Other features of Prader-Willi syndrome appear during early childhood and remain throughout life, requiring careful management. In females, the clitoris and labia may be small. The testicles may be small or not descended from the abdomen into the scrotum (cryptorchidism). Males may have a small penis and scrotum. A baby may seem unusually tired, respond poorly to stimulation, have a hard time waking up or have a weak cry. Poor sucking makes feeding difficult and can result in failure to thrive. Infants may have a poor sucking reflex due to decreased muscle tone. Children may be born with almond-shaped eyes, a narrowing of the head at the temples, a turned-down mouth and a thin upper lip. Babies may rest with their elbows and knees loosely extended instead of fixed, and they may feel floppy or like rag dolls when they're held. A primary sign during infancy is poor muscle tone (hypotonia). Signs and symptoms that may be present from birth include: Symptoms may slowly change over time from childhood to adulthood. Signs and symptoms of Prader-Willi syndrome can vary among individuals.
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