Developmental Delays & Vision

Vision is foundational to motor, cognitive, and social development. When a child has developmental delays, an undetected vision problem can hold back progress in other areas — and addressing it can support the whole plan.

Development also builds in layers. Primary reflexes and the sensory systems come first; motor development, ocular motor control, and sensory processing sit on top of them; and communication, attention, and academics sit on top of those. When a lower layer is still unsteady, everything above it costs more effort — which is why a developmental vision evaluation looks at the whole picture rather than eyesight alone.

The Developmental Pyramid

Read from the bottom up: primary reflexes (ATNR, STNR, TLR, Moro, palmar, head righting, spinal Galant) support the sensory systems — visual, auditory, tactile, vestibular and proprioceptive. Those support motor development (body schema, bilateral integration, ocular motor control, motor planning), which supports sensory processing and perceptual motor skills (visual perception, visual motor integration, balance, speech, sequencing), then communication (visual and auditory memory, phonetic awareness), then attention and focus (visual spatial perception, organizational skills, self-regulation) — and finally academics: reading, comprehension, math and learning.

Retained Primitive Reflexes

Primitive reflexes are automatic, involuntary movements present in infants from birth. They are controlled by the brainstem and are essential for survival and early development, emerging in utero or shortly after birth and gradually integrating as a child's nervous system matures. Because they shape motor skills and sensory processing, they also have implications for how vision develops. A few examples:

1. Asymmetrical Tonic Neck Reflex (ATNR). Triggered when an infant turns their head to one side: the arm and leg on the side the infant faces extend while the opposite arm and leg flex. Persisting beyond its normal integration stage, it can lead to difficulty with eye-hand coordination and with tracking objects using both eyes.
2. Symmetrical Tonic Neck Reflex (STNR). Triggered when an infant flexes or extends their neck. If the STNR is not properly integrated, it can affect a child's ability to coordinate eye movements and to focus on objects at different distances.
3. Moro Reflex. Often called the "startle reflex," the Moro is triggered by sudden movement or a loud noise. If it persists, it can bring heightened sensitivity to visual stimuli along with difficulty in visual attention and focusing.
4. Tonic Labyrinthine Reflex (TLR). Related to the position of the head in relation to gravity, this reflex affects muscle tone in response to head movement. Without proper integration it can make it hard to hold an appropriate head posture for visual tasks.
5. Palmar and Plantar Grasp Reflexes. These involve gripping with the hands and toes when pressure is applied to the palms or soles. If they persist, they can interfere with the fine motor skills needed for writing and manipulating objects — which indirectly affects visual tasks that require precise hand-eye coordination.
6. Babinski Reflex. The big toe extends and the other toes fan out when the sole of the foot is stroked. Present beyond infancy, it can indicate neurological issues that may affect overall motor and sensory development, potentially including vision.
7. Galant Reflex. The infant arches their back and turns toward the side of the body that is stroked. If it persists, it can affect postural control and balance — both of which matter for stable visual perception.

Primitive reflexes are expected to integrate as a child grows and the central nervous system matures. When they persist beyond their normal timeframe, they can point to an underlying neurological issue or a developmental delay — and addressing that with appropriate intervention supports sensory and motor development, which in turn supports vision and a child's overall growth. Our primitive reflexes page goes reflex by reflex through the signs we look for, and the post Primitive Reflexes and Vision: The Connection covers the link in more depth.

Why Crawling Matters

Crawling is the stage when a baby learns to move around on hands and knees, typically between about 6 and 10 months of age. It is an important motor milestone — and it does real work for the visual system:

1. Visual stimulation. Crawling gives infants a different perspective on their environment than lying down or sitting. Seeing objects from a lower angle and being able to explore adds visual input that helps build visual processing skills.
2. Eye-hand coordination. Coordinating hands and knees, and reaching for objects along the way, gives babies practice aligning visual focus with hand movement — the foundation for grasping and manipulating objects.
3. Depth perception. On the move, a baby has to judge distance and depth to avoid obstacles and navigate, which refines depth perception and the sense of spatial relationships.
4. Visual tracking. Crawling encourages babies to follow objects and people with their eyes, developing the smooth tracking later needed for reading and sports.
5. Binocular vision. Crawling encourages using both eyes together — the basis for judging distance accurately and perceiving the world in three dimensions.
6. Peripheral vision. Looking around to stay aware of surroundings and avoid obstacles builds awareness of what sits outside central focus, useful for sports and navigation.
7. Visual exploration. Crawling lets babies move toward what interests them, inspect it closely and interact with it — active exploration that refines visual processing and teaches them about object characteristics.

Every child develops differently. Not all babies crawl in the traditional hands-and-knees manner; some skip crawling or find another way to get around. Crawling is one experience among many, and it is the combination of them that shapes motor skills, cognitive development, sensory processing and vision. For more on what to expect and when, see how vision shapes developmental milestones and our visual-spatial development milestones.

Not sure whether vision is part of what you are seeing at home or at school? The symptom checklist takes about two minutes, and the problems we help with shows how these pieces fit together. A developmental vision evaluation at our Boynton Beach and Boca Raton offices answers the question directly.

Care starts with a comprehensive developmental and binocular vision evaluation that pinpoints exactly what's happening. From there, Dr. Murray builds an individualized plan — which may include lenses or prism, in-office vision therapy, and coordination with your other providers — at our Boynton Beach and Boca Raton offices.