9m old not sitting independantly

[greenmom17]

My dd just turned 9m yesterday, and I'm concerned about a few things. She can sit on her own, but will easily fall over - and not try to catch herself at all. She falls straight back and onto her face if we don't catch her.

She has learned to sort of bend herself in half - leaning forward, and swing her legs around to get onto her tummy. She can raise herself up on hands and knees and rock back in forth. She can support her weight for a bit when standing.

She's also hard to hold - she's floppy, doesn't hold on, and I really need both hands to hold her securely. Also when she's laying down, and we pull her hands to a sitting position it seems like her shoulder sockets pop out a bit?!

Would you be concerned?

She's also had excema and congestion with milk, symptoms cleared with soy. Not sure if it's related.


*cross-posted - life with a babe

[by-the-lake]

Never hurts to have a PT eval. It could be very enlightining and very helpful for you and your babe

[askew]

Sounds like my DD who has hypotonia. I would have EI evaluate for PT, just to see. We do PT and by DD loves it, and I have seen real progress with the sessions.

[sbgrace]

It does sound like low muscle tone. I would request a PT evaluation. If you're in the US in most states it is free through Early Intervention/Birth to Three/First Start whatever the name is in the particular state.

[greenmom17]

Thank you for the suggestions. Can hypotonia exist by itself, or is it always a symptom of something larger?

[by-the-lake]

Asking that question (a very good one, too), and you get so many differing answers. Even the 'experts' do not agree. IMO, since you asked I think it is only a symptom of something else. My DS was dx at 7 months with 'central hypotonia'. As time goes by, other things, mostly sensory, keep popping up. My DS stimms, is now showing speech delay and some social/self help delays. We also have not ruled out CP. I also question some metabolic stuff. I am going to ask more questions for sure at our neuro follow-up Friday.
Did you get ahold of Birth-to-Three or Early Intervention?

[sbgrace]

My son's geneticist told me he believes it is always something else (often metabolic when the cause isn't obvious) but that something may be minor in impact and we may not know enough to find it at this point in technology. In my son's case it mattered but he was sick in other ways by your daughter's age (he had severe reflux and was already failure to thrive month other things). He's doing well now in this area.

[greenmom17]

Thank you both! I have a 9m well check this morning with the ped. I've also discovered that the Landau reflex (think superman position) has not emerged or can't because of low core strength. Also worrisome is the parachute reflex - does not put down her left arm at all, only right (slowly).

My 4yr ds has SPD, verbal apraxia, GI/yeast issues and a host of other minor ailments which would add up to a PDD-NOS dx. He has low trunk strength as well. So I know it's a possibility that dd may follow that route, although she is very social.

Our appt. this morning can't come soon enough. I appreciate your thoughts and will update later.

Good to know about the metabolic cause as well, I've found that with most MD's YOU have to tell THEM what to test for....

[askew]

Hmm. Well my DD has the hypotonia from a brain injury. She is also on seizure meds that really exacerbate the issue. When you mentioned one arm not responding to the parachute reflex a red flag for CP went up for me. CP is just a blanket term for brain injury that effects movement, and it can often be very mild. I have a friend who's 4 year old was just diagnosed after many years of just being late on milestones and sort of clumsy etc. They kept pushing and finally got an MRI that showed damage, albeit small. If I were in your shoes I would push for a ped neurologist appointment and perhaps ask for an MRI just to rule out any brain issues. Good luck today!

[greenmom17]

Had her appt, growing well - 20lbs, 29". We were given a referral for an OT and PT evaluation. Came right home and made the appt. for Mon and Tues next week.

Ped said to do the evals first, then he will refer to a neurologist if the OT/PT think it is needed. I will push for a MRI or CAT to rule out any damage. I had a normal pregnancy, developed pre-eclampsia at 37w and she was delivered c-section 2 days later. 7lbs 14oz, healthy, apgars normal.

today when I was gently throwing her in the air saying "wheee!!" that her left arm only raises about half as much as the right.

