Starfish Therapies

February 9, 2012

What Does Low Tone Mean?

Muscle tone is the resting state of your muscles.  When a child has low muscle tone it means that they need to put a lot more energy into getting their muscles to turn on to do what they want them to do.  I often try to explain this to parents by describing that feeling when you finally get to sink into the couch or your favorite arm chair and relax and then someone calls you from the other room and you have to rev up the energy to get up.  Think about having to do that every time you move because that’s what it can be like for kiddos who have low tone.

Generally kiddos with low tone seem to be squishable because they melt right into you when you hug or hold them.  This is great for cuddling but if you are carrying a baby or kiddo around that is melting into you, it means they aren’t able to help support themselves in your arms so it can seem as if you are carrying a heavy weight around.  As their muscles get stronger they get better at activating them so that if you are carrying them, they can hold their own trunk up without having to lean on you.  Its amazing how much lighter this can make them feel!  (Another way to get the idea is if you are holding a kiddo by their hands to help them stand and they just decide to have spaghetti legs and you weren’t expecting it).

When I talk about strength being a challenge for kids with low tone I am talking about not just their ability to generate enough force to move their arm or their leg, but also their endurance and their ability to switch their muscles on and off.  These components all work together to produce movement.

I know that I talk about core strength a lot but for these kiddos its really important.  Just think if your trunk (core) was as stable as a slinky.  Do you think it would be easy to move your arms and legs, to do fine motor activities, to run and jump or even walk, to keep an upright posture in school to help with learning?  It would be challenging to do all of these things and so many more. That’s why when I work with kids with low tone I am often doing activities that will challenge the whole body but also focus on the core.  I also work to increase either how long they can do an activity (such as sitting on a ball for trunk control) or how many times they can do something (such as bridging) because this will help to increase the endurance of their muscles so they can stay working as long as they want them to.

Since it is harder to move and to activate their muscles, a lot of times they may need more practice, help and support, not to mention motivation to get moving! When they are little I do lots of tummy time to develop their butt muscles, anti-gravity trunk extensors, their head and neck muscles and their shoulder muscles.  The more interesting you can make the activity the longer you can get them to want to play in this position.  I do other activities as well, such as pull to sit to work on abs and head control (I make them work both going up and going down).  Going down is often easier (until you get close to the ground) because their muscles are already turned on so they just have to keep them on so they don’t ‘crash’ unlike going up where they have to turn their muscles on and its really hard when you are flat on the ground because you are fully working against gravity. I could go on all day and I might have to do another post just on activities!

Since these kiddos have to put out so much more energy to do things than a person with regular muscle tone, and the fact that we are constantly asking them to do more, don’t be surprised if they get tired easily.  For instance, it may not seem like it is that hard to sit in a chair to do work but if you think about all the energy they have to expend to keep their body up nice and straight its not surprising that they are tired.  When they are little they may need to nap more often, especially if they are doing therapy.  If you are in a mommy and me or a gymboree class you may notice that your kiddo needs to take breaks a little more frequently than the other kiddos.  This is normal for them.  However, you also want to remember the goal of working on their endurance so it doesn’t hurt to challenge them.  Just like when I am training for a race, 3 miles may be in my comfort zone but to get to the marathon I will have to challenge myself to run a little bit further than my comfort zone allows each day.

TheraTogs or the Spio suit or even hip helpers are tools that can be helpful for kids with low tone to give them a little extra support in the core so that they can practice the skills they need to practice.  I also use a lot of tickling to remind a muscle to turn on and stay on.  Sometimes using a slightly unstable surface like a sitting disc or a therapy ball can also be a reminder to keep muscles on.  Since it is unstable its a lot harder to sink into the support like they would be able to in a nice firm chair.  Also using wedges (although I wish I could find these filled with sand in addition to the air filled ones) in a chair (tilted forward) can help to activate a child’s core for improved sitting as well.  What are other tools that have helped either kids you have worked with or your own child – I’m sure I’m leaving out a ton of ones I’ve thought of or used but I always love to hear new ideas!

You can download an informational handout of this information here!




  1. Thanks for such a great explanation of what “low tone” means! It’s hard to explain to other people what low tone means for my son and why he struggles to sit in a chair.

    Comment by mamacarlson09 — February 10, 2012 @ 4:51 am | Reply

  2. Wonderful explanation, tnx it ll b gud if u can post more activities in improving tummy muscle strength inorder to improve standing balance n also sitting endurance.

    Comment by privj — February 11, 2012 @ 7:51 pm | Reply

  3. […] it was specifically related to kiddos with Down Syndrome, it also is applicable to kiddos with low tone.  In fact, many of the tips are applicable across the board to other therapies and for any child […]

    Pingback by Bringing Therapy Home « Starfish Therapies — February 14, 2012 @ 12:05 pm | Reply

  4. Your explanation on low tone explained my child perfectly and made it easier for me to try and explain to others who ask me! Thank you!

