My child has been diagnosed with low muscle tone. What does this mean?

Who gets a diagnosis of low muscle tone?

An infant or child will get a diagnosis of low muscle tone when:

  • The muscles appear to be less firm than usual
  • The child appears to be floppy and to have loose joints
  • The child appears to be less alert and have poor posture and attention

For a more technical discussion please see Rethinking Low Muscle Tone

Often a child gets a diagnosis of low muscle tone because of one or more movement difficulties

  • May be late learning to sit and walk - but not always
  • Has trouble sitting erect and working at a table - tends to sit with back rounded, may lean on one hand when drawing and writing
  • Has difficulty sitting still, tends to fidget, does not complete school tasks
  • Has difficulties with handwriting and drawing 
  • May tire very quickly, not like walking far, have trouble going up stairs
  • May be good at games that involve short bursts of running, but have difficulty with posture in sitting, drawing and handwriting - these tasks require sustained activity in the postural muscles
  • Sit between legs on floor (w-sitting), does not like cross legged sitting
  • Appear to have poor attention span or concentration, gives up easily
  • Cannot hang on the monkey bars, does not like climbing on the jungle gym, is fearful

About the author

L 6m bouncing on lap 2.jpg

Pam is a physical therapist, university teacher and grandmother with a passion for sharing sound validated information with parents.  Read more


 

The first thing to understand is that low muscle tone is a not a condition or a diagnosis

Low muscle tone does not cause any of the behaviors or difficulties listed above.

Low muscle tone cannot be measured. Nowhere will you find a good reason for why your child has low muscle tone. You will also not find any effective treatment being described.

So what is causing my child’s movement difficulties?

Children who have been labeled as low toned usually have one or more of the following three underlying conditions:


None of these conditions can be cured. They are there for life

Hypermobile joints, difficulties with learning new skills and an anxious nature are all part of a person’s makeup. They are there for life. 
 

But here is the good news

Joint hypermobility does not stop a person from doing anything. It just means that you may need to work a little harder to get fit and stay fit. It is just a matter of training.

Children with joint hypermobility often have an anxious nature – so they need to learn about courage and overcoming the tendency to avoid difficult tasks.

Children with coordination difficulties are also able to learn new skills – it takes more time and patience and they may be a little slower at performing some tasks. Having an anxious nature is a challenge but children can be taught ways to deal with their fears and anxieties and not be tripped up by them.

 


Recognizing joint hypermobility

finger extension_0.jpg

Fingers that bend back to 90 degrees

wrist flexion_1.jpg

Wrist can be bent so that thumb touches the forearm 

hypermobile standing with elbows_0.jpg

Knees and elbows  bend backwards 

Hypermobile joints and tight muscles as a cause of movement difficulties

Sometimes joint hypermobility is missed because the child appears to have tight muscles. It is important to understand tight muscles is a common feature of joint hypermobility, especially in the muscles crossing the back and sides of the hips.  It is also important to understand that this muscle tightness if often an important underlying cause of some of the difficulties experienced by children with a diagnosis of low muscle tone. 

ben longsitting slumped.jpg w sitting.jpg sitting slumped hips abducted.jpg
Tight back and hip muscles affect sitting posture in children with joint hypermobility
 

Shifting from "Oh my gosh!" to "Lets get moving" 

Let’s go back to the reason your child was labeled "low toned".  Most probably there are age appropriate activities that your infant, toddler or child has difficulty performing. It may have been delayed milestones, difficulties with classroom or playground activities, drawing and handwriting or perhaps learning to ride a bicycle. Your child may have attention difficulties. 

The only effective way to overcome these performance difficulties is task based training which pays attention to muscle strength and flexibility, fitness and stamina, coordination, persistence and a sense of I-can-do-this.

This allows you as parent to make an important mental shift from a sense of “There is something fundamentally wrong with my child” to a more positive sense of “There are some things my child cannot do today – but with some training these difficulties can be overcome “.

