What Causes Hypotonia In Newborns

Will My Child Outgrow Low Muscle Tone

Hypotonia or low tone as a cause of chronic constipation

No, it doesnt just go away. Thats because muscle tone doesnt really change.

Seeing first steps, jumping, and running may seem to suggest that the low tone days are behind you. But thats not the case.

Kids are adaptable. Your child will reach milestones by working within the limitations hypotonia creates. That doesnt mean the limitations are gone.

Absolutely not.

Having low tone is exhausting. Thats a simple answer, not an excuse.

Your childs muscles have to work overtime to keep up. So extra breaks and the occasional accommodations arent bad things.

Evaluation And Management Of The Infant With Hypotonia

When you first observe or suspect an infant has hypotonia, you face a decision whether the condition is benign and likely to resolve over time vs. a more serious condition with an important neurologic basis.

You will be in a position to make that call in many cases in your practice. Related observations include spontaneous movement during a physical examination basic laboratory testing and any relevant family history of genetic-based disease. These can go a long way to guide your diagnosis. Any abnormality in growth, feeding patterns, or respiration also provides important clinical clues.

Pediatricians, depending on their experience, can determine when a “wait and watch” approach is appropriate. For example, benign hypotonia is more likely when there are no major delays in growth or motor milestones, no signs of abnormal respiration, and parents report normal feeding patterns.

Since we cannot test the strength of a 7- or 8-month-old infant by asking them to offer resistance with their arms and legs, its useful to observe the amount and quality of their spontaneous movements. Watch their head control when you pull the infant to sit from a supine position. Does the head lag behind at all? How vigorously does the infant kick or grasp? These signs can help examiners compare impressions of degree of weakness, if there is any, in hypotonic infants.

Parents may be unaware of any low muscle tone, so its important to include hypotonia on your physical examination checklist.

What Are The Causes Of Hypotonia In Infants

Hypotonia is a symptom and it can manifest due to several underlying causes. Hypotonia can be present since birth or may develop later during infancy. At birth it is regarded as congenital hypotonia where as if it is later on it is called acquired hypotonia.

It can result from neurological diseases or muscular problems. Inheritance, injury and illnesses can cause damage to the brain, spinal cord, muscle junction etc. Here are some of the underlying causes for hyportonia in infants:

Causes of hypotonia at birth:

  • Premature baby has increased risk of developing hypotonia. However, most babies grow out of it after few years.
  • Hypothyrodism since birth: Lack of thyroid hormone in infants can cause loss of muscle tone. In severe cases there may be associated mental retardation.
  • Severe infection leading to serious condition called sepsis.

Genetic causes: Hypotonia is common feature in certain genetic condition such as:

  • Down syndrome

Brain and spinal cord problems:

  • Injury to brain or spinal cord during childbirth.
  • Infection affecting brain such as meningitis and encephalitis.
  • Kernicterus: It is a condition that can damage brain of the infant. It is caused by high level of bilirubin and jaundice in new born.
  • Cerebral palsy

Other causes may include hypoglycemia, congestive cardiac failure, inherited metabolic diseases.

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Tall Kneeling Challenges Glute And Core Stability

  • Easy: holding tall kneel position at a supporting surface such as a low bench/table the cube chair works great for this!
  • Medium: heel sit to tall kneel to bring puzzle pieces from floor to puzzle on couch or low table
  • Hard: blow bubbles or hold a ball or balloon up just beyond their reach, encouraging them to come up into a tall kneel position. Can they hold this position and play here for a few seconds?

How Boston Children’s Hospital Approaches Muscle Weakness


Your child’s muscle weakness can be caused by several different diseases, and treatment cannot begin without sussing out the real cause. At Boston Children’s, doctors have several tests available to diagnose the cause of your child’s weakness. Once the diagnosis is nailed down, several treatment programs, including physical therapy programs, are at hand to help your child live a normal life.

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Treatment For Hypertonia In Babies

The treatment options may vary depending on the underlying cause. The following treatments could be prescribed for babies .

  • Baclofen, a muscle relaxer and an antispasmodic drug, is prescribed as a first-line treatment for babies with brain anomalies.
  • Benzodiazepines, such as diazepam, are also used in initial treatment for hypertonia due to brain problems.
  • Vitamins are often prescribed for babies with seizures.
  • Levodopa, a type of amino acid, is given to babies with CNS-related causes but with no abnormalities seen in neuroimaging tests.
  • Carbamazepine and phenytoin are prescribed for peripheral nervous system-related causes of hypertonia.
  • Botox injections could be given to relax hypertonic muscles.
  • Physiotherapy could be conducted, often in conjunction with other treatments, to improve muscle tone.

