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What is hypotonia?
Hypotonia is an abnormally severe loss of muscle tone. The
muscles feel soft and doughy.
Diagnosing the cause of hypotonia in a particular child is
very difficult. Hypotonia is a symptom of many cerebral,
spinal, genetic, or muscular diseases. Some of the diseases
associated with hypotonia are Guillain-Barre syndrome,
muscular dystrophy, myasthenia gravis, Werdnig-Hoffman
disease, poliomyelitis, meningitis, and encephalitis. Injury
or trauma can also cause hypotonia. Doctors use certain
medical procedures to determine why the child has hypotonia.
Computerized tomography (CT) scans, magnetic resonance imaging
(MRI) scans, electroencephalogram (EEG), a variety of blood
tests, chromosome karyotyping, spinal taps, electromyography
(muscle and never conduction tests), and muscle and nerve
biopsy are a few of the tests which may be conducted to
diagnose the cause of hypotonia.
Signs of hypotonia
Normally developing children tend to develop motor skills,
posture control, and movement skills by certain ages.
Motor skills are divided into two parts. Gross motor skills
include the ability of an infant to lift its head while lying
on the stomach, to roll over from its back to its stomach.
Normally, children develop the gross motor skills which enable
them to get into a sitting position and remain seated without
falling over, balance themselves, crawl, walk, run, and jump
by certain ages.
Fine motor skills include the ability to grasp a toy or
finger, transfer a toy or a bottle from one hand to another,
point out an object, follow a toy or a person with the eyes,
or to feed themselves.
Children who have too little muscle tone are unable to move
independently. They have a hard time resisting gravity's pull
on them. These children are slow to develop the skills to
crawl, to sit, to pull on furniture or people to help them to
stand, and to walk.
Children with hypotonia are sometimes labeled "floppy" because
they have the look and feel of a rag doll. There is no clear
definition of the muscles when the arms and legs are felt.
They cannot maintain a hand grasp. These children are not able
to maintain any position for very long, such as holding their
head up or holding out their arm. When they sit, they are
often slumped down on themselves and their head may rest on
their shoulders because they cannot hold any position for too
Since the muscles that support the bone joints are so soft,
there is a tendency for hip, jaw, and neck dislocation to
occur. In addition, they are slow to develop a sense of
There is a problem when feeding children with hypotonia. The
children are unable to suck or chew adequately for long
periods. They have a hypotonic gag reflex, their mouth is
usually open and their tongue sticks out.
There are breathing and speech problems. Many times children
with hypotonia breath very shallowly, making it difficult for
them to sustain any activity, make noises, or talk for very
Once the cause for the child's hypotonia has been
established, treatment programs can be created for the parent
to help the child develop further. Treatment programs include
the use of positioning techniques to teach the child how to
move about horizontally, how to lie on his or her side, to
sit, etc. Sensory programs to teach the child to respond to
stimuli (sight, sound, taste, smell, touch) are also used.
Other individualized programs and therapies can be developed
once the initial diagnosis is determined.
There are a number of support organizations. Here are just
a few to consider contacting:
National Rehabilitation Information Center 4407 Eighth Street
Catholic University of America
Washington, DC 20017
Muscular Dystrophy Association, Inc.
810 Seventh Avenue
New York, NY 10019
American Coalition of Citizens with Disabilities 1012 14th NW
Washington, DC 20036
National Multiple Sclerosis Society
205 East 42nd Street
New York, NY 10017
1. Low tone, floppy, "rag doll"
2. Ability to extend a limb beyond its normal limit
3. Risk of dislocating jaw or hip or neck vertebrae
4. Delayed motor development
5. Tone remains the same regardless of body position
6. Muscles are soft and doughy
7. Shallow breathing, possible choking
8. Little sustained speech
9. Underactive gag reflex, open mouth, protruding tongue
10. Tone improves with increasing age, becomes more normal
11. Joint compression through spine and extremities
12. Insecure in most standing or sitting positions
13. Is unable to hold head up or arm out for very long
14. May be unable to suck or chew adequately for long periods
August 1997, The Benign Congenital Hypotonia Site,