Hypotonia is the medical term for decreased muscle tone. Hypotonia, or poor muscle tone, is usually detected at birth or during infancy. Congenital hypotonia with favorable outcome is characterized by an early neonatal onset and a benign clinical course. Hypotonia, congenital nystagmus, ataxia and abnormal. Outgoing teen meredith zanelotti has been able to remain active through management of her low muscle tone and underlying genetic disorder at the johns hopkins hypotonia center. Hypotonia and how to assess muscle tone with the pediatric patient. The deficits causing hypotonia can originate in the brain, spinal cord, peripheral nerves, neuromuscular junction, and muscle. Hypotonia definition of hypotonia by medical dictionary. Hypotonia in infants pediatrics clerkship the university. Evidencebased clinical algorithm for hypotonia assessment. If you continue browsing the site, you agree to the use of cookies on this website. In healthy muscles some amount of stiffness or tension. Again, specialist treatment and support may be needed while the baby improves.
The commonly used term floppy refers to hypotonia, or weakness, or both. Haley 1886 concludes that posture reactions righting, balance and supporting reactions develop later in these children than in normal children. Sep 27, 2019 hypotonia, or poor muscle tone, is usually detected at birth or during infancy. Hypotonia in babies born to mothers with myasthenia gravis usually improves quickly. Hypotonia, also known as low tone, is the most common motor abnormality in young children. An organised approach is essential when evaluating a floppy infant, as the causes are numerous. A previously unrecognised phenotype characterised by obesity, muscular hypotonia, and ability to speak in patients with angelman syndrome caused by an imprinting defect. Neurological conditions are those that affect the nerves and nervous 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. Hypotonia is a medical term used to describe decreased muscle tone. The condition was first described in 1956 among infants who were termed floppy infants. Hypotonia definition of hypotonia by merriamwebster. Hypotonia decreased muscle tone is a symptom rather than a condition.
Clinical approach to the floppy child the floppy infant syndrome is a wellrecognised entity for paediatricians and neonatologists and refers to an infant with generalised hypotonia presenting at birth or in early life. In cases where hypotonia is caused by an infection, the symptoms may disappear if the infection is treated successfully. Click on the link to view a sample search on this topic. They rest with their elbows and knees loosely extended. Hypotonia definition of hypotonia by the free dictionary. How can theratogs contribute to the management of children with hypotonia. At boston childrens, doctors have several tests available to.
In contrast, weakness is diminished muscle power or strength. Nov 19, 2015 the diagnosis of benign congenital hypotonia bch is now a controversial one. Pubmed is a searchable database of medical literature and lists journal articles that discuss hypotonia, congenital nystagmus, ataxia and abnormal auditory brainstem response. To pardon the errs pragashniegovender androbinwendyelizabethjoubert schoolofhealthsciences,universityofkwazulunatal,westvillecampus,privatebagx, durban,southafrica. Hypotonia, or low muscle tone, occurs when the muscles have decreased tension or resistance to movement. My son was born with hypotonia and other disorders. Hypotonia is a condition of abnormally low muscle tone the amount of tension or resistance to movement in a. Hypotonia represents a diagnostic challenge because it may be the presentation. There are also nonneuromuscular entities that may be associated with hypotonia including. A neurological examination is theassessment of sensory neuron and motorresponses, especially reflexes, to determinewhether the nervous system is impaired. Infants with this problem seem floppy and feel like a rag doll when held. 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.
