• Deana Rosaia

Let's Talk Tone, Muscle Tone.

Move over Webster, we are getting nerdy with the dictionary.


One of the most common things I hear from parents is 'The therapist/doctor/teacher says my kid has low tone' with a panicked look on their face.

Other things I hear:

“I want to fix my child's low tone”

“So and So said my kid needs therapy because they have low tone, but I have no idea what that means”

I want to clear the air and shed some light on this mysterious label we are quick to slap on a kiddo and scare the living lights out of parents.

Guess what, we all have it. It’s a range. And when you understand they why and how, it can take some of fear away. Knowledge. Is. Power.

Fun Facts about tone – and I am going to keep it simple. No, I am not a neuro physiologist talking to another PHD. I am a momma talking to other mommas. So there.

Tone is the communication between your brain to your muscles that determines how much ‘resting energy’ your muscles should have to prepare for movement.

Think of it this way. If we didn’t have muscle tone, we would be puddles on the floor. Our muscles have to maintain “resting energy” to prepare to move.

Tone cannot be fixed or changed. In some instances, specifically for too much tone, medication can help to decrease the communication from the brain to the body, but it’s a temporary fix. We CAN make temporary adjustments to a child’s body to help increase or decrease the communication, but these are temporary and a tool to help support movement.

Tone is NOT muscle strength. I repeat. Tone is NOT muscle strength.

Tone is a RANGE. There is low normal, high normal, abnormal low & abnormally high – and everything in between.

Low normal: you may be a bit “loosey goosey” or “flexible.” Your baby might be on the longer end of normal to reach milestones. They might be a “leaner” as a toddler and seemingly melt into any support you give.

High normal: these littles are usually a bit stiff or “wired.” They seem to have lots of resting energy and just bounce like a ball around and around. They might be “stiff” as babies or seem very intense. I have found that babies with high normal tone might meet their milestones, TOO early – for their own good.

Abnormally Low: This qualification of low tone will usually come with a medical condition where low tone is a symptoms of the diagnosis. Kiddo’s with abnormally low tone typically need support to build strength and reach their motor milestones. The brain is under anticipating how much energy the body needs to move and therefore, it takes MORE strength for kids to produce the same amount of movement as their peers. These littles sometimes are like little puddles, but rest assured, they are THE BEST cuddlers.

Abnormally high: Again, the diagnosis of high tone is symptom of another underlying medical diagnosis. In this instance the brain is OVER communicating how much resting energy the muscles need and as a result, movements are very stiff, rigid and kiddos have a difficult time controlling their bodies.

So, back to the strength point. Tone is NOT muscle strength. Let me explain.

Tone is the energy communicated from the brain to the body in anticipation of movement.

Strength is a muscles ability to forceable contract to produce movement.

Why does this matter? And, how does it relate to tone?

Kiddos with low normal or abnormal low tone have LESS resting energy in their muscles in anticipation for movement. It will then take MORE strength to produce the same level of movement as their peer with higher tone.

It will take more strength, balance and practice – insert the role of a pediatric physical therapist!


When a baby is referred to pediatric physical therapy with 'low tone' we are not changing the tone. We are helping build enough strength to move DESPITE their baseline level.

Kiddos with abnormally high tone will have an over communication of resting energy in anticipation for movement often causing an imbalance in muscle strength rather than muscles working together, in a coordinated way, to produce smooth movement.

Again, this is pediatric physical therapy can play a part – identifying the imbalance & helping to manage the strengthening, flexibility and coordination to produce purposeful movement.

Goodness I hate an inappropriate label – labels in general are pretty much blah in my opinion. They put kids in a box and trap them with tape.

So, your kiddo has tone. Great. Let’s focus on movement, function and most importantly PARTICIPATION in the most amazing aspect of a child's life, PLAY.

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