Health A to Z
Hypotonia is the medical term for decreased muscle tone.
Healthy muscles are never fully relaxed. They retain a certain amount of tension and stiffness (muscle tone) that can be felt as resistance to movement.
For example, a person relies on the tone in their back and neck muscles to maintain their position when standing or sitting up. Muscle tone decreases during sleep, so if you fall asleep sitting up, you may wake up with your head flopped forward.
Hypotonia isn't the same as muscle weakness, although it can be difficult to use the affected muscles. In some conditions, muscle weakness sometimes develops in association with hypotonia.
It is most commonly detected in babies soon after birth or at a very young age, although it can also develop later in life.
Hypotonia present at birth is often noticeable by the time a child is six months old, if not before. Newborn babies and young children with severe hypotonia are often described as being "floppy".
Signs of hypotonia in a child include:
A child with hypotonia often takes longer to reach motor developmental milestones, such as sitting up, crawling, walking, talking and feeding themselves.
An adult with hypotonia may have the following problems:
Hypotonia is a symptom rather than a condition. It can be caused by a number of different underlying health problems, many of which are inherited.
Hypotonia can also sometimes occur in cerebral palsy, where a number of neurological (brain-related) problems affect a child's movement and co-ordination, and after serious infections, such as meningitis.
In some cases, babies born prematurely (before the 37th week of pregnancy) have hypotonia because their muscle tone isn't fully developed by the time they're born. However, provided there are no other underlying problems, this should gradually improve as the baby develops and gets older.
Read more about the causes of hypotonia.
If your child is identified as having hypotonia, they should be referred to a specialist healthcare professional, who will try to identify the cause. The specialist will ask about your family history, pregnancy and delivery, and whether any problems have occurred since birth.
Read more about how hypotonia is diagnosed.
Depending on the cause, hypotonia can improve, stay the same or get worse over time.
Babies with hypotonia that results from being born prematurely will usually improve as they get older. Babies with hypotonia caused by an infection or another condition will usually improve if the underlying condition is treated successfully.
Unfortunately, it's often not possible to cure the underlying cause of hypotonia. Hypotonia that has been inherited will persist throughout a person's life, although the child's motor development may steadily improve over time in cases that are non-progressive (don't get worse).
Read more about treating hypotonia.
Hypotonia (decreased muscle tone) is a symptom rather than a condition. It can be caused by a number of underlying problems, which can either be neurological or non-neurological.
Neurological conditions are those that affect the nerves and nervous system. Hypotonia is most commonly linked to neurological control of muscle tone.
To function normally, muscles depend on signals from motor nerves. These signals can become disrupted at the level of the brain and spinal cord (central hypotonia), or as a result of nerve damage between the spinal cord and muscle (peripheral hypotonia).
Neurological conditions that affect the central nervous system and can cause central hypotonia include:
Neurological conditions that affect the peripheral nervous system and can cause peripheral hypotonia include:
Non-neurological problems that can cause hypotonia in newborn babies and young children include:
Hypotonia can sometimes occur in older children and adults, although this is less common. It can be caused by some of the problems mentioned above, but other possible causes include:
Weakness and problems with mobility and balance are also common with these conditions.
If hypotonia (decreased muscle tone) is suspected in a newborn baby or young child, they'll be referred to a specialist.
This will usually be a paediatrician (a specialist in treating children) with expertise in disorders of the nerves and nervous system, or a neurologist (a specialist in disorders of the nerves and nervous system).
The specialist will start by asking a number of questions, which are likely to include:
Following the initial assessment, a full physical examination will be carried out and a blood test may be offered.
Other tests that may be recommended include:
In some cases, no underlying cause can be found despite numerous tests. This is sometimes referred to as benign congenital hypotonia. In this situation, treatment and support can be offered to manage functional difficulties after other causes of hypotonia have been excluded.
The recommended treatment plan for hypotonia (decreased muscle tone) will depend on the underlying cause.
Hypotonia caused by a baby being born prematurely will usually improve as the baby gets older. However, specialist treatment and support may be needed during this time and for other problems associated with prematurity.
Hypotonia in babies born to mothers with myasthenia gravis usually improves quickly. Again, specialist treatment and support may be needed while the baby improves. In cases where hypotonia is caused by an infection, the symptoms may disappear if the infection is treated successfully.
If a cure for the underlying cause of hypotonia isn't possible – as is unfortunately often the case – treatment will mainly focus on trying to improve and support the person's muscle function through the use of physiotherapy, occupational therapy, and speech and language therapy. For example, orthotics and adaptive equipment may be required.
In some cases, funding may be available from social care services to help pay for things such as home adaptations, walking aids and wheelchairs. If additional support is needed at school, funding may also be available.
If physiotherapy is recommended, the physiotherapist will assess your child's muscle tone and ask them to carry out a series of exercises and tasks.
In treating hypotonia, the main objectives of physiotherapy are to:
The physiotherapist will design a programme that includes a range of exercises for your child to do on a daily basis. Therapy should be fun and integrated into your child's daily routine and everyday activities, both at home and at school.
Occupational therapy teaches you the skills needed to carry out day-to-day activities. For example, the occupational therapist may focus on improving the hand and finger skills needed for dressing and feeding.
As with physiotherapy, you may be offered regular occupational therapy sessions. You'll also be taught exercises and tasks you can perform on a daily basis.
Equipment to help you move around more easily may also be recommended, such as ankle or foot supports if your ankles or feet are affected by hypotonia.
A speech and language therapist (SLT) can assess your child's feeding and swallowing, and help identify swallowing problems that can sometimes be associated with hypotonia. The SLT will also be able to make recommendations about feeding support.