Primitive Reflexes and Airway Development: The Connection Between the Nervous System, Breathing, and Childhood Growth

Early neurological development helps lay the foundation for breathing, feeding, posture, and coordinated movement.

Airway health begins long before a child develops a full set of teeth.

From the earliest stages of development, the nervous system plays an essential role in breathing, feeding, swallowing, tongue movement, posture, and coordination. These foundational functions help shape how children grow, interact with their environment, and develop more complex motor skills.

But what happens when early developmental patterns persist beyond infancy?

In an Airway Circle presentation, Dr. Jill Ghormley, ND, explored the relationship between primitive reflexes, the vagus nerve, oral motor development, and pediatric airway health.

Dr. Ghormley is an award-winning naturopathic physician and the first licensed Deaf naturopathic doctor in the United States. A graduate of Bastyr University, she also holds a master's degree in Biomedical Communications from the University of Illinois at Chicago.

Specializing in physical medicine with a focus on neurology, Dr. Ghormley holds advanced certification in Pediatric Sacral Occipital Technique (PSOT). Her clinical approach emphasizes understanding underlying contributors to dysfunction rather than focusing exclusively on symptoms.

Her presentation raised an important question for airway-focused professionals:

Could early neurological development be an overlooked part of the clinical picture in children struggling with breathing, feeding, sleep, and oral function?

What Are Primitive Reflexes?

Primitive reflexes support early survival and motor development as the nervous system matures.

Primitive reflexes are automatic, involuntary movement responses that emerge during fetal development and early infancy.

Dr. Ghormley described these reflexes as the body's original programming, comparing them to factory settings that help newborns survive and interact with their environment.

These reflexes are primarily mediated by the brainstem and support essential early functions, including feeding, protection, and movement.

As the central nervous system develops, many primitive reflexes gradually become inhibited or integrated, allowing more mature voluntary motor control.

Examples include:

• Rooting reflex: Helps newborns turn toward stimulation near the mouth to locate a feeding source.
• Sucking reflex: Supports early feeding and nutritional intake.
• Moro reflex: Produces an automatic response to sudden movement or sensory stimulation.
• Asymmetrical Tonic Neck Reflex (ATNR): Creates characteristic arm and head movement patterns during infancy.
• Spinal Galant reflex: Produces a trunk response to stimulation along the lower back.
• Tongue extrusion reflex: Helps protect the airway by pushing unfamiliar substances forward during early feeding development.

These early reflexes are a normal part of infancy. Their persistence beyond expected developmental periods may warrant further neurological or developmental assessment, particularly when accompanied by functional difficulties.

Why Primitive Reflexes Matter for Neurodevelopment

Primitive reflexes help support the transition from automatic movements to increasingly sophisticated voluntary motor control.

During infancy, children gradually develop the ability to control their head, coordinate their eyes, stabilize their trunk, reach across the body, crawl, stand, walk, chew, swallow, and speak.

These skills depend on the coordinated development of multiple neurological systems.

Dr. Ghormley emphasized that persistent primitive reflex patterns may be associated with difficulties involving:

• Postural control and coordination
• Sensory processing
• Crossing the midline
• Balance and movement
• Speech articulation
• Oral motor function
• Attention and behavioral regulation

For myofunctional therapists, speech-language pathologists, occupational therapists, physical therapists, and pediatric airway providers, these observations encourage a broader developmental assessment.

However, retained reflexes do not automatically indicate neurological impairment, and their presence alone does not establish the cause of a child's symptoms.

The goal should always be to understand how the child functions, not simply whether a reflex can be elicited.

Primitive Reflexes and the Developing Airway

One of the central themes of Dr. Ghormley's presentation was the connection between early neurological development and airway function.

During infancy, breathing, feeding, swallowing, and tongue movement must work together.

Newborns have anatomical characteristics that differ significantly from those of adults, including relatively small nasal passages, a higher laryngeal position, and a tongue that occupies a substantial portion of the oral cavity.

Infants strongly favor nasal breathing, particularly during feeding, making nasal airway patency especially important.

Even relatively minor nasal obstruction can interfere with feeding comfort and breathing coordination.

Dr. Ghormley encouraged clinicians to consider how early neurological development, oral motor control, and anatomical restrictions may influence the child's ability to coordinate these functions.

For airway-focused professionals, this reinforces the importance of evaluating the entire feeding and breathing system rather than looking at tongue movement in isolation.

The Rooting, Sucking, and Extrusion Reflexes

Feeding requires coordinated activity between the tongue, lips, jaw, swallowing system, and airway.

