What to Know about Low Muscle Tone in Infants and Children

Low muscle tone, or hypotonia, is a term to describe the resting state of your child’s muscles

Low muscle tone happens when the length of the resting muscle is slightly longer than normal, so this means that the muscle will require more force to contract. Low muscle tone is characterized as a floppiness in the muscles and/or your child might have extra flexibility in his joints. Although you cannot change muscle tone, you can work on strengthening exercises to make your child stronger, meet milestones, improve posture, and improve endurance for play, sports, and school!

Low muscle tone might be diagnosed during a newborn exam, infant well checks throughout the year, or later in a child’s life, all depending on the severity of the muscle tone and how it is presenting.

For example, a baby with low muscle tone might have decreased head control and sitting balance that might not be “noticed” until it is time to start solids. Or a baby with low muscle tone might take a longer time to crawl. With children, a child with low muscle tone will present with decreased endurance for playtime, sports, or school, or may sit with poor posture.

If you believe your infant may be experiencing low muscle tone, you might see:

• Child feels limp when lifted (like a rag doll)
• Child has increased flexibility/relaxed joints
• Delay in gross motor milestones such as rolling, sitting, crawling, walking
• Tires easily/decreased endurance during play
• Decreased functional strength
• Decreased head control after 3 months

If you believe your child may be experiencing low muscle tone, you might see:

• Child is limp when lifted (like a rag doll)
• Child has increased flexibility/relaxed joints
•  Delay or decreased coordination with  such as throwing, catching, running, skipping, galloping  (Delays in gross motor milestones)
• Tires easily/decreased endurance during play, sports, and school
• Decreased functional strength 

Low muscle tone can be associated with various syndromes and diagnoses. However, it also can be present in a child without any other diagnoses, in which the cause is unknown.

When an infant has low muscle tone, it can affect the infant’s endurance for playtime, achieving fine and gross motor milestones, and may have difficulty feeding. It may also be difficult for him to participate in everyday tasks and activities at home and school. This can be frustrating for a child as he grows and realizes that his siblings or other children can do certain skills or activities that he has difficulty with.

Strengthening muscles, specifically the muscles that stabilize your child’s shoulders, hips, and core, can help give your child more stability for various tasks and activities. Depending on the severity of the muscle tone, some children can eventually catch up to their peers with some strengthening.

Exercises/activities for your infant with low muscle tone:

1. Lots of tummy time! Work on tummy time in small increments as you build endurance and tolerance in your baby. You can do tummy time propped up on a pillow to give your baby more support, on a floor mat, or on the caregiver’s lap or chest.

2. Work on reaching for toys in different positions such as lying on their back, belly, side, and sitting/standing (once developmentally appropriate).

3. Once your baby is crawling, continue to encourage crawling on different surfaces and areas— hardwood, carpet, grass, over pillows, up stairs to strengthen core and arm muscles.

4. Once your baby is standing/walking, encourage lots of walking on various surfaces and lots of reaching and squatting for toys to strengthen the core and hip muscles.

Exercises/activities for your child with low muscle tone:

Gross motor activities:

1. Bounce on a therapy ball. This activity requires the help of an adult to stabilize the child as they sit on the ball. The adult can then bounce the child up and down, and gently roll the ball side to side, and front to back to further challenge the child’s core muscles to stay upright.

2. Animal walks. Children can move like different animals such as a crab walk (moving on hands and feet with bent knees/elbows with belly button facing the ceiling), bear walk (moving on hands and feet with bottom in the air), snake crawl (belly crawl), bunny hop (two-footed hopping).

These movements require your child to use different positions and different muscles and provide weight-bearing input to your child’s joints.

3. Tug of war. A gentle pull on a thick rope will engage your child’s core and hips. You can hold the same rope or toy as your child as long as they have a good grip and take turns pulling backward for 10-15 seconds or as long as your child can tolerate. Just make sure they have pillows behind them for a soft landing!

4. Laundry. Have your child push and pull the laundry basket around the house! You can fill the laundry basket with some books or toys to add resistance, all to your child’s tolerance! This activates the core and provides good weight bearing to your child’s joints.

5. Play with a ball. Any type of throwing, kicking, hitting, catching game will help your child work out their bodies. Give a whole lot of encouragement, too, since often kids with low muscle tone may not be the most coordinated. However, in this instance, it’s not about catching or hitting well, it’s about making it fun to work out.

Fine motor activities:

1. Scrunching, ripping, balling up paper. Hand exercises are just as important for a kid with low muscle tone as the big muscle workouts are. Writing and drawing are often harder for kids with low muscle tone, as the activity of sitting up can be a challenge, as well as the act of holding a writing instrument

2. Watering the flowers with a spray bottle. Again, hand exercises are so important so your child can build those muscles that will make schoolwork easier. The act of squeezing a spray bottle will help make their hand muscles stronger.

How therapy can help

Children with low muscle tone may need a variety of therapies to help them reach their potential.

Occupational therapy can help your child with low muscle tone work on their handwriting abilities, daily self-care skills, feeding, and general strength and coordination.

Physical therapy will help your child work on gross and fine motor milestones they may be lagging in. This includes muscle strengthening, functional skills, and any other physical delays a child with low muscle tone struggles with.

Speech therapy is sometimes needed because the muscles in your child’s face may also need toning and strengthening.

At Lumiere Children’s Therapy, we develop a multi-therapy specialized plan specifically for your child. As you can see, children with low muscle tone often need several types of therapy. Call us today for an evaluation and check out our website for details on how we can help your child!