Muscle tone in children: norm and pathology

Muscle tone is the amount of tension in a muscle when it is at rest. Children need muscle tone to maintain an upright posture and move. Sometimes muscle tone can be too high (hypertonicity), which manifests itself in excessive stiffness, or too low (hypotonicity), which manifests itself in the form of lethargy and weakness of the muscles.

When the tension in a child's muscles at rest is below normal, the baby is considered to have hypotension. Its severity can vary from mild to severe. Hypotonia is different from muscle weakness, but often infants and children with hypotension also have muscle weakness.

Muscle tone in children: norm and pathology

Muscle tone in children: norm and pathology
Tone disorders occur in almost every baby in the first year of life. It is very important to identify the problem in time and help the child cope with it.

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Tone is the minimum muscle tension required to maintain the body position at rest. A baby who has lived in the fetal position for 9 months tends to have increased muscle tone after birth. However, the norm is considered to be such muscle tension when an adult can easily straighten the baby’s legs or unclench his fists. An important criterion is the symmetry of the tone and its predominance in the flexor muscles. With age, the tone gradually decreases.

To control muscle tone, it is necessary to regularly show the child to the doctor. The pediatrician checks the baby's reflexes and evaluates the condition of the baby's muscles.

Do children outgrow hypotension?

The outcome in a particular case largely depends on the nature of the underlying disease. Hypotension usually does not get much worse and sometimes even gets better. Usually it does not threaten life expectancy. Hypotension does not inherently affect intelligence, although a number of underlying medical conditions can negatively affect one or more aspects of cognitive function. Whether a child will grow up due to hypotension depends on the underlying cause of the condition. If there is an underlying cause that can be treated, such as an infection, muscle tone often improves. Infants with benign congenital hypotonia can often improve as they grow, but mild weakness may persist into adulthood. When there is an incurable underlying condition, hypotension may not go away, but there are many ways to control decreased muscle tone.

Self-control: normal muscle tone

Up to 1 month Lying on his back, the baby assumes the “fetal position”: arms are bent and pressed to the chest, fingers clenched into a fist, legs apart at the knees, skin folds are symmetrical. Lying on his stomach, the baby turns his head to the side, placing his arms under his chest. At the same time, he bends his legs and imitates crawling movements.

From 1 to 3 months, the baby can stretch his arms forward and bring them to his eyes or mouth. Closer to three months of age, he begins to reach for a toy - for play and development. If you put a rattle in his open palm, he holds it tightly. He lifts and holds his head well while lying on his stomach, turns his head in different directions.

From 3 to 6 months In the supine position, the baby’s arms and legs are half bent, palms open. The child purposefully reaches out to the toy and takes it. Closer to 4 months, the baby learns to roll over from his stomach to his back, and closer to 6 months - to sit up and crawl. By six months, the child rests on open palms, rising with outstretched arms.

From 6 to 9 months The child moves actively, rolls over from his stomach to his back and back. Sits down, crawls and makes the first attempts to stand up.

From 9 to 12 months, the baby crawls, stands up and tries to walk, first with support, and then independently.

Features of muscle function in a newborn

While in the mother's womb, the child needs to feel his position, and the baby receives all these sensations thanks to muscle contraction. When a child is born, muscle tone helps his mental and physical development: due to it, the baby learns to hold his head, tries to grab a toy, rolls onto his tummy and side, and later learns to sit, crawl and walk. In order for all these skills to be carried out one by one and on time, physiological muscle tone is necessary - slight tension in the skeletal muscles even in a state of complete relaxation.

At different ages, muscle tone in a newborn manifests itself differently, and it is especially pronounced in the first months of life. This happens because for 9 whole months the child developed and lived in a cramped space - the womb, where he did not have the opportunity to be highly active. Therefore, by the time of birth, all the baby’s muscles are extremely tense - they are in hypertonicity. Hypertonicity is distributed unevenly across muscle groups - this explains the typical position of the baby: the head is thrown back, and the arms and legs are pressed to the body. The muscles of the thighs have especially high tone in a baby: if you try to spread his legs, you will feel resistance. This muscle hypertonicity in an infant will last for about 4 months, gradually decreasing by two years: at this age, the muscle tone of a child and an adult is approximately the same.

Hypertonicity

Increased muscle tone develops as a result of damage to the nervous system and brain. Causes: hypoxia during childbirth, birth injuries, cerebral hemorrhages, meningitis. Symptoms Hypertonicity is characterized by stiffness and tightness in the baby. The child does not relax even in his sleep, his legs are pressed to his body, and his hands are clenched into fists. Newborns may experience head retention that is not typical for this age. It occurs due to increased tone of the neck muscles. There are attacks of intestinal colic, anxiety and sleep disturbances; frequent regurgitation, trembling of the arms and chin may be characteristic.

Why is it dangerous? Reduces the speed of psychomotor development of the baby. Children with hypertonicity begin to sit up, crawl and walk later than their peers.

How is hypotension treated?