    Comment by Krista — February 15, 2012 @ 2:22 am | Reply

  5. […] 5.  What Does Low Tone Mean? […]

    Pingback by Top Ten Blog Posts of 2012 « Starfish Therapies — December 31, 2012 @ 7:01 am | Reply

  6. […] wrote a post a while back describing low tone so I thought I would try to do the same with high tone.  Tone is the resting state of your […]

    Pingback by What does High Tone mean? « Starfish Therapies — January 14, 2013 @ 12:01 pm | Reply

  7. This Is Joey thank YOu Stacy for explaining so I understand wish you were closer to Help us Diane

    Comment by Diane Demeraski-Vaspory (hamster) — January 14, 2013 @ 3:08 pm | Reply

  8. […] had Trevor I assumed Tummy Time meant lying stomach-down on a mat, and that was it.  Due to his hypotonia he hated Tummy Time and screamed pretty much the second he was placed face down on the ground.  At […]

    Pingback by Have a Ball With Tummy Time! « Motherhood And Other Adventures — January 28, 2013 @ 8:40 pm | Reply

  9. […] 6.  What Does Low Tone Mean? […]

    Pingback by 2013 Recap and Top Ten Posts | Starfish Therapies — January 1, 2014 @ 5:18 pm | Reply

  10. […] he has low muscle tone, otherwise known as hypotonia.  The best explanation I’ve found for hypotonia is here.  It is a really helpful link for both Puck & […]

    Pingback by This is my Boy. | CLOVER & PUCK — February 22, 2014 @ 12:32 am | Reply

  11. i have just found out my 3 yr old son has low muscel tone and a tremor its hard for people to understand and for for to describe it thaks this has helped me to

    Comment by Georgina Brewster — March 10, 2014 @ 2:28 am | Reply

  12. Hi.
    My 8 year old son has just been diagnosed with low muscle tone. They tell me its affecting his school work as well. Please advise if there’s anything I can do to help my son at home. I was also advised to get him a crazy straw to help with his neurological developement.

    Comment by Shereen — April 29, 2014 @ 9:16 am | Reply

    • Ideally you want to do a lot of core work with him. Also look at some options for seating discs or wedges that can help with his posture at school which may help with his school work. You could look into a Spio Suit that would give him some input at his core and help to keep his muscles engaged. Getting him involved in activities like Karate, swimming, climbing, gymnastics or anything that engages the whole body will help him to develop his strength which will help with the low tone. You may want to look at a PT eval to get some ideas that are specific to your son’s needs. Hopefully that helps some.

      Comment by Starfish Therapies — May 1, 2014 @ 3:08 am | Reply

  13. […] Shortstop.  He has a wide range of abilities and challenges.  Most of his challenges stem from hypotonia, attributed to acute encephalopathy at birth.  We are still undergoing extensive testing to try to […]

    Pingback by What is PT, OT, and LT? | CLOVER & PUCK — December 26, 2014 @ 5:20 am | Reply

  14. Hello there,

    I am a Graduate Student at Rochester Institute of Technology getting my Master’s degree in Industrial Design and I’ve just found your blog. 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 them to take. If you wouldn’t mind taking a look at it and possibly sending it along 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:

    Thank you!


    Comment by lianabeer — December 29, 2014 @ 1:19 am | Reply

    • I went to take your survey but my child has low tone and high tone. You didn’t have an option for that.

      Comment by Lee — April 17, 2015 @ 5:46 pm | Reply

  15. […] 9.  What Does Low Tone Mean? […]

    Pingback by Top Ten Posts of 2014 | Starfish Therapies — December 31, 2014 @ 4:50 pm | Reply

  16. Hi , my kid is 7 yrs old .. She has low tone .. She is able to walk , climb up With not assistance and climbing down ( with very little assistance ) .. But stooping down to retrieve objects , sitting down from standing position is diff .. She sits on couch and bed but sitting on a stool or lower chair is diff .. She gets up from low surface / seat .. She has fear of hts .. Het OT tells me that she needs more and more practice to achieve this .. Can you pls share your knowledge as to what muscles are involved for sitting down ( with out a thud ) and how can I help my kid ..

    Comment by Shruthi — February 15, 2015 @ 2:28 pm | Reply

  17. […] the body and with your internal organs, since they are also made up of muscular tissue.  (See this article from Starfish Therapies if you want to learn more about low tone.) Are you getting where I am going […]

    Pingback by Natural Constipation Relief for Kids {Part 2} — March 12, 2015 @ 3:02 am | Reply

  18. Once these kiddos begin pulling to stand, we often see instability at their foot/ankle due to poor control by their deltoid ligament complex. This results in hyper-pronation, the body weight shifts medial and we see delays in the progression of their upright gross motor skills. Surestep SMOS provide stability to the foot and ankle while allowing and facilitating the development of typical heel-toe gait, strengthening of the foot intrinsics, activation of the proprioceptors and development of balance reactions. With Surestep SMOs, we have seen children with gross motor delays of 5-8 months begin to develop at a more typical rate and make tremendous progress.