Early oral reflexes have direct relevance to feeding and airway protection.

The rooting reflex helps newborns locate the breast or bottle, while the sucking reflex supports the coordinated activity necessary for feeding.

The extrusion reflex causes the tongue to push material out of the mouth. This protective response is especially prominent early in infancy and generally diminishes as feeding skills mature and infants become developmentally ready for complementary foods.

Dr. Ghormley discussed the possibility that persistent oral reflex patterns may complicate the transition to more mature feeding and tongue movement.

When evaluating a child with feeding difficulties, clinicians should consider:

• Tongue mobility and coordination
• Lip seal
• Suck-swallow-breathe coordination
• Oral sensitivity
• Feeding readiness
• Jaw stability
• Respiratory effort
• Posture and head control

Persistent feeding difficulties deserve evaluation by appropriately trained pediatric feeding specialists, particularly when accompanied by coughing, choking, poor weight gain, or respiratory symptoms.

The Tongue, Palate, and Craniofacial Growth

The tongue plays an important role in oral function and interacts with the developing jaws and palate.

During her presentation, Dr. Ghormley discussed how tongue posture and movement may influence maxillary development and the available space within the oral cavity.

A tongue that rests low rather than against the palate may coexist with mouth breathing, a narrow dental arch, a high-arched palate, or other craniofacial differences.

These relationships are relevant to myofunctional therapy because tongue posture is both a functional finding and a possible reflection of structural limitations.

Clinicians should consider whether low tongue posture is associated with:

• Nasal obstruction
• Enlarged tonsils or adenoids
• Reduced tongue mobility
• Orofacial hypotonia
• Jaw or palatal development
• Feeding history
• Oral habits
• Neuromotor coordination

Although oral function and craniofacial development interact, the claim that retained primitive reflexes directly cause narrow palates or airway restriction requires stronger evidence.

Mouth Breathing, Sleep, and Neurological Regulation

Mouth breathing is an important clinical sign in pediatric airway assessment.

Dr. Ghormley discussed the relationship between persistent mouth breathing, breathing patterns, autonomic regulation, and developmental concerns.

Children who regularly breathe through their mouths may have underlying nasal obstruction, allergic inflammation, enlarged tonsils or adenoids, craniofacial restrictions, or sleep-disordered breathing.

Depending on the underlying cause, they may also experience restless sleep, snoring, dry mouth, altered oral posture, and daytime difficulties.

From a developmental perspective, poor sleep can influence attention, emotional regulation, learning, and behavior.

This is why airway screening should be considered when a child presents with overlapping sleep, behavioral, or developmental symptoms.

Rather than assuming that mouth breathing is caused by retained primitive reflexes, clinicians should evaluate the possible respiratory, anatomical, and neurological contributors.

The Vagus Nerve and Autonomic Nervous System

The vagus nerve was another major focus of Dr. Ghormley's presentation.

As cranial nerve X, the vagus nerve contributes to parasympathetic regulation and carries sensory and motor fibers involved in multiple functions, including cardiovascular regulation, gastrointestinal activity, and aspects of swallowing, phonation, and airway protection.

It participates in communication between the brain and internal organs and is an important part of autonomic regulation.

Dr. Ghormley discussed the concept of vagal tone and its potential relationship to stress responses, breathing patterns, digestion, and neuromotor development.

She also described clinical observations involving children with persistent primitive reflex patterns and signs of autonomic dysregulation.

These observations raise interesting research questions, although low vagal tone should not be assumed to cause retained reflexes, tongue hypotonia, or sleep apnea without appropriate assessment and evidence.

For airway providers, the practical message is to consider autonomic regulation alongside breathing, sleep, feeding, and functional development.

Primitive Reflexes, Anxiety, and Sensory Processing

Some children experience significant sensory and behavioral challenges that may overlap with airway or sleep concerns.

Dr. Ghormley described clinical presentations involving anxiety, hypersensitivity, attention difficulties, developmental differences, and persistent reflex responses.

Children with these concerns may have difficulty processing stimulation, adapting to environmental changes, maintaining postural control, or organizing complex movements.

However, ADHD and autism are not caused simply by retained primitive reflexes, and reflex integration should not be presented as a treatment or cure for either condition.

A comprehensive evaluation may involve occupational therapy, developmental pediatrics, psychology, sleep medicine, speech-language pathology, or neurology.

For airway-focused professionals, the important question is whether an underlying sleep or breathing problem is contributing to the child's daytime difficulties.

