Opinions please on ds's hypotonia

Hi all,
My ds is 12.5mo and is my 3rd baby.
I am seeking some honest opinions from experienced paed physios about how he's going, the kind of Rx he is currently having and what to expect down the track.

Ds sat at about 6-7mo, did plenty of tummy time prior to this, however didn't really roll intentionally...more accidentally from front to back a couple times. No issues really, very similar in development to my first two dd's.
By 8-9mo I was noticing that he wasn't really making much progress towards anything else, but tried to just relax. (My two dd's crawled at about 10mo, walked about 13-14mo.)

By 11mo I decided I probably should start the ball rolling. I was concerned that he wasn't making any attempt to crawl and also that he couldn't go from lying to sitting. He wasn't mobile at all, no bottom shuffling etc. The only thing he could do was extend his arms and glide a tiny bit backwards. So I got onto a waiting list for paed PT at a big teaching hospital. First appt was last week.

PT didn't really do any kind of formal eval that I could detect, more just observation with minimal handling. She noted that he had some mild low tone round his trunk and pelvis. Commented he was sitting very straight though, challenged his balance in all directions, commented he has a very wide/ far reach and tends to ring sit a fair bit (wide base).
She said tone was within nomal limits and gave me 3 basic things to do:
-get him to reach thru diagonals as far out as possible
-practice getting from supine-> sitting via side lying
-practice 4 point kneeling with some gentle rocking

She didn't appear concerned and to see her again in 3 wks.

Other info on ds:
-vocalises well, at least 8-10 words
-happy and bright, cognitively "with it" (smiles, laughs etc)
-no issues at all with feeding, eating etc
-started taking weight thru legs at 11.5mo, prior to that he wouldn't...now does it strongly and can do it unsupported, but unsafe with sitting back down/ falling
-not attemtping to cruise but will reach as far as possible in standing

-after a week of exercises, is starting to bounce on bottom and rock forwards independently to taking weight on hands and one knee (from a sitting position)
-can maintain 4 point kneeling (couldn't do this 2-3 weeks ago)
-is pivotting 180-360 degrees to change directions while sitting (by moving his legs to the side)
-is pivotting a lot more when on his tummy and starting to glide around, moving up to 1 metre or so but not commando crawling as such

What I would like to know is this:
-is his low tone really mild or should I be more worried?
-is he likely to move along fairly quickly to being able to cruise and walk soon without appearing outside "normal" bounds?
-when do you start worrying and looking to see paediatrician, neurologist etc?
-he still doesn't seem to be making much progress with supine-> sitting...hates coming thru side lying and can't push up onto elbow...I really feel he should be able to do this at >12mo...
-should he be having more Rx eg ballwork, more hands on therapy etc?
-should his Rx be more frequent to get more progress?

Thanksyou so much if you've made it this far and I would appreciate any thougths/ opinions!!

Anybody?? (-:

dear colleague,
I have found that the way children are treated is different in every country. Have experience (30yrs) working with kids in holland germany and spain ( and am a mum too). The way children are handeld varies per country.I also know a bit about the situation in aussie because I lived there as a kid.

One of the big differences between north and south european cultures ( and assuming that the people and life in the usa nz and aussie are similar to n. europeans ) is that in the south the children ( babies) are handeld the whole day. They are hardly ever in their beds, being carried around over shoulders, on arms, from one person to the next and falling asleep in all kinds of postures and places.
From day one they get a lot more sensory stimulation that children who are fed, get a new nappy and, after a little play and tummmy time, are sent back to bed again. ( a child needs rest is the assumption) .I have not seen many children with a positional plageocephalia here in spain, is not as common as it is in most of our countries.

If you send me your email address I will send you some information on motor development and especially the variation possible ( Prechtl). Prechtl stated that the range is motor variation is even greater than the normal motor variation stated in the AIMS manual ( alberta infant motor scale- the test for motor development ).

You still have many questions and you have every right to ask.
Hyponia is not easy to assess, and yes it is normal practise to observe children as an assessment. The quality of their movements, the possibilites they have to shift weight gives a reasonable impression.... AND...it always takes a while to get to know a child.
Your therapists first impression was probably very right..... changing weight is the first motor step to actually move.

I would strongly suggest you ask your therapist for more background information as well. You can also ask her what her idea is about the development and if you should see the paediatrician as well.
One of the things I have always said to all my patients ( the parents that is ) is that if you have a feeling that something is wrong, you might be right, so get it checked.

Suggestions:
what I normally say to all parents is.... give your child a lot of safe moving experiences....
ask an extra appointment with your physio to get ask all the appropriate questions because you sound worried....

NB 1 - My oldest son was born with a very big head on a long thin body... It took him a lot longer to raise his head and his motor development was slow. The people around me were a lot more worried than I was and I would get lots of comments such as.......
oh ! he isn´t crawling, getting up, sitting up etc etc all the time. These things can really get you worried. I would have to keep explaining that I knew nothing was wrong.
NB 2- I once treated a little boy ( the 5th in that family) who was not developing much as all. THE reason was that he was getting his way all the time.. if he wanted to have something, his bros and sisters would get it for him and he had learn early in life that all he had to do was to "ask" and he got everything delivered.... no reason to move at all, he could be moved if he so wished...!! You can understand he didn´t like me at all... I was forcing him to work himself and he fully udnerstood this.... it didnt take long for him to catch up.... there was actually nothing wrong with him at all...

If you send me an email. I will send you the information.
kind regards
esther
[email protected]