    Comment by Anne Pare — April 16, 2015 @ 1:21 pm | Reply

  19. Reblogged this on Our Life With RyLeigh Joy and commented:
    This right here…..

    Comment by Our Life With RyLeigh Joy — April 18, 2015 @ 9:09 pm | Reply

  20. […] What does low tone mean?, by Starfish Therapies. Great explanation! […]

    Pingback by Explanation of Low Tone | lovenlearning — August 19, 2015 @ 1:14 pm | Reply

  21. Reblogged this on Suzanne's Blog.

    Comment by AgentSuzanne — October 13, 2015 @ 1:52 am | Reply

  22. […] This can often be confusing for parents and difficult to explain to others so we wrote ‘What Does Low Tone Mean?’ to help with that […]

    Pingback by Low Tone and Growth Spurts | Starfish Therapies — February 15, 2016 @ 11:09 pm | Reply

  23. […] This can often be confusing for parents and difficult to explain to others so we wrote ‘What Does Low Tone Mean?’ to help with that […]

    Pingback by PT Corner: Low Tone and Growth Spurts | PediaStaff Pediatric SLP, OT and PT Blog — February 17, 2016 @ 9:29 pm | Reply

  24. […] This can often be confusing for parents and difficult to explain to others so we wrote ‘What Does Low Tone Mean?’ to help with that […]

    Pingback by PT Corner: Low Tone and Growth Spurts | PediaStaff - Therapy Jobs and Resources — February 17, 2016 @ 9:31 pm | Reply

  25. I feel like this describes my daughter. How can I find out if she has low muscle tone?

    Comment by Concerned mother — February 18, 2016 @ 6:03 am | Reply

  26. […] were discussing children who have hypotonia (low muscle tone), and how they have a harder time turning their muscles on and keeping them on.  Strengthening […]

    Pingback by Priming the Muscles | Starfish Therapies — March 10, 2016 @ 11:52 am | Reply

  27. […] were discussing children who have hypotonia (low muscle tone), and how they have a harder time turning their muscles on and keeping them on.  Strengthening […]

    Pingback by PT Corner: Priming the Muscles | PediaStaff Pediatric SLP, OT and PT Blog — March 16, 2016 @ 3:01 pm | Reply

  28. […] were discussing children who have hypotonia (low muscle tone), and how they have a harder time turning their muscles on and keeping them on.  Strengthening […]

    Pingback by PT Corner: Priming the Muscles | PediaStaff - Therapy Jobs and Resources — March 16, 2016 @ 3:02 pm | Reply

  29. Excellent explanation…gonna share this!

    Comment by A Bonifas, OTR/L — March 21, 2016 @ 11:32 pm | Reply

  30. Thanks so much for a great explanation of low tone. I am a pediatric OT who is also a grandma of a 20 month old with Sotos Syndrome. So many relatives have asked what low tone means…..your explanation is so succinct and covers it so well! Thanks so much.

    Comment by Laura Flood, OTR/L — December 30, 2016 @ 1:52 am | Reply

  31. Reblogged this on Сенсорная интеграция и мы. and commented:
    Мышечный тонус является состояние покоя ваших мышц. Когда ребенок имеет низкий мышечный тонус это означает, что они должны положить гораздо больше энергии в получении свои мышцы, чтобы включить, чтобы делать то, что они хотят, чтобы они делали. Я часто пытаюсь объяснить это родителям, описывая это чувство, когда вы, наконец, погружаться в диван или ваш любимый кресле и расслабиться, а затем кто-то звонит вам из другой комнаты, и вы должны увеличить скорость энергии, чтобы встать. Подумайте о том, чтобы сделать это каждый раз, когда вы двигаетесь, потому что это то, что это может быть, как для kiddos, которые имеют низкий тон.

    Comment by Л.Н. — January 11, 2017 @ 6:06 am | Reply

  32. […] a child has low muscle tone or high muscle tone there are other things to consider.  For a child with low muscle tone, they […]

    Pingback by Growth Spurts | Starfish Therapies — January 29, 2017 @ 12:29 am | Reply

  33. Thank you! thank you! For this artical!!!

    Comment by Sar Ah — October 29, 2017 @ 5:34 am | Reply

  34. […] 2. What Does Low Tone Mean? […]

    Pingback by Top Ten Blog Posts of 2017 | Starfish Therapies — December 30, 2017 @ 1:11 pm | Reply

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