Being able to finally take your baby home from the hospital is an incredible moment that symbolizes a new chapter for your family and begins the journey of raising a child. If you notice your baby is unusually stiff within the first few days of being home, you may be alarmed.
Most likely, it is not a big deal, particularly if your birthing process was not traumatic. If your baby is abnormally stiff, there is a small possibility that this is a symptom of a more serious underlying problem. Clinical muscle stiffness is known as hypertonia.
The birth injury and cerebral palsy lawyers at Miller & Zois may be able to help you if you believe your baby was injured as a result of a medical error during childbirth. Our lawyers have years of experience handling these medical malpractice claims. Below, we discuss the possible causes of hypertonia and their outcomes for patients, citing recent medical literature. To contact us for a free consultation about your case, call (800) 553-8082 or fill out this brief online form.Causes of Stiffness Hypertonia
Hypertonia is an umbrella term that describes when there is an abnormally high muscle tone in the infant's body. High muscle tone causes the baby to be stiff and rigid. Newborn babies with this condition may have difficulty with mobility and flexing. A stiff baby is often called hypertonic or is said to have “stiff baby syndrome.”
Experiencing muscle stiffness or rigidity can be a symptom of several different conditions that range in severity, some of which are discussed in detail below. In general, hypertonia is usually caused by an insult to the brain, spinal cord, or nervous system. Trauma to the baby’s head, strokes, brain tumors, toxins, neurodegeneration, such as Parkinson’s disease, and neurodevelopmental abnormalities, such as cerebral palsy, can cause hypertonia.
“Hypertonia in infants is a symptom of multiple medical emergencies and conditions, some of which result from birth injuries, and which must be diagnosed by a medical professional.”
There are three types of hypertonia, spasticity, rigidity, and dystonia, each of which has different symptoms and underlying causes. Many healthcare providers use spasticity and hypertonia interchangeably. Spasticity is a subtype of hypertonia that involves exaggerated reflex responses. Rigidity is when there is muscle resistance across the range of motion. Dystonia is characterized by involuntary, repetitive muscle contractions.
While it's important to be concerned about your baby's health, there are many causes of stiff baby syndrome that can be completely harmless and easily fixed. With more serious conditions, there are available treatments that can manage your baby's symptoms. Common treatments for hypertonia include seeing a physical therapist, muscle spasm medications, and surgeries. If you had a prior pregnancy with no complications, there is a much lower chance that your baby will develop one of the conditions listed below.
“Most of the conditions that cause hypertonia are curable or treatable.”
If you're concerned about your baby, the best way to proceed is to talk to your pediatrician as soon as possible. There are many explanations as to why your baby is hypertonic, and your pediatrician can conduct the appropriate diagnostic tests to determine what is causing the hypertonia. We discuss some common causes of hypertonia below.Cerebral Palsy
Cerebral palsy (CP) is a medical condition that can develop as a result of brain damage during childbirth. During delivery, if the baby experiences reduced blood flow to the brain over an extended period, the baby becomes hypoxic. Hypoxia is the term that describes when a part of the body is deprived of adequate oxygen supply. This lack of oxygen damages the motor control centers of the brain and causes CP. The symptoms of this condition include muscle stiffness, rigidity, and spasticity.
“Cerebral palsy is one of the most common birth injuries cited in medical malpractice cases.”
There are four types of CP. Spastic cerebral palsy is the most common type of cerebral palsy and it is characterized by hypertonic muscles. Having spastic cerebral palsy may affect the child’s ability to move, walk, or use their hands because they don't have control of their muscles. Their muscles may also have involuntary movements or be pulled towards a certain side of the body. This condition is permanent but there are a wide variety of treatments that can mitigate and manage the symptoms.Erb's Palsy and Shoulder Dystocia
Erb's palsy is a different type of birth injury that involves the function of the nerves. Erb's palsy is not caused by lack of oxygen but instead occurs when the nerves in the baby's upper arm, shoulder, or side of the neck (known as the brachial plexus) are physically damaged while descending through the birth canal. This nerve damage often happens when a baby experiences shoulder dystocia during delivery.
Shoulder dystocia is when the baby's shoulders get stuck during labor, typically on the mother’s pelvic bone. Medical professionals have to perform certain maneuvers to be able to deliver the baby, but these maneuvers can be damaging. Pulling on the head, using forceps, or using vacuum extraction may damage the nerves in the brachial plexus and limit or completely restrict the communication between the brain and the shoulder, arm, and hand. For this reason, shoulder dystocia can result in medical malpractice. Erb's palsy symptoms include muscle stiffness, arm weakness, decreased grip, impaired circulatory development, or paralysis of the arm.Kernicterus
Kernicterus is a type of preventable brain injury that occurs as a result of untreated jaundice in newborn babies. Most babies experience jaundice shortly after being born, with 60-80% of infants in the United States being affected. Premature babies are more likely to have jaundice. The condition is usually harmless, and most babies are quickly treated with no complications. Jaundice is easily recognizable because it causes a baby’s skin to turn a yellow-orange color. This skin color comes from a build-up of bilirubin in the blood, a waste product that's produced when your liver breaks down old blood cells.
