Kids With Low Muscle Tone Can Sit For Dinner: A Multi-Course Strategy

Low muscle tone can create so many different issues during mealtime.  Staying still and safe in a chair can be a real issue for these kids, and yet many are seen to be just “behaving badly”.  Here is a roadmap to navigate mealtimes when your child has issues with wriggling, sliding, falling or leaping up every few minutes.

First, understanding how low muscle tone influences behavior can help defuse some of the criticism and arguments.  Low tone creates too much information, as instability creates movement that distracts even the child who is moving.   Inadequate muscle and joint receptor stimulation doesn’t produce enough information in the form of position and movement sense for the brain to process (proprioception and kinesthesia for all you therapists out there). Add in loose ligaments around major joints (it is common to see these two issues together), and your child can really struggle to stay in her chair even with the best intentions.  Imagine yourself in this situation:  you cannot feel that your hips are sliding off the seat until you are just about on the floor, and when you do move, it seems like that is the best way to get more information about where your body is vis-a-vis the chair.  No one wants you to move, and no one wants you to fall.  If your child with low muscle tone decides that she dislikes sitting for meals but happily eats everything standing up or on the run, this could be the reason.

Kids can start out looking pretty good on a chair, especially if they have a supportive chair that is the right height, seat depth, and provides solid foot placement on the floor or on a footplate. Booster seats that aren’t buckled securely onto a chair are a huge hazard for these children.  Don’t go there.   The Tripp Trapp chair has been the go-to chair for a lot of children with muscle tone issues for years.  There are others that provide similar support without the serious sticker shock.  Look around and ask your therapist what features are important.

One adaptation I like for these chairs or booster seats with a smooth surface is using non-skid shelf liner as a seat mat.  It can be cut to your exact seat dimensions and cleaned easily.  I don;t recommend adhering it to the seat.  The mat gives a little bit of grip on clothing that limits the sliding on a smooth wooden seat.  Some children like the matting glued to the footplate as well for tactile feedback, but that makes it harder to clean, a tripping hazard at times, and it can bunch up when the adhesive loosens in spots.

I also like to make custom placemats for younger children that encourage them to place their non-dominant hand on the mat unless it is needed for bowl stabilization. I trace that hand in a location on the mat that is slightly in front of them, next to the traced line for the bowl/plate.   Hand-on-the-table is not as polite as “hand in your lap” positioning, but these children often need to use that hand in this position to shift their weight forward through their trunk and use it actively to stabilize their body  during the meal.  The usual result if their hand is left in their lap?  They slump toward one side, or that non-dominant hand will start to twist the tablecloth, bang on the table or make another action to energize or stabilize their nervous system.

Kids with low tone often try to rock while sitting or try to rock the chair to get more proprioception and some vestibular input.  Placing any chair near a wall is often the difference between a child flipping the chair backwards or not.  Banging the chair into the wall once or twice requires a conversation; flipping backward head first may require an E.R. visit!

Being involved in the family meal is always desirable for social skills and developing family togetherness.  For kids with low muscle tone, conversation can help them stay more alert at a time of day when they may be fatigued.  Their desire for movement might be satisfied by socially acceptable actions:  help setting the table, getting up to retrieve things from the kitchen for family members during the meal, and cleaning up.  If you were looking for reward chart items or just assigning household tasks to all family members, this can help everyone.

There are many more individual strategies to improve mealtime sitting.  I invite you to share your most successful ideas!

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