Tag Archives: low muscle tone in young children

Low Muscle Tone and Dressing: Easy Solutions to Teach Independence

When a child says “I do it myself” most adults are thrilled.  Kids with low muscle tone want to do things like the big kids too, including dressing themselves, but they often end up in a tangle of sleeves or twisted pant legs.  Here are a few suggestions to make learning to get dressed and managing clothing for toilet training and for life in general easier.

  1. Select clothes that are easy to get on and off.  That means that they should be a little loose, a little stretchy, and not too long.  Tops that hang down over the tush have to be rolled up for a little girl to sit on the potty.  A top that ends at the waist cannot fall into the bowl.  Lycra leggings or tight jeans with zipper fasteners are harder to manage independently.  If your child is just getting the hang of pulling on/pushing off clothes, adding fasteners is making this a lot harder.  Opt for elastic waistbands over any other style, and knit fabrics with some cotton.  These don’t cling as closely.  Shorter sleeves and pant legs without a knit cuff are easier to get on and off.
  2. Kids with low tone aren’t that stable in standing without support.  They can sit on a low step stool with feet flat on the floor to get dressed, preferably with the stool against a wall so they don’t fall backwards.  No stool?  You can try sitting on the lowest stair step.  Also try leaning their back against a wall.  Sitting on the floor (with a few exceptions) is less successful than what therapists call “short sitting” for kids with low tone.  They tend to w-sit or roll their backs when floor sitting, so that they are way off balance and reasonably fearful of tipping over.  This makes it harder to slide legs into pants and raise arms up into sleeves.  Sitting on a stool can put a child’s hips in a more stable position to activate the muscles from trunk to toes for more stability.  Bonus round: these are the same muscles a child needs for walking and running!
  3. These kids are used to being dressed, sometimes well past 3 years of age, so they are going to be familiar with standing while the clothing is pulled off of them or pulled up.  They will want to just step into pants while you hold the waist of the pants.  Changing their attitude from “you dress me” to I dress myself” is huge.  Adults do not realize what goes into dressing because they have been independent for so long.  Try to imagine royalty getting those amazing gowns and tiaras on with the help of assistants, versus getting all that clothing on by themselves. Totally different execution.  They would have to pay attention and make a plan.  If your child has issues with sequencing movement as well as postural control issues, this part of learning to get dressed may be the bigger hurdle.  Your little prince or princess has to change his/her mindset, paying attention to movements and balance in a new way.  This can start in baby steps.  Just finishing the removal of his arms from the sleeves of a shirt while you turn away for a second builds awareness and practice.  Then add pulling the arm out of a sleeve that you hold taut at the wristband.  Keep adding more steps as the child builds skills.
  4. Distractions and rewards.  If a child is used to being dressed in front of the TV, that will have to change.  Learning a new skill while watching “Paw Patrol” isn’t going to work.  Watching it as a reward for learning a new skill is a better plan.


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Low Tone At Preschool: How Tone Affects Safety and Play

Low muscle tone can create safety issues and difficulty using toys at school.  Here are some reasons why things can fall apart (literally, sometimes!) and how small changes make the difference between success and failure at school.

First, there are good reasons that children with low tone struggle to sit, stand or move around the classroom safely and independently.  It is easy to see the loose-limbed elbows and the w-sitting, but the less visible components of low tone are the sensory information that is lost and the child’s behaviors as she tries unconsciously to give herself more vital sensory input.  When a child is at rest, low tone means it will take a longer time (usually fractions of a second) for the brain to generate adequate muscle contradiction to initiate movement.  Fewer and slower muscle fiber contractions while moving creates an incomplete message regarding the muscle’s degree of stretch and amount of the contractions.   Less force from muscles on joint receptors gives inadequate position sense information.

Children with low tone are not receiving the correct amount of sensory information at the right time to create smooth and accurate movement or to be accurately aware of their body position without using vision or getting additional sensory information from another source.

We do not realize the rapid delivery of information in our brain that is necessary for safe and effective movement.  Those fractions of a second can be the difference between a child sliding off the chair or catching herself quickly.  Adults sometimes blame a child for being inattentive, but very young children do not compensate by checking their position before they start a movement or while they are moving.  As a child gets a little older, they can use those strategies.  In preschool, it would be like reminding them to check for nearby exits on a plane when they board.  Pointless.  The part of the brain that can monitor and anticipate potential problems is undeveloped for this task at this age.

