Tonic Labyrinthine Reflex (TLR)

In our last article, we discussed the symmetrical tonic neck reflex, what its implications are if it is not integrated, and what we can do to break the pattern. This month, we are going to take a look at another reflex, known as the tonic labyrinthine reflex, or TLR.

When the TLR is elicited, it has an effect on the child’s muscle tone opposite to that of the STNR. When an infant looks up, the reflex causes the child to straighten its arms and legs. When the head is bent, all limbs bend as well.

The TLR is active during the birthing process and remains present until 4 months of age. It is linked with our vestibular system, which is responsible for our balance. It is important during the birthing process to avoid suffocation. It can be seen clearly at the age of 2 months. Because this reflex is initially poorly developed, an infant has poor head control. Better head control is established as the TLR develops.

If the TLR is not fully integrated but remains present in our children the following difficulties may occur. When the child is starting to walk, they may experience difficulties judging space, speed, depth, and distance. Children with a present TLR have also been noted to walk on their toes. As the child gets older, the presence of the reflex can influence the integration of movements of the upper and lower limbs. This affects actions where simultaneous movement is required, such as walking or swimming. Children with a retained TLR are thus perceived as clumsy.

During early school years, the child is more likely to slouch while at the table or sit in different positions, such as on their legs, or with a twisted body. When told to correct their position, they lose energy as a result of trying to fight the reflex, resulting in poor concentration. They also do not like lying on their tummies to read a book or watch TV. Children with a retained TLR may also suffer from motion sickness as a result of the influence on their vestibular system.

Identification of this reflex is thus very important as sometimes the effect of the reflex may be so slight that it is difficult to pick up. A comprehensive occupational therapy assessment tests for the presence of a TLR.


Luckily, integration of this reflex is still possible with a little work. In order for the reflex to disappear, we need to break the natural and unconscious pattern that takes place. This means that when the child’s head is flexed, we need to try and cause their arms to extend, and when the child’s head is extended, we need their arms to bend. This can be achieved through playing games while lying on their tummy, requiring the child to support their body weight on their elbows while working. The child should be encouraged to look up to allow for breaking of the pattern. This can be achieved by getting the child to draw with their paper tilted and elevated off the floor.

In summary, the tonic labyrinthine reflex is naturally found in infants up until the age of 4 months. It results in involuntary movement when the head is bent or straightened, causing straightening or bending of the arms and legs. If not integrated, it can have a negative effect on skills requiring depth, speed, and space perception, as well as difficulties with the vestibular system. Integrating of the reflex involves activities where the child is encouraged to support their body on their elbows while playing on their tummies with their head extended.

I hope this article offers some understanding on this primitive reflex and the implications it can have if it is still present in your child, even if the presence is slight. Remember, integration of this reflex is still possible through the use of occupational therapy and home activities. Keep an eye out for our next articles where more primitive reflexes will be discussed.

Happy parenting!