I did notice that a hallmark of CP is asymetrical reflexes. That's hard to digest, I must be honest.

A tumor or mass in her brain could also cause an asymetrical reflex, but I'm not allowing myself to go down that road yet.

Dr. Google is a blessing and a curse. You can really make yourself sick with worry when you start researching things

Thanks again for your thoughts and suggestions

[sbgrace]

It's very hard to face possibilities. You're in the hardest part. Diagnosis, whatever they are, are a step toward acceptance and moving on emotionally. Not knowing traps you in the hard part. So as hard as it is facing this stuff now makes it easier over-all.

I'd want a neuro referral and I'd ask for it now in case there is a wait (likely there is). I'm not sure why the pediatrician felt OT/PT should be the ones to say whether or not she needed more testing. That's his job--they aren't doctors and ours wouldn't have made a medical type recommendation. In fact, some got in legal problems for doing just that with a child. It's outside the scope of their profession. Beyond that it is within the scope of the doctor's profession so I don't know why he thought to wait to get their opinion given the presentation.


Given your son I wanted to post metabolic information for you.
http://www.mothering.com/discussions...d.php?t=734501

[greenmom17]

SBGrace, thank you for your kindness. I'm gratefull to all the mamas who take time to offer hope and suggestions.

I'm going to make an neuro appt. tomorrow, knowing like you said, it will be a couple of weeks before we can get in. I can always cancel if needed.

Thanks again, much appreciated

[KCMichigan]

Both my DDS (now almost 5) were delayed in reflexes--they were preemies.

Both started PT at 15 moths.

DD1 has very very mild CP. She is fully walking, running, jumping, just clumsy and hits milestones late. She sat unaided at 10.5 months or so, walked at almost 18 and ran/jumped at 2+. We've done a lot PT/OT. She has trunk hypotonia as well and toe walked. MRI showed large frontal space w/ extra fluid (possible damage, but not clarfied) she has a very big round head (95+%tile)- we will not pursue another one unless changes are suspect.

DD2 had a CP dx, b ut it was changed when they found she had severe reflux. Her posturing/stiffness was due to pain and not CP as much. She did Pt/OT as a baby/toddler- but has had none since age 3. She still takes meds for it. MRI fine.

Cognitively they are smart as whips, fine motor is also not a problem. DD1 has some social delays/SPD on top of the mild CP.


Good Luck on your evals! Early Intervention is great and was very helpful to us, I cant imagine were my DDs would be without it. The are doing fantastic and I would not think that they struggled so much gross motorwise when they were younger!

[greenmom17]

Thank you KCMichigan. Sounds like your dd's are doing well!

My dd also has a 95th percentile head...hmmm. We are going ahead with a MRI, as well as OT and PT therapies. With asymmetrical reflexes and left side weakness (not severe, but still present), as well as right hand preference already (shouldn't be present till 18m), I would not be surprised if she receives a mild CP dx as well. I'm just glad we are able to start therapy quicky.

Thanks everyone

[by-the-lake]

Wow! That sounds like DS. His head is in the 95%, so we did the MRI. No extra fluid, but did see a cellebellar formation problem. We see developmental peds in late August...I am thinking a CP diagnosis too.
I see you are in PT and OT. Did you have her speech evaluated as well? My son is in PT, OT, and ST.
When is the MRI?

[loraxc]

FWIW, my DS was dxed with hypotonia and showed some asymmetric limb use at that age. He also showed handedness (right) very early. They were concerned about CP and he did have an MRI (normal) along with a host of other tests and a neuro consult. He was in PT for about 6 months and could not sit up at 9mo either, but when he got to be about a year it all came together and he actually walked at 12.5 months. He was discharged from PT and at 2.5 appears entirely normal except for hypermobile joints. No other delays have ever emerged, and in fact he is now ahead of where his sister was at this age in terms of gross motor skills. We still have no idea what was going on.