Treatment of hypotension depends on the underlying disease, if any. Physiotherapy and speech therapy are often recommended and used with very good results. Physical therapy is used to improve fine motor control and overall body strength, while speech therapy helps with breathing, speaking and swallowing difficulties. Toddlers and children with speech problems can greatly benefit from using sign language in the family until speech becomes clear to the family. Ankle/foot orthoses are sometimes used for weak ankle muscles. Hypotonic, passive infants may require additional stimulation. Building muscle strength is an important part of managing hypotension, and significantly increasing muscle strength will help make the symptoms of hypotension less obvious. A pediatric physical therapist can work with the child and parents to develop a program of play activities that develop gross motor skills, improve posture, and increase muscle strength and endurance.

Hypotonicity

Decreased muscle tone is less common than hypertonicity. The condition is typical for premature infants, children with endocrine and infectious diseases. Severe pronounced hypotonicity may indicate an intracranial hematoma or serious birth injuries.

Symptoms Children with hypotonia have prolonged sleep, a sedentary lifestyle, rare crying and whims. During sleep, the baby's arms and legs are extended along the body, and the stomach has a “spread out”, frog-like appearance. Such babies suck poorly and gain weight; they begin to hold their heads up late.

Why is it dangerous? With hypotonicity, the processes of sucking and swallowing may change. Possible breathing problems pose a serious threat to life.

Symptoms of hypertonicity and hypotonicity of muscles in infants

Increased muscle tone (hypertonicity) in infants can occur due to damage to the nervous system or brain due to:

• birth injuries;
• hemorrhages;
• hypoxia (lack of oxygen) during childbirth;
• meningitis;
• increased excitability in a child.

Symptoms of hypertension:

• great body tension, tightness;
• inability to relax during sleep (fists clenched, arms near the chest, legs near the stomach);
• holding the head immediately after birth due to hypertonicity of the neck muscles;
• restless sleep, colic;
• frequent tremor (shaking) of the chin;
• excessive regurgitation;
• when placing the baby on his feet, he tucks his fingers and tries to stand on his “tiptoes”;
• if you pull a child by the arms, he does not straighten them, but tries to rise with his whole body;
• possible curvature of the neck (if a cervical injury occurred during childbirth);
• the child later begins to crawl, sit and walk.

Hypotonia (decreased muscle tone) in a newborn most often occurs in premature babies and in children with brain problems, as well as with endocrine pathologies and infection:

• when infected in the womb;
• during birth trauma;
• due to intracranial hematoma.

Symptoms of hypotension:

• lethargic and constantly sleepy state of the baby;
• low mobility, poor appetite and slow weight gain;
• the baby does not hold his head up for a long time, his arms and legs are extended along the body;
• the tummy has a flattened shape;
• when spreading the hips, no muscle resistance is felt;
• if you lay the baby on his tummy, he does not try to bend his arms and raise his head, but lowers his face to the surface;
• in severe forms: impaired sucking, swallowing, breathing.

Dystonia (asymmetric tone) of muscles in an infant occurs if the muscles experience uneven tone: some of them are in decreased tone, others are in increased tone.

Symptoms of dystonia:

• the baby takes unnatural positions;
• the child falls on his side, and his body arches;
• skin folds are unevenly located;
• the child’s posture develops with complications: scoliosis, clubfoot, and curvature of the neck may occur;
• psychomotor development is impaired;
• in severe forms - cerebral palsy (cerebral palsy).

Treatment of tone disorders

Complex therapy for tone disorders is prescribed by a pediatric neurologist. Typically, doctor's orders include:

• kinesitherapy (movement treatment, includes a course of massage and special gymnastics - active and passive);
• physiotherapy (magnetic therapy, electrophoresis, mud, water and heat treatment, etc. - prescribed in courses, usually alternating);
• drug treatment (in some cases, vitamins, drugs to reduce intracranial pressure, and drugs that improve metabolic processes are prescribed).

Timely diagnosed tone disorders respond well to complex treatment. After therapy, they disappear without a trace and no longer bother either the child or his parents.

Children with tone disorders need a massage from a competent specialist. Children's massage therapists determine the tone of each muscle and carry out the appropriate correction: relieve spasm or help increase tone. An unprofessional massage performed by a mother or grandmother can lead to a worsening of the child’s condition.

Author: Olesya Butuzova, pediatrician
The material used photographs belonging to shutterstock.com

How to evaluate tone features

Typically, a newborn's muscle tone is assessed by looking at the baby's sleeping position and when he or she moves. Only a neurologist can assess the more subtle features of the condition of your child’s muscles, who will first ask the mother certain questions: about how the baby was born (as a result of physiological labor or cesarean section) and what his presentation was (facial, breech, etc. .). The reason for the increased tone of the neck muscles in a baby, due to which the baby's head is thrown back too much, can be a facial presentation during labor, and increased tone of the legs (when the legs are straightened) often occurs with a breech presentation. But the “embryo” position that the child takes when sleeping is a sign of normal tone. In this case, the child’s arms are clenched into fists and bent at the chest, and the legs with hips apart are bent towards the tummy.

