STIFF MUSCLES:
Hypertonicity means stiff or tight rigid muscles. The tight muscles are often misunderstood to mean ‘strong’. Signs of tight muscles can include but are not limited to; crouched or hunched positions, arching back (hyperextension), tight legs and/or arms/neck (hard to move) and clenched fists. This tightness often contributes to irritability. Many babies (especially those who were exposed to more than one substance) may have what is called ‘variable’ tone which means different parts of the body can be tight and other more floppy (e.g. tight arms and legs and floppy truncal/tummy (core) tone). Most strategies are useful for both tight and floppy muscles as they tend to ‘modulate’ or coordinate the baby’s muscle tone.
NOTE: The Following Videos found in this kit under the Parenting Tips from Specialists will provide more information and/or demonstration that might be useful for some of the interventions recommended here.
STRATEGIES BY DISCIPLINE
NEURODEVELOPMENT
A baby should have muscles that provide just a little resistance but do not feel stiff or hard to move. This can cause the baby to be more irritable and to fall behind in some developmental experiences and it may take longer for your baby to build their motor skills (reaching for objects, grasping objects, crawling etc.). For example, if they have tight arms that stay to the sides, and they don’t engage in bringing their hands to their mouths or in the middle of their body then begin to miss out on what is called mid-line play and then this delays some of the cognitive (thinking) development.
Infant massage will be very important to help the baby with movement and stiffness.
Tummy time is important and will help the baby to develop better muscle tone and coordination of their muscles. It is important to make sure that the baby is safe in tummy time and to make sure that breathing passages are always clear.
Exercises like playing ‘bicycle’ with the baby’s legs and pat-a-cake with the baby’s arms will help reduce the tightness. It will help to make it a part of the daily routine. For example, for 5 minutes after every day-time diaper change.
Do not let them be in ‘stand’ positions. Hold them in more curved positions. Although they may seem strong this is just tight muscles.
Sometime infants can become too tight if they are limited in the positions they are placed in or held. For example, you should switch arms (sometimes hold on your left side and others on the right side) when feeding your baby in so that they turn their head in both directions (to look at or away from you). Also, every couple of weeks change which end of the basinet/crib where their head is so they anticipate you coming from both left and right side.
MEDICAL
It is important to determine the root cause. Have the baby’s doctor examine them to evaluate them for any other potential concerns.
Make sure the infant’s environment is at the right temperature (70-72 degrees). If they are too cold this could also impact their movements.
Frequent and baby safe position changes are recommended. Rigid muscles encourage more pressure areas (use soft materials and watch infant temperature).
NURSING
Infant Massage will be important to decrease stiffness and help with irritability.
Chest to chest contact can help decrease stiffness.
OCCUPATIONAL THERAPY
Infant massage is very beneficial to decrease tight muscles especially with baby yoga as part of the routine.
Certain positions are more helpful to make tone less tight: tummy time.
SPEECH PATHOLOGY
Infant Massage
Be very aware of tight muscles and FEEDs – as this can result in coughing or choking or poor coordination of the suck/swallow/breathe pattern necessary for safe and productive eating.
It will help to teach your baby to use a pacifier. Sucking is very calming which will help to decrease the stiffness. You will need to teach them to use a pacifier when they are calmer so they learn to coordinate their sucking rather than just spit it out. “Spitting it out” is due to not being able to coordinate the suck, swallow, breathe (SSB) rhythm resulting in the pacifier fall out and/or frustration.