• Sierra Christensen

Hypotonia...NOT weakness.

#hypotonia #lowtone #pediatricphysicaltherapy #awareness #earlyintervention #parenting

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The fourth blog in this series is on hypotonia, which is a common symptom found in children. This is in hopes of empowering YOU, the parents and caregivers. My mission in starting develoPT was to bring access to high-quality healthcare and education for ALL children and families. I want to bring more attention to these conditions and possibly help some of you prevent issues with your little one down the road.

If you missed the previous guides on torticollis, plagiocephaly, and craniosynostosis, you can find them HERE. Now, on to hypotonia!


Hypotonia is decreased muscle tone. To completely understand hypotonia, we need to talk about muscle tone in general. Muscle tone is the typical tension and stiffness present in your muscles, even when relaxed. This helps provide resistance to passive movement. People rely on muscle tone for posture and maintaining their position when sitting or standing. Tone decreases during sleep, so this is why you may find your head flopped forward or to the side if you fall asleep sitting up. Muscle tone is controlled by signals from the brain to the nerves in the muscles. Hypotonia IS NOT the same as muscle weakness, although they often present together. It can be difficult to use muscles with hypotonia, and weakness may develop in association with hypotonia.

For example, if we use a rubber band analogy, the muscles in our bodies are like rubber bands; everyone’s bands are at different tensions, but there is an ‘optimal’ tension. The majority of us are pulled to around the ‘optimal’ tension, but each person varies upon a spectrum.

Children with hypotonia have less tension in their muscles, which leads to less support and stability in their joints. They have to use more energy and muscle activation to get to a ‘typical’ resting state. They have to work harder to complete each movement, which can be the reason for delayed motor, feeding, and speech skills.



-Little/no control of head and neck muscles

-Feeling limp/doughy when held

-Issues with posture and mobility

-Often chooses to W-sit because of instability

-Unable to place weight through legs or shoulders

-Arms and legs hang straight down by their sides, rather than bending at joints

-Difficulty sucking and swallowing

-Mouth hangs open with tongue protruding


-Shallow breathing

-Weak cry/quiet voice

-Delayed motor milestones

-Poor reflexes


-Difficulty transitioning between positions

-Extreme flexibility

-Tendency of joint dislocations (ligament and joint laxity)

-Difficulty reaching or lifting objects


Hypotonia happens from damage to the brain, spinal cord, nerves, or muscles. There are many different causes of this damage: trauma, environmental factors, genetic, muscle, or nervous system disorders. Down syndrome, cerebral palsy, genetic disorders, and prematurity are some of the common disorders with hypotonia. Hypotonia is normally detected in infancy or shortly thereafter. Many times, health problems lead to hypotonia. Sometimes, though, hypotonia can be a condition on its own called benign congenital hypotonia, or the cause cannot be determined.


Since hypotonia is most often a sign of an underlying disease, finding the root cause is very important. The root cause of hypotonia can affect treatment pathways and outcomes.

If/when the cause is found, the underlying diagnosis is treated first, followed by symptomatic treatment for the hypotonia. Pediatric physical therapy helps your child improve motor control and overall strength, in addition to giving you recommendations on how to help your child succeed and embrace their unique potential. PT for kiddos with hypotonia is extremely vital, because it will teach them functional skills and make their quality of life better.

So, the million dollar question....can you change muscle tone? I am going to answer this as no, but hear me out. Hypotonia itself typically does not change because it is a characteristic of a person’s nervous system. That being said, strength, motor control, and coordination can be gained to help compensate in functional activities and provide stability. So in some ways, it will look like hypotonia improved, but in reality, you are improving ways to compensate for the low tone, and getting stronger. It is a confusing relationship! Either way, a child with hypotonia CAN improve his/her skills with the right assistance, and that’s really all that matters!


-Lots and lots of play!! (P.S. This is my recommendation for ALL children!)





-Pediatric occupational therapy

-Pediatric physical therapy

Knowledge empowers YOU to help your baby embrace their fullest potential! If you would like a helping hand to guide you along the way, and get a customized evaluation for your sweet babe, please reach out to me on my website,

In the meantime, I have put together a visual that summarizes the most important aspects of hypotonia and treatment. It is awesome to quickly refer to, even with a crying baby ;) You can access it HERE!



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