Low Muscle Tone

We were referred by our pediatrician to see a PT for our 10 month old who at his nine month check up was not purposely rolling, crawling, pulling up to stand nor cruising.
He didn’t qualify for our state’s PT services because he didn’t meet qualifications with 20% delay in gross motor skills (with MECATS eval he placed equivalent to 8months in gross motor skills). They said he has low muscle tone/ floppy ankles and that with practice he would catch up on milestones.


  1. Is low muscle tone something that cannot be corrected and will always have to worked on throughout his life?

  2. Is low muscle tone specific to certain areas of the body?

  3. What activities/ exercise can I do to help strengthen the ankles?

  4. Activities to prepare for pulling up to stand?

Hi @Bustial -these are really such great questions!

:green_square: Muscle tone itself does not change, but we PTs focus on building muscle strength (which is different than tone) to help children compensate and participate in age appropriate play or skills. There is a range of what is considered “normal” tone and with sufficient strength, most children and adults can engage is any type of physical activity.

:green_square: Low tone is typically generalized throughout the body

:green_square: In order to progress in gross motor skills, babies need to develop strength through their whole bodies-head control, the core, arms, and legs. Babies don’t typically begin developing strength in their ankles until they begin weight-bearing activities like pulling to stand, cruising, and walking.

Strength needs to develop in the core and hips before your baby will be strong enough to pull to stand and begin to weight-bare through the feet.

However, if the evaluating PT noticed excessive joint laxity, it is probably a good idea to keep a close eye on things to make sure your baby has the opportunity to build that muscle strength. Also, If your baby isn’t rolling purposely or crawling at this point, it’s probably worth getting a second opinion or seeking out private therapy where percentage delay isn’t a factor (or maybe a local hospital has outpatient services?). If that’s not available, many states will reevaluate every 3 months, so don’t hesitate to call back!

Here are some great posts from my friend and amazing PT @Emily_Whigham_Heisey that can get you started with some ideas of activities you can do at home:

Getting into a tall kneel (this position can be great to play in and works on strengthening the core, hips, and legs)

Transitioning from tall kneel to standing:


Practicing going from Sit → Stand

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Thank you so much for linking the videos for quick access and for helping me by narrowing it to the types of exercises needed!!!

I appreciate the advice on potentially getting a second opinion … in a week span from his eval where he crawled slow and with left leg and foot inward, he is now crawling in an alternating back and forth movement with legs and a little faster. He’s also pulling to knee position on his own (he wobbles a bit) from furniture that’s at eye level or below, can’t pull up yet to anything above that. Should I monitor progress after giving lots and purposeful practice with the types of exercises or get 2nd opinion through private agencies right away first?

Also, is it know the cause of low muscle tone? Are there things I need to do differently next time (baby) around?

That is so great that there has been so much progress! I think it’s important to trust your gut with regards to a second opinion. A private PT doesn’t have the same strict qualification standards as an early intervention provider because of the differences in funding source so they should be able to give you ideas for progressing and other things to do. With regards to low tone, there are a lot of things that can have low tone as part of the diagnosis but some kids have low tone for an unknown reason. If this is the case then I don’t think there is a lot you can do differently. I wish I had a better answer or explanation, we hear that question all the time.

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