STNR Reflex Integration: Signs, Exercises, and How It Differs From ATNR

Brittany Ferri PHD,OTR/L
Occupational Therapist, Writer
January 09, 2026

The Symmetric Tonic Neck Reflex, also called STNR or STNR reflex, is an important part of child development. As with other reflexes, the STNR should develop at a certain point, then disappear (integrate). When this happens, a child should demonstrate improved hand-eye coordination, which helps with functional tasks such as writing, scissor use, throwing/catching a ball, sports, and more. The STNR also helps with posture, meaning it enables a child to hold their body in various positions against gravity. With proper muscular development, a child can sit upright without support, crawl, stand, and walk as time goes on.

The STNR is often compared to other crucial reflexes – especially the ATNR, so it is important for parents to know the difference between each and how they impact a child’s life. In this article, I will discuss how to test the STNR and what signs to look for. I will also offer some STNR reflex integration exercises from the standpoint of a pediatric occupational therapist.

What Is the STNR Reflex?

Parents can first expect to see this reflex when their child is between 6 and 9 months old. If a child is developing properly, you can observe this reflex until the child is between 9 and 11 months old. At this point, it should disappear or integrate.

When I test STNR in a baby or toddler, I use my fingertips to slowly move the youth’s head up and down. In the up position, the baby’s head should be bent backward so they can look at the ceiling. In the down position, the baby’s head should be bent forward so their chin is tucked into their chest.

Once this happens, I watch other parts of the child’s body for changes. When the child’s head is in the down position, I observe the child’s arms (they should be bent) and legs (which should be straight). When the child’s head is in the up position, I look to see if their arms are straight and their legs are bent. These are all signs of an integrated STNR.

Since I primarily work with school-aged children, I use some alternative methods to test this reflex. If a child is capable, I will ask them to follow instructions to complete the head movements on their own. When testing the STNR, I have a child start off in the ‘all fours’ position. This means they are kneeling with their feet supporting some of their weight and using flat hands with straight arms to support their upper body. I will have the child go through the head movements all at once – starting by tucking their head into their chest and slowly untucking as they move their head up toward their back. As they do this, I carefully pay attention to any arch in the child’s back, twitching or trembling in their arms or legs, and other signs of movement in these body parts.

If a child struggles to hold the same ‘all fours’ position as their head moves through this sequence or obviously demonstrates some of the movements above, this may point toward difficulties with the STNR. We will outline signs of a retained STNR in more detail in the next section.

Parents and caregivers often ask me why these (and other reflexes) are important for a child’s development. I explain that when a child’s head is in the upright position, it prepares their visual system to look around and take in the environment they are part of. This not only gives a child sensory information to learn about their world, but it also allows their bodies to move accordingly to explore their surroundings. 

Think of what happens when a child crawls, for instance. They need to know what is around them that is an obstacle to getting around and what is a tool that can help them reach their destination. When a child begins crawling, this is one of the first times they use this skill. However, STNR movements help children of all ages enhance their coordination to pull themselves into a standing position, stand without help, walk, run, jump, hop, ride a bike, and more. These reflexes help children during formative years, and the skills they develop stay with them for a lifetime. This is why STNR reflex integration exercises are so important.

Signs of Retained STNR in Children

Aside from asking, “What is STNR?” teachers, parents, and caregivers are also most eager to know what the signs of a retained STNR are. Children behave differently based on the setting they are in and what is expected of them. Therefore, each of these individuals may observe different signs from one another. I will review with you what a child’s movement, learning, and physical health looks like if they demonstrate a retained STNR and explain why they might benefit from STNR reflex integration exercises:

