“My child has low muscle tone and fatigues easily. She struggles to make it through her school day and is coming home with tons of homework. She is physically unable to get through her written homework, even with my help. I am trying to balance making sure she completes all of the homework so that she is learning and seeing to it that she has some down time before she goes to sleep at night. Do you suggest that I communicate with her school and let them know how difficult things are and how hard she is working? How should I modify her homework?”

Thanks for your question. This is a common situation for children with low muscle tone, also known as hypotonicity. Muscle tone is the amount of force that the muscles use to move or complete a task. For example, when you reach for a juice container that you assume is full, your brain signals your arm and hand to lift it carefully since it is heavy. Many of us have experienced that feeling of lifting an empty juice container with too much force, only to have it go flying. That is our tone. It determines how much a muscle needs to work to accomplish an activity. When someone has low muscle tone, these regular tasks can become more challenging. Depending on the severity of the hypotonicity, the muscle strength and endurance become affected as well.

Handwriting is one of those skills that requires a synthesis of a great many skills, including, though not exclusively, gross- and fine-motor strength and coordination; sensory organization; language development; cognitive development and so much more. This is why so many children struggle with handwriting. When low muscle tone is an issue, shoulder and arm strength, hand position and finger grasp and overall endurance can impede handwriting. This can affect a child’s ability to keep up with work in the classroom and complete assignments for homework.

There are many different strategies to help a child get through homework when low muscle tone is a factor.

1) Break up the assignments. Most of our children have different assignments for different subjects. Each assignment should be given a specific amount of time to complete. After that period of time, the child should have a timed break. This break can be used for a snack, to run around the house or yard (or some other form of exercise, such as swinging or jumping, our favorites). After the break, the child returns to work and repeats the cycle.

2) There are certain assignments that can be verbally completed with a note from the parent stating that the assignment was completed successfully. Spelling and vocabulary in the early grades are examples of subjects that may be able to be completed verbally with a note to the teacher from the parent.

3) Children with low muscle tone benefit greatly from extra movement and different types of sensory experiences, including tactile. This stimulates the muscles and allows the child to be more alert and the muscles become more responsive. Activities such as bouncing on an exercise ball, wall push ups, playing with putty or sand, and jumping jacks are all great strategies to help children with muscle tone increase their endurance.

Our practice maintains an open-door policy to parents and caregivers so that carryover is always possible. Additionally, we strongly encourage all of our families to communicate with their children’s teachers and work closely to find the best solutions so their children can maximize their potential in school. As therapists, we speak or email with teachers on a regular basis. It is so important for teachers and interventionists to communicate, and all parents should encourage their children’s therapists and teachers to work as a team. It is only as a team that our children can reach their greatest potential.

Alyssa Colton MA, OTR/L and Aviva Lipner MA, OTR/L are pediatric occupational therapists and owners of Kids’ Therapy Place, LLC and Kids’ Therapy Toy Store. They can be reached at [email protected].

By Alyssa Colton and Aviva Lipner