflexes (Moro, rooting, sucking, grasp, stepping) are expected in all healthy newborns and are tested as part of the newborn neurological exam. Absent or significantly diminished reflexes may indicate a neurological concern, prematurity-related immaturity, or the effects of medication and should be evaluated by your pediatrician. At 0-1 month, newborns are expected to have several primitive reflexes that demonstrate normal brain and nervous system function. These include the Moro reflex (startle), rooting (turning head toward touch on cheek), sucking, palmar grasp (gripping finger), and stepping reflex. Your pediatrician tests these at birth and at well-child visits. Absent or very weak reflexes can be caused by prematurity, birth injury, exposure to medications or substances, infection, or neurological conditions. Some variation in reflex strength is normal, but complete absence of reflexes warrants further evaluation. It is generally considered normal when all primitive reflexes present at birth and during the newborn period. However, you should contact your pediatrician promptly if complete absence of primitive reflexes in a newborn, which may indicate significant neurological depression or injury.

Sources: [1], [2]

Normal vs. Concerning

Usually Normal
Worth Discussing
All primitive reflexes present at birth and during the newborn period
Complete absence of primitive reflexes in a newborn, which may indicate significant neurological depression or injury
Gradual fading of reflexes at the expected developmental time points
A floppy, unresponsive baby with absent reflexes and poor feeding, which requires urgent medical evaluation
Slight variation in reflex strength that does not affect function
One or more reflexes seem weaker than expected

By Age

What to expect by age

0-1 month

Newborns are expected to have several primitive reflexes that demonstrate normal brain and nervous system function. These include the Moro reflex (startle), rooting (turning head toward touch on cheek), sucking, palmar grasp (gripping finger), and stepping reflex. Your pediatrician tests these at birth and at well-child visits. Absent or very weak reflexes can be caused by prematurity, birth injury, exposure to medications or substances, infection, or neurological conditions. Some variation in reflex strength is normal, but complete absence of reflexes warrants further evaluation.

1-3 months

Primitive reflexes should still be present during this period. As the brain matures, these reflexes begin to integrate (fade) gradually. The stepping reflex fades first, usually by 2 months. The others persist through this period. If reflexes that should be present are absent, your pediatrician may recommend neurological evaluation.

3-6 months

Primitive reflexes normally begin to fade during this period as voluntary movements replace them. The Moro reflex typically fades by 4-6 months, and the palmar grasp integrates as voluntary grasping develops. Reflexes that persist too long (beyond their expected time frame) can also be a concern.

6-12 months

Most primitive reflexes should have integrated by this age. Persistent primitive reflexes beyond their normal time frame may indicate neurological issues and should be evaluated. Conversely, the protective reflexes (such as the parachute reflex) should be developing.

What to Tell Your Pediatrician

  • Describe when you first noticed missing primitive reflexes in newborns and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if one or more reflexes seem weaker than expected.
  • Mention if your baby does not root, suck, or grasp as strongly as expected.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • All primitive reflexes present at birth and during the newborn period
  • Gradual fading of reflexes at the expected developmental time points
  • Slight variation in reflex strength that does not affect function
Mention at your next visit when...
  • One or more reflexes seem weaker than expected
  • Your baby does not root, suck, or grasp as strongly as expected
  • Reflexes seem to persist longer than expected or are not fading on schedule
Act now when...
  • Complete absence of primitive reflexes in a newborn, which may indicate significant neurological depression or injury
  • A floppy, unresponsive baby with absent reflexes and poor feeding, which requires urgent medical evaluation

What You Can Do at Home

  • Keep track of when you notice missing primitive reflexes in newborns — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that all primitive reflexes present at birth and during the newborn period — this is generally within the range of normal.
  • At 0-1 month, focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
  • While monitoring at home, seek immediate care if complete absence of primitive reflexes in a newborn, which may indicate significant neurological depression or injury.

Weak Rooting Reflex in Newborns

A weak rooting reflex (where baby turns toward a touch on the cheek to find the breast or bottle) can sometimes contribute to feeding difficulties in newborns. It may be caused by prematurity, sleepiness, recent feeding, illness, or neurological factors. Most babies develop a stronger rooting reflex with time and feeding practice, but persistent weakness should be evaluated.

My Baby Seems Floppy (Hypotonia)

A "floppy" baby is one whose muscles feel unusually relaxed and who may slip through your hands when you lift them under the arms. Many cases of mild floppiness improve on their own as your baby grows stronger, but it is important to have your pediatrician evaluate your baby to rule out any underlying conditions.