Birth History and Early Developmental Screening

Dr. Ghormley emphasized the value of obtaining a detailed prenatal, birth, and developmental history.

Her clinical intake includes questions about pregnancy, delivery, neonatal complications, early feeding, and developmental milestones.

Relevant history may include:

• Prematurity or low birth weight
• Complicated delivery
• Assisted delivery
• Cesarean section
• Neonatal respiratory concerns
• Feeding and latch difficulties
• Torticollis
• Delayed motor milestones
• Persistent feeding or swallowing concerns

Dr. Ghormley also discussed IVF pregnancies and possible associations with developmental patterns. However, IVF or Cesarean delivery alone does not establish that a child has retained primitive reflexes or an airway disorder.

These factors are best viewed as elements of a comprehensive history, not as diagnostic indicators by themselves.

Primitive Reflexes and Tongue-Tie Assessment

Dr. Ghormley also discussed primitive reflex screening in children being evaluated for tethered oral tissues.

Her clinical philosophy emphasizes assessing neurological and motor development before proceeding with interventions such as frenotomy, oral appliances, or palatal expansion.

This is especially relevant for children who have difficulties with feeding, tongue mobility, cervical movement, oral coordination, or postural control.

However, the decision to release a tongue-tie should be based on a comprehensive functional assessment and the patient's individual indications.

Primitive reflex integration is not an established prerequisite for frenotomy, and a child with clinically significant feeding impairment should not experience unnecessary delays in appropriate care.

For the interdisciplinary airway team, the broader lesson is that surgical decisions should consider function, development, anatomy, and expected outcomes.

Primitive Reflexes and Speech Development

Speech requires complex coordination between the brain, respiratory system, tongue, lips, jaw, soft palate, and larynx.

Dr. Ghormley discussed the ATNR and its possible relationship to difficulty crossing the midline and coordinating movements.

Because early motor development and oral motor function are interconnected, clinicians may encounter children with overlapping postural, fine motor, feeding, and speech difficulties.

This does not mean retained ATNR directly causes a speech disorder.

Instead, the presence of multiple developmental concerns may indicate the need for a broader assessment.

Speech-language pathology, occupational therapy, and physical therapy can work together to identify functional limitations and develop measurable treatment goals.

Reflux, Digestion, and Airway Symptoms

Dr. Ghormley also addressed the relationship between gastrointestinal symptoms, upper airway irritation, and breathing.

Reflux may coexist with feeding difficulties, throat irritation, nasal or pharyngeal symptoms, and sleep disturbances.

In infants, these concerns require careful evaluation because symptoms can have multiple causes.

Dr. Ghormley discussed conservative positioning and feeding strategies within her integrative clinical approach.

However, infant reflux management must be consistent with pediatric safety guidelines. Infants should be placed on their backs on a flat, firm sleep surface, and wedges or inclined sleep positioning should not be used for routine reflux management. Thickened feeds and medication decisions require individualized medical guidance.

The important message is to identify the underlying source of the symptoms instead of assuming every feeding, breathing, or sleep concern has the same cause.

Can Primitive Reflex Patterns Be Addressed in Older Children?

Dr. Ghormley expressed optimism about helping older children who continue to experience developmental and motor challenges.

In her clinical practice, treatment may involve PSOT, movement-based interventions, functional assessment, and interdisciplinary care.

She discussed how treatment may take longer in older children and how her approach sometimes combines neurodevelopmental work with dental, craniofacial, and gastrointestinal evaluation.

Importantly, evidence for specific primitive reflex integration programs remains limited.

The American Occupational Therapy Association advises against using reflex integration programs without a clear connection to functional outcomes. Treatment should prioritize measurable improvements in activities such as feeding, movement, participation, and daily function.

This distinction is essential for responsible clinical care.

Why Early Detection Matters

One of the strongest messages from Dr. Ghormley's presentation was the importance of early detection.

Children often communicate dysfunction through their breathing, feeding, posture, sleep, movement, and behavior long before they can explain what they are experiencing.

For healthcare professionals, recognizing those signs may create an opportunity for earlier evaluation and appropriate referral.

Early screening should consider:

• Feeding and swallowing function
• Nasal breathing
• Oral rest posture
• Tongue mobility
• Lip seal
• Motor milestones
• Head and neck movement
• Sensory processing
• Sleep quality
• Snoring and breathing disturbances
• Craniofacial development

Recognizing a concern early does not mean every child requires treatment. It means clinicians have an opportunity to determine whether the concern is developmentally appropriate or requires further investigation.

