Hypotonia – Floppy Infant Syndrome

Associated Conditions

By The CP Family Network

Children who are born with or develop cerebral palsy may also manifest a condition known as hypotonia, or low muscle tone (the amount of tension or resistance to movement in a muscle). The condition is also known as “floppy infant syndrome” or “infantile hypotonia.”

Individuals with this diagnosis are said to be “hypotonic” and demonstrate “hypo-tonicity.” In children with cerebral palsy this condition is defined as ataxic (weak tone) or athetoid cerebral palsy (fluctuating tone).

The long-term effects of hypotonia depend on the severity of the condition and its cause, but early treatment is considered critical. Imagine, as a child, trying to learn to pull up, crawl, walk, or talk without the ability or a greatly reduced ability to move muscles. Hypotonia can even affect autonomic functions such as swallowing and gastric emptying. It’s no wonder children with hypotonia face many challenges with basic life skills.

Causes of Hypotonia

Hypotonia can be found in many neurological disorders. Neurons in the brain and central nervous system are responsible for initiating impulses that trigger motor movement. Cerebral insult to these neurons, the connections between them, or damage to nerve pathways in the central nervous system or spinal cord can lead to decreased sensation and muscular tone.  Specifically, damage to the cerebellum portion of the brain can result in hypotonia, considering that the cerebellum facilitates the controlling and coordinating of muscles and helps with sustaining posture.

Signs and Symptoms

  • Children with hypotonia may exhibit poor head control and possibly fail to meet other developmental milestones such as sitting or crawling.
  • A child may exhibit floppy muscle tone, a lack of gross motor movements, and poor torso control.
  • A child may display difficulties with sucking, swallowing, and oral motor functions also known as dysphagia.
  • It can present issues involving a child’s ability to walk, sit, maintain torso control, or use upper and lower extremities.
  • Depending on the nature, severity and location of the cerebral damage, hypotonia can affect the entire body or be limited to parts of the body.
  • Children with this disorder may or may not exhibit developmental disabilities, or mental retardation.
  • A child with brain injury resulting in hypotonia may or may not experience a seizure disorder or movement disorders.

Complications of Hypotonia

Complications can include:

  • Delayed gastric emptying (gastroparesis) and intestinal motility problems.
  • The potential to impact cardiac function and bladder control, and may influence pulmonary function by inhibiting diaphragm and respiratory muscle tone.
  • Children with ataxic (weak tone) or athetoid cerebral palsy may be at increased risk of contractures and muscular atrophy due to restricted function.
  • Lack of oral motor function puts a child at risk of reflux, GERD, and aspiration.

Management and Treatments

Although there is no cure for the underlying neurological injury, children with hypotonia can benefit greatly from consistent, physical, occupational and speech therapy. Therapy offers the venue to strengthen diminished or hypotonic muscle groups, and in some cases prevent muscular atrophy and contractures of the affected joints. In some cases therapy can help the brain establish new and different pathways to help facilitate and improve a specific motor function.

What Parents Need to Know About Hypotonia

  • Parents need to find a neurologist, developmental pediatrician and/or movement disorder specialist to assist in the management of hypotonia and any accompanying movement disorders.
  • Document challenges that your child may be experiencing to better customize therapy and intervention services to your child’s specific needs.
  • Parents need be  assertive in acquiring all the supportive, adaptive, and assistive services and technology their child could benefit from.
  • Physical therapy, strength training, and range of motion are all vital components in the management and prevention of the neuromuscular consequences of ataxic or athetoid cerebral palsy.
  • The prevention and management of hypotonia or any movement disorder requires a team approach. Parents are the core of that team, and communication and continuity are key. Put together a good team. Ideally medical professionals with special needs experience would be preferred, but that’s not always possible. Find providers you can communicate with easily, that respect your knowledge as the parent, and that you can establish a rapport and continuity with.



Human Anatomy and Physiology, Fifth Edition, Copyright 1978, 1981, 1984, 1987, 1990 by Wm. C. Brown
National Institute of Neurological Disorders and Stroke NINDS – Hypotonia

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