Muscle & Motor Challenges in Opioid-Exposed Children: What Every Caregiver Should Know

When people think about the long-term effects of prenatal opioid exposure, they often think about learning, behavior, or attention. One area that is often overlooked is muscle and motor development.

Children with prenatal opioid exposure may be more likely to experience differences in muscle tone, movement, coordination, and motor skills. These challenges can affect everything from feeding as an infant to writing, playing sports, getting dressed, and participating confidently in school.

As with all of the symptoms in the constellation, not every child will experience these challenges, but they are more common in opioid-exposed children.

Muscle Tone Conditions

Hypertonia (High Muscle Tone)

Hypertonia means a child's muscles are tighter than normal. Their muscles stay contracted even when they should be relaxed.

Children with hypertonia may:

• Feel stiff when you pick them up

• Have difficulty moving their arms or legs freely

• Resist stretching during diaper changes or dressing

• Walk on their toes

• Have trouble with smooth, coordinated movement

In babies, hypertonia can make everyday tasks surprisingly difficult. Some caregivers describe struggling to get a baby's arm through a shirt sleeve because the shoulder muscles are so tight.

Hypotonia (Low Muscle Tone)

Hypotonia is the opposite of hypertonia. Instead of being too tight, the muscles are less firm and provide less support.

Children with hypotonia may:

• Feel "floppy" when held

• Tire easily

• Have delayed milestones like sitting or walking

• Struggle with posture

• Have difficulty with balance

For infants, low muscle tone can also affect sucking and swallowing, making feeding more challenging.

Torticollis

Torticollis occurs when the muscles on one side of the neck become tight, causing a baby's head to tilt or turn to one side.

Signs may include:

• A consistent head tilt

• Preference for looking one direction

• Difficulty turning the head equally both ways

• Flattening on one side of the head from always resting in the same position

The good news is that early physical therapy is often very effective, especially when started in infancy.

Motor & Coordination Challenges

Gross Motor Delay

Gross motor skills involve the large muscles used for movement. A child with a gross motor delay may take longer to:

• Roll over

• Sit independently

• Crawl

• Walk

• Run

• Jump

• Climb stairs

Some children eventually catch up, while others continue to benefit from physical therapy as they grow.

Fine Motor Delay

Fine motor skills involve the small muscles in the hands and fingers.

Children may have difficulty:

• Holding a pencil

• Using scissors

• Buttoning clothing

• Zipping jackets

• Using utensils

• Building with small blocks

• Writing neatly

Fine motor challenges often become more noticeable once children enter school.

Poor Motor Planning (Dyspraxia)

Motor planning is the brain's ability to figure out how to move the body to complete a task.

A child with poor motor planning may:

• Know what they want to do but struggle to make their body do it

• Learn new physical skills more slowly

• Have trouble copying movements

• Seem awkward during sports or playground activities

• Need extra practice with everyday tasks

In other words, despite the child’s effort, the brain struggles to organize movement.

Poor Coordination

Coordination challenges can affect many everyday activities.

Children may:

• Trip frequently

• Bump into furniture

• Drop objects often

• Have difficulty catching or throwing a ball

• Struggle to ride a bicycle

• Appear clumsy compared to peers

These differences can affect confidence as much as physical ability, especially in school or team sports.

Cerebral Palsy

Research is continuing to explore the relationship between prenatal opioid exposure and cerebral palsy. Current evidence suggests children with prenatal opioid exposure may have an increased risk, and this remains an active area of study.

Cerebral palsy is a group of movement disorders caused by differences in the developing brain that affect muscle control, posture, and movement.

Symptoms vary widely. Some children have very mild challenges, while others need significant support with mobility and daily activities.

Not every opioid-exposed child with motor difficulties has cerebral palsy, and many motor challenges occur independently of a cerebral palsy diagnosis.

Why Early Recognition Matters

Motor challenges affect much more than movement.

They can influence:

• Feeding

• Dressing

• Handwriting

• Play

• Sports

• Confidence

• Independence

• School participation

The earlier these differences are recognized, the sooner families can access therapies that help children build strength, coordination, and confidence. Earlier intervention can also lead to better long term outcomes.

What Can Help?

If you notice muscle or motor differences, talk with your child's healthcare provider about a developmental evaluation. Physical therapy (PT) and occupational therapy (OT) can play an important role in supporting muscle strength, coordination, movement, and everyday skills.

For young babies, opportunities for active movement—such as tummy time and being carried in an ergonomic baby carrier—can also help support healthy muscle development.