Hypotonia in Babies

What is hypotonia?

Hypotonia is poor muscle tone. People diagnosed with hypotonia don’t show resistance when joints in their body move. Another term for hypotonia is “floppy infant syndrome.”

Muscle tone is the amount of resistance (tension) to the movement your muscles have at rest. If you relax your left arm and use your right arm to pinch your bicep, the resistance you feel is your muscle tone. For people diagnosed with hypotonia, pinching their bicep would feel soft, without any resistance.

Muscle tone is your body’s response to force and allows you to maintain your posture to sit and use your reflexes, like moving your arms and legs, and helps regulate the function of organs in your body.

If you have poor muscle tone, your arms and legs appear droopy, similar to a rag doll.

Your baby might have trouble sitting upright, keeping their head up and bending their elbows and knees.

Muscle weakness and hypotonia aren’t the same. Muscle weakness is a lack of strength in your muscles and is often a symptom associated with hypotonia.

Who does hypotonia affect?

Hypotonia is present at birth, and healthcare providers diagnose hypotonia most frequently during early infancy before your child is six months old.

Hypotonia can also affect adults.

How common is hypotonia?

Hypotonia is the most common condition that affects a newborn’s motor skills. The exact rate of occurrence is unknown, as hypotonia is often a symptom of another condition.

Is hypotonia a disability?

Hypotonia, as a condition on its own, could identify as a disability because it can affect how a person performs their daily tasks. It’s extremely rare for a baby to have a hypotonia diagnosis without an underlying condition associated with it.

Hypotonia, as a symptom, isn’t a disability, but the underlying diagnosis could be a disability.

Hypotonia doesn’t affect a person’s intellectual abilities.

What are the symptoms of hypotonia?

Children with hypotonia have symptoms where their body resembles a rag doll. Healthcare providers might refer to your baby being “floppy” from their diagnosis. Symptoms of hypotonia include:

• Your baby is unable to lift their head or control neck muscles.
• Your baby feels limp when held.
• Your baby cannot place weight on their legs.
• Your baby’s arms and legs hang straight at their sides without a bend at their elbow or knee.
• Your baby has difficulty swallowing or sucking.
• Your baby has a weak cry.
• Your baby shows muscle weakness.

Children diagnosed with hypotonia may have delayed developmental milestones that affect their motor skills, including:

• Sitting upright.
• Crawling.
• Walking.
• Saying their first words.
• Feeding themselves on their own.

What causes hypotonia?

A communication error between the pathways that control movement causes hypotonia. These pathways connect the brain, spinal cord, nerves and muscles. Causes of hypotonia include:

• Brain damage or problems with how your baby’s brain formed during fetal development.
• Conditions that affect how nerves communicate with muscles.
• Conditions that affect muscles.
• Conditions that target nerves responsible for communicating to muscles.
• Infection.
• Lack of oxygen before your baby is born or immediately after.

What conditions have hypotonia as a symptom?

Hypotonia is usually a symptom of another condition. These conditions can be genetic and congenital (present at birth). Some conditions cause damage to nerves and the brain as your baby grows, resulting in hypotonia as a symptom. These conditions include:

• Achondroplasia.
• Down syndrome.
• Prader-Willi syndrome.
• Spinal muscular atrophy.
• Tay-Sachs disease.
• Trisomy 13.
• Williams syndrome.

Other conditions that can cause hypotonia include:

• Born premature (before 37 weeks).
• Cerebral palsy.
• Exposure to poisons or toxins.
• Hypothyroidism.
• Sleep apnea.
• Spinal cord injury.

How is hypotonia diagnosed?

Diagnosis of hypotonia occurs early after your child is born or before they turn six months old. Your healthcare provider will examine your baby for physical symptoms of the condition in your child’s muscles by observing their:

• Balance and coordination.
• Motor skills (grasping, rolling over, sitting up).
• Reflexes.
• Sensory skills (vision, hearing, touch).

Your healthcare provider will also examine your family’s medical and genetic history and identify if the condition was the result of any complications that occurred before your baby was born or during delivery.

What tests diagnose hypotonia?

