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    Hypotonia

    Decreased muscle tone; Floppy infant

    Hypotonia means decreased muscle tone.

    Considerations

    Hypotonia is often a sign of a worrisome problem. The condition can affect children or adults.

    Infants with hypotonia seem floppy and feel like a "rag doll" when held. They rest with their elbows and knees loosely extended, while infants with normal tone tend to have flexed elbows and knees. They may have poor or no head control. The head may fall to the side, backward, or forward.

    Infants with normal tone can be lifted with the parent's hands placed under the armpits. Hypotonic infants tend to slip between the hands as the infant's arms rise without resistance.

    Causes

    Muscle tone and movement involve the brain, spinal cord, nerves, and muscles. Hypotonia may be a sign of a problem anywhere along the pathway that controls muscle movement.

    Causes may include:

    • Brain damage or encephalopathy, due to:
      • Lack of oxygen before or right after birth
      • Problems with brain formation
    • Disorders of the muscles, such as muscular dystrophy
    • Disorders that affect the nerves that supply muscles (called motor neuron disorders)
    • Disorders that affect the ability of nerves to send messages to the muscles:
      • Infant botulism
      • Myasthenia gravis
    • Inborn errors of metabolism (rare genetic disorders in which the body cannot properly turn food into energy)
    • Infections
    • Other genetic or chromosomal disorders or defects that cause brain and nerve damage, such as:
      • Down syndrome
      • Prader-Willi syndrome
      • Tay-Sachs disease
      • Trisomy 13
    • Other miscellaneous disorders:
      • Achondroplasia
      • Congenital hypothyroidism
      • Congenital cerebellar ataxia
      • Marfan syndrome
      • Poisons or toxins
      • Spinal cord injuries that occur around birth

    Home Care

    Take extra care when lifting and carrying a person with hypotonia to avoid causing an injury.

    What to Expect at Your Office Visit

    The physical examination will probably include a detailed examination of the nervous system and muscle function.

    A neurologist (specialist in brain and nerves) will usually help evaluate the problem. Geneticists may help diagnose certain disorders. If there are also other medical problems, a number of different specialists will help care for the child.

    Which diagnostic tests are done depends on the suspected cause of the hypotonia. Most of the conditions associated with hypotonia also cause other symptoms that can help in the diagnosis.

    Many of these disorders require ongoing care and support.

    References

    Fenichel GM. The hypotonic (floppy) infant). In: Bradley WG, Daroff RB, Fenichel G, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 29.

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    • Hypotonia

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    • Central nervous system

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      • Hypotonia

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      • Central nervous system

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      Review Date: 12/1/2011

      Reviewed By: John Goldenring, MD, MPH, JD, Pediatrician with the Sharp Rees-Stealy Medical Group, San Diego, CA. Review provided by Verimed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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