With respect to infantile hypotonia, it may be considered the least resistance that an alert but not. Objectives the learner will be able to explain the definition of hypotonia and how to assess muscle tone with the pediatric patient. Children born with hypotonia have low muscle tone and lower than average strength. The floppy infant evaluation of hypotonia request pdf. Rolling, independent sitting with good postural alignment, independent standing with good skeletal alignment, selfinitiation of cruising and motivation to move, single limb stance. Hypotonia hypotension, the lowering of tone tension of a tissue, organ, or system. 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. The case for making the diagnosis during the first week of life. 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. In the clinical setting, we speak of 2 types of tone.
The old term, proposed by walton, was benign congenital hypotonia, denoting the presence of muscle weakness and hypotonia, with the exception of werdnighoffmann disease. Honor society of nursing stti hypotonia is itself a symptomits low muscle tone that may be caused by a variety of disorders or injuries. They may also have difficulty maintaining good posture when sitting or standing. 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. The elements of the clinical evaluation of the hypotonic child including those. Hypotonia is the medical term for decreased muscle tone. Truncal hypotoniain laymans terms redefining perfect. The pediatric neurologist is regularly asked to evaluate a hypotonic patient. Specific etiologies of central hypotonia include brain insults and malformations, as well as genetic, metabolic, traumatic, anatomical, or idiopathic causes of central neural dysfunction.
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. Low muscle tone, or hypotonia, is one of the physical problems often associated with developmental delays. 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. 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. 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. Helping your baby with hypotonia learn to walk callahan, elisabeth, callahan, patrick on.
Sign of both benign and serious conditions exhaustive differential diagnosis rare disorder overwhelming advances in diagnosis and management 3. The imortant clue as to whether this is a central or peripheral hypotonia is the. A structured approach to the assessment of a floppy. For example, a person relies on the tone in their back and neck muscles to maintain their position when standing or sitting up. 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. Hypotonia may be the presenting sign for many systemic diseases and diseases of the nervous system.
In general, a good history, physical examination, and neurologic exam will lead to the diagnosis. Depending on the underlying cause of the condition, there may or may not be a cure for hypotonia. In some cases, braces may be needed to permit a full range of movement in patients with hypotonia. Children can have generalized hypotonia or it may affect just speci. A total of 105 parents of children who were diagnosed with hypotonia returned a questionnaire. Hypotonia is a condition in which the patient has poor or decreased muscle tone. Some of the diseases associated with hypotonia are guillainbarre syndrome, muscular dystrophy, myasthenia gravis, werdnighoffman disease, poliomyelitis, meningitis, and encephalitis. Among the various medical problems related to infants with praderwilli syndrome, those that have implications for management include hypotonia, developmental delay, and feeding problems. Hypotonia is a medical term used to describe decreased muscle tone. Tone is defined as the resistance of muscles to stretch 1. Hypotonia is a common finding with cerebral palsy and other neuromuscular disorders. Children with low muscle tone may need to put in more effort to get their muscles moving properly when they are doing an activity. Cerebral palsy hypotonia causes, treatment, symptoms.
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. Hypotonia article about hypotonia by the free dictionary. Neonatal hypotonia childrens hospital of orange county. An adult with hypotonia may have the following problems. 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. There are also nonneuromuscular entities that may be associated with hypotonia including. It can present significant challenges in terms of localization and is associated with an extensive differential diagnosis. The learner will be able to perform an evaluation of a child with hypotonia. Parents are regularly told that their child has this tone problem but the usual explanation is simply that the child has low tone. Decreased muscle tone and strength that results in floppiness. An algorithm for the systematic evaluation of infants with hypotonia is. 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 majority of individuals function in the mildtomoderate range of intellectual disability.
With respect to infantile hypotonia, it may be considered the least resistance that an alert but not overstimulated infant generates while opposing passive movement. Hypotonia market is expected to grow at a cagr of approx. Hypotonia will present differently based upon the etiology and subsequent severity of the muscle flaccidity. Weakness of muscles and lack of strength are difficult to live with. 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.
