Some kids seem to pick up new movements almost by watching. Others have to think hard about every step: how to pump on the swing, how to hold the pencil, how to get a coat zipped before the bus comes. If your child is in the second group, you may have heard the words "just clumsy" more times than you can count.
Sometimes that's all it is. Kids develop at their own pace, and plenty of them trip, spill, and bump into things along the way. But for some children, coordination is consistently hard work, and it's worth understanding why. Here's how we, as pediatric therapists in Philadelphia, think about developmental coordination disorder (DCD), and where early movement patterns called primitive reflexes may fit in.
What Is DCD (and Why You May Hear "Dyspraxia")
Developmental coordination disorder, or DCD, describes children whose motor coordination is noticeably harder for them than for other kids their age, enough that it gets in the way of everyday life at home, at school, or at play. In the UK and in a lot of online parenting content, you'll often see the word dyspraxia used for a similar picture. Here in the US, DCD is the term you're most likely to hear from therapists and schools.
A few things are helpful to know up front:
DCD isn't about effort or intelligence. Many kids with coordination challenges are bright, creative, verbal, and deeply empathetic. They're often working harder than anyone realizes.
It's about planning and carrying out movement. The challenge usually isn't strength alone. It's the brain-body teamwork of figuring out what to do, in what order, and how much force to use.
A diagnosis comes from a qualified professional after a careful evaluation. A blog post (including this one) can help you notice patterns, but it can't tell you what's going on for your child.
The Foundation Underneath: Primitive Reflexes
Before babies can choose to move, they move automatically. Primitive reflexes are those built-in, automatic movement patterns, like the startle reflex that sends a newborn's arms flying out. (We wrote all about that one in our post on the startle (Moro) reflex in babies.)
These reflexes have important jobs early on. Over the first months and years, as babies roll, push up, crawl, and explore, the brain gradually takes over with more controlled, intentional movement. The reflexes quiet down into the background. That process is often called integration.
Sometimes, traces of these early patterns stay more active than we'd expect for a child's age. When that happens, a child may be fighting their own automatic responses while trying to do something on purpose. Think of it like trying to write a neat sentence while someone keeps nudging your elbow.
It's important to be honest here: retained reflexes are one piece of a bigger picture, not the explanation for DCD. Coordination is shaped by many things, including sensory processing, body awareness, vision, muscle tone, and practice. Looking at reflexes can simply give us another useful lens.
Reflexes We Often Look At When Coordination Is Hard
Here are a few early patterns therapists commonly check in on, described in everyday terms:
The startle (Moro) reflex. If a child's body still reacts strongly and quickly to surprises, like noise, touch, or sudden movement, calm, planned movement can be harder to access. These kids may seem jumpy, cautious, or easily overwhelmed in busy spaces.
ATNR (asymmetrical tonic neck reflex). In infants, turning the head makes the arm on that side straighten. If this pattern lingers, crossing the middle of the body can feel awkward, which can show up in handwriting, catching, or switching hands mid-task.
STNR (symmetrical tonic neck reflex). This one links head position with how the arms and legs bend or straighten. When it's still active, kids may slump at the table, sit in a "W," skip or rush through crawling, or find it tricky to coordinate their top and bottom halves (think swimming or jumping jacks).
TLR (tonic labyrinthine reflex). Tied to head position, balance, and muscle tone. Children may look floppy or stiff, tire easily when standing, or feel unsure on uneven ground.
Spinal Galant. Sensitivity along the lower back can make sitting still on a chair genuinely uncomfortable, which can look like fidgeting or "not paying attention."
A Quick Parent Checklist
Notice any of these showing up regularly (not just on a tired day)?
Trips, bumps into things, or drops items more than peers
Avoids the playground, bikes, scooters, or ball games
Finds buttons, zippers, utensils, or shoelaces frustrating long after friends have them down
Handwriting is slow, messy, or physically tiring (see our post on what's really behind pencil struggles)
Slumps, leans, or wraps legs around the chair at meals or homework
Startles easily or seems on high alert in loud, busy places
Gets worn out or upset by tasks that "should" be easy
Learning a new movement skill takes many more tries than expected
One or two checks doesn't mean something is wrong. A cluster of them, especially if it's affecting your child's confidence, is a good reason to check in. Our post on whether your toddler is just clumsy covers what's typical for younger kids, too.
Simple Movement Ideas to Try at Home
These are playful, low-pressure ways to give the body more of the movement experiences it loves. Keep it fun, stop if your child is upset, and think "a few minutes most days" rather than drills.
Animal walks. Bear crawls, crab walks, and inchworms build strength and get the top and bottom of the body working together.
Crawling games. Tunnels made of couch cushions, crawling races down the hallway, or "pushing" a ball with your nose. Crawling is a big-kid activity too!
Cross the middle. Big figure-eights with ribbons or scarves, tapping opposite hand to opposite knee to music, or passing a ball around the body.
Rolling. Log rolls down a grassy hill at Fairmount Park, the Schuylkill River Trail, or the Wissahickon area, or across the living room floor.
Slow balancing. Walk along a curb, painter's tape line, or a playground beam. Slow is harder (and better!) than fast.
Heavy work. Pushing a laundry basket, carrying groceries, or wall push-ups can help kids feel more organized in their bodies. (More on that in our post on proprioception.)
How B.well tots Supports Coordination
At B.well tots, our occupational and physical therapists look at the whole child: reflexes, sensory processing, posture, strength, breathing, and what daily life actually asks of your kid. Our Neuro.well approach brings reflex-informed movement into that bigger picture as a supportive tool. It isn't a cure, and it doesn't erase a diagnosis. The goal is simply to make movement feel a little less effortful, so your child can spend more energy on being themselves.
We see families in our Fishtown, Fairmount, and Wyndmoor offices, as well as through home visits around Philadelphia and virtual sessions. For families who want focused, concentrated support, our intensives may be a good fit. If your child already works with another OT or PT, that care matters. Reflex-informed work can sit right alongside it.
Not Sure Where to Start?
You know your child best. If something about the way they move is nagging at you, it's okay to ask questions without having all the answers yet.
This post is for educational purposes and isn’t a substitute for individualized medical advice.