Tell-tale Signs of Handwriting Delays

As I wrote the title to this post, I had a flashback to my school days, and all the writing we did back then (binders full of handwritten notes)! I remembered my hands being fatigued, sweaty, and cramping. I could barely move my fingers after writing for a bit because I had been gripping so tightly to my pencil. I really did not enjoy this part of school…and let’s face it, handwriting is a BIG part of school, especially in the latter years.

Did you or your child have a similar experience?
Does your child complain when they are required to do handwriting tasks?
Seem slow at it or rush through it (to finish as quickly as possible)?
Have a tight grasp (like mine) or too loose of a grasp?
Hold the pencil awkwardly?
Place too much or too little pressure on the the pencil?
Do they fatigue quickly from handwriting?
Do they have difficulty stabilizing the paper with one hand while writing with the other?
Do they have to turn the paper to complete written tasks?
Do they lay their head on the table or too close to the the paper?

These are just some of the signs that your child may have underlying physical delays that make handwriting extra difficult. I did not know about occupational therapy while in elementary and high school, nor did my family. Had we known, I probably would have benefited from it myself. I could have used interventions to improve my shoulder strengthening and fine motor strength, grasp, and dexterity.

For some children, increasing their legibility and the ease with which they can perform handwriting tasks may be as simple as making it a priority to have your child perform finger-strengthening tasks, like:

  • Playing with play doh
  • Baking (kneading dough)
  • Crafting (tearing paper, using scissors, hole punches)
  • Games/activities using tongs

(Pinterest and Google offer lots of great ideas on things you can do to increase fine motor and grip strength.)

Often the delay may not be that easy to correct. As a pediatric occupational therapist, parents and teachers often want me to help with their child’s handwriting. That is usually their greatest concern because, to the untrained eye, it is the noticeable problem area. My job is to look beyond the obvious and discover why their handwriting is a challenge for them. Is it a retained primitive reflex? Decreased Bilateral Coordination? Visual-Motor Delays? Weakness? Decreased Dexterity? Generalized weakness?

Q: If I have a concern about my child’s handwriting, why should I seek occupational therapy services? 

Because, if not addressed, difficulty in handwriting can lead to some or all of the following:

  • Frustration and inability to keep up with peers in classroom
  • Decreased self-esteem and a increased dislike for school
  • Poor grasp- leading to compensatory strategies that are not appropriate for task and inefficient, causing fatigue of muscles
  • Increased difficulty in other areas of academics as they age if there are underlying physical delays that have not been treated (as listed above)
  • Difficulty with self-care tasks such as buttons, zippers, opening various tops/jars
  • To be proactive against frustrations by child, parents, and teachers
  • Frustration and difficulty with these tasks can cause negative behaviors and outbursts due to low self-esteem and frustration

To view helpful charts related to developmental milestones please see the links below: 

Fine Motor Developmental Chart

Written Communication Development Chart

If you have any questions, comments, or concerns please contact me! I offer free developmental screenings. A screening will determine whether a full occupational therapy evaluation is warranted or not.


Christiana Cooper, OTR/L
Kaleidoscope Occupational Therapy LLC

Be Brave

My Post-12

“You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. You must do the thing you think you cannot do.” -Eleanor Roosevelt

Happy New Year to all!

I don’t know about you, but 2018 was a whirlwind for my family and I. As I scroll through Facebook, I often see people posting their theme word for 2019. For 2017-2018 our word was “brave.” A year and a half ago (because of some unfortunate circumstances), my husband and I uprooted from NC and moved to VA. We were confident this was the right decision, but that didn’t make it easy. We had an 18-month-old and I was 30 weeks along with our second child and a very difficult pregnancy (and therefore, not working). In fact, neither of us had a job. What we did have was each other, the encouragement and prayers of family and good friends, and our belief in a good and sovereign God who would provide for us as we trusted in Him.

As we thought about what we would name our second son, we wanted it to be a remembrance of this season for us, and also – on the day when he is required to act on faith – that he would have the courage he needs as he looks back to our example. Which is why we landed on the Dutch name “Coen” – which means brave.

Along with the challenges, our family has been richly blessed in 2018. Tyler has always had work in front of him (including recently providing him with a position at a wonderful church) and an opportunity in the months ahead to be Student Pastor at a church plant in our community.

Additionally, I was able to start my own private practice – Kaleidoscope Occupational Therapy LLC! Something I never dreamed I would have the courage to do. Since I launched this practice a couple of months ago, it has spurred a new passion in me for providing OT services and I have had the honor of working with some really special families!

