![]() ![]() However, the assessment with Bayley - III or any other standardized scale may be difficult when the infant has a profound weakness. It covers the ages from 1 to 42 months and assesses motor, cognitive, language, and social-emotional domains of development. The Bayley scale (Bayley -III) may be used. A standardized neurodevelopmental assessment must be done in older children. Infants with central hypotonia usually have a higher prevalence of cognitive delays. For example, hypotonia at birth with poor Apgar score may indicate hypoxic-ischemic encephalopathy, whereas poor muscle tone developing 12 - 24 hours after birth may indicate a metabolic disorder. Information regarding the onset of hypotonia and the clinical course can also help to determine the etiology. ![]() Details regarding maternal exposure to toxin/drugs, any infections during pregnancy, mode of delivery, gestational age, and Apgar score at birth must also be obtained. Prenatal and perinatal history includes details about the fetal movements, presentation at birth, amniotic fluid amount through the course of pregnancy, and complications during delivery. Attention should also be paid to the presence of hypotonia in the family members with a known cause such as muscular diseases, genetic disorders, and consanguineous marriage. The developmental history of the child, as well as of the parents, can also aid in the diagnosis. History - Initial evaluation starts with a detailed history, which should include family history, prenatal, and perinatal history. In the USA, California, Pennsylvania, and Utah have a high incidence of infant botulism, with about 50% of cases in California. Even though worldwide incidence is rare, the majority of cases are diagnosed in the USA, which can be attributed to clinician awareness. Acquired hypotonias can be due to toxins or infections, including infant botulism. Spinal muscular atrophy has an incidence of 1 in 6,000 to 1 in 10,000 live births. The most commonly seen peripheral causes include spinal muscle atrophy, congenital muscular dystrophy, and congenital myopathies. Peripheral and unknown causes account for the rest. Metabolic diseases, including peroxisomal and storage disorders, are rare causes of central hypotonia. Down syndrome is the most common genetic cause of central hypotonia, followed by Prader Willi syndrome. Central hypotonia is seen in up to 60%-80% of cases. These typically include hypoxic-ischemic encephalopathy or genetic abnormalities. Among congenital hypotonias, central pathology accounts for most. The majority of the cases of hypotonia are congenital. The exact incidence of hypotonia is difficult to determine because it is not a disease itself but a presenting feature of various diseases. Specific treatments are available for some diseases, but in general, treatment comprises providing supportive care with rehabilitation services, nutritional and respiratory support. Determining the etiology is crucial for the management and prognostication. There is an extensive list of causes, but approaching the case systematically and obtaining a detailed history and physical examination can help reach a diagnosis. Although easily recognizable, it may be challenging for a clinician to determine the underlying cause of hypotonia. Hypotonia may or may not be associated with muscle weakness. It must be differentiated from weakness, which refers to a decrease in the maximum power a muscle can generate. It is abnormally decreased resistance encountered with passive movement of the joint. ![]() ![]() Hypotonia is a poor muscle tone resulting in floppiness. It is determined by resistance encountered with passive stretching of a muscle or the passive movement of a limb at a joint. It is a continuous and passive partial contraction of the muscles which maintains posture. The tone of the muscle is defined as a residual tension in a muscle at rest. ![]()
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