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Do you know the difference between muscle STRENGTH and muscle TONE? If not, you are about to learn all about it!
As Occupational Therapy Assistants, we often work with children who have low muscle TONE. While this is different from muscle STRENGTH, it can go hand in hand (but not always!).
As always, we give you our fav. tips, tricks, and strategies to help your child (or client, or family member, or neighbor …) if they have low muscle TONE.
SHOW NOTES
What’s the Difference Between Muscular Endurance and Muscular Strength?
Single person logic and reasoning games:
My First Rush Hour (3+)
Rush Hour (8+)
Gravity Maze (8+)
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When a child struggles with movement, posture, or coordination, the termsmuscle tone andmuscle strength often come up in conversation. But did you know these are two completely different concepts?
As pediatric occupational therapists and advocates for healthy child development, it’s important we help parents and professionals understand how tone and strength affect children—especially those with sensory processing challenges, developmental delays, or diagnoses like autism or Down syndrome.
Let’s start with simple definitions:
Muscle Strength is theactive ability of a muscle to generate force. This is what helps us lift, push, pull, and carry.
Muscle Tone refers to thepassive state of readiness in a muscle at rest. It’s the underlying tension that helps us maintain posture and respond quickly to movement.
Think of muscle tone as the volume on your radiowhen it's turned on but not playing music. Muscle strength is what happenswhen the music blasts—it’s power in action.
Children with low muscle tone often also display low muscle strength and endurance. However, tone is a neurological trait, while strength can be improved through physical activity and training.
You can’t necessarily “change” muscle tone—but you can absolutely build strength and functional skills in children with both low or high tone.
Muscle tone falls into three main categories:
Muscles are ready for action but not too tight or too loose. This allows for fluid movement and stable posture.
Muscles feel soft or floppy, and the child may appear “loose-jointed” or struggle with posture and endurance.
Often seen in:
Autism.
Down syndrome.
Sensory processing disorder.
No diagnosis at all (low tone can exist independently).
Muscles are overly tight or stiff, limiting range of motion. Often observed in children with cerebral palsy or those who toe-walk.
Therapies for hypertonia may include stretching, orthotics, medication, or surgical interventions—often under the guidance of a pediatric neurologist or rehab specialist.
Recognizing low tone early is key to supporting your child’s development. Here are common signs:
Head lag when pulled to sit by 3 months.
Floppy limbs and difficulty maintaining tummy time.
Delays in rolling, sitting, crawling, or walking.
Slouched posture or leaning on furniture.
Fatigue with simple tasks (e.g., sitting upright at a table).
“W-sitting” as a compensation for poor core stability.
Open-mouth posture and drooling.
Clumsiness or frequent tripping.
Weak grip and trouble with buttons, zippers, or handwriting.
Difficulty sitting still or holding a pencil correctly.
Avoiding gross motor tasks (e.g., playground climbing).
Needing more breaks than peers during physical or academic work.
Many of these children expend more energy than their peers just to sit upright or complete basic tasks—and that can lead to frustration, low self-confidence, and even behavioral challenges.
Low tone doesn’t just affect how a child moves. It influences how they feel, learn, and interact with the world.
Children with hypotonia often:
Struggle with posture during learning activities.
Tire quickly during play, meals, or therapy.
Experience delays in speech or feeding due to oral-motor weakness.
Show compensatory movements (like locking elbows or winged shoulder blades).
Avoid stairs, playgrounds, or sports due to fatigue or difficulty.
But here's the good news: While tone may not change, we can absolutely improve how the body functions with intentional strategies.
Here are six effective ways parents, educators, and therapists can support children with low tone:
Prepping the body for any task boosts performance. Try 5–10 minutes of:
Jumping on a mini trampoline.
Animal walks (bear crawl, crab walk).
Play dough squishing or theraputty play.
A short sensory path.
Kids with low tone are workingharder than others—so motivation matters. Offer praise, small incentives, or visual trackers to reinforce effort and build resilience.
Obstacle courses activate the whole body in fun, purposeful ways. Include:
Jumps (e.g., 5 jumping jacks).
Core tasks (e.g., wall pushups, crawling under chairs).
Balance challenges (e.g., walking on a line).
Repeat 3–5 times and adjust difficulty as needed.
Use a therapy ball for:
Seated play (to engage core muscles).
Gentle bouncing during reading or games.
Rolling forward for weight-bearing on hands (helps shoulder stability).
Tummy time isn’t just for babies—it’s a valuable position for strengthening at any age!
Outdoor play naturally boosts strength and stamina. Encourage:
Playground time (swings, monkey bars, climbing).
Nature walks.
Pushing a sibling in a wagon.
Bike riding or scooter play.
Support your child under the armpits or around the rib cage when lifting. Avoid pulling by the hands or arms to reduce joint strain.
Understanding the difference between muscle tone and strength is essential for supporting children’s development—whether you're a parent trying to help your child climb the stairs or a therapist building a treatment plan.
Here’s what we want you to remember:
Muscle tone is neurologically based. It may not “improve,” but function and strength absolutely can.
Children with low tone need more rest, encouragement, and movement variety to thrive.
Your support makes a lasting difference. With patience, consistency, and the right tools, progress is always possible.
BORING, BUT NECESSARY LEGAL DISCLAIMERS
While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.
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