We frequently have children of all ages in the clinic who have been diagnosed with low muscle tone (hypotonia). 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 explanation.
Recently, my coworkers and I were talking about a few babies/children who we were seeing who have low tone and how we could see the progress they were making but it was often hard for the parents to not only see but to understand why it might possibly be taking ‘so long’ or longer than other children.
As a sidebar, I love having other therapists around to discuss the kids we are lucky enough to work with. By discussing the kids, we are able to help pull the pieces of information and ideas we have in our head and synthesize them into something that makes sense and we can explain to others! What came out of our discussion is:
When a child has low tone, we have already acknowledged that they have to work harder to engage their muscles and keep them turned on to complete activities. As the child uses their muscles they are helping to get them stronger so that they can generate more force and maintain that force generation for longer periods of time (endurance). For instance, when a baby is working on tummy time they have to turn their muscles on to lift their head up off the support surface – to do that they need to be able to generate enough force so that their muscles can turn on and lift the head. Once they have their head lifted up, they need to be able to keep that force turned on long enough so that they can look around. With practice it gets easier to lift their head and they can do it for longer periods of time.
That is until they grow. A child in their first year of life is in a constant growth spurt for the most part. Not only is their body changing, but they are constantly learning new skills for their development.
If you think back to when you were a child in elementary or middle school and you hit a growth spurt (or to other children you have seen if you can’t remember yours!), it was as if you woke up with a whole new body. You were probably a little bit clumsy (in my case a lot clumsy since I was already clumsy to begin with) and your movements were not very coordinated. I often visualize a baby lamb or horse or giraffe taking their first steps when I think of young kids going through growth spurts.
Now, put that same awareness on a little baby who is changing every day. Especially if that baby has low muscle tone. Our muscles learn to work in a certain way and they get really efficient at it. If you change their length or change the weight that they have to move, all of a sudden they are a little less efficient. For kids with low tone, they are playing a constant game of catch up. They are working hard each day to get stronger and become efficient but then someone goes and changes the parameters of the game on them. Now they have to learn how to work at a new length with a new weight, and very often a new activity.
And, each time they grow or are faced with a new developmental task, they need to find their stability again before they can work on their mobility. For instance, its very hard to reach for a toy in sitting, if they are having trouble generating the strength to hold themselves in sitting, or its hard to crawl if they can’t hold themselves in a hands and knees position. So, with each growth spurt, they will need to relearn how to find stability before they can go back to working on their mobility.
Hopefully I helped to explain things a little and didn’t just make it more confusing!