Movement

• Difficulty moving the upper body (arms) and lower body (legs) at the same time during sports, swimming, and other physical activities: Children with a retained STNR usually have trouble with any tasks that require coordinated movements or movements that involve both the upper and lower body.
• Delayed crawling as a baby: Babies with a retained STNR may attempt to crawl but cry or stop altogether when they have difficulty. They may also try to use only their arms or only their legs in an attempt to get around this issue. Some babies with a retained STNR will skip crawling altogether and pull themselves up to walk instead.
• Bear walking: This is another sign of difficulty crawling, as children may begin to bear walk before they traditionally walk. Bear walking involves walking on their hands and feet, which support their body and keep it off the ground as they move. Similarly, children may make other somewhat awkward attempts at crawling.
• Falling over when sitting upright: For babies, this may be seen when they try to sit upright without support, as they will fall over or wobble more than other babies may. Older children may fall over when sitting at their desk or the dinner table.
• Trying to sit on their knees instead of their bottom: As children get older, they may kneel and sit on their lower legs that are neatly tucked underneath them. This is done in an attempt to get around sitting upright in a traditional way.
• Bouncing in a chair when asked to sit down
• W-sitting: This involves sitting on the floor in a wide stance with bent knees and feet that do not align with the hips. The lower legs jut out at an angle, leading a child’s lower body to form the shape of a “W” when you view it from above. This results from poor strength.
• Preferring to lie on their stomach rather than sit upright: This position requires far less strength than others do, so it is usually preferred by children with a retained STNR.
• Tiring quickly when holding their head upright: This most clearly happens when a child is sitting at a desk during class or while doing work. Teachers and parents may observe a child propping their head up with their hands, slumping forward in their chair, or placing their head down on their desk. Younger children may also delay crawling due to difficulty holding their head up for long periods.
• Walking in an ape-like manner: Children may move their arms and legs too much when walking or swing their arms and legs out to the sides because they can’t control them well.

Learning

• Avoiding writing and reading tasks or completing them very slowly: This can happen for many reasons, but children with a retained STNR have difficulty with back-and-forth head movements (even small ones needed to read a book), which can lead to difficulty with these academic tasks. This includes following a single line of words when reading or writing, copying words from one place to another, putting their ideas on paper, and having difficulty getting started on homework, exercises, or other movement-based tasks.
• Poor concentration: Since this is a telltale sign of attention-deficit/hyperactivity disorder (ADHD), it is important to get to the bottom of what is causing focus issues in a child. A retained STNR can present like this due to excess fidgeting and postural adjustments. Poor concentration may also lead a child to forget the instructions for what they are working on. In many cases, this concern is a combination of the two causes.
• Reversing letters and numbers: Children may write these figures backwards due to dyslexia or other learning difficulties. However, a retained STNR causes difficulty with the movements needed to copy letters and numbers correctly.
• Difficulty estimating measurements and distances such as height, length, width, and depth
• Difficulty estimating the speed or other movement properties of objects

Physical

• Struggling to hold their paper as they write, draw, or color
• Difficulty holding a writing utensil of any kind – crayon, pencil, marker
• Wandering around when asked to sit for any amount of time
• Wrapping their feet around the legs of a chair while sitting
• Being a messy eater, especially when using a spoon or a fork
• Difficulty catching, throwing, or following a ball with their eyes
• Being called clumsy or klutzy by others – falling often, tripping over things, bumping into people or things as they walk or move

ATNR vs STNR: Key Differences Explained

Due to their similar names, STNR is often confused with another reflex called ATNR. While ATNR and STNR are both integral to a child’s development, they differ somewhat. ATNR, asymmetrical tonic neck reflex or ATNR reflex, involves movements and positions of the arms and head, whereas STNR looks at that of the arms, legs, and head. I will outline the main differences in the table below.

STNR Reflex Integration Exercises

Based on how a child responds to the STNR test, they will likely benefit from exercises to strengthen certain muscles and movement patterns. These exercises target the weaknesses identified by STNR testing. I will list several STNR reflex integration exercises, detail specifically how to complete each exercise, and discuss how each exercise will improve upper and lower body coordination.

Ball Crawling

How it benefits those with a retained STNR: The act of crawling can be difficult for those with a retained STNR. This exercise offers postural support so a child can focus on the smoothness and coordination of their upper and lower body without worrying about the rest of their body.