Physiological hypertonicity in the first months after birth does not allow the baby to perform normal human movements: he can quickly move his legs, cross them, push off, bend and straighten them. But the baby also does not yet know how to actively move his arms: he is only able to bend them at the elbows and sometimes unclench his fists. The baby's head is tilted back slightly due to hypertonicity of the neck muscles. A baby's muscle tone may increase sharply when he cries or is worried.

Treatment of hypertonicity and hypotonicity of muscles in infants

To prescribe adequate treatment for hyper- or hypotonicity in a baby, you need to contact a neurologist who will conduct a detailed study and prescribe a set of procedures, which include:

• massage;
• osteopathic treatment;
• gymnastics;
• swimming;
• physiotherapeutic procedures, water and mud therapy, magnetotherapy, electrophoresis, ultrasound, heat therapy;
• medications to relieve muscle spasms, vitamins, herbal remedies, homeopathic remedies.

To treat hypertension, it is necessary to relieve excess muscle tension. For simple forms of hypertension, it is recommended to alternate baths with relaxing herbal infusions and massage. If parents have mastered the basic techniques of massage, they can perform it at home on their own: massage movements include stroking (using palms and grasping), light rubbing, rocking on a fitball. Under no circumstances should you use sharp (slamming, chopping) movements, or prevent your baby from using jumpers and walkers ahead of time - all this will only increase muscle tension and the load on the spine.

With hypotension, on the contrary, all the above-mentioned “prohibitions” are permitted, because the main goal of massage is to stimulate muscle function. In addition to a tonic massage, the doctor may recommend swimming classes and special exercises on a fitball to tone the muscles.

As a rule, massage and exercises are enough to correct muscle tone disorders in a newborn. However, if the disorders cannot be corrected and over time you begin to notice strange tensions in some muscles in your baby, as well as a delay in mental development, immediately make an appointment with a neurologist.

Massage for a child with hypotension

When a newborn baby is born, he does not behave as fully as an adult. This happens because a change in environment for a newborn baby is a huge stress for his entire body; the child develops physiological reflexes, an adaptive reaction that manifests itself in the first months of life. Typically, a newborn baby has muscle hypertonicity, which is due to the fact that the baby was in a constrained state for all 9 months in the womb. But it also happens that parents notice such symptoms in their baby as a decrease in muscle tone, which is expressed in the fact that the child is lethargic, eats poorly, sleeps more often, he begins to hold his head up later than his peers, hold a toy in his hands, sit down, etc. .d. This condition of the baby should not leave parents without attention and requires immediate help from a pediatrician.

Treatment of hypotension is aimed at developing the muscles of the whole body, such as massage and therapeutic exercises. It is better to entrust massage for hypotension in a child to a specially trained massage therapist, strictly following the instructions of a pediatrician or neurologist. Depending on the severity of this pathology, taking into account the age of the child and his characteristics, the massage therapist selects certain exercises and the number of massage sessions specifically for your baby. Massage for hypotonic muscles in a child is aimed at activating the baby’s skeletal muscle system and providing a general strengthening effect. This is done thanks to special exercises that look like light stroking of the limbs, back, tummy, rubbing and pinching, warming up for the upper and lower limbs in the form of effleurage, spreading the arms and legs apart. When performing such exercises, one should take into account the characteristics of the newborn’s body; massage for a child with weak muscles should be performed with light, gentle, but at the same time rhythmic and fairly active movements.

When a massage is performed for hypotonicity in a child, you should periodically change the position of the baby’s body, turning it onto its back, tummy, left and right side. During the massage, the child needs to be in a good mood and it is not allowed to massage a crying child who is in a restless state. If this causes discomfort in the child, then in this case you should refuse massage sessions and repeat them after a certain period of time, because the child grows up and changes his feelings towards the world around him.

Massage for a child with weak muscles is more intense, impulsive; massage movements should be deep and aimed at increasing muscle tone. The massage is performed in such a way that the massage therapist applies weak pressure shocks to both individual muscle groups and active points, which allows the muscles to be excited and the tone in them to be stimulated. The massage therapist performs such movements separately with the phalanges of the fingers, sometimes with the entire palm, taking into account the delicate and miniature features of the structure of the newborn baby.

In order for the treatment of hypotonicity in children to be effective, massage for hypotonic muscles in a child should be combined with special gymnastics, which is a set of exercises that strengthen the weakened muscles of your baby.

This gymnastics can be performed by both a massage therapist and mother after special training, and the following exercises are most often used:

• crosswise - the baby’s arms are moved to the side and brought together so that the left arm goes to the right, and the right one to the left;
• boxing exercise - an adult grabs the child’s arms and performs movements that resemble boxing a punching bag;
• pulling up - the baby is pulled up by the arms, slightly lifting the legs off the table and lowered down;
• stompers - lying on the back, you need to take the baby’s leg and with little effort try to straighten the leg, pulling it towards the gluteal muscles, then the same is done with the second leg.

Caring parents should take care of the health of their baby and approach this with special care and attention. Timely seeking help from a specialist and massage for hypotonicity in a child can help get rid of such unpleasant symptoms for life. Otherwise, the consequences of hypotonicity in a newborn may be reflected at an older age and the child may face problems such as curvature of posture and delayed physical development. Take care of your baby's future health by providing him with proper care and attention!