With proper monitoring after birth, jaundice is not a cause for concern. It's a natural part of the baby's body adjusting to the world after birth. However, in rare cases, if the jaundice is not treated by the child’s doctor and is allowed to progress, a baby can start to accumulate high levels of bilirubin, which can lead to brain injury. Since mild neonatal jaundice is such a common occurrence, there have been cases of healthcare providers neglecting to screen for excessive bilirubin in a baby's blood.
Kernicterus symptoms include reduced muscle tone, muscle stiffness and spasms, fever, and unusual eye movements. If your baby is exhibiting signs of kernicterus, it's important to seek out medical help to prevent serious complications.Frequently Asked Questions
The condition of having abnormally stiff muscles that are difficult to move is called hypertonia. In infants, hypertonia can be caused by a multitude of health problems, but typically results from damage to the nervous system. Hypertonia is also a symptom of cerebral palsy, Erb’s palsy, and kernicterus (jaundice). How the condition is treated depends on the underlying cause.
If your baby overextends their head and neck when held, this may be an early sign that they have cerebral palsy, a congenital muscle disorder. Another sign of cerebral palsy is when the baby stiffens or crosses their legs when they are picked up.
The cause of cerebral palsy is often a traumatic birth, so there is less of a chance your child has CP if their birth was normal. Muscle stiffness is an early sign of cerebral palsy in infants less than 6 months old, but it may be attributable to another issue or condition. If your child does have cerebral palsy, they will begin to show more pronounced developmental delays, such as trouble with crawling, standing, picking up objects, and visual attention.
There are a number of treatment options for hypertonicity, including therapy, oral antispastic agents, nerve blocks, and surgery.
Any hypertonia treatment plan begins with therapeutic exercise and work to improve range of motion. Therapeutic exercise includes a variety of treatment techniques that are used to decrease or inhibit tone. There is also some evidence to support the benefits of music therapy.
There are also a number of medications that improve spasticity. These include baclofen, benzodiazepines, dantrolene, clonidine, and tizanidine. Intrathecal baclofen (ITB) therapy has been shown to reduce spasticity and improve general functioning.
Surgery is also an option in some cases to improve function and appearance. The surgical procedure often involves tendon lengthening or transfer.Recent Medical Studies
Case study on the use of intensive pediatric neurorehabilitation in the treatment of kernicterus by Jessie Mann et al., Journal of Clinical Movement Disorders, 2020.
Kernicterus, a result of untreated jaundice, is one condition that causes hypertonia. This case study looks at one instance of a boy with kernicterus and how his condition was treated. A treatment plan for this condition may include occupational, speech, and physical therapy. The boy in this case study was also being treated with stem cell therapy. Researchers found he had success with an intensive, four-hours per day for three weeks of therapy.
Spinal Hyper-Excitability and Altered Muscle Structure Contribute to Muscle Hypertonia in Newborns After Antenatal Hypoxia-Ischemia in a Rabbit Cerebral Palsy Model by Sylvia Synoweic et al., Frontiers in Neurology, 2019.
The researchers in this study wanted to better understand what causes high muscle tone in newborn babies after they experience oxygen deprivation. In order to do so, they tested numerous mechanisms in rabbits. They found that muscle resistance to stretching is primarily explained by changes to the passive properties of muscles. In other words, while you might expect that damage to the nerves and their ability to communicate would be the most important factor in explaining hypertonia, the passive mechanics of muscles, such as their elasticity, is just as important if not more so.
Management of hypertonia in cerebral palsy by Nickolas Nahm et al., Current Opinion in Pediatrics, 2018.
This article is a review of the treatments available to treat hypertonia. Though these treatments are specific to cerebral palsy patients, many apply to other children and adults who suffer from hypertonia. These treatments include botulinum toxin (Botox) injections, baclofen, and rhizotomy surgery. According to the authors, the best course of treatment depends on the patient and their goals.
“Neonatal hypertonia–a diagnostic challenge” by Anthony Hart et al., Developmental Medicine & Child Neurology, 2014.
This study is one of the most comprehensive overviews of the diagnosis of newborn hypertonia. The authors present a diagnostic approach in the form of a flow chart to help healthcare providers in the difficult process of diagnosing this condition. Diagnosis is based on family history, medical history, and current symptoms. For each possible diagnosis, the authors diagram the corresponding age of onset, symptoms, and what to test for.
If you believe your baby was injured during birth, you and your child may be entitled to financial compensation from the healthcare providers or hospital that handled the delivery. If your child has a lifelong injury, this money can change the quality of life that your child will have.
Calling a lawyer may also allow you to find out what really happened to your child. At Miller & Zois, our birth injury and cerebral palsy lawyers have many years of experience handling these cases. Call the birth injury lawyers at Miller & Zois at 800-553-8082 or get a free online consultation.