Pdf hypotonia in infants can be a confusing clinical presentation leading to inaccurate evaluation and unnecessary investigations. What is hypotonia parent guide and frequently asked questions. Hypotonia definition is the state of having hypotonic muscle tone. They retain a certain amount of tension and stiffness muscle tone that can be felt as resistance to movement. Treating hypotonia 01012009 outgoing teen meredith zanelotti has been able to remain active through management of her low muscle tone and underlying genetic disorder at the johns hopkins hypotonia center. Since the first description in 1956 it has been possible to diagnose children more accurately who would otherwise have received this diagnosis. Physical therapy considerations for children with down syndrome nads conference august 11, 2018 joanna mcfaul, pt, dpt, pcs joanna. The term hypotonia is most often used to denote a lowering of blood pressure below 10565 mm hg 148. A 22year retrospective study of hypotonic neonates admitted to the neonatal intensive care unit was conducted. Dr peter camfield, iwk health centre, 5850 university avenue, po box 3070, halifax, nova scotia b3j 3g9. Congenital myotonic dystrophy type 1 dm1 is characterized by hypotonia and.
Hypotonia, commonly known as floppy baby syndrome, is a state of low muscle tone often. Hypotonia will present differently based upon the etiology and subsequent severity of the muscle flaccidity. Novel gnb1 missense mutation in a patient with generalized. Low muscle tone is often associated with floppiness, limpness or a.
Pediatric teaching program, moses cone hospital, greensboro, nc a previously healthy 2monthold boy is brought to the emergency department with 3 days of decreased oral intake and 5 days of constipation. Central hypotonia results from a defect arising from the brain, brain stem, or spinal cord above. Infants with normal tone tend to have flexed elbows and knees. A schematic approach to hypotonia in infancy joanna leyenaar md mph, peter camfield md frcpc, carol camfield md frcpc department of pediatrics, dalhousie university, iwk health centre, halifax, nova scotia correspondence. Hypotonia in children, approach slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The parents report she was a little fussy last night when they put her to bed, but it was not out of the ordinary. The learner will be able to perform an evaluation of a child with hypotonia. Clinical and developmental assessment identifying the underlying cause of congenital hypotonia remains difficult, despite. The learner will be able to differentiate the common causes of hypotonia in the pediatric patient. Congenital hypotonia with favorable outcome sciencedirect. It may appear that the childs muscles do not have enough stiffness to stabilize or move the limbs adequately. May 31, 2019 please use one of the following formats to cite this article in your essay, paper or report. Low tone is not a diagnosis in itself but, rather, a symptom.
While weak infants are always hypotonic, hypotonia is often present with normal strength 2. Children can have generalized hypotonia or it may affect just speci. Malnutrition malnutrition in the mother as well as the baby or child. The latter, also called a neuro exam, may be performed with. Find out what hypotonia is, what causes it, plus how its diagnosed and treated. Generalized hypotonia diminishes the function of the somatosensory position and movement receptors in joints and muscles, contributing to delays and deficits in the development of postural control and gross motor skills. 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 structured approach to the assessment of a floppy neonate ahmed. It shows mild hipotropia with a normal visual acuity and binocularity in infraversion position contrasting with the severe hipotropia and ambliopy found. 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 is a common chief complaint listed in referrals to child neurologists in both inpatient and outpatient settings. It should be noted that our study is confined to describing only those infants whose hypotonia was caused by pws so that the prevalence of neonatal hypotonia in scotland during the study period and hence the proportion of those hypotonic infants who actually had pws is unknown. Your childs doctor will obtain a medical history for your family and your child and will perform a physical examination that will likely include a detailed muscle function and neurological examination. In infants and in children younger than 5 years, manual muscle testing generally. Low muscle tone, or hypotonia, is one of the physical problems often associated with developmental delays. A previously unrecognised phenotype characterised by. Neonatal hypotonia, also known as floppy infant syndrome, is the main presenting clinical feature of most neuromuscular diseases of early life 1. Many of these resources were collected as part of an elibrary support binder initiative led by the office of the provincial paediatric therapy recruitment and retention coordinator in british columbia.
