I’ve been told that my child has ‘Low Tone’…What now?

Many parents ask the question about what it means when they have been told that their child has low tone. What exactly does this mean? Can low tone change? What is all this talk about their core strength? Does this affect them in daily life?

Here are the answers from an Occupational Therapy perspective… Let’s start with what muscle tone is. Muscle tone is the tension or contraction which a muscle has even in a resting position. A normal muscle tone will feel slightly ‘springy’ when the muscle belly is pressed. For example, when pressing into the middle of your bicep muscle, it feels firm but has a small amount of give before bouncing back. Our muscles are challenged throughout our day as we move, change body positions, and increase the demand on our muscles through speed of movement, control, and strength for various activities. If you have been advised by your child’s Paediatrician, Physiotherapist, Speech Pathologist or Occupational Therapist that your child has low tone, they are referring to the tension your child’s muscles hold, and they may refer to it as Hypotonia. Hypotonia can look like the following:

The reason some children have low muscle tone is generally unknown. However, low muscle tone can be the result of trauma, environmental factors, or genetic, muscle, or central nervous system disorders. It is often seen in people living with Down Syndrome, Cerebral Palsy, Muscular Dystrophy and Autism Spectrum Disorder to name a few.

Low muscle tone cannot be changed. However, it can be strengthened. This is confusing right?! There are many mixed messages when you google low muscle tone and if and how it can be remediated. What is important to know is that muscle tone is different to muscle strength, tone is the general activity the muscle has when resting versus strength being the force a muscle has when placed into resistance. As OTs, we can assist your child to build their muscle strength and adapt their approach and environment to support them in daily activities even when they have low tone.

Preparing their body for everyday activities such as play and learning at school. We will use warm up activities such as animal walks, jumping on the trampoline and using a scooter board to help them establish and remember an optimal posture in preparation for seated activities. As OTs we love these interventions because they are fun but also support the child in developing their core strength…. That phrase again, what is it? Core strength is building the muscles in the torso, abdominals, upper back and lower back to have a base of support to build our gross motor (ball skills, hopping, running, skipping) and fine motor strength and skills (holding pencils, drawing, writing and manipulating small objects). By building core strength we also help our children in building a good posture for when they are required to engage in seated activities such as writing tasks at school and sitting at the dinner table for a meal with the family. To further support this we also recommend adapting the activity and seating for your child. Having an appropriate sized seat for the child will look like they can bend their knees at a 90 degree angle at the front of the seat, their bottom is at the back of seat with the hips at a 90 degree angle and their forearms are comfortably resting on the table. Providing a wedge or cushion for them to sit on, ensuring their feet are flat on the ground or provide a small step for them to place their feet on are compensatory ways to further support their posture whilst seated but build their core strength at the same time. Other strategies can include changing body positions to help reduce fatigue for a child with low muscle tone, such as encouraging them to lay on the floor on their stomach for an activity in the classroom.

There are many ways to assist children who have been described as having low muscle tone (hypotonia) and many strategies will be used by your child’s Occupational Therapist. The question that is important to ask your child’s OT is how you can support your child to continue to build their core strength and posture and manage fatigue in between Occupational Therapy visits within their everyday activities.

The Royal Children's Hospital Occupational Therapy department 2018, ‘Kids Health Information: Low muscle tone, accessed 21 May 2020 ,< https://www.rch.org.au/kidsinfo/fact_sheets/Low_muscle_tone/>.

Atchison, B & Diane Powers Dirette 2012, Conditions in occupational therapy: effect on occupational performance, Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia.

National Institute of Neurological Disorders and Stroke, 2000, ‘Hypotonia Information Page’, accessed 21 May 2020 , <https://www.ninds.nih.gov/Disorders/All-Disorders/Hypotonia-Information-Page>.