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Motor Milestones

Does My Child Have Low Tone?

Dr. Allison Mell, DPT
December 29, 2022
Does My Child Have Low Tone?

It’s the end of a very long day. You finally got the kids into bed, folded a pile of laundry, and cleaned up from dinner. Now you’re finally ready to sink into the softness of your couch, curled up in your Comfy. Just then, your toddler comes down absolutely parched like no child ever before and desperately needs your help, forcing you to recruit all your mental and physical energy to get up off that comfortable deep sofa.

The energy it takes to get up in that moment is just like the energy our low tone kids (and adults) need to exert for all of their movements. Why is that? Do they just get tired more easily?

Well, yes and no. Hypotonia, or low muscle tone, means that the muscles have lower than normal tension at rest, or in other words, are not in an optimal position to start with. This lack of tension is similar to a stretched out rubber band. Low tone muscles need to recruit extra force to do the same job as muscles with normal tone.

So how do you know if your child has low tone?

Hypotonia can be difficult to assess because it is really measured subjectively. It’s not the same as measuring height and weight. A professional can assess tone by moving the muscles passively and feeling the amount of resistance the muscles give. Parents at home wondering if their child has hypotonia should speak with their pediatrician or physical therapist. But the best way to determine if there is any concern at all is through your child’s movement and function.

Here is a list of questions to consider and pay attention to throughout your child’s day:

  1. Is my baby motivated to move?
  2. Is my baby meeting milestones within the typical time frames?
  3. Does my baby feel very “floppy”?
  4. Does my toddler drool excessively?
  5. Does my toddler have difficulty chewing tougher foods?
  6. Does my child struggle to climb and run at the same speed and with the same endurance as other children?
  7. Does my child struggle to complete fine motor tasks like buttoning shirts, coloring for long periods, or writing because the muscles just don’t seem strong enough?
  8. Does my child struggle to stand in place-always needing to lean against a wall or asking to sit down?
  9. Does my child often sink into a “W” position while sitting?
  10. Does my child have pronated feet (flattened arch)?
  11. Does my child complain of feeling tired after only small periods of movement?

The description of “feeling very floppy” is a common one used by parents of their children with hypotonia. Because it takes more effort to get their muscles going, these children aren’t as motivated to move because it’s just easier not to. This usually leads to a delay in meeting milestones within the typical time frames. You may have also noticed that tone can affect not only the large muscles of the body, but also the small muscles of the hands and even the muscles in the face. A child can also have lower muscle tone in certain areas of the body and normal muscle tone in others.  

Is there a reason my child has hypotonia?

Many parents ask if hypotonia is a sign of an underlying condition. Sometimes it is, but it can also be a diagnosis all on its own. It really depends on the individual and should be discussed with your doctor. There is also a range in the degree of low tone you may see from mild to more severe as seen in diagnoses like Down Syndrome.

Now you might be wondering… will my child with low tone have to deal with this forever?

Well, yes and no. Tone doesn’t change. A child with low tone will become am adult with low tone. However, strength, and as a result function, absolutely can change. The best way to support your child is to help increase the strength of the muscles in order for  movement to become easier. So, while the tone we are born with is the tone our muscles will have all our lives, strength in the muscles can change. More strength will compensate for low tone making it easier to move and have better endurance with physical activities.

For babies, this means motivating your baby to move through pivoting, rolling and reaching. More weight bearing through the arms and legs during crawling will help strengthen the core, arms and legs. Toddlers and older children can be encouraged to do obstacle courses, scooter board races, yoga, walking on uneven surfaces like sand, swimming, swinging, and climbing. These activities may not come easily to our low tone kids- they might even be the exact activities your child wants to avoid- but with continued exposure, encouragement, and help from you, they can build strength to improve their function and quality of life.  

Here are some tips to improve function:

Big Muscle Groups: Strengthening strengthening and more strengthening! Negotiating playground equipment, holding yoga poses, climbing up and down stairs, running, and going through obstacle courses are great ways to strengthen the body's large muscle groups in a fun way to compensate for low muscle tone.

Feet:  Orthotics can be extremely helpful to children with low tone who have moderate to severely pronated feet (flat feet). Because the feet are literally the foundation of our bodies, we need stability in those joints. If your child is having difficulty with gross motor skills, seek out the guidance of a local PT and orthotist to determine if orthotics would be helpful. We have seen incredible results.

Hands:  Playing with resistive materials like play dough, putty, and slime can help strengthen the hand muscles. Squeezing tongs, cutting, gluing, and other craft projects can be a great workout for all the intrinsic hand muscles.

Mouth: Drinking out of a straw, chewing hard or chewy foods like pretzels or granola bars, and blowing bubbles are all good strengthening exercises for the mouth muscles to improve drooling and difficulty eating. A consultation with a speech therapist can also be super valuable!

Bottom Line:

Hypotonia is a congenital condition that may or may not be related to an underlying diagnosis. Low tone muscles are those that have less than normal tension at rest and need to recruit more energy to fire than muscles within the normal range of tone. This results in difficulty activating the muscles for gross motor, fine motor, and oral motor movements. Children with low tone are often delayed in meeting milestones, aren’t as motivated to move, and fatigue quickly. While hypotonia is a lifelong condition, increasing strength in the affected muscle groups can help improve function. And the most effective way to build strength in children is through play!  

Have questions about low tone and how to help your child? Join my membership for lots of great activities to develop strength from birth to kindergarten+ !

You can also pop onto my weekly Live Q & A's where I’m available to answer any of your personal questions inside the membership!

Dr. Allison Mell is the founder of Tots on Target and a physical therapist based out of New Jersey.

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