If your healthcare provider suspects hypotonia, they’ll take steps to diagnose the underlying condition that caused hypotonia as a symptom. Tests could include:

• Imaging tests to observe the brain like an MRI or CT scan.
• Genetic test to identify any genetic abnormalities responsible for symptoms.
• Electromyograms to measure how muscles and nerves function.

How is hypotonia treated?

After a hypotonia diagnosis, your healthcare provider will test for the underlying condition that caused hypotonia as a symptom. Your healthcare provider will begin treating the underlying condition, followed by symptomatic treatment to address symptoms, including:

• Physical and occupational therapy to improve motor skills.
• Speech-language therapy to address difficulties in speaking, swallowing and breathing.
• Sensory stimulation therapy to improve sensory function.

As babies diagnosed with hypotonia might have trouble eating and swallowing due to their weakened muscle tone, your healthcare provider might place a tube in your child’s nose or directly into their stomach to provide nutrients to your baby.

How soon after treatment will my baby feel better?

Hypotonia is a lifelong condition, but muscle tone can improve over time with successful treatment for the underlying condition that caused your baby’s symptoms.

How can I reduce my risk of having a child diagnosed with hypotonia?

There isn’t a way to prevent hypotonia because it’s often the symptom of an underlying condition, which can be genetic. Genetic conditions are not preventable. If you plan on becoming pregnant and want to understand your risk of having a child with a genetic condition, talk to your healthcare provider about genetic testing.

If you’re pregnant, you can take steps to prevent having a child prematurely by:

• Following guidance by your healthcare provider on recommended activities during pregnancy.
• Avoiding tobacco and not using recreational drugs.
• Eating a well-balanced diet.
• Taking care of yourself and treating any underlying health conditions that could affect the outcome of your pregnancy.

What can I expect if I have a baby with hypotonia?

The prognosis of hypotonia varies based on the underlying diagnosis. Hypotonia is a lifelong condition that can get better with treatment. Most babies who have a hypotonia diagnosis show great improvement in their muscle tone as they get older.

If your child receives an underlying genetic condition diagnosis, there’s a chance that symptoms of hypotonia could worsen over time. To better understand your child’s diagnosis, talk with their healthcare provider or a genetic counselor.

How do I take care of my child with a hypotonia diagnosis?

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. If you lift a baby with hypotonic by placing your hands under their armpits, they can slip out of your hands, as they don’t have muscle resistance there. Your baby will have a difficult time supporting themselves in a way similar to babies who don’t have the condition. Follow treatment recommended by your healthcare provider to improve your baby’s muscle tone over time.

When should I see my healthcare provider?

If you notice your baby’s muscle tone decreases or your baby is weaker than normal, visit your healthcare provider. This is especially important if your child was able to accomplish certain motor skills like sitting upright or grabbing objects, and then suddenly, they cannot perform those tasks.

What questions should I ask my doctor?

• Are there side effects to my baby’s treatment that addresses their underlying condition?
• Is my baby’s hypotonia the result of a genetic condition?
• How can I help my baby improve their muscle tone at home?

What is the difference between hypotonia in babies and adults?

Both babies and adults can have a hypotonia diagnosis. Babies who receive a hypotonia diagnosis retain their diagnosis for their entire life, even if symptoms improve. New hypotonia diagnoses in adults could result after a traumatic injury, brain tumor, stroke or condition like Parkinson’s disease.

Symptoms may be similar for both babies and adults, where they’re clumsy, have trouble getting up from lying down or sitting, and show increased flexibility in their elbows and knees.

Treatment with physical and occupational therapy, along with treating the underlying condition, helps conditions in babies and adults improve over time.

What is the difference between hypotonia and hypertonia?

Hypotonia is weak muscle tone and hypertonia is too much muscle tone. If your baby has hypertonia, their muscles are stiff and it’s difficult for them to move their arms and legs.

A note from Cleveland Clinic

As a parent, it may be stressful to see your baby limp and weak, similar to a rag doll. Your healthcare provider will work closely with you to provide an accurate diagnosis of the underlying condition for your baby so they can receive treatment. Over time and with treatment, your baby will improve with support from their caretakers until they can support themselves.