Contradictions of Low Muscle Tone

You’ve been told by your pediatrician that your child has hypotonia, otherwise known as low muscle tone.  You then did some research, asked some good questions, and found that children with low muscle tone can also be very strong. To most people this seems like a confusing contradiction – “How can my kid have low tone but actually be strong?”

Let’s start with the basics: muscle tone is defined by the amount of tension in our muscles when they are at rest. However, when muscles are at rest, they don’t just completely turn into mushy blobs, as there is always some level of activity going on. Squeeze your inner thigh where there is some fat. It’s squishy, right? Now squeeze one of your calf muscles. It feels firmer, correct? That firmness you notice is the passive muscle activity going on that you don’t find in fat – that firmness is your muscle tone.

It’s easy to detect differences in muscle tone in babies, because babies are generally not very strong human beings yet. When you pick up some babies, they feel sturdy and solid. These babies have higher muscle tone. It doesn’t make them better or worse than any other baby out there.  It’s simply their state of being. Some babies feel “floppier” when held, and those babies fall to the other end of the spectrum, displaying classic lower tone. Again, it’s not a good or bad thing – it just is. So, here’s the hook:  since tone only describes a muscle when it is inactive or resting, it is quite possible for a child with low tone to still be very strong when they exert themselves and activate their muscles.

Due to variances in normal human physiology tone of a variety of levels can be considered typical and appropriate. Less commonly, and often associated with a neurologic diagnosis such as Cerebral Palsy, a child can have high muscle tone outside of the typical range.  More commonly, and often not associated with anything in particular, a child can have low muscle tone outside of the typical range.  It should be noted that these muscles with less tone tend to stretch further, meaning that children with low tone are often more flexible than the average kid. Our muscles also provide a certain level of stability and integrity to our joints. When those muscles have less tension, the joints are less supported by resting muscles. This means that a child must activate those muscles to get the same amount of joint support that a child with higher muscle tone gets by doing nothing at all. Children with low muscle tone have to work harder to stabilize their joints and move against gravity. This is why children with low muscle tone can be delayed in motor, feeding, and verbal skills (don’t forget that your lips, cheeks, and tongues are muscular as well).

As a pediatric physical therapist, parents often ask me, “Will my child outgrow low tone?” and my answer is always the same: yes and no. No, because tone is something that is specific to each person’s own nervous system that simply won’t change. But I’ll also reason yes, it will change over time to most eyes, because the low tone recognized as an infant will become less prominent as children age and their strength, coordination, and muscular endurance improve.  So as a child with low tone naturally becomes stronger and more coordinated as they age, low tone becomes less and less of a barrier and less and less noticeable.

So, what can you do to help your child with low muscle tone? While any sort of physical activity will benefit your child, there are some specific activities that are especially great for children with low tone.

Swimming

Water does a few wonderful things for children with low tone. This is an activity that you can start when a baby is only a few months old, and it will benefit a child with low muscle tone throughout their development. Due to the buoyancy of water, it eliminates some of the weight of gravity. If a child is struggling to move against gravity, water is a great place to practice. Water also “pushes” a child around a bit as it moves. This encourages increased practice controlling their posture. Water tends to relax most children. This is especially important, because it is common for children with low tone to stiffen up in attempt to support themselves. Finally, in order to move around in water, almost every muscle in the body must work, thus encouraging strength building. There are a few flotation devices that can help a baby or toddler with low muscle tone in the water. An “aquatic neck ring” is a great device for babies, and it can be purchased online. Two common brands and varying prices worth looking into are Waterway Babies and Otteroo. In a neck ring, the baby is able to float comfortably with their entire body below the surface of the water and use their arms, legs, and trunk muscles to move about. For toddlers, a Puddle Jumper is a preferred option. These devices can be found online and via most major chain stores. Puddle Jumpers are coast guard approved and they encourage maximal movement and strengthening the water. That said, always directly supervise your child whenever they’re playing or working in the pool for safety’s sake.

Gymnastics

Many gyms and local park districts offer gymnastics classes, including parent-tot courses, starting around 18 months old. Gymnastics encourages muscle strengthening, endurance building, postural control, coordination, and balance. For young children under five years old, a typical gymnastics class will include climbing and playing in a foam pit, which requires use of almost every muscle in a child’s body. Children will learn to perform forward rolls, which encourages abdominal activation. Walking on a balance beam requires postural control, support of the trunk, and narrowing of their base of support to challenge their balance. Time spent on a trampoline will facilitate leg strengthening and assist with achieving jumping if they have not yet mastered this skill. On bars, children will be encouraged to support their body weight through their arms, activating the shoulder girdle, pectoral muscles, and abdominal muscles. Swinging on the bar strengthens their grip as well. Gymnastics also encourages body awareness so that a child can become more mindful of where their body is at in space.

Play at home

There are some games that you can play with your child at home to encourage overall improved strength, stability, and body awareness.

  • The take-home message of this story is that your child with low muscle tone can achieve great physical stamina, strength, and endurance. It just might take a little extra time and effort. Low muscle tone is a passive state of being that has no bearing on what your child’s muscles can do when they kick into high gear. Swimming, gymnastics, and the above listed at-home activities are just small selection of activities that can help your child achieve a strong physical status. A great place to get them started is by attending our monthly Respite Night held at our Highland clinic. 
  • Animal walks: have your child try walking like a crab, bear, frog, flamingo, you name it!
  • Fly like superman while lying on your belly, and lift your arms and legs off of the ground. Also try swimming on the ground by kicking your legs and swinging your arms.
  • Instruct your child to make a bridge by lying on the ground with their feet flat and knees bent. Have them lift their bottom up off of the ground, and drive cars underneath to encourage holding this position.
  • Fill a large bag or a laundry basket with heavy items, and encourage your child to both push and pull it around the house. Do races with siblings to add an extra challenge.
  • Play with bubbles. Have your child lay on their back. Blow bubbles above their legs and encourage them to lift their legs to pop the bubbles with their feet.
  • Do wheelbarrow walks. Adapt by holding your child at their hips, thighs, or knees if holding them at their ankles to too difficult.
  • Explore kiddie yoga.

And now that you are more cognizant of the “low muscle tone” contradiction, you’re equipped to better help your child build that ever-important strength to grow, learn, and ultimately be happy and confident when out and about with both friends and family.

Written By: Cyndi Stedman