 

   Visit the new 

Developmental Gym 

website 

All you need to know about movement skills training for infants and children

 

What can I as a parent do to help my child – starting today?

  • Make a list of your child’s strengths and weaknesses and discover that there is more that is right than wrong with your child.
  • Become very knowledgeable about task based training – and become your child’s coach. Read more

More about muscle tone

The term muscle tone refers to two aspects of muscles' structure and function.

  1. The inherent stiffness of a muscle - its resistance to being stretched and firmness when palpated (squeezed).
  2. A muscle's (or groups of muscles') readiness for action - the muscle's responsiveness to signals from the brain and to sensory feedback.

    The term low muscle tone is used when the muscles' stiffness is less than usual (ie it is low) and the readiness for action is also low (muscles respond slowly).


How is a muscle's firmness (tone) tested?

The clinician may make a judgment about a muscle's firmness and inherent stiffness by:

  • Squeezing the muscle to feel the resistance to compression
  • Lifting up and moving the limbs and feeling the resistance to this movement 

The trouble with these tests is that they are not reliable and do not provide any useful information.


What determines a muscle's firmness? 

The firmness of a muscle is determined by its inherent stiffness and this in turn depends on the stiffness in the connective tissue sheaths that encase each muscle fiber, hold the bundles of muscle fibers together and connects the muscle to the tendons.

In children with hypermobile joints  the connective tissue is less stiff than usual. (It has more give and is more easily stretched).

This tendency for less stiff connective tissue which results in hypermobile (lax)  muscles and joints is genetically determined. About 10-15% of people are hypermobile.

The other very important structure that that determines a muscle's firmness and resistance to being stretched is the giant molecule titin. 

Titin is a very large elastic molecule found within the muscle cell.  The size and strength of the titin molecules is determined by the  amount of work a muscle is made to do on a regular basis. Strong muscles have larger and stiffer titin molecules - and this makes the muscle firmer and stiffer.  The muscle has better tone.

Generally speaking, strong muscles are firmer and have better tone. It is a common fallacy that you can have strong muscles which are also "low toned".  Strengthening a muscle makes it firmer and changes the form of the titin which is component of a muscle fiber which provides the tension and recoil in the muscle.  


Muscle tone, alertness and readiness for action

The term muscle tone is also used to describe the a muscle's readiness for actionThis is set by the child's alertness,  general level of arousal and readiness for action.  

The brain primes the muscles for action by sending signals to the muscles’ sensory receptors.  In effect the sensory receptors become more alert and provide more effective sensory feedback and respond more quickly. This allows for the rapid adjustments needed for maintaining balance and postural stability.

  • When a child is alert and engaged,  the muscles are primed for action.  The muscle tone is good and the posture is erect.
  • When a child is over-aroused, the muscles may become twitchy and overactive.  This makes the child less able to focus attention on a task.
  • If a child is anxious, finds a task difficult and is having trouble focusing his attention, the normal alertness for action signals do not reach the muscles. They become less responsive and provide less sensory feedback.  Muscle tone is lowered and the child's posture becomes less erect and alert..

What next?

How to help your child - starting today

Infants and toddlers with joint hypermobility
 


 

Comments

Weighted Blankets or weighted compression vests

My son is almost 2 and 1/2 and his therapists have recommended that we get him a weighted vest or blanket. I have been researching them and found one that I feel comfortable with purchasing (since they are all quite expensive). My question is can these weighted vests and blankets provide some type of benefit? I do joint compressions with him and he seems to really enjoy it (my son is nonverbal as well). I was just hoping to get some input on these types of products before purchasing since they are pricy. Thank you in advance.

Diane

No solid evidence

Hi Diane 

Thank you for your question.  

I did a quick scan on Pubmed to locate the latest research on the use of weighted blankets and vests. The general consensus seems to be that there is no solid evidence that the use of these items decreases arousal, improves attention or sleep. 