These studies have discussed differential diagnosis in hypotonia of central versus peripheral origin,14 longterm prognosis for children with hypotonia, 1,11 assessment techniques, 8,11,14 characteristics of children with hypotonia, 1 and suggestions for intervention. Oct 12, 2015 hypotonia in children, approach slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Hypotonia article about hypotonia by the free dictionary. Hypotonia is reduced resistance to passive movement of joints. Christophers hospital for children, philadelphia, pa a 10monthold previously healthy girl presents to the emergency department after being found unresponsive by her parents. If your infant has hypotonia, they may appear limp at birth and not. Hypotonia american academy of pediatrics textbook of pediatric. Hypotonia is a lack of resistance to passive movement, whereas muscle weakness results in impaired active movement.
Hypotonia in a newborn presents a diagnostic challenge for clinicians. Hypotonia and weakness comprehensive pediatric hospital. She specialized in clinical pharmacology after her bachelors mbbs. It is not the same as muscle weakness, although the two. Ppt neonatal hypotonia clinical approach to floppy baby. Ananya mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. An organised approach is essential when evaluating a. Physical therapy considerations for children with down. Case report ocular hypotonia and transient decrease of vision as a consequence of exposure to a common toad poison renato pejic,1 marija simic prskalo,1 and josip simic2 1university clinical hospital mostar, department of ophthalmology, bosnia and herzegovina 2faculty of health studies, university in mostar, bosnia and herzegovina correspondence should be addressed to renato pejic. A child afflicted with hypotonia will present visually like a rag doll because their limbs and head appear to flop to their. Hypotonia is most commonly linked to neurological control of muscle tone. How boston children s hospital approaches muscle weakness.
A free powerpoint ppt presentation displayed as a flash slide show on id. 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 may be the presenting sign for many systemic diseases and diseases of the nervous system. Your childs muscle weakness can be caused by several different diseases, and treatment cannot begin without sussing out the real cause. Despite the many advances in diagnostics, the clinical assessment of children with hypotonia presents a diagnostic challenge for clinicians due to the current subjectivity of the initial clinical assessment. A case report of an atipical inferior rectus congenital fibrosis associated with a generalized muscular hypotonia is presented. The aim of this paper is to report on an evidencebased clinical algorithm ebca that was developed for the clinical assessment of hypotonia in children as part of the output of a. A child with hypotonia may also have problems with speech or exhibit shallow breathing. May 31, 2019 some causes of hypotonia are a result of malnutrition, these include. Among the various medical problems related to infants with praderwilli syndrome, those that have implications for management include hypotonia, developmental delay, and feeding problems. However, disorders of the central nervous system may also manifest. Jun 05, 2019 hypotonia literally means loss of muscle tone.
Some children with hypotonia may have trouble feeding, if they are unable to suck or chew for long periods. Reviewarticle evidencebased clinical algorithm for hypotonia assessment. Neonatal hypotonia clinical approach to floppy baby osama naga, m. Deletion of prepl causes growth impairment and hypotonia in mice. Low muscle tone is often associated with floppiness, limpness or a feeling of heaviness when a limb is moved by another person.
Objectives the learner will be able to explain the definition of hypotonia and how to assess muscle tone with the pediatric patient. Hypotonia, developmental delay, and feeding problems. Generalized neonatal hypotonia implies a pathologically decreased postural tone involving at least the extremities, trunk and neck occurring during the first month of life. Please use one of the following formats to cite this article in your essay, paper or report. Low muscle tone is not the same as muscle weakness, and it can be caused by spinal cord or nerve damage or traumatic brain injury tbi. The present paper discusses a rational, simple and accurate diagnostic approach to hypotonia in infancy, illustrated by the case of a fivemonthold infant. For example, a person relies on the tone in their back and neck muscles to maintain their position when standing or sitting up. It can be caused by a number of underlying problems, which can either be neurological or nonneurological. The old term, proposed by walton, was benign congenital hypotonia, denoting the presence of muscle weakness and hypotonia, with the exception of werdnighoffmann disease. Hypotonia and weakness may signify a variety of systemic, neurologic, and neuromuscular disorders table 1201. Department of pediatrics, university of north carolina hospital, chapel hill, nc 2.