Three-year-old Alexander Heyns plays next to his mother at the physiotherapy centre, fitting shapes together into a box. “Look, mama, they are all in now,” he says, blue eyes sparkling.

“When he first came here, he would never do this,” says his mother, Lynette. “He would come in shouting and charge around, touching everything. He found it difficult to focus.”

Alexander has been getting physiotherapy for “low muscle tone” since he was two years old. While the term “low tone” conjures up the idea of a floppy, weak child, Alexander is big for his age and very active.

His physiotherapist, Pam Hansford, says many people don’€™t understand what low muscle tone is, and she prefers to talk about “poor posture and poor body alignment”.

Cape Town-based Hansford runs a unique, holistic neuro-developmental practice for children. The emphasis is on building on a child’€™s strengths, rather than focusing on his or her weaknesses. And therapy takes the form of play — from building houses to playing with shaving cream and bouncing balls.

Muscle tone is what enables us to keep our bodies in a certain position. Children who lack the muscle strength to keep themselves upright against gravity often prop themselves up against things rather than standing or sitting up straight, and they find it difficult to sit still.

When they get to school, they often get into trouble for not concentrating or trying. But instead, they are trying so hard to keep themselves upright that this interferes with their ability to listen to the teacher properly.

“Often the harder the children try, the more tense they get. This distorts their body posture and alignment yet further, and slows them down even more,” says Hansford.

“The child is then not in a position to divide his or her attention between the work and the teacher and often gets accused of not listening when they are in fact trying very hard.”

“Alexander was always very active, and could never concentrate on one thing,” says Lynette. “Because he was our first child, we didn’€™t know any different. And my friends all said boys were just like that.”

But when Alexander went to play school, his teacher noticed that he didn’€™t like to sit down to paint or play with play dough, he didn’€™t interact much with other kids and that he avoided playing on the jungle gym.

“The teacher suggested that we take him for an assessment with a physiotherapist,” says Lynette, “and this is how we ended up here.”

No one knows exactly what causes low muscle tone, but traumatic births and genetics (inheriting low muscle tone from parents) are the main probable causes.

Professor Sheena Carter of Emory University in the USA says that premature babies are “more likely to develop motor problems” than full term babies as they are more likely to suffer problems with their blood or oxygen supply.

Jenny van der Hoff is convinced that her son David’€™s low tone problems stem partly from his difficult birth and subsequent confinement in intensive care for 10 days.

“When David was about four months old, my sister, who is a physiotherapist, noticed that he favoured turning to the one side only,” says Jenny. “He only sat at nine months, and walked very late.”

When David was two years old, Jenny started taking him to physiotherapy at her sister’€™s suggestion. Two years later, Jenny says her son “is blossoming because he can now do many things he had tried so hard to do in the past but couldn’€™t”.

“I used to see this little boy getting exhausted with the effort of trying but not managing to do things. Now at the end of the day, he’€™s tired but it’€™s because he’€™s doing so much.”

While not much research has been done on causes of low muscle tone, there are plenty of lifestyle-related habits that interfere with a child’€™s ability to develop good posture and body alignment.

Hansford says many children from more affluent homes are “movement deprived” ‘€“ from being confined to little plastic seats, walking rings or push chairs as babies, and by playing computer games or watching TV instead of playing outside when they are older.

If babies’€™ movements are confined and their balance is upset, says Hansford, they “cannot develop good shoulders, free arm movement and eye-hand co-ordination skills”.

“Some parents cart their babies around in those round-backed baby car seats,” says Hansford. “Safety is important, but once out of the car the less time baby spends lying around in an inclined seat, the better.

“Just look how his back collapses and goes skew. And he isn’€™t in a position to see, connect or use his hands.”

She says a tiny pillow under a baby’€™s head is enough to enable her to see what is going on. “Babies need to lie flat so that they can get their hands to their knees and feet.”

She laments the fact that many parents have dumped the old-fashioned, flat-bottomed prams in favour of permanently inclined pushchairs that tend to put a baby off balance.

Hansford also encourages parents to put their babies on their stomachs as this lengths the spine. “Parents no longer want to let their babies sleep on their stomachs because of fear of cot deaths. But parents should compensate by letting their babies sleep on their stomachs during the day, when adults are awake, and also put them on their tummies to play.”

Walking rings also hamper a child’€™s development by putting “a wide plastic shelf between the child and the world and upsetting a child’€™s balance”.

“If children don’€™t learn to use their back and stomach muscles properly, they won’t learn how to lean forward and take weight on their arms, crawl and strengthen their shoulders and hips. This is important for an upright posture so that a child can function successfully in class,” says Hansford.

For new parents, low muscle tone may seem to be yet another terrifying potential problem lying in wait for their babies.

But Johannesburg-based physiotherapist Justine Elgar is positive that the combination of knowledge and physiotherapy can overcome many postural problems in children.

The first problem, she says, is that “low muscle tone has become such a buzzword recently, yet few parents and teachers know what it is”.

A large part of her practice involves education ‘€“ “giving seminars to make people more aware of how to identify problems with posture and movement.”

“There is so much pressure on children at school these days, that the average kid can’€™t cope. Many children just need a few sessions of physiotherapy to develop positive habits and restore their self-confidence. Then they’€™re away.”


About The Author

Kerry Cullinan

Kerry Cullinan is the Managing Editor at Health-e News Service. Follow her on Twitter @kerrycullinan11

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How to help your child to develop good posture

  • Let you baby spend time flat on her tummy, both when awake and sleeping. This is important to lengthen the spine and strengthen neck muscles.
  • Ensure that your baby spends time in a horizontal position, rather than inclined in a little seat. This will enable her to see her hands and play with her feet, thus developing hand-eye coordination.
  • When your child is sitting on the floor, encourage her to sit cross-legged. Discourage “froggy legs” (sitting on her bottom, with one leg curled back on either side). This makes the hips turn inwards. Let a young child sit on the edge of a flat pillow to encourage a slight curve in the lower back.
  • When your child is sitting on a highchair or chair, make sure that the seat and back are at right angles and her feet are flat on the ground, or on a foot rest. (Make a foot rest with telephone directories).
  • Her forearms can rest light on the table as this encourages should control and lifts the ribcage out of the pelvis.
  • When your child wants to draw, encourage her to kneel at a low table. Secure the paper with prestik or tape. Encourage her to rest her free arm on the table top, not clutching a koki lid.
  • When looking at a book, a child’€™s arms should be comfortably supported with both hands on the sides of the book. Her nose should be opposite the middle of the picture or text being looked at to facilitate the easy flow of eye movement.