I would suggest that you take a look at the two abstracts below, and then ask your child's therapist to explain why she suggests the use of weighted garments, what short and long term benefits can be expected, and whether you can borrow a vest to try out so that the effects can be assessed for your boy. 

Here are links to the abstracts of two recent articles: 

Gringras P, Green D, Wright B, Rush C, Sparrowhawk M, Pratt K, Allgar V, Hooke N, Moore D, Zaiwalla Z, Wiggs L. Weighted blankets and sleep in autistic children--a randomized controlled trial. Pediatrics. 2014 Aug;134(2):298-306.

Abstract http://www.ncbi.nlm.nih.gov/pubmed/25022743

Hodgetts S, Magill-Evans J, Misiaszek JE. Weighted vests, stereotyped behaviors and arousal in children with autism. J Autism Dev Disord. 2011Jun;41(6):805-14.

Abstracts http://www.ncbi.nlm.nih.gov/pubmed/20839040

Best wishes 

Pam 

 

9 months and not crawling

My is 9months and 1 week, he can not crawl and cant stand firm.he is floppy.. he can swing his legs and hands when lying down. He can sit on his own... he has low motor drive from the upper body.. will he walk ?? What can i do to help...

Good sitting development

Many infants only start crawling at 10-12 months, especially if they are hypermobile.

You say your infant is sitting at 9 months - that is usually a sign that he is developing well. Many infants with low tone - those that feel a little floppy - crawl and walk later than usual and may not put their feet down to stand before a year. Take a look at  My infant wont put her feet down to stand on the Developmental Gym for Infants website. 

Unless your child has a brain or spinal cord disorder such as cerebral palsy or a condition that affects the muscles,  she will probably walk.  If you are concerned about your infant's development you should ask you family doctor to take a look at her and if there are any real concerns he or she will refer you to a pediatrician. 

Graduate Thesis

Hi I'm sorry to write a second post but I forgot to send my contact information in case there was any help you might be able to offer me to help with my thesis project. My email is [email protected]

Thank you again!

Abnormal Muscle Tone - Graduate Thesis

Hello there. I am a Graduate Student at Rochester Institute of Technology getting my Master's degree in Industrial Design. I'm working on my graduate thesis right now and I'm trying to find a way that design can have a positive impact on children with low and high muscle tone. I really need some input from parents of children with abnormal muscle tone and have put together a quick survey for anyone who can help me to take. If you wouldn't mind taking a look at it and possibly sending it a long to anyone you know who might be of help I would appreciate it more than you know. I would love to give you more information on my project if you're interested! The link to the survey is: https://www.surveymonkey.com/s/T5B7NSV .

I also have a link to track my thesis progress: http://lianabeer.wordpress.com

Thank you!!

pain for 6 years!

Hi my son is 8 years old. We were told that he has poor muscle tone and he has kohlers disease. He had severe stuttering and pain in his legs since he was 2 and he leans almost completely forward while running he isn't even half the speed of other children his age. He cant write without it hurting and he also has tremors. My son is a very happy kid and loves to learn but the older he gets the sadder he becomes cause now he is being picked on a school for running like a grandma as these children will put. What can we do as parents? I feel like we've done everything we can!

Hello If your son has a

Hello

If your son has a diagnosis of low muscle tone it is very probable that the underlying difficulty is joint hypermobility. Has your son seen a physiotherapist with an interest in joint hypermobility?

It sounds like he would benefit from an exercise program to strengthen his legs for running.

A physiotherpist can evaluate your son and provide you with an exercise program to improve his fitness and perhaps even improve his pain. 

 

 

11year old swimmer

My child is very fit use to doing lots of long distance swimming . Over last 6months has said he has no power in his arms and legs his times are slower and he is finding it difficult to train he has started to miss training and pull out of competition. He is getting very upset. Any idea why this is happening. Claire

stands on one leg and lean towards any substance

My 6 old autistic son always stands on one leg and lean towards any substance or he walks here and there. Nowadays, i never see him standing erect on 2 legs. He seems to be clumsy. Please advise.

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