Hypotonia is not a specific disorder, but mostly a symptom of a number of other disorders which cause deterioration of the muscle fibers 2, 5, 6, 11. Hypotonia is characterized by reduced resistance to passive range of motion in joints versus weakness, which is a reduction in the maximum muscle power that can be generated. The term hypotonia is most often used to denote a lowering of blood pressure below 10565 mm hg 148. Hypotonic infants seem floppy hypotonia in infants is also referred to as floppy baby syndrome and head control may be poor causing the head to fall forwards, backwards or sideways in the sitting position. Hypotonia part 3 intervention strategies for children with low muscle tone functional skills and goals for a child with hypotonia. When relaxed, they tend to lay in a frogleg position. They may struggle to hold their head up and may sit slumped.
Some causes of hypotonia are a result of malnutrition, these include. We present a case of infantile pompe disease that was detected at a four month well visit in the presence of hypotonia and failure to. The imortant clue as to whether this is a central or peripheral hypotonia is the. Brain damage or encephalopathy, due to lack of oxygen before or right after birth, or problems with brain formation.
This version supersedes any previous versions of this document. Shes new to all of this and is frightened and i remember that feeling well. Depending on the underlying cause of the condition, there may or may not be a cure for hypotonia. Hypotonia, commonly known as floppy baby syndrome, is a state of low muscle tone the amount of tension or resistance to stretch in a muscle, often involving reduced muscle strength. The learner will be able to differentiate the common causes of hypotonia in the pediatric patient.
Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength. A total of 105 parents of children who were diagnosed with hypotonia returned a questionnaire. Low muscle tone, or hypotonia, is one of the physical problems often associated with developmental delays. Although there is no specific medicine available to manage the generalized hypotonia but a few medicines have been tried by some experts. Pdf the floppy infant syndrome is a wellrecognized entity for pediatricians and neonatologists. Hypotonia in infants can be a confusing clinical presentation leading to inaccurate. Peripheral hypotonia is further divided into disorders of anterior horn cells, peripheral nerves, neuromuscular junction, and muscle. Hypotonia hypotension, the lowering of tone tension of a tissue, organ, or system. Untreated hypotonia can lead to hip dislocation and other problems. They retain a certain amount of tension and stiffness muscle tone that can be felt as resistance to movement. Babies often have poor control of neck muscles, causing their heads to fall to one side.
Hypotonia isnt a particular medical condition, but a potential outward manifestation of several different diseases and disorders that affect motor nerve control by the brain or muscle. Individuals with this condition have normal development in infancy, but typically by 18 months they become increasingly irritable and begin to lose previously acquired skills developmental regression. Rolling, independent sitting with good postural alignment, independent standing with good skeletal alignment, selfinitiation of cruising and motivation to move, single limb stance. Sometimes, if the condition is due to injury or a treatable condition like an infection, it may be possible to increase muscle tone over time. Neonatal hypotonia often cant be cured, especially if the underlying cause has created permanent damage or is ongoing. An adult with hypotonia may have the following problems. The hypotonia wheel and guide may be useful for therapists, therapy students and early intervention providers who work with infants and young children with hypotonia. Honor society of nursing stti hypotonia is itself a symptomits low muscle tone that may be caused by a variety of disorders or injuries. Findings should be documented on the neonatal hypotonia investigation sheet. It is not the same as muscle weakness, although the two. Neonatal hypotonia childrens hospital of orange county. Objectives the learner will be able to explain the definition of hypotonia and how to assess muscle tone with the pediatric patient. Helping your baby with hypotonia learn to walk callahan, elisabeth, callahan, patrick on. Specific etiologies of central hypotonia include brain insults and malformations, as well as genetic, metabolic, traumatic, anatomical, or idiopathic causes of central neural dysfunction.
