Learn more about low muscle tone (or hypotonia) and how you can support kids who have LMT.
Have you ever heard a child described by a health care professional or even a parent as a “floppy baby?” The medical term for this is low muscle tone (LMT) or hypotonia. LMT can be diagnosed at birth or later in life. The cause can be identified as an issue with the neurological or muscular systems or the cause can be unrelated to any other medical condition (benign congenital hypotonia). Low muscle tone can also be the result of a genetic condition.
How to tell when a child has low muscle tone
-tires easily and may appear lethargic
-has increased flexibility
-demonstrates poor reflexes
-has decreased strength
-may have speech difficulties
-shows decreased tolerance of activity or decreased endurance
-has a hard time maintaining static postures (sitting/standing)
-presents with global developmental delays
-often demonstrates w-sitting and/or slumped posture when sitting unsupported
What is muscle tone?
Muscle tone is the resistance of a muscle to active or passive stretch, or the overall stiffness of the muscle. Normal muscle tone serves three purposes.
1 || It assists in maintaining posture, or the resistance of the muscle to the forces of gravity. Muscle tone helps to ensure that the center of gravity is aligned over the base of support. In other words, it allows the body to maintain an upright posture in sitting or standing.
2 || Because muscle acts as a spring, it can store energy and release it at a later time. Why is this important? Think about how you walk. When a leg pushes off, some of the stored energy is released and helps propel the leg and body forward, thereby assisting the muscles that normally pull the leg forward.
3 || Muscle tone helps keep body movements smooth and fluid instead of jerky and uncoordinated.
What happens when children have low muscle tone?
Children with LMT expend a lot more energy and effort to move or to sustain a posture/position. Their movements often appear as if they are laborious and disconnected. It may take so much effort to crawl 5’ across the floor that, when they get to their destination, they can’t possibly hold their head up to see the toy they were going for. Or, in the case of a school aged child, the effort that it takes to swing a heavy backpack up onto her shoulders might be keeping her from being able to pick her feet up to walk down the hall without tripping.
What can we do to help kids with low muscle tone?
The first step in knowing how to address a child’s low muscle tone is to find out the pathology. This is a task best suited for a team of doctors who can determine whether the underlying cause may require more advanced medical treatment or if the child’s muscle tone will improve over time without any long-term effect on the child’s function.
Once the cause has been established, it is important to provide intervention to help a child maximize their muscle tone and adapt functional tasks as necessary to conserve energy as they get stronger.
Suggestions for children with low muscle tone
1 || Patience
Remember that a child with low muscle tone may not be able to do several repetitions of a strengthening exercise or may not be able to tolerate more than 2 minutes of perfect posture in a classroom chair. Patience and positivity are key!
2 || Warm up
Warm-up activities can improve a child’s endurance by helping to wake up the muscles and can help increase a child’s level of alertness body awareness.
3 || Consistency
Improving strength and muscle tone can be a long and slow process. It will not happen overnight and it will not happen without daily practice.
4 || Motivation
No one wants to do the same old, boring squats every single day! Make it a game to squat to retrieve the pieces of a puzzle. Have a wall sit competition between peers. Make exercises more like a game and less like a chore and the child will be more likely to adhere to a consistent program.
5 || Play Based Activities
6 || Weight Bearing Activities
Weight bearing involves the use of muscles against gravity. In this type of activity, muscle groups work together to support the bones as the body holds a position such as standing, propping up on your elbows in a prone position to play a game, or doing a downward dog in yoga. As a child is provided with more weight bearing opportunities, his movements become more and more coordinated and smooth and his bones, joints, and muscles become stronger and increasingly stable.
Jump on a trampoline, push a giant ball down a wall, crab walk, bear crawl….wake up those joints so that the child knows where her body is in space and can more effectively strengthen those muscles that stabilize and protect her joints.
8 || Think Proximal Before Distal
Improving core strength will inevitably improve a child’s endurance and the functional use of their extremities (arms/legs/hands/feet). This core strengthening exercise program is not only comprehensive but fun with QR codes included so a child can see videos of each exercise! Try playing games with the child in prone position (lying on his belly). Or, try playing in quadruped (all fours), where you can work on a child’s overall strength, balance and coordination and also the integration of reflexes!
9 || Provide Appropriate Support
Providing appropriate support in various work spaces (desk, alternative seating) is key. While a child is gradually working on improving overall muscle tone, it is sometimes important to meet them where they are and provide the necessary support so that daily functional tasks aren’t arduous and frustrating.
Consider alternative seating to provide adequate postural support in the classroom. Modify the weight of the child’s backpack by discussing with teachers the possibility of a child leaving some of his supplies in the classroom. Incorporate frequent rest or posture breaks that may include heavy work activities to wake the muscles back up. Establish a consistent, daily exercise program that can be done in short bursts to fit easily within a day (these Hallway Waiting Games are a great example of how to do that!) Finally, keep the lines of communication open between parents, teachers and professionals to maintain consistency and accountability.
What are your questions about low muscle tone? Ask away in the comments below!