Physical Therapy and Hypotonia and Other Delays

Hypotonia and Other Developmental Delays

Many children with developmental delay are diagnosed with low tone or hypotonia.  Low tone infants are often referred to as “floppy” because their lack of tone can make them feel like ragdolls when being held. Children with developmental delays may not have hypotonia, but may present with similar challenges to the child who does have low tone.  These children often have difficulty learning the next steps of gross motor development.  Depending on the degree of delay the child may have difficulty with the early milestones of crawling and walking, or may struggle later on with higher level gross motor skills, such as keeping up with friends on the playground.  

Children with developmental delays often have trouble with daily activities as well.  They may have difficulty learning to dress and feed themselves.  Low tone in the core can also affect control of the mouth and lead to feeding problems and drooling.  Children with low tone will often lock their joints, such as the knees and elbows, and will have flat feet.

Physical Therapy, Hypotonia and Developmental Delay

During a physical therapy evaluation a child’s gross motor skills and movement patterns are observed.  The child’s flexibility, strength, and sensory organization will be assessed.

Based on the evaluation findings, physical therapy can include:

  • Strengthening exercises
  • Stretching
  • Balance activities
  • Gait training
  • Orthotic recommendations

The SMILE Approach For Children with Hypotonia and Developmental Delays

At Kid PT we are focused on uncovering hidden potential.  Our approach can help children to skyrocket their skills to the next level by eliminating differences and disconnections in the body that you may not know are even there, until we show you where to look.   

Kid PT uses the Sensory Motor Integration for Life and Education (SMILE) approach to help children with developmental delay to achieve their goals.  The three levels of the SMILE Approach build up the core foundations of movement that some children have not developed on their own.  The three pieces of SMILE work together to ALIGN the body, ACTIVATE the neuromuscular system, and INTEGRATE the sensory-motor systems.  These three pillars work as a sequence of increasing sensory-motor complexity to build a solid foundation for movement. More advanced developmental skills for learning and daily life can then develop with more spontaneity and less intervention.  

Learn More About the SMILE Levels of Intervention


  • Children with low tone are often assumed to be flexible everywhere.  When you look closely at their core, the opposite is discovered.  Children with low tone typically don’t develop sufficient three-dimensional control in their core.  Without the development of core control, asymmetries, often from in utero positioning, remain.
  • Children with low tone are often extra sensitive to these postural imbalances compared to other children. Children with any developmental delay, without neurological dysfunction, are often responding ONLY to postural imbalances. Which means, if we eliminate the imbalances, the child takes off spontaneously and without further intervention. In these children, change happens FAST.
  • For some children, especially children with developmental delay without a neurologic injury, Level 1 will be all they need.  For other children, they will need to move on to Level 2 and 3 of the SMILE approach.


  • Once a child has the available mobility to achieve a balanced core, many children need additional guidance to learn how to turns those muscles on.  Once a child learns how to combine deep breaths with good posture, they are ready to gain strength, endurance, and motor control in order to use that control all day.
  • Many children with hypotonia have used compensatory patterns since infancy, such as breath holding to keep their balance.  This solution doesn’t work well when the child has to breathe or talk.  A lack of deep breathing skills can affect a child’s balance, can cause constipation, limits turning on the calming system that opposes the fight-or-flight response and can affect visual skill development.
  • The SMILE approach is not your typical core strengthening program!  Typical core strengthening does not focus on the activation of the inner core as preparation for movement.  We focus on quality, not quantity.  The breath and control of posture are integral to this level.


  • The integration  level brings the sensory-motor team online and into daily function.  This is accomplished in different ways depending on the motor abilities.  The goal of Level 3 is to make movement as automatic as possible so that children can focus on higher level skills, whether it is moving through the classroom without bumping into things or learning algebra.
  • Integration is a key for a child to move their movement skills to the next level.  We move through daily life without consciously thinking about how we are moving our bodies.  We can walk while daydreaming without bumping into a street sign and we can sit in a chair without falling off while reading and writing.  This may sound natural for many of us, but children with postural deficits use excessive energy, attention and focus to fulfill all of the expectations they face each day.

By focusing on the building blocks of movement through the S.M.I.L.E. approach, children can build the foundations they need for success in daily life and in school.  Call Kid PT today to learn more how we can help your child unlock their potential.

If you have concerns both in your child’s movement patterns as well as their engagement