A child may use too little force when they are scribbling with a crayon, or so much that the crayon breaks.  That happens as she tries to perceive position and movement, no matter how frequently the teachers tell her to “be gentle”. This is a sensory-motor issue for her.   It would be as if you were wearing oven mitts and holding a raw egg.  Try not to break it,  but don’t drop it!  Another child may not perceive that his foot is sliding off a step on the playground, and instead of moving it forward, he slides off the step completely.  “Being careful” is harder for young children when they do not have the impulse control to check foot position or remember to place their feet in the center before climbing up.  Using tools such as a toy hammer is very difficult when just standing in a stable position is a challenge.  Hitting a plastic nail head with a hammer requires a stable core so that the swing is accurate and powerful (golf, anyone?).  Most children with low tone struggle every day to establish enough core stability for seemingly simple tasks.

Low muscle tone will create a few familiar postural patterns with most children.  The “seated asymmetrical slouch” so that one hand is holding up his head and one hand is playing, the “full-body belly flop onto the play table” so that both hands can push trains, and the “draping over furniture or people” without any awareness are all familiar to the families of low-toned children.  Maintaining a stable posture for a few seconds isn’t difficult, but staying there for a while or staying stable while thinking and talking can be too great a load for the brain.  Something has to go, and it is often postural control.  Your child isn’t conscious of his choice, but if he is having fun, he is going to choose the position that is the least demanding.  Unless he decides to get up and run…….

The other effect of low tone in the preschool classroom can be “the child with ants in his pants”.  Children learn very early on that changing positions, especially moving very quickly or landing hard into surfaces, will raise their muscle tone briefly, give them more body awareness information and help them stay alert.  None of this is appreciated at most schools, especially when a child launches himself into/onto other children for fun.  If a child has only mildly low tone and no other diagnosis, it is easy to attribute this to behavioral or attentional problems.

What can teachers and parents do?

  • Hands work better when hips and shoulders are stable and/or supported.  Encourage children to sit rather than stand to perform coloring, cutting, and toy or block assembly.  They may even be safer and more successful lying on their stomach on the rug. The exception would be coloring on a vertical slanted easel, every OT’s favorite position for preschool coloring with low-toned kids.  Children benefit from placing their “helper hand”, the non-dominant one, forward at about chest height on the easel to give more trunk and shoulder support to the hand that is coloring.
  • Find a chair that allows a child to place their feet flat rather than on their tiptoes or sliding out under the table.  Remember that changing her chair height is going to mean that the table surface may not be right either.  Most preschoolers don’t manage booster cushions well; they slide around and play on them.  If a child is too distracted by a booster seat, it is better to find a solid and stable seat for sitting.
  • Choose toys and tools that have extra sensory input built in.  Thicker crayons can handle more pressure, textured handles give a bit more touch information, and sometimes even a slightly heavier toy is easier to feel and manipulate than a lighter one. Smooth surfaces and tiny clasps are harder to manipulate for children who aren’t perceiving slight changes in joint and muscle position.  Making fasteners larger or even demonstrating a more powerful grasp pattern can help.  Most children love sensory input, so even children without low tone will benefit from a wider range of materials and textures.
  • Fatigue and illness will exaggerate problems with tone.  Being tired makes all of us a little unsteady, but it really hits low-toned kids hard.  The same is true when they have a cold.  If they have an ear infection or fluid in their ears, their vestibular system is not functioning well either.  This is the time to stand closer to them on the playground and even avoid the use of slides and climbing activities unless you are within a fingertip’s range to catch them.  It is also the time for less criticism of all their compensations such a leaning their chin on one hand to keep their head up at the table.  They may be trying as hard as they can on that day.
  • Create a purposeful reason to get up and move around after sitting still.  Just a little bit of muscle contraction, joint pressure and vestibular input can be enough to recharge the nervous system for better performance.  Preschoolers like to be useful and there are lots of “jobs” you can give a child that build self-esteem instead of complaining that they are slouching.  Just tossing out their napkin and returning to their seat can be enough, or handing out cups for snack.  Almost any small task would work, including cleaning up toys.  Everyone is happy to instill that habit in children!