The Importance of Interdisciplinary Collaboration

Dr. Ghormley concluded with a message that closely aligns with the Airway Circle mission: it takes a village.

Complex pediatric cases often require professionals from multiple specialties to understand the full clinical picture.

An interdisciplinary team may involve pediatricians, ENTs, pediatric dentists, orthodontists, myofunctional therapists, speech-language pathologists, occupational therapists, physical therapists, neurologists, psychologists, and other appropriately trained professionals.

Each specialty provides a different perspective.

A pediatrician may evaluate development and medical concerns. An ENT may identify nasal obstruction or adenotonsillar enlargement. A myofunctional therapist may assess oral rest posture and functional patterns. An occupational therapist may evaluate sensory processing and motor participation. A speech-language pathologist may assess feeding, swallowing, and speech development.

The goal is not to have every provider treat everything.

It is to recognize when a child needs another professional on the team.

Clinical Questions for Healthcare Professionals

When evaluating a pediatric patient with airway, feeding, or neurodevelopmental concerns, consider asking:

• Does the child breathe through the nose comfortably?
• Is there snoring or restless sleep?
• Does the child struggle with feeding or swallowing?
• Are there signs of reduced tongue mobility?
• Is lip seal present at rest?
• Has the child experienced significant developmental delays?
• Is there a history of torticollis or limited head movement?
• Are there persistent motor coordination difficulties?
• Are sensory or behavioral concerns affecting daily function?
• Is there a history of prematurity, neonatal complications, or feeding difficulty?
• Could poor sleep be contributing to attention or behavioral symptoms?
• Would the patient benefit from evaluation by another specialist?

These questions help connect airway screening with a more comprehensive developmental history.

Key Takeaways for Healthcare Professionals

• Primitive reflexes support early survival and motor development. Persistent reflex responses may warrant evaluation when associated with functional limitations.
• Breathing, feeding, swallowing, and oral motor development involve coordinated neurological and anatomical systems.
• Tongue position and craniofacial development should be evaluated alongside nasal patency, airway anatomy, and functional history.
• Mouth breathing and snoring in children deserve attention, particularly when accompanied by sleep disruption or developmental concerns.
• The vagus nerve contributes to autonomic regulation, but claims linking vagal tone directly to specific airway disorders or retained reflexes require further investigation.
• Primitive reflex screening should complement, not replace, comprehensive neurological, developmental, or airway evaluation.
• Interventions should be selected according to the child's needs and evidence-supported functional goals.
• Early identification and interdisciplinary collaboration can help families access appropriate care before difficulties become more complex.

The Airway Circle Perspective

Children benefit when healthcare professionals collaborate across airway health, feeding, neurological development, and functional therapy.

At Airway Circle, we believe the best patient care begins with understanding the bigger picture.

Dr. Jill Ghormley's presentation encourages healthcare professionals to look beyond isolated symptoms and consider how neurological development, oral function, breathing, feeding, sleep, and the broader body interact.

A child struggling with tongue movement may also have feeding or motor coordination challenges.

A child experiencing behavioral difficulties may also be sleeping poorly.

A child who persistently mouth breathes may need more than exercises to establish nasal breathing.

These observations reinforce the importance of careful assessment, appropriate referrals, and evidence-informed collaboration.

The goal is not to find one explanation for every symptom.

The goal is to understand the child well enough to identify which systems need support.

Final Thoughts

Primitive reflexes are an important part of early human development, and their relationship to motor coordination, sensory processing, and oral function is an area of ongoing clinical interest.

Dr. Ghormley's presentation encourages clinicians to ask deeper questions about the origins of developmental and airway difficulties.

But asking deeper questions also means distinguishing established findings from emerging theories.

Effective pediatric airway care requires both curiosity and clinical precision.

By screening early, evaluating function, addressing breathing difficulties, and working together across disciplines, healthcare professionals can support healthier development and better long-term outcomes.

The future of airway care is not simply about treating the airway. It is about understanding the developing child.

Need Guidance With Airway, Breathing, or Myofunctional Therapy?

Finding the right support for airway health, breathing, sleep, tongue function, feeding concerns, oral restrictions, or developmental challenges does not have to feel overwhelming.

With the right guidance, patients, parents, and healthcare professionals can better understand the clinical picture and explore the next best steps.

Whether care involves myofunctional therapy, ENT evaluation, pediatric dentistry, sleep assessment, tongue-tie evaluation, occupational therapy, speech-language pathology, physical therapy, or referrals to the right provider, the goal is to improve function and quality of life.

Your journey to better breathing, better sleep, and better oral function starts here.