Hypotonia is reduced resistance to passive movement of joints. Some of the diseases associated with hypotonia are guillainbarre syndrome, muscular dystrophy, myasthenia gravis, werdnighoffman disease, poliomyelitis, meningitis, and encephalitis. Pdf the term hypotonia is often used to describe children with reduced muscle tone, yet it remains abstract and undefined. Parents are regularly told that their child has this tone problem but the usual explanation is simply that the child has low tone. For example, a person relies on the tone in their back and neck muscles to maintain their position when standing or sitting up. Hypotonia and chorea in early infancy, with delayed walking ability dystonia, myoclonus, tics, adhd may be associated over time learning difficulties in some, mental retardation may be present various combinations of, thyroid 67% and lung 46% features beneficial effect.
The case for making the diagnosis during the first week of life. Hypotonia is a condition in which the patient has poor or decreased muscle tone. In some cases, especially if the cause if a genetic disorder, hypotonia and its symptoms may last a lifetime. Truncal hypotoniain laymans terms redefining perfect. Most children are not born with hypotonia, but develop it as a result of some other disorder or disease. Hypotonia in a newborn presents a diagnostic challenge for clinicians.
The present paper discusses a rational, simple and accurate diagnostic approach to hypotonia in infancy, illustrated by the case of a fivemonthold infant girl recently referred to the iwk health centre in. Hypotonia article about hypotonia by the free dictionary. Hypotonia definition is the state of having hypotonic muscle tone. Hypotonia is the medical term for decreased muscle tone.
Normally, even when relaxed, muscles have a very small amount of contraction that gives them a springy feel and provides some resistance to passive movement. Congenital hypotonia with favorable outcome is characterized by an early neonatal onset and a benign clinical course. The process used to design the hypotonia wheel could be used as a template to develop intervention guidelines for. Hypotonia is a medical term used to describe decreased muscle tone. Children can have generalized hypotonia or it may affect just speci. The clinical consequences of hypotonia andor weakness may be evident even in. The old term, proposed by walton, was benign congenital hypotonia, denoting the presence of muscle weakness and hypotonia, with the exception of werdnighoffmann disease. Sign of both benign and serious conditions exhaustive differential diagnosis rare disorder overwhelming advances in diagnosis and management 3.
Muscle tone and movement involve the brain, spinal cord, nerves, and muscles. Hypotonia market is expected to grow at a cagr of approx. Children born with hypotonia have low muscle tone and lower than average strength. Hypotonia is a relatively common problem in the newborn period, affecting not only otherwise healthy preterm infants but also those with sepsis, neurological disease and metabolic disorders. Similar to ftt, liver dysfunction and cardiomyopathy larger percentage of cases had hypotonia as an additional feature most hypotonic neonates do not have an underlying metabolic diagnosis need comprehensive diagnostic approach hypotonia. Primary indication for metabolism consultation in 4% of 258 consults 19982000.
The learner will be able to perform an evaluation of a child with hypotonia. Floppy, or hypotonic, infant is a common scenario encountered in the clinical practice of child neurology. Among the various medical problems related to infants with praderwilli syndrome, those that have implications for management include hypotonia, developmental delay, and feeding problems. This is a retrospective, singlecentre study with revision of the files of the. Hypotonia definition of hypotonia by medical dictionary. As with any clinical problem in neurology, attention to certain key aspects of the history and examination allows correct localization within the neuraxis and. Today in email i was asked by a mom with a new diagnosis of truncal hypotonia to explain it in laymans terms for her. Hypotonia is a symptom of many cerebral, spinal, genetic, or muscular diseases. With respect to infantile hypotonia, it may be considered the least resistance that an alert but not. Infants have feeding difficulties, failure to thrive, hypotonia, hyporeflexia, prolonged napping or need to be awakened for feeds, and generalized lethargy. Just upload files you want to join together, reorder them with draganddrop if you need and click join files button to merge the documents. Hypotonia definition of hypotonia by the free dictionary. Hypotonia is a medical condition in which babies are born with a floppy head, owing to the fact that they have less to no control over their neck muscles.