If hypertonia is a result of another condition, it could also be treated simultaneously.

What Does It Mean If A Baby Is Floppy

The term floppy infant syndrome is used to describe abnormal limpness when an infant is born. Infants who suffer from hypotonia are often described as feeling and appearing as though they are rag dolls. They are unable to maintain flexed ligaments, and are able to extend them beyond normal lengths.

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When Should Baby Hold Head Up

How Does Your Baby Develop the Strength to Hold Her Head Up? When your baby is between 1 and 3 months old, shell be gradually gaining the strength needed to hold her head up. By around 2 months, while shes lying on her stomach, you might notice she can raise her head for just a few seconds at a time.

Will My Child Have A Normal Life

The Floppy Infant: Hypotonia

No two people have the exact same definition of normal.

Will your child face obstacles? Yes.

Will there be rough days? Absolutely.

Are there a lot of medical appointments in your future? Probably.

But theres no reason hypotonia should rob your child of leading a happy, healthy, productive, and fulfilling life.

And heres a positive, but no less real, perspective.

The challenges your child faces will create resilience and inner strength. Never forget that youre raising a fighter.

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Signs And Symptoms Of Hypotonia In Infants

Hypotonia can develop at any age but most often it is seen in infants. The signs and symptoms of hypotonia in children are as follows:

  • Weakness of muscles that is noticeable as the infant grows.
  • Initially after birth the child is not able to suck properly.
  • No control of neck muscles leading to bending of head on one side.
  • Flexible joints and is not able to stand or place weight on legs.
  • Frequently falls due to weak muscles of joints.
  • Delayed milestones, especially motor skills.
  • Weak cry
  • Weak posture
  • Clumsy behavior
  • Protrusion of abdomen as the abdominal muscle is weak. They are not able to hold the abdominal organs.
  • Difficulty in lifting or reaching any object.

Enhancing Healthcare Team Outcomes

Early recognition of hypotonia and finding the underlying etiology are important for the formulation of an appropriate management plan. Approaching each case systematically by obtaining a detailed history, performing a comprehensive physical examination with a detailed neurological examination, and selecting the investigations carefully, leads to a diagnosis in the majority of the patients of hypotonia. Neuroimaging and DNA based diagnostic tests have been found to successfully reduce the time and expense in reaching a specific diagnosis.

Genetic diseases have moral, ethical, and legal implications. Newborn screening, prenatal testing, and carrier testing should also require the involvement of an ethical team of the institutions. Having an interprofessional team that provides rehabilitation services, respiratory support, nutritional support, and involves various sub-specialists such as geneticists, child neurologists, etc. have been found to have better outcomes for the patient.

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What Makes Surestep Smos Unique

All SMOs may look similar, but theyre not the same.

Unlike other SMO options, Surestep SMOs provide your child with a variety of exceptional benefits:

  • Uniquely flexible and comfortable plastic
  • Shortened footplates for more freedom of movement
  • Modifications to meet your childs unique needs
  • 30+ fun patterns to choose from
  • Fabrication from measurements instead of messy casts

Give your little one the best opportunity to crush milestones and catch up with peers. Ask for Surestep by name.

Signs And Symptoms Of Hypotonia In Babies

Benign Congenital Hypotonia

Hypotonia may not be noticeable in babies younger than six months, although they might have it since birth. Babies with severe hypotonia can be like rag dolls without any muscle strength. Many of them have a frog-like posture.

Hypotonic or floppy babies may have delayed motor development, but their intelligence is not affected by this condition. However, the clinical features may vary depending on the underlying causes of hypotonia.

The signs and symptoms of hypotonia in babies may include the following.

  • Floppy head due to no or less control on neck muscles even after three months of age
  • Arms or legs may slip through your hands while holding
  • Unable to keep any weight on shoulder or neck muscles
  • Weak cry
  • Arms and legs stay straight with no bending at joints, such as elbows, knees, or hips

Infants usually achieve head control after three months of life, but they have some muscle strength from birth. Motor developmental milestones such as crawling, sitting up, talking, eating, and walking, are often delayed in babies with hypotonia.

