Low tone in babies: what it really means (and why it’s more common than you think).
Babies with low muscle tone, also known as hypotonia, often appear “floppy,” with soft, relaxed arms and legs that make movement and posture more challenging. Hypotonia isn’t a diagnosis in itself; it’s a symptom of an underlying condition or developmental stage.
Some potential causes include:
Genetic or neurological conditions such as Down syndrome, Prader-Willi syndrome, congenital myopathies, or central nervous system differences.
Perinatal issues: prematurity, lack of oxygen during birth (hypoxia), or birth trauma.
Metabolic or endocrine disturbances, including hypothyroidism or mitochondrial dysfunctions.
Hypotonia and Pre-term Babies
There is a strong link between prematurity and low tone. Pre-term babies often display hypotonia because:
Their muscles and joints are still immature, as much of tone develops in the last trimester.
The nervous system is still developing, so motor signals aren’t as coordinated.
NICU stays, medical interventions, or complications (such as hypoxia or brain bleeds) may further affect tone.
For many pre-term babies, low tone improves over time as the nervous system matures. With gentle support, lots of movement opportunities, and early therapy if needed, these babies often catch up beautifully.
How Does Hypotonia Affect Milestones & Feeding?
Because their muscles are less ready to provide stability, low-tone babies may take longer to:
Lift their head during tummy time
Roll over, sit, crawl, or walk
Grasp toys or self-feed
Babble and articulate speech sounds (oral muscles can also be affected)
Feeding can be particularly challenging: weak jaw, lips, and tongue may affect latching, sucking, and swallowing. These babies can fatigue quickly at the breast or bottle. They may also drool excessively or have trouble transitioning to solids.
Is There a Connection Between Hypotonia & Reflux?
Yes. Babies with low tone sometimes experience reflux because:
Their digestive tract muscles (including the lower oesophageal sphincter) may not close tightly, allowing milk to come back up.
Core weakness can slow digestion and make positioning more difficult.
This doesn’t mean all hypotonic babies will have reflux, but the overlap is common enough that parents and clinicians watch carefully for feeding discomfort, arching, or slow weight gain.
How Do Clinicians Check for Hypotonia?
Paediatricians and therapists often use simple orthopaedic and neurological assessments in babies, such as:
Pull-to-Sit Test: When gently pulling a baby from lying to sitting, a baby with low tone will have little or no head control (the head lags far behind).
Scarf Sign: When bringing the baby’s hand across their chest, the elbow crosses midline easily (due to loose muscles).
Vertical Suspension Test: When held upright under the arms, the baby may slip through the examiner’s hands because the shoulder muscles don’t activate strongly.
Horizontal Suspension Test: When held in a “flying” position, a low-tone baby may drape over the examiner’s hand instead of holding some extension.
These tests help clinicians differentiate hypotonia from normal variations and guide whether further neurological or genetic evaluation is needed.
Three Simple Daily Exercises to Support Development
Parents can play an important role with safe, simple activities:
Tummy Time with Engagement
Best from: Birth onward (as soon as baby is medically stable).
Why: Early tummy time on your chest or lap feels safe and comforting, while also gently strengthening neck, shoulders, and upper back.
Tip: In the first 6–8 weeks, keep it short (a few minutes at a time), then gradually increase as baby tolerates more.
Supported Sit-Ups (Pull-to-Sit Play)
Best from: Around 2–3 months, when baby is starting to show better head control.
Why: This encourages activation of trunk and neck flexors, and it’s a fun way to interact.
Tip: Go slowly, watch for head lag (very normal before 3 months). By 4 months, babies should start to assist more actively.
Oral Motor Play
Best from: Around 3–4 months onward, as babies bring hands and toys to their mouth and begin teething exploration.
Why: Chewing, mouthing, and tongue movements build tone for feeding and eventually speech.
Tip: Offer safe teething toys, silicone spoons, or even your clean finger for gentle gum play.
So in summary:
Tummy time: Newborns onward.
Pull-to-sit: 2–3 months+
Oral motor play: 3–4 months+
Feeding & Advocacy: Practical Tips for Parents
Work with feeding specialists (lactation consultants, speech pathologists) who understand hypotonia.
Watch for reflux signs to provide the right support.
Early therapy such as osteopathy to support their development.
Celebrate your baby’s progress, even tiny steps forward are win.
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Hi I’m Michelle, I teach parents how to calm their unsettled newborn with simple exercises and strategies. I can help you support your baby through issues such as colic, infant reflux, oral restrictions and birth strain. I’m an osteopath with over 20 years experience and a mum of 2 boys.