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5 Home Physiotherapy Exercises for Low Muscle Tone (Hypotonia)

Mar 27th, 2020 | by Cait Parr, PT, DPT

Cait Parr, PT, DPT

March 27th, 2020

What is Hypotonia in Children?


Although it’s sometimes called Floppy Baby Syndrome, Hypotonia is the medical term used to describe abnormally low muscle tone. Normally, even relaxed muscles have a very small amount of contraction that gives them a springy feel and provides some resistance to passive movement. It is not the same as muscle weakness, although hypotonia and weakness can often go hand in hand. Muscle tone is regulated by signals that travel from the brain to the nerves and tell the muscles to contract. Hypotonia does not affect intelligence. Pediatric therapy helps children overcome hypotonia; the primary treatment for most children with congenital hypotonia is occupational and physiotherapy

Common Diagnoses/Causes 

Hypotonia can be seen in children with Down syndrome, cerebral palsy, autism spectrum disorder, muscular dystrophy, Marfan’s syndrome, and Sensory Processing Disorder (not an official DSM diagnosis), among other diagnoses. Sometimes, the cause of hypotonia remains a mystery, with no clear diagnosis. Hypotonia can happen from damage to the brain, spinal cord, nerves, or muscles. The damage can be from trauma, environmental factors, or genetic, muscle, or central nervous system disorders. 

Signs and Symptoms 

Hypotonia in infants  is usually noticeable by 6 months of age, by which time the low muscle tone in babies typically becomes apparent. Babies with hypotonia have a floppy quality because their arms and legs hang, and they tend to have little or no head control. Children with hypotonia may have difficulty transitioning in and out of positions and be slow to attain motor milestones, resulting in global developmental delay. Hypotonia in toddlers may cause movements with clumsy or inefficient patterns, difficulty with hand-eye coordination, and a preference to sit and watch rather than move and groove with other kids. Other symptoms of hypotonia include problems with mobility and posture (such as difficulty sitting upright without significant leaning or support), breathing and speech difficulties, ligament and joint laxity, poor reflexes, and getting easily frustrated with physical challenges. 

Exercises That Can Help Low Muscle Tone in Babies:

1. Crawling across different surfaces 

  • Easy: Army crawl on carpet (increased resistance compared to tile or linoleum) 
  • Medium: Couch cushions (more pliable surfaces present a dynamic challenge) 
  • Hard: Crawling up ramps or steps (with close supervision for safety) 

2. Pulling to stand (options in order from easiest to hardest) 

  • Easiest: from sitting on parent’s legs (motivation: hugs, kisses, and snuggles!) 
  • from sitting on low bench or couch cushion (motivation: whatever is cool on the couch or low table – games, toys, food) 
  • from kneeling through half kneel (more advanced, might need help to keep one leg kneeling instead of going over toes) 
  • at vertical surface (try introducing cool fridge magnet toys at the refrigerator) 
  • Hardest: push to stand using low bench or cushion for hands 

3. Squatting and returning to stand.. 

  • ..with trunk/arms/hands on couch or low table for support (trunk being most support, hands provide least support) 
  • place motivating toy or game with pieces on floor to encourage your child to squat and pick one up and then stand up and place toy in a container on supporting surface

4. Tall kneeling challenges glute and core stability!  

  • Easy: holding tall kneel position at a supporting surface such as a low bench/table – the cube chair works great for this! 
  • Medium: heel sit to tall kneel to bring puzzle pieces from floor to puzzle on couch or low table 
  • Hard: blow bubbles or hold a ball or balloon up just beyond their reach, encouraging them to come up into a tall kneel position. Can they hold this position and play here for a few seconds?

5. Other

  • Bilateral play – promotes use of both sides of body and movements that cross midline  
  • Sports skills – requires hand eye coordination, reaching, squatting, balance 
  • Navigating obstacles – play tunnels build strength, endurance, and motor planning 
  • Climbing up and down – targets both concentric and eccentric muscle activation 
  • For more creative ideas, visit our Instagram page (@napacenter
For Further Reading: 

Hypotonia Treatment at NAPA Centre

At NAPA Center, we offer intensive and traditional pediatric therapies to help children achieve their full potential. We have clinics in Los Angeles, Boston, Austin, and Sydney, Australia. We take an individualized approach to therapy because we understand that each child is unique with very specific needs. If your child needs our services, we will work closely with you to select the best therapies for them, creating a customized program specific to your child’s needs and your family’s goals. If you’re interested in learning more, contact us and our team will be in touch shortly!

About the Author 

Cait Parr is a pediatric physiotherapist at NAPA Center. Her favorite animal is snails, because they remind her to slow down and enjoy the beautiful details about life. She loves desserts almost as much as she loves long walks with her husband on the beach at sunset.

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