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!