Hypotonia | Low Muscle Tone in Children

What is Hypotonia?

The word “hypotonia” comes from a combination of Greek words: “hypo” meaning low or under + “tone” meaning to stretch, + “ia” which is used to describe diseases or medical conditions. With that said, “hypotonia” is not a disease; rather, it describes symptoms which can be caused by various diseases and disorders that result in a baby or child having low muscle tone. 

According to Healthline, Hypotonia is easily recognizable because it affects muscle strength, motor nerves, and the brain. In short, hypotonia describes muscles that are floppy. As such, an infant with hypotonia tends to display a “rag doll” quality when he or she is held.

If present at birth, a low muscle tone baby may not be able to keep their knees and elbows bent, and as they develop, a low muscle tone child may have poor or no head control. Accordingly, a child with hypotonia may be unable to adequately develop gross motor skills such as crawling and fine motor skills such as grasping a toy, a crayon, or even food, creating complications in eating. A low muscle tone baby or child will need to put in more effort to get their muscles moving properly when they are doing any sort of activity, even with such common activities as sitting, crawling, rolling, and walking. There is also a tendency for hip, jaw, and neck disorders to occur due to the lack of muscle tension, and your child may experience breathing and speech difficulties, as well as poor reflexes and associated ligament and joint laxity.

Outlook Over Time | Do babies grow out of low muscle tone?

Depending upon the underlying cause, hypotonia can be life-long condition. Children that are diagnosed with underlying genetic condition may worsen over time. However, if the cause is idiopathic, meaning a condition that arises spontaneously and not directly related to an identifiable cause or intervening event, children tend to improve their muscle tone naturally over time and benefit greatly from treatment such as physical, occupational, and speech therapies.

With that said, Hypotonia does not affect your child’s intellect!

Assessing the Condition

According to WebMD doctors can diagnose the condition in the first few minutes of life. Doctors do routine checks of newborn’s muscle tone at 1 minute and 5 minutes after birth. Sometimes hypotonia develops later, but it will usually be noticeable by 6 months of age.

If you are concerned about your child’s muscle tone, it is advisable that you see your pediatrician who will likely refer you to a neurologist to investigate the underlying cause(s). It is also likely that your pediatrician will suggest that you involve an occupational therapist and physical therapist to advise on treatment and activities to develop your child’s muscle tone.

Causes of Hypotonia

According to the National Institute of Health, hypotonia can result from damage to the brain, spinal cord, nerves, or muscles which may be caused by trauma, environmental factors, or genetic, muscle, or central nervous system disorders. For instance, hypotonia can be caused by brain damage due to lack of oxygen right before birth, severe infections, or simply problems with the way the brain was formed in the womb.

Some common causes can include, but are not limited to:

• Down syndrome
• Muscular dystrophy
• Cerebral palsy
• Prader-Willi syndrome
• Myotonic dystrophy
• Marfan syndrome
• Tay-Sachs disease

Sometimes, hypotonia is caused by botulism infections or due to contact with poisons or toxins. However, this form of hypotonia often goes away after recovery from the infection or contact with the contaminant. It is however not uncommon to fail to discover the acute underlying cause of the hypotonia, and many cases are idiopathic meaning that the child’s low muscle tone arises spontaneously and is not directly related to an identifiable cause or intervening event.   

How to Care for a Child with Hypotonia

It is critical that you take extra care when lifting your baby because babies with hypotonia are more delicate, with soft spots where their muscles are, causing them to appear floppy. Practically, if you lift a baby diagnosed with hypotonia by placing your hands under their armpits, there is a possibility that they can slip out of your hands, as they don’t have muscle resistance there. Similarly, it is advisable to always support your child’s neck when holding them, as they will likely not have the muscle strength to be able to do this on their own.

As with any healthcare issue, it is important that you follow the treatment recommended by your healthcare provider to improve your baby’s muscle tone over time. They may also be able to help you learn how to best handle and care for your child with low muscle tone.

Treatment for Hypotonia

Diagnostic Evaluation

Treatment is always preceded by a thorough diagnostic evaluation, usually performed by a neurologist. This examination will likely include a detailed muscle function and neurological examination which may be performed with instruments that cause no pain or discomfort to your child, including instruments such as lights and reflex hammers. The goal of this examination is to assess motor and sensory skills, balance and coordination, reflexes, functioning of the nerves, as well as your child’s awareness and interaction with his or her surroundings.

It is also not uncommon for the doctor to order several tests such as:

• CT or MRI scan of the brain
• Blood tests
• Electromyography (EMG) to measure how well the nerves and muscles work
• Electroencephalogram (EEG) to measure electrical activity in the brain
• Spinal tap, which can measure the pressure inside the spine and let the doctor get a sample of the fluid around the spinal cord for testing
• Muscle biopsy, when the doctor gets a sample of your child’s muscle tissue to study under a microscope
• Genetic tests

Treatment Types

Once a diagnosis has been made, the underlying condition is often treated first, followed by symptomatic and supportive therapy for the hypotonia. In creating a treatment plan, your child’s general health, age, and ability to participate in therapies will drive the plan. For instance, physical therapy can improve motor control and overall body strength whereas occupational therapy can help your child address activities of daily living. Speech-language therapy can help breathing, speech, and swallowing difficulties. Therapy for infants and young children (early intervention therapy) may also include sensory stimulation programs to help babies and young children respond to sight, sound, touch, smell, and taste.

Specific treatment for hypotonia will be determined based on:

• your child’s age, overall health, and medical history
• the extent of the condition
• the underlying cause of the condition
• your child’s tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference.

Solace Pediatric Healthcare Occupational Therapists

If you are concerned that your child may suffer from low muscle tone, Solace Pediatric Healthcare offers a comprehensive treatment approach provided by experienced Occupational Therapists, Physical Therapists, Speech Therapists, and specialist in early intervention therapy, who come to your home and work with your child. Every therapy session is based on your child’s specific needs and no two therapy plans are alike.

Our mission is to support you and your family in providing professional clinical evaluations, treatment options, resources, and information so you feel empowered to make the best decisions for your child and family. We provide therapy in a nurturing environment that promotes those we serve to grow, learn, play, and thrive while receiving care in the security of their home. We work with the family, physicians, teachers, and specialists to create the best individualized plan for your child consistent with the methodologies supported by AOTA.

When you or your physician contacts Solace Pediatric Healthcare, we will schedule a comprehensive evaluation with one of our therapists in your home. They will thoroughly discuss the evaluation, recommendations, options, individualized goals and assist you in working with our child at home.

We also believe in continuity of care and seek to ensure that in-home therapy is provided by the same clinician who is familiar with your child’s individualized needs, goals, and overall progress. If you would like to speak with someone who can help you to get started, please do not hesitate to contact us at 303-432-8487, option 1 or visit our parental referral page to get in touch for an evaluation of your child.