Congenital hypotonia definition of congenital hypotonia. There are also nonneuromuscular entities that may be associated with hypotonia including. Hypotonia may be a sign of a problem anywhere along the pathway that controls muscle movement. It is an important clinical feature that may indicate an underlying systemic illness or neurological problem at the level of the central or peripheral nervous system. Weakness of muscles and lack of strength are difficult to live with. Hypotonia definition of hypotonia by merriamwebster. Congenital hypotonia with favorable outcome sciencedirect. The majority of individuals function in the mildtomoderate range of intellectual disability. With hypotonia, the brain fails to transmit the proper electrical signals to the muscles that tell them to contract. Hypotonia, or low tone as it is commonly referred to by physiotherapists is a common symptom of taysachs.
Decreased muscle tone and strength that results in floppiness. Hypotonia may be the presenting sign for many systemic diseases and diseases of the nervous system. Tone is defined as the resistance of muscles to stretch 1. In general, a good history, physical examination, and neurologic exam will lead to the diagnosis. Low muscle tone is used to describe muscles that are floppy, which is also known as hypotonia. The deficits causing hypotonia can originate in the brain, spinal cord, peripheral nerves, neuromuscular junction, and muscle. Cerebral palsy hypotonia causes, treatment, symptoms. Children with low muscle tone may need to put in more effort to get their muscles moving properly when they are doing an activity. Assessment of neonatal hypotonia clinical guideline v3. The differential diagnosis of hypotonia is organized anatomically into central and peripheral causes.
The low tone, floppy baby is a common occurence in nurseries and nicus, they are poor feeders, especially breastfeeding. It can present significant challenges in terms of localization and is associated with an extensive differential diagnosis. Weakness also can manifest as decreased strength and frequency of spontaneous movements. Hyperbaric oxygen therapy hbot as hbot is a generalized treatment for children with cerebral palsy, children with ataxic cp are also eligible for this treatment system. Pdf joiner allows you to merge multiple pdf documents and images into a single pdf file, free of charge. Muscle tone is most easily shown as movement of an extremity but certainly including the trunk, neck, back and the shoulder, and pelvic girdles. The elements of the clinical evaluation of the hypotonic child including those. The pediatric neurologist is regularly asked to evaluate a hypotonic patient. Hypotonia is a condition of abnormally low muscle tone the amount of tension or resistance to movement in a muscle, often involving reduced muscle strength. An algorithm for the systematic evaluation of infants with hypotonia is. In the clinical setting, we speak of 2 types of tone. It is defined as reduced resistance to passive range of motion in joints. Hypotonia in the newborn is a common presenting feature of systemic illness or neurologic dysfunction at any level of the central or peripheral nervous system.
The floppy infant evaluation of hypotonia request pdf. Malnutrition malnutrition in the mother as well as the baby or child. If low muscle tone occurs in infants, the baby may seem floppy or like a rag doll. With respect to infantile hypotonia, it may be considered the least resistance that an alert but not overstimulated infant generates while opposing passive movement. To describe the outcomes of children diagnosed before the age of two with idiopathic hypotonia. A complete as sessment for weakness includes evaluating for cry, suck, facial expressions, antigravity movements, resistance to strength testing, and respiratory effort.
They may also have difficulty maintaining good posture when sitting or standing. Cln1 disease is an inherited disorder that primarily affects the nervous system. A structured approach to the assessment of a floppy. Centrallymediated hypotonia will be further referred to in this document as central hypotonia in the interest of simplicity. A child afflicted with hypotonia will present visually like a rag doll because their limbs and head appear to flop to their. Outcomes of infants with idiopathic hypotonia request pdf. Neonatal hypotonia clinical approach to floppy baby hypotonia in the newborn is a common presenting feature of systemic illness or neurologic dysfunction at any level of the central or peripheral nervous system. Hypotonia is a common finding with cerebral palsy and other neuromuscular disorders. It is not the same as muscle weakness, although the two conditions can coexist.
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