Excessive Moro (Startle) Reflex in Newborns

The Moro (startle) reflex is a normal primitive reflex present in all newborns. Some babies seem to have a more active or sensitive startle reflex, which can cause them to wake frequently during sleep. This is a normal variation and typically diminishes by 3-4 months of age. Swaddling can help reduce the impact of the Moro reflex on sleep.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is missing primitive reflexes in newborns normal?
Primitive reflexes (Moro, rooting, sucking, grasp, stepping) are expected in all healthy newborns and are tested as part of the newborn neurological exam. Absent or significantly diminished reflexes may indicate a neurological concern, prematurity-related immaturity, or the effects of medication and should be evaluated by your pediatrician.
When should I call the doctor about missing primitive reflexes in newborns?
Complete absence of primitive reflexes in a newborn, which may indicate significant neurological depression or injury A floppy, unresponsive baby with absent reflexes and poor feeding, which requires urgent medical evaluation
When is missing primitive reflexes in newborns normal?
All primitive reflexes present at birth and during the newborn period Gradual fading of reflexes at the expected developmental time points Slight variation in reflex strength that does not affect function
What causes missing primitive reflexes in newborns?
Primitive reflexes (Moro, rooting, sucking, grasp, stepping) are expected in all healthy newborns and are tested as part of the newborn neurological exam. Absent or significantly diminished reflexes may indicate a neurological concern, prematurity-related immaturity, or the effects of medication and should be evaluated by your pediatrician. Common explanations include: All primitive reflexes present at birth and during the newborn period. Gradual fading of reflexes at the expected developmental time points.
What should I mention to my pediatrician about missing primitive reflexes in newborns?
You should mention missing primitive reflexes in newborns at your next visit if: One or more reflexes seem weaker than expected. Your baby does not root, suck, or grasp as strongly as expected. Reflexes seem to persist longer than expected or are not fading on schedule.
Is missing primitive reflexes in newborns normal at 0-1 month?
Newborns are expected to have several primitive reflexes that demonstrate normal brain and nervous system function. These include the Moro reflex (startle), rooting (turning head toward touch on cheek), sucking, palmar grasp (gripping finger), and stepping reflex. Your pediatrician tests these at birth and at well-child visits. Absent or very weak reflexes can be caused by prematurity, birth injury, exposure to medications or substances, infection, or neurological conditions. Some variation in reflex strength is normal, but complete absence of reflexes warrants further evaluation.
Is missing primitive reflexes in newborns normal at 1-3 months?
Primitive reflexes should still be present during this period. As the brain matures, these reflexes begin to integrate (fade) gradually. The stepping reflex fades first, usually by 2 months. The others persist through this period. If reflexes that should be present are absent, your pediatrician may recommend neurological evaluation.
Should I go to the ER for missing primitive reflexes in newborns?
Seek emergency care if complete absence of primitive reflexes in a newborn, which may indicate significant neurological depression or injury, or if a floppy, unresponsive baby with absent reflexes and poor feeding, which requires urgent medical evaluation. When in doubt, call your pediatrician's after-hours line for guidance.
Does missing primitive reflexes in newborns go away on its own?
In many cases, missing primitive reflexes in newborns resolves on its own, especially when all primitive reflexes present at birth and during the newborn period. By 6-12 months, most primitive reflexes should have integrated by this age. Persistent primitive reflexes beyond their normal time frame may indicate neurological issues and should be evaluated. Conversely, the protective reflexes (such as the parachute reflex) should be developing.
AAPNIH

References

  1. [1]American Academy of Pediatrics. Newborn Reflexes. HealthyChildren.org. AAP
  2. [2]National Library of Medicine. Primitive Reflexes. StatPearls. NIH

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Missing Primitive Reflexes in Newborns.

Things to mention

  • Describe when you first noticed missing primitive reflexes in newborns and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if one or more reflexes seem weaker than expected.
  • Mention if your baby does not root, suck, or grasp as strongly as expected.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • One or more reflexes seem weaker than expected
  • Your baby does not root, suck, or grasp as strongly as expected
  • Reflexes seem to persist longer than expected or are not fading on schedule

Urgent signs to report immediately

  • Complete absence of primitive reflexes in a newborn, which may indicate significant neurological depression or injury
  • A floppy, unresponsive baby with absent reflexes and poor feeding, which requires urgent medical evaluation

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

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Related Resources

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Bottom line

Most cases of missing primitive reflexes in newborns are normal. Talk to your pediatrician if complete absence of primitive reflexes in a newborn, which may indicate significant neurological depression or injury.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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Related Medical Concerns

Weak Rooting Reflex in Newborns

A weak rooting reflex (where baby turns toward a touch on the cheek to find the breast or bottle) can sometimes contribute to feeding difficulties in newborns. It may be caused by prematurity, sleepiness, recent feeding, illness, or neurological factors. Most babies develop a stronger rooting reflex with time and feeding practice, but persistent weakness should be evaluated.

My Baby Seems Floppy (Hypotonia)

A "floppy" baby is one whose muscles feel unusually relaxed and who may slip through your hands when you lift them under the arms. Many cases of mild floppiness improve on their own as your baby grows stronger, but it is important to have your pediatrician evaluate your baby to rule out any underlying conditions.

Excessive Moro (Startle) Reflex in Newborns

The Moro (startle) reflex is a normal primitive reflex present in all newborns. Some babies seem to have a more active or sensitive startle reflex, which can cause them to wake frequently during sleep. This is a normal variation and typically diminishes by 3-4 months of age. Swaddling can help reduce the impact of the Moro reflex on sleep.

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