Floppy, or hypotonic, infant is a common scenario encountered in the clinical practice of child neurology. 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. Hypotonia in a newborn presents a diagnostic challenge for clinicians.
The term hypotonia is most often used to denote a lowering of blood pressure below 10565 mm hg 148. Untreated hypotonia can lead to hip dislocation and other problems. Babies often have poor control of neck muscles, causing their heads to fall to one side. With hypotonia, the brain fails to transmit the proper electrical signals to the muscles that tell them to contract. Shes new to all of this and is frightened and i remember that feeling well. This version supersedes any previous versions of this document. They may struggle to hold their head up and may sit slumped. It is not the same as muscle weakness, although the two. Findings should be documented on the neonatal hypotonia investigation sheet. 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. Congenital hypotonia with favorable outcome sciencedirect. 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.
Peripheral hypotonia is further divided into disorders of anterior horn cells, peripheral nerves, neuromuscular junction, and muscle. 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. 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. As with any clinical problem in neurology, attention to certain key aspects of the history and examination allows correct localization within the neuraxis and. 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. When relaxed, they tend to lay in a frogleg position. Hypotonia in infants can be a confusing clinical presentation leading to inaccurate. Muscle tone and movement involve the brain, spinal cord, nerves, and muscles. Hypotonia definition of hypotonia by the free dictionary. Hypotonia, or low tone as it is commonly referred to by physiotherapists is a common symptom of taysachs. The differential diagnosis of hypotonia is organized anatomically into central and peripheral causes.
Some causes of hypotonia are a result of malnutrition, these include. It is defined as reduced resistance to passive range of motion in joints. Although there is no specific medicine available to manage the generalized hypotonia but a few medicines have been tried by some experts. Pdf joiner allows you to merge multiple pdf documents and images into a single pdf file, free of charge. Hypotonia is reduced resistance to passive movement of joints. Hypotonia definition of hypotonia by medical dictionary. 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. Hypotonia definition is the state of having hypotonic muscle tone. Most children are not born with hypotonia, but develop it as a result of some other disorder or disease. Congenital hypotonia definition of congenital hypotonia. The low tone, floppy baby is a common occurence in nurseries and nicus, they are poor feeders, especially breastfeeding. Today in email i was asked by a mom with a new diagnosis of truncal hypotonia to explain it in laymans terms for her.
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. 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. Hypotonia part 3 intervention strategies for children with low muscle tone functional skills and goals for a child with hypotonia. In some cases, especially if the cause if a genetic disorder, hypotonia and its symptoms may last a lifetime. Assessment of neonatal hypotonia clinical guideline v3. Hypotonia definition of hypotonia by merriamwebster. They retain a certain amount of tension and stiffness muscle tone that can be felt as resistance to movement. The clinical consequences of hypotonia andor weakness may be evident even in.
Congenital hypotonia with favorable outcome is characterized by an early neonatal onset and a benign clinical course. Low muscle tone is used to describe muscles that are floppy, which is also known as hypotonia. Brain damage or encephalopathy, due to lack of oxygen before or right after birth, or problems with brain formation. 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 process used to design the hypotonia wheel could be used as a template to develop intervention guidelines for. 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.
This is a retrospective, singlecentre study with revision of the files of the. The deficits causing hypotonia can originate in the brain, spinal cord, peripheral nerves, neuromuscular junction, and muscle. Weakness also can manifest as decreased strength and frequency of spontaneous movements. A child afflicted with hypotonia will present visually like a rag doll because their limbs and head appear to flop to their. Cln1 disease is an inherited disorder that primarily affects the nervous system. The learner will be able to differentiate the common causes of hypotonia in the pediatric patient. Pdf the floppy infant syndrome is a wellrecognized entity for pediatricians and neonatologists. Hypotonia may be a sign of a problem anywhere along the pathway that controls muscle movement. Neonatal hypotonia often cant be cured, especially if the underlying cause has created permanent damage or is ongoing. Centrallymediated hypotonia will be further referred to in this document as central hypotonia in the interest of simplicity. 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.