Muscle tone is the amount of tension (or resistance to movement) in muscles. Our muscle tone helps us to hold our bodies upright when we are sitting and standing. Changes in muscle tone are what enable us to move. Muscle tone also contributes to the control, speed and amount of movement we can achieve.

Low muscle tone is used to describe muscles that are floppy, which is also known as hypotonia. Children with low muscle tone may need to put in more effort to get their muscles moving properly when they are doing an activity. They may also have difficulty maintaining good posture when sitting or standing. Many children with low muscle tone have delays in their gross motor development (e.g. rolling, sitting, walking).

Low muscle tone may be caused by problems with the nerves or muscles. Often the low muscle tone is idiopathic, which means the cause is unknown.

Signs and symptoms of low muscle tone

If your child has low muscle tone, their muscles may seem to be floppy from birth. Your child may:

• seem limp when you lift them
• have increased flexibility in their joints
• have poor posture 
• get tired easily (have low endurance) because of the extra effort they have to put in to activate their muscles or maintain their posture
• not have much strength in their muscles
• have delays in reaching gross motor milestones, such as rolling, sitting, crawling or walking.

When to see a doctor

Sometimes, low muscle tone is diagnosed shortly after birth during newborn health checks or at maternal and child health checks. In other cases, low muscle tone becomes evident later, usually when gross motor development delays become more obvious. If you are concerned about your child's muscle tone, see your maternal and child health nurse or GP.

You may be referred to a paediatrician, who may examine and investigate for possible underlying causes of the low muscle tone. An occupational therapist or physiotherapist may become involved, to advise on treatment and activities to help improve your child's muscle tone.     

Treatment for low muscle tone

Most children with idiopathic low muscle tone will naturally improve over time, without any long-term impact on their physical strength and abilities. However, some people may experience muscle weakness into adulthood.

A physiotherapist or occupational therapist can offer strategies and suggestions to help your child maximise their muscle tone.

Warm-up activities can improve your child's endurance by helping to activate the muscles. It is important to encourage your child to do a warm-up activity every day. While these activities will not lead to a permanent change in your child's muscle tone, they will help your child know what it is like to do everyday things using a more stable posture. Make the activities fun and exciting as this can help increase your child’s level of alertness and muscle tone.

For example, bouncing on a mini trampoline before sitting at a table to do a drawing may help your child to sit up straight rather than slump. If your child is slouching after they have started an activity, get them to stop what they are doing and have them do 10 star jumps to activate their muscles.

Squeezing and rolling playdough before writing may help your child to maintain their hold on the pencil and write for a longer period of time.

Your physiotherapist or occupational therapist will recommend suitable warm-up activities, but some other suggestions include:

• Space hopper – encourage your child to bounce on a space hopper in the backyard or up and down the hallway.
• Running on the spot, stomping, star jumps, skipping with a skipping rope.
• Crawling activities, crab walks, bear walks, bunny hops – make it fun by setting up an obstacle course, relay or race.
• Tug of war – use a dressing gown cord or twist a bathroom towel to make a rope. Play tug-of-war with your child either sitting, standing or kneeling.
• Play ball games – catching, throwing, bouncing, aiming at targets.
• Newspaper scrunch – scrunch up sheets of newspaper into balls. Once a few balls have been made get your child to throw them into a bin or at a target.
• Tong relay – pick up small toys or objects with a pair of tongs and run and place them in a container.
• Spray bottles – water plants or make pictures by squirting water on the concrete.
• Arm wrestles – sit opposite your child with elbows on the table. Hold each other’s hands and encourage your child to push against your resistance.

Key points to remember

• Low muscle tone is used to describe muscles that are floppy. It is also referred to as hypotonia.
• Children with low muscle tone may have increased flexibility, poor posture and get tired easily.
• Warm-up activities can increase muscle tone by activating the muscles. Your child should do warm-up activities every day.

For more information

• See your doctor, Maternal and Child Health Nurse, occupational therapist or physiotherapist.

Developed by The Royal Children's Hospital Occupational Therapy department. We acknowledge the input of RCH consumers and carers. 

Reviewed September 2018. 

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.