How does decreased tone manifest itself?
With hypotonia, the baby's posture is noticeably weak: in the arms it seems soft and slips, when pulled up by the handles the head falls back, in the position on the stomach the baby does not lean on the forearms and does not raise the head. Legs and arms are often straightened and separated, movements are sluggish and poor. Sucking may suffer: the child gets tired, takes frequent pauses, and slowly gains weight. It is important that these signs in themselves are not a diagnosis, but a reason for an in-person examination by a neurologist who will check reflexes, range of passive movements and age-appropriate skills.
- The head throws back when pulled up by the handles
- On the stomach does not rest on the forearms
- Arms and legs are sluggishly extended, “frog” pose
- Lean, slow movements
- Weak sucking and fatigue during feeding
- Delay of turning over, sitting, crawling
Possible reasons
The causes are divided into central, associated with the brain and spinal cord, and peripheral, associated with nerves, neuromuscular transmission and the muscles themselves. Central ones are more common: consequences of hypoxia during childbirth, prematurity, intracranial hemorrhages, previous infections, chromosomal syndromes. Peripheral causes are less common, but require quick diagnosis: spinal muscular atrophy, congenital myopathies, peripheral nerve lesions. Metabolic and endocrine causes are distinguished separately - congenital hypothyroidism, which is detected during neonatal screening, rickets, and severe metabolic disorders. Sometimes the decrease in tone turns out to be temporary and is associated with a previous illness or prematurity.
- Consequences of hypoxia and birth trauma
- Prematurity and immaturity of the nervous system
- Chromosomal and genetic syndromes
- Spinal muscular atrophy and congenital myopathies
- Congenital hypothyroidism
- Past infections of the nervous system
- Severe rickets and metabolic disorders
What does the doctor look at?
The neurologist evaluates not just one movement, but the whole picture: the resting posture, the reaction to being pulled up by the handles, being held horizontally, the newborn’s reflexes and their timely extinction. Be sure to check skills with age: holding the head, resting on the forearms, turning over, sitting, crawling. The course of pregnancy and childbirth, Apgar score, birth weight, neonatal screening results, and family history are important. It is important to distinguish general hypotonia from weakness in one limb, which indicates local damage.
- Posture at rest and while suspended
- Pull-up test
- Reflexes of a newborn and the timing of their extinction
- Comparison of skills with age norms
- Assessment of movement symmetry
- History of pregnancy, birth and neonatal screening
What examinations are needed
The examination is prescribed individually, because hypotension is a symptom, not a diagnosis. Neurosonography through the fontanelle allows you to see the consequences of hypoxia, hemorrhage and brain developmental defects. Ultrasound of the hip joints excludes dysplasia, which often accompanies tone disorders. According to indications, thyroid hormones, calcium, vitamin D and creatine kinase levels are checked, and if a neuromuscular disease is suspected, they are referred for genetic testing and electroneuromyography. MRI of the brain is performed when a more accurate answer is needed than ultrasound provides.
- Examination by a pediatric neurologist and pediatrician
- Neurosonography
- Ultrasound of the hip joints
- TSH and thyroid hormones
- Calcium, vitamin D, creatine kinase
- Genetic examination and ENMG according to indications
- MRI of the brain if necessary
What should parents do and how can they help?
The main rule is not to engage in self-diagnosis using videos from the Internet and not to prescribe courses of medications to your child yourself. If the tone is reduced, the main treatment is aimed at the cause: for hypothyroidism, replacement therapy is prescribed, for vitamin D deficiency - its replenishment, for genetic diseases, treatment is carried out by a specialized specialist. In all cases, regular therapeutic exercises and massage, selected according to age, help, as well as proper organization of the day: laying on the stomach from the first weeks, time without swaddling, games that encourage stretching and leaning. It is important to keep a skill diary and attend follow-up examinations.
- Regularly place your baby on his stomach while he is awake.
- Therapeutic exercises and massage as prescribed by a doctor
- Treatment of the underlying disease
- Replenishing vitamin D deficiency as recommended by your pediatrician
- Do not use medications “for tone” without prescription
- Note the emergence of skills and show notes to the doctor