If your child is having trouble reaching certain developmental milestones, hypotonia may be to blame. A child is said to have low muscle tone — hypotonia — if muscles are on the loose, floppy side, says Danielle Keeton, MACCC-SLP, director of Le Bonheur Early Intervention and Development.  Children with low muscle tone often have delayed motor skills, muscle weakness and coordination problems. 

Hypotonia is often associated with diagnoses like Down syndrome, Hypothyroidism and other genetic or neurological impairments. This type of hypotonia is more easily identified. However, mild hypotonia, often noticeable to parents, may not be noticed by others.

The research is also mixed about the effectiveness of intervention for children with only mild hypotonia. Some pediatricians may prefer the “wait and see” strategy, while others may seek evaluations by professionals, like physical therapists.

As a parent, it’s always important to trust your instincts.  You know your baby better than anyone else and can have a “sixth sense” when something just doesn’t seem right. 

Early motor milestones to watch for include:

By 3 months

• Lifting head and chest while lying on tummy
• Wiggling and kicking arms and legs

By 6 months

• Sitting with only a little support and holding head steady

By 12 months

• Crawling on hands and knees
• Pulling up to stand and moving around while holding on to furniture

By 18 months

• Walking without any help
• Running stiffly with eyes focusing on the ground

By 24 months

• Bending over to pick up toys without falling over
• Walking up steps without help
  

If your child’s floppy muscles are creating delays in early motor milestones, it may be beneficial to obtain an evaluation from a professional. An evaluation can provide you with a piece of mind; even if you discover during the process that there was nothing to worry about. You can discuss your preference for an evaluation with your pediatrician and can also contact the local early intervention system. Each state has an early intervention system for infants and toddlers that can assist you in finding a professional to evaluate your child’s condition. 

Danielle Keeton, MACCC-SLP, director of Le Bonheur Early Intervention and Development (LEAD), weighs in on the topic of selecting a child care center and offers some helpful tips for parents below.

We’ve all heard that nobody’s perfect.  This rule is true when it comes to child care. Somehow as parents, we do expect perfection, and – for good reason – we trust them with our precious little ones.  Parents know that early learning experiences shape child development, so choosing a child care center for your child is an important decision – and one that’s often filled with anxiety. Parents have so many questions and want to make the best choice.

Learning what makes a “high-quality” child care can be overwhelming.  To simplify the standards it helps to understand childcare licensing.  Child care is divided into three categories by the Tennessee Department of Human Services (DHS):

• Family child care home – for five to seven children
• Group child care home – for eight to 10 children
• Child care center – for 13 or more children

Some parents prefer the home environment, while some prefer the center environment.  Parents should visit both to see which setting may work best for their individual needs.  Once you know the type of child care environment you are looking for and the general area or zip code, you can contact a support agency like the Shelby County Child Care Resource and Referral (CCR&R). The Shelby Co. CCR&R is part of Le Bonheur Children’s Community Health and Wellbeing division, and it helps parents narrow down choices from the more than 800 licensed child care providers in Shelby County to a select few that meet your family’s needs.  Once you have your short list, here are a few guiding rules:

Visit early and often.
Make a drop-in visit during morning hours, when most kids are awake.  The drop-in visit (just show up at the door and knock) is the best way to see what happens when no one is looking.  Schedule a time to come back later for a formal tour and meeting with the director and teachers. 

Ask anything and everything.
Ask about rating, credentials and accreditations.  The Tennessee DHS uses a star-rating system to rate the quality of centers that it licenses.  Centers can receive up to three stars, with three being the highest rating.  The National Association for the Education of Young Children (NAEYC) offers a national accreditation for child care centers.  The NAEYC accreditation is the gold standard for the highest quality child care.  The National Association for Family Child Care (NAFCC) offers a similar certification for home-based child care.

The Tennessee DHS has created a very helpful workbook with more questions than most parents can imagine. Just download, print and take with you to the tour or meeting.

Trust your intuition and your child.
You know your child better than anyone else.  A center may have the highest ratings, most prestigious accreditations, most credentialed staff and still, something’s just not right. Trust your parental instincts.  If your child is old enough, involve them in the decision process. Children are typically very intuitive and gravitate to environments that are welcoming and friendly.