I am so grateful for a husband who has supported me and encouraged me to step out; who did not let fear stop me from this adventure! I have loved meeting new people and working with some of the sweetest kids! I was so moved – just yesterday – when a child I am working with was asked, “What do you want to learn more about in 2019?” He replied, “How to use my body together better.” The kids I work with often have to be brave and attempt to do tasks that come naturally for most but are difficult for them. This little boy’s response meant he is willing to “be brave” by challenging himself in our therapy sessions in the new year.

What is one thing that fear has been keeping you from in 2018? My hope for each of you is that 2019 would be the year that you see what is possible when fear is pushed aside.


Christiana Cooper, OTR/L

Parents What You Need to Know About Primitive Reflexes: Part 4

Remember back to the day your child was born. You probably noticed when you’d stroke their cheek that they would turn their head and open their mouth  (rooting reflex). Or the first time they wrapped those tiny little fingers around yours? That’s the Palmar Reflex. Maybe you stroked the bottom of their foot, and noticed their big toe would extend upward and the rest of their toes would spread (Babinski reflex).

We’re closing our primitive reflex blog series by taking a look at the Tactile Primitive Reflexes – which include the three we’ve mentioned, as well as the suck/swallow and the Spinal Galant reflex.  Let’s take a look at each one!

Rooting Reflex

One of the very first things a baby will do after delivery is nurse from his or her mother. What many may not realize is that – at the day of arrival – the child has been practicing for this moment for weeks! A light touch to the cheek and the rooting reflex is stimulated. At that moment, the mouth opens and the tongue elongates and the child is looking for food.

This reflex emerges between 24-28 weeks in utero, is fully developed by birth, and should be inhibited by 3-4 months old.

A child with a retained rooting reflex may exhibit hypersensitivity around the mouth, difficulty chewing certain types of foods and dribbling, speech/articulation difficulties due to poor fine muscle control of the internal and external mouth area.

Suck and Swallow Reflex

The rooting reflex, which allows the baby to find where the food is elicits the suck and swallow reflex at the moment where the roof of the mouth and the nipple touch. That moment of stimulus from the nipple elicits the suck and swallow reflex allowing for feeding. As crucial as it is for feeding, this complex suck and swallow reflex is necessary for much more! The combination of suckling, swallowing, and breathing is a multi-sensory ability that affects one’s speech as they develop!

The suck and swallow reflexes begin working together around 24-34 weeks in utero and should be inhibited by 3-4 months old.

If this is retained some common signs would be: sucking on fingers, thumbs, and clothes (to seek oral stimulation); incorrect development of the palate; poor muscular control of the mouth leading to speech and articulation challenges; and retained links between the hand and mouth movement (i.e. while writing there is movement of the mouth).

Palmar Reflex:

When my children were newborns, this was my favorite reflex! I thought my baby would never let go of my finger and we could stay in that moment forever. The Palmar Reflex emerges around 11 weeks in utero and is fully present at birth. This reflex helps the baby to find protection by “grabbing” onto their caregiver. This Palmar Reflex is also associated with the suck and swallow reflex in that they elicit one another. As much as I loved this reflex when my child was a newborn, I did not enjoy it so much around 3-6 months when this reflex becomes inhibited. Why? Because this is the time when your child begins dropping everything. For my children, it was the joy of dropping every bite of their food off their tray for the dog to enjoy!

The effects of a retained Palmar Reflex could include the following: poor fine motor skills and manual dexterity, lack of hand/mouth separation, and hypersensitivity to touch of the palms.

Babinski Reflex

The Babinski reflex is stimulated when the bottom of a babies foot is stroked and the large toe extends upward and the other toes fan out. Whereas, if the Babinski reflex is absent all the toes will point down (flex) when the stimulation to the sole of the foot is given.

The Babinski reflex is one that is normal to have retained longer than most reflexes, up to 2 years of age. Past this time, the presence of the Babinski reflex is most often a sign of dysfunction within the central nervous system.

Spinal Galant Reflex

Lastly, the Spinal Galant reflex, may be less familiar to you but it is one that is often retained in children. As an Occupational Therapist, I often hear from parents that their child (who is older than 5 years) is still wetting the bed. When I hear this, I often wonder if it could be a retained Spinal Galant reflex. The Spinal Galant emerges at 20 weeks in utero, is fully present at birth, and is inhibited by 3-9 months of age. This reflex is purposeful in helping the baby make his way down the birth canal during delivery.

If retained, you may notice that the child acts like he has “ants in his pants.”

Is your child always wiggly and fidgeting? Do they have poor short term memory, bedwetting, concentration, and/or poor posture?

If yes, those signs may point toward a retained Spinal Galant reflex!


God has designed the body in such an incredible way. With a few of the right exercises over time, you can actually re-wire your child’s body and brain and inhibit these reflexes!  How amazing is that?!

