Asymmetrical Tonic Neck Reflex

Original Editor - Ahmed Essam

Top Contributors - Rucha Gadgil, Ahmed Essam, Kim Jackson and Ahmed M Diab  

What is it?[edit | edit source]

This reflex is elicited by turning the child's head to one side. A normal response is seen if the baby's extensor tone increases on the side the head is facing, and flexor tone increases on the opposite side[1]. It is a part of the development of muscle tone, consistent one-sided movements with their body, and proper hand-eye coordination [2].

Position[edit | edit source]

Child supine lying position,head at mid position and arms beside the body.

Stimulus[edit | edit source]

Turn head slowly to one side, and hold in this extreme position with jaw over the shoulder

Response[edit | edit source]

Extension at arm and leg of face side and flexion at arm and leg of occipital side

Duration[edit | edit source]

From birth to four-six months[3]


Significance[edit | edit source]

Prolonged ATNR can be associated with developmental delays. Child may show poor balance while sitting or standing or when they move their head from side to side, struggling to cross the midline of their body with their arms and legs and jerky eye movements[5].

Studies have found that retained ATNR may negatively affect children’s reading capabilities, hand-eye coordination, visual tracking, handwriting (including an excessively tight grip), translation of ideas into written text and often lead to dyslexia[6][7].

Reference[edit | edit source]

  1. Zitelli BJ, McIntire SC and Nowalk AJ. 2012. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. Ed. 6. Philadelphia: Elsevier
  2. Arcilla CK, Vilella RC. Tonic Neck Reflex. [1]
  3. Votroubek W. 2009. Pediatric Home Care for Nurses: A Family-Centred Approach. Ed. 3. Sudbury: Jones and Bartlett Pblishers Inc.
  4. Nicole Edmonds. Available from:
  5. McPhillips, M. and Sheehy, N. Prevalence of persistent primary reflexes and motor problems in children with reading difficulties. Dyslexia, 2004. 10: 316-338.
  6. McPhillips M, Jordan-Black JA. Primary reflex persistence in children with reading difficulties (dyslexia): a cross-sectional study. Neuropsychologia. 2007 Mar 2;45(4):748-54. doi: 10.1016/j.neuropsychologia.2006.08.005. Epub 2006 Oct 9. PMID: 17030045.
  7. Gieysztor EZ, Choińska AM, Paprocka-Borowicz M. Persistence of primitive reflexes and associated motor problems in healthy preschool children. Arch Med Sci. 2018 Jan;14(1):167-173. doi: 10.5114/aoms.2016.60503. Epub 2016 Jun 13. PMID: 29379547; PMCID: PMC5778413.