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How Do You Manage Patients With Mitochondrial Myopathies

The types of associated symptoms and signs observed in mitochondrial myopathies influence the choice of anesthetic management. Propofol is avoided primarily based on its effects on mitochondrial metabolism. In many of these children, any catabolic stress such as fasting, infection, or surgery rapidly leads to hypoglycemia and acidosis, so modifications in the usual fasting recommendations and infusion of intravenous dextrose are included whereas solutions containing lactate are not recommended. Although there are no contraindications, the severity of concomitant organ dysfunction associated with the mitochondrial disorder requires that an anesthetic plan be modified based on each patients disease including presence of seizures, hypoventilation, acidemia, cardiomyopathy, renal or hepatic dysfunction, and aspiration risk. Volatile anesthetics can be used safely, but patients may have increased sensitivity requiring lower concentrations. Both sensitivity and resistance to nondepolarizing muscle relaxants have been reported. Succinylcholine has been used without adverse event, but caution is advised because the reported number of patients is small. Diaphragmatic muscle fiber atrophy and dysfunction is known to occur in individuals after positive pressure ventilation., Though the exact amount of time that it takes for this to occur in patients with preexisting myopathy is unknown, it is prudent to consider minimizing time on positive pressure ventilation when possible.

How Do You Manage Patients With Hypotonia Of Unknown Etiology

In infants and children presenting with an unknown cause of hypotonia, anesthetic recommendations are often based on a presumptive diagnosis. If the infant has had recurrent episodes of hypoglycemia and/or acidosis, our approach is to manage it as a potential mitochondrial myopathy. At present, in children who have mitochondrial myopathies, the approach is to use volatile anesthetics and avoid the use of propofol. In infants who do not have any metabolic abnormalities, propofol is used and succinylcholine and volatile agents are avoided. Regional anesthetic techniques as well as other induction anesthetic agents such as ketamine and etomidate could be considered, each with their unique profiles. Ketamine can cause increased intracranial and intraocular pressure, so caution should be exercised in patients in whom this increased pressure could be a cause for concern. Etomidate has the well-described effect of causing adrenocorticoid dysfunction even after a single dose, with prolonged use causing increased morbidity. The clinical significance of this after a single dose is not clear because the suppression resolves quickly.

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Hypotonia : Signs Causes And Treatment

Hypotonia is a condition where the baby has a low muscle tone. In healthy babies, muscles are not fully relaxed. You may notice some amount of stiffness or tension during muscle movement. This muscle resistance is called muscle tone. However, this is not seen in babies with hypotonia. They usually have a flexed posture.

Muscle weakness can be associated with hypotonia, but it is not the same. Although hypotonia may occur at any age, newborns and young babies are commonly affected by it. The treatment and outcome of hypotonia may vary depending on the underlying causes.

Read this post to know about signs, causes, diagnosis, and treatment of hypotonia in babies.

How To Recognise Hypotonia

Pediatrics Hypotonic Infant: By Wendy Stewart M.D.

Hypotonia that is present at birth usually becomes noticeable by the time a child is six months old. Signs include:

  • They have little or no control of their neck muscles so their head tends to flop.
  • They feel limp when you hold them, as though they could easily slip through your hands.
  • They are unable to place any weight on their leg or shoulder muscles.
  • Their arms and legs hang straight down from their sides, rather than bending at their elbows, hips and knees.
  • They may find sucking and swallowing difficult and they may have a weak cry.

A child with hypotonia may take longer to reach developmental milestones, such as:

  • sitting up

An adult with hypotonia may have the following problems:

  • becoming clumsy
  • difficulty with getting up from a lying or sitting position
  • an unusually high degree of flexibility in the hips, elbows and knees
  • difficulty reaching for or lifting an object

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Signs And Symptoms Of Hypertonia

Hypertonia signs and symptoms may vary depending on the severity of the damage and the part of the brain or spinal cord affected. Some babies may have high muscle tone on both sides of the body, while a few may have it on one side.

Common signs and symptoms seen in hypertonia in babies include the following .

  • Reduced range of motion
  • Unable to walk or stand as peers
  • Involuntarily crossing of the legs

According to the affected area of the brain, hypertonia can be spastic or rigid. Spasticity causes higher reflex responses and increased muscle spasms. Rigidity causes excessive stiffness of the muscles.

Can Babies Outgrow Hypotonia

Kids With Hypotonia Will Outgrow It

Kids with hypotonia become adults with hypotonia. Along the way, theyve simply learned how to compensate for their limitations. But without proper hypotonia treatment, poor alignment and other long-term problems can develop.

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