Ask the Professional

Dear Etty:

This might sound like a silly question, but what does 'hypotonia' mean. I know that
children with Down syndrome are considered 'floppy', but I still don't understand
and am embarrassed, after three years, to ask my therapists.

Malky T.
Brooklyn, NY

Dear Malky:

I think your question is great and I'll try to explain 'hypotonia' without getting too

Muscle tone refers to the amount of tension or resistance to movement in a muscle.
Muscle tone is what enables us to keep our bodies in a certain position or posture.
Changes in muscle tone is what enables us to move. For example, to bend your arm
to bring your hand up to your face, you shorten the biceps muscles, increasing its
tone, and lengthen the triceps muscle, decreasing its tone. To complete a movement
smoothly, the tone in all muscle groups involved must be balanced. The brain must
also send messages to each muscle group to actively change its resistance.
Children with decreased tone are said to have hypotonia, or floppiness. When your
child has low muscle tone he will have trouble maintaining positions without
support because his muscles do not contract enough and are too relaxed. I hope this
clarifies things for you.

Dear Etty:

Is there any benefit to breastfeeding, as opposed to bottle-feeding my baby? I find
it stressful but would persist if it were especially beneficial for my child with Down

Mrs. G.
Chicago, IL

Dear Mrs. G:

The following are benefits that are especially helpful for your child:
* Claims have been made that breastfeeding increases the chance of improving a
child's IQ (to date there is no proof substantiating this fact)
* Nursing your baby will also encourage a preferred oral motor posture for sucking,
minimizing a tongue thrust
* Substantial savings monetarily
* Antibodies unique to your child's needs

Having in mind these benefits, you must also take into account your feelings. If it is
difficult or you feel anxious or depressed, understand that these negatives far
outweigh the positives. You must be a happy and loving mother first and foremost.

Dear Etty:

Now that our son is walking, does he still need physical therapy? He is 22 months

Rabbi and Mrs. S.
Monsey, NY

Dear Rabbi and Mrs. S:

The question is not if he is walking, but rather, how he is walking? If he can go
up and down steps smoothly, negotiate obstacles and is walking with a nice, narrow
base of support, it is possible he may no longer need PT. But if this is not so, then
beyond the walking there is still much to address. In order that the child be able to
accomplish the already mentioned skills, he will need good motor planning, good
balance, good weight shifting and lots of confidence. Therapy should continue if
these skills are needed, challenging him in all sorts of standing and walking
postures, i.e. balance board, balance beam and obstacle courses.
Use your experience and the advice of the therapist to come to a decision as to
whether to continue PT or not. As a general rule, any child with a diagnosis
expected to affect gross motor skills, such as Down syndrome, can benefit from PT
and is not likely to be discharged before age 3.

This article first appeared in issue #9 of Down Syndrome Amongst Us

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