After reading this series of blogs on primitive reflexes, if you are you concerned your child may have some retained reflexes, please give me a call! Let’s set-up a FREE 5-10 minute screening! A screening will let you know if a full occupational therapy evaluation is warranted! So why wait?!

-Christiana Cooper, OTR/L


Goddard S. Reflexes, Learning, and Behavior: A Window Into the Child’s Mind. Fern Ridge Pres. 2005., ed 2.

NeuroRestart. Primitive Reflexes. (2018). Retrieved from

Parents: What You Need To Know About Primitive Reflexes (Part 3)

All day long, we perform tasks that are second-nature to us  – we don’t think twice about them! Just this morning, you probably made breakfast, got showered and dressed, tied your shoelaces, drove a car, sat at a desk and wrote a note.

What do all these tasks have in common?
They require the use of all four of our limbs!

It is because of well-integrated positional primitive reflexes that we can do these tasks without much thought (except for making food, which requires a lot of thought for me).

There are 3 positional primitive reflexes:

  • The Asymmetrical Tonic Neck Reflex (ATNR)
  • The Symmetrical Tonic Neck Reflex (STNR)
  • The Tonic Labyrinthine Reflex (TLR).

All three of these reflexes are technically activated by the position of the head. The ATNR and STNR, specifically, are activated by the position of the neck. The TLR is vestibular in origin as it is affected by head position and activated by the labyrinthine apparatus of the ear.

ATNR (Asymmetrical Tonic Neck Reflex)

Y220px-Asymmetrical_tonic_neck_reflex_(ATNR)_in_a_two-week-old_femaleou’ve probably seen the ATNR reflex without even knowing it! If you’ve ever seen a baby laying on their back looking like they are about to start a fencing match, you have seen ATNR.  This is a reflex that emerges at 18 weeks gestation and should be inhibited by the time the child is 6 months old. It is purposeful in utero because it facilitates movement (a kicking motion), develops muscle tone, and provides vestibular stimulation. As it provides continuous motion, a balance mechanism is stimulated and neural connections increase. ATNR is also crucial in the development of eye-hand coordination.

Signs of a retained ATNR reflex:

  • Difficulty crossing midline (i.e. tasks that require two hands working together).
  • Failure to establish a preferred/dominant hand.
  • Eye movements will also be affected. If following an object visually (with head remaining still) as it is moved slowly in front of him on a horizontally there will be a slight jerk/twitch/jump of the eyes as the object is moved from one side of his nose to the other. This same hesitancy will also prevent fluency when he later tries to read.
  • Poor balance
  • Poor ability to perform smooth cross-patterned movements (i.e. marching while hitting right hand to left leg and vice versa)
  • Poor visual perceptual skills
  • Poor handwriting
  • Poor expression of ideas

STNR (Symmetrical Tonic Neck Reflex)

The STNR does not last long as it emerges when the child is 6-9 months old and should be inhibited by 9-11 months old. But though it is short lived, it is critical during the crawling stage. STNR effectively divides the body in half at the horizontal midline.  Children who retain the STNR rarely crawl on hands and knees correctly (there may have been compensatory strategies).

Crawling is one of the most important movement patterns in the prolonged process of teaching the eyes to cross the midline. Crawling facilitates a connection – for the first time – of the vestibular, proprioceptive, and visual systems.  Without this integration there can be a poor development of balance and poor space and depth perception.

Signs of a retained STNR reflex:

  • Poor posture
  • Tendency to “slump” when sitting
  • An ape-like walk
  • Sitting with legs in a “W” position
  • Poor hand-eye coordination
  • Messy eating
  • Clumsiness
  • Inability of a child to change focus easily from blackboard to desk
  • Slowness during copying tasks
  • Difficulty learning to swim or unsynchronized movements when swimming above the water
  • Can affect attention

TLR (Tonic Labyrinthine Reflex)

The TLR can be divided into two categories: TLR Forward (emerges in utero and integrates by 4 months) and TLR Backward (emerges at birth and integrates gradually between 6 weeks and 3 years old). The TLR is elicited by movements of head forwards or backwards, above or below the level of the spine. Head movement should be the prime initiator of early movement, tone, and balance. TLR affects the distribution of muscle tone throughout the body, helping the newborn “straighten out.” Balance, muscle tone (balance between flexor and extensor muscles), and proprioception are all trained during this process.

Signs of a retained Forward TLR include: 

  • Poor posture
  • Hypotonus (weak muscle tone)
  • Vestibular-related problems
  • Poor sense of balance
  • Propensity to get car sick
  • Dislike of sporting activities, PE classes, running, etc.
  • Oculomotor dysfunctions
  • Visual-perceptual difficulties
  • Spatial problems
  • Poor sequencing skills
  • Poor sense of time.

Signs of a retained Backward TLR include:

  • Poor posture
  • Tendency to walk on toes
  • Poor balance and coordination
  • Stiff/jerky movements
  • Vestibular related problems
  • Poor sense of balance
  • Motion sickness
  • Oculomotor dysfunction
  • Visual-perceptual difficulties
  • Visual spatial perception problems
  • Poor sequencing skills
  • Poor organization skills

Do any of these symptoms sound familiar? Have you seen them in your child? A child you know? Maybe in yourself?!

Our bodies are amazing creations. When they don’t function as they were designed to function, however, a lot of different challenges arise. What is truly amazing, though, is that God has designed us in such a way that – when these challenges arise – we can re-teach our bodies and re-wire our brains so that we can perform at our highest potential!

If you are concerned that your child may have a retained primitive reflex, please call me to set an appointment for an evaluation!

Just one more post is left in our Primitive Reflex Series!  Stay tuned!


-Christiana Cooper, OTR/L


Goddard S. Reflexes, Learning, and Behavior: A Window Into the Child’s Mind. Fern Ridge Pres. 2005., ed 2.

Parents: What you need to know about Primitive Reflexes (Part 2)

“Treat the cause, not the symptom.” 

That will always be our approach at Kaleidoscope OT!

I have personally worked with a number of children who have a difficult time engaging with others, performing academically, or overcoming maladaptive behaviors.

A common starting point in my search for the root cause of the problem: primitive reflexes (which I talked about in my last post – link ). You’ll remember from that last post that more than half (65%) of healthy preschool-aged children have some level of retained primitive reflexes, which can affect them physically, emotionally, academically, or socially!

In the next couple of posts, we’ll be sharing what the specific primary primitive reflexes are, when they should be integrated, and the possible effects on children if they are retained!

Primitive reflexes can be broken into three categories: 1) The Moro Reflex (multisensory), 2) primitive reflexes of position, and 3) the primitive tactile reflexes. Today, we’ll focus on the first.



What is it and when does it disappear? We’ve all seen the Moro reflex. It occurs when an infant is startled and behaves as if she is falling – a sharp inhale and a shooting out of her arms. This is the first reflex to develop in utero and is known as the earliest form of “fight or flight” response. It exists for the survival of the infant, and is the only reflex that that can be triggered by all of the senses. An activated Moro reflex – along with the sympathetic nervous system – produces increased heart rate, breathing, and raised blood pressure, together with crying to get the attention from caregivers what the child needs for help.

Typically, this reflex begins to fade away within 2-4 months after birth, however, in extreme cases of danger, it may be triggered in later life and be considered normal.

What if the reflex is retained? Since the Moro reflex can be triggered by each sense, if it is retained there can be profound challenges later in childhood among all sensory systems. And because it is so foundational to development, the child who retains this reflex is constantly “on guard” and very easily overreacts to a situation or sensory input. Below is a list of other possible symptoms of a retained Moro reflex.

  • Vestibular hypersensitivity (knowing where your head is in space): motion sickness, poor coordination (i.e. hand/eye movements) and poor balance.
  • Touch hypersensitivity: a child may be startled by unexpected touch or easily feel that there is an invasion of body space.
  • Visual hypersensitivity: visual perceptual issues, poor reaction to light, eyes become tired under fluorescent lighting, photosensitivity, immature eye movements and slow reaction to fast-approaching objects (such as a ball being thrown for him to catch).
  • Auditory hypersensitivity: difficulty discriminating between sounds or shutting out background noise.
  • Physiological and emotional effects: Shy, fearful, poor at peer relationships, and coping with affection or aggressive, excitable, difficulty reading body language of others and be dominating. A child with a retained Moro does not enjoy change and has a very difficult time adapting to it (especially those changes where he perceives he has no control).
  • Biochemical effects of a Moro leads to an increased production stress hormones, cortisol and adrenaline, designed to increase sensitivity and reactivity. These hormones also assist the body’s defense against infection and allergy. However, if a child has a retained Moro, there may be a decrease in the efficacy of the immune responses. This means a child with a retained Moro reflex is more susceptible to suffer from allergies, pick up colds, and possibly have food or additive sensitivities. In addition, his glucose metabolism acts fast resulting in sudden onset of fatigue and mood swings.

If you see an item above present in your child, it does not necessarily mean they have a retained Moro reflex. If you read through the list, however, and see a few areas that trip an alarm and cause you to say: “Yes! That sounds like my child!” then it would be a great idea to get their Moro reflex (and possibly others) tested! Over the course of the next couple blogs we will cover position and primitive tactile reflexes! A lot more information to come that may be very relevant to you and your child! Keep tracking with us!

-Christiana Cooper, OTR/L


Goddard S. Reflexes, Learning, and Behavior: A Window Into the Child’s Mind. Fern Ridge Pres. 2005., ed 2.