How to do it:

1. Lie on your stomach on an exercise ball. The ball should be big enough that you are slightly raised off the ground, but small enough that you can touch the ground with your hands and feet.
2. Slowly move your hands and feet at the same time to inch forward while keeping your body on the ball.
3. Locate an object across the room (this can be an object you previously placed there or one that is already there) and inch your way toward it.
4. Continue to make slow, steady, coordinated movements. If you feel your arms or legs are getting out of control, pause and take a breath before starting again.
5. Once you reach the object, get off the ball and stand up.
6. Stretch and shake your arms and legs out for 30 seconds.
7. Get back on the ball in the same position you were before.
8. Start inching back to where you started. Locate another object, keep your eyes on it, and slowly make your way there.
9. Once you get there, get off the ball and stand up.
10. Stretch and shake your arms and legs out for 30 seconds.

Yoga Switch

How it benefits those with a retained STNR: Assuming postures and switching between them can be difficult for people with a retained STNR. In particular, there are several yoga poses that involve coordination between the head and neck and the lower/upper body. By working to complete one of these yoga poses, then transitioning smoothly to another and back, this can greatly improve the body’s coordination.

How to do it:

1. Find a comfortable spot to sit – ideally on a carpet, rug, mat, or by placing a blanket down on harder floor surfaces.
2. Kneel on the floor, then sit on top of your feet as they are tucked under you.
3. Get comfortable in that spot, then slowly bend at the waist and reach forward to touch the floor in front of you with straight arms and flat palms.
4. First, reach directly in front of your knees. Then, if you are comfortable and able, slowly inch your hands forward on the floor to reach further away from you.
5. Once you cannot reach forward any further, inch your hands slowly back until they are directly in front of your knees.
6. Bring your upper body back to an upright position where you started. So you should be sitting on top of your feet with your upper body straight and hands resting in your lap.
7. Repeat steps 3 through 6 again, ensuring you go slowly through these motions.
8. Do this again for 5-10 repetitions.

Scooterboard Scavenger Hunt

How it benefits those with a retained STNR: Scooterboards are a great way to strengthen the core and encourage free movement of the arms and legs. This device also encourages strengthening of the upper and lower body, all while requiring a child to keep their head still through neck stability.

How to do it:

1. Arrange 10 objects (small to medium-sized) around the room, ensuring they are spread out enough.
2. Have your child sit on their feet while on the scooterboard.
3. Tell them to push themselves around the room using their hands as they retrieve 5 objects.
4. Have your child reposition so they are lying on the scooterboard on their stomach.
5. Tell them to push themselves around the room using both their hands and legs now as they retrieve the remaining 5 objects.

Cat and Cow

How it benefits those with a retained STNR: These are two more yoga poses that allow children to practice the exact motions needed to integrate STNR. These poses both involve smooth and controlled head, arm, and leg movements, so they help improve coordination between the neck and lower body.

How to do it:

1. Have your child sit on the floor on their hands and knees.
2. Tell them to start with the cat pose and arch their back so it is round and curved. Be sure they keep their legs and arms planted firmly on the ground while they do this. They should also tuck their head into their chest.
3. Have them hold this pose while you count to 20.
4. Next, tell them to move into the cow pose, where they push their stomach down and try to move it toward the floor. Again, be sure they keep their legs and arms firmly planted as they do this while their head points up toward the sky.
5. Have them hold this pose while you count to 20.
6. Tell them to relax their body and lie down on the ground on their back.
7. Tell them to repeat steps 2 and 3 for another cat pose.
8. Tell them to repeat steps 4 and 5 for another cow pose.

Soundsory

How it benefits those with a retained STNR: This research-backed program uses a combination of music and exercise to improve the coordination, balance, and motor skills of children. SoundSory targets the body’s sensory system to stimulate the brain and train the nervous system to improve movements.

How to do it:

1. Watch several videos that guide you through your 3-4 daily SoundSory exercises.
2. Put on the SoundSory headphones and start listening to the music as instructed.
3. Keep listening as you do each of the day’s exercises as many times as you comfortably can in 25 minutes. If you have trouble, follow the modifications given in the instructions or simply dance to the music as you choose.
4. Listen to the music while resting and taking deep breaths for 5 minutes. This completes your first 30-minute session.
5. Repeat these sessions no more than once daily for 5 to 7 days each week.
6. Take a 3-week break after you have completed 20 sessions.
7. Complete another 20 sessions to finish the program.

When to Seek Professional Support

If you have completed these STNR reflex integration exercises with your child and they continue to have difficulty in some of the above areas, it may be time to discuss your concerns with a healthcare professional. You can mention your child’s difficulties to their pediatrician. 

If your child is seeing a physical therapist or an occupational therapist, they can help. If you want to bring your child to a physical therapist or occupational therapist, you can ask their doctor for a referral. Be sure you are seeing a professional who specializes in pediatrics (children) and is knowledgeable about reflex integration.

Occupational therapists (OTs) assist children in building functional skills such as writing, using scissors, dressing, using the bathroom, showering, and more. If your child’s STNR concerns are impacting any of these areas, an OT may be able to help. In the event your child is more affected by difficulty running, walking, crawling, hopping, jumping rope, riding a bike, and more, they may benefit from seeing a physical therapist (PT). In many cases, children with reflex integration concerns may need help from both professionals. PTs and OTs work closely together to ensure the children they treat receive well-rounded care, so this should help your child grow stronger and learn new skills.

SoundSory is another evidence-based way to improve motor and sensory concerns related to a retained STNR. This fun, innovative program uses a combination of music and exercise to improve a child’s coordination, emotion regulation, attention, and more. SoundSory can benefit a range of developing children and is perfectly suitable for any child due to its non-invasive, easy-to-use approach.

How Retained STNR Affects Daily Life

There are several ways in which a retained STNR can impact a child’s daily life. A child may benefit from STNR reflex integration exercises if they have some of the following difficulties:

• Difficulty sitting still at school

• Displaying poor posture while sitting to do homework, eat meals, or watch television

• Fatiguing quickly during exercise and physical activities, such as when doing sports or playing on the playground

• Difficulty focusing for visually taxing activities such as reading, writing, coloring, drawing, sports, and more 

STNR Progress Markers

It is important to look for small changes in your child over the course of weeks, not days. This is because it takes time to see the effects of STNR reflex integration exercises. Look for improvements in younger children, such as smoother crawling and more exploration/use of their arms to interact with their environment as they crawl, walk, or sit. 

For older children, be on the watch for signs such as an improved ability to copy words or look between near and far locations (such as when copying from the board during class or playing a game), less time spent with their head on the desk, and the ability to sit upright for longer periods of time. In general, parents should expect to see overall improved endurance when it comes to movement and daily activities.

Frequently Asked Questions About STNR

What age should the STNR reflex integrate?

The STNR reflex can be integrated as early as 9 months, but should be integrated by 11 months of age.

Can STNR be retained without ATNR?

Yes, it is possible to retain the STNR and not the ATNR since they are distinct reflexes with different functions in the body.

How long does STNR integration usually take?

STNR integration often takes several months. The exact time frame for improvement depends on how often your child does exercises and what, if any, other motor difficulties your child may have.

Can a child have both retained STNR and ATNR?

Yes, it is common for some children to retain both of these reflexes.

Do STNR and ATNR require different exercises?

Yes, there are specific exercises for both STNR integration and ATNR integration. They involve many of the same body parts, but are distinct due to their different roles in the body.

Should STNR be addressed before ATNR?

Reflexes are typically addressed in the order they develop and integrate within the body. As such, it is more common to address ATNR before STNR if a child has retained both.

References:

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Brittany Ferri PHD,OTR/L

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My areas of expertise include occupational therapy, rehabilitation medicine, telehealth, and mental health. With nearly 10 years of healthcare experience, I am also qualified to write on topics such as exercise, health insurance, nutrition, orthopedics, geriatric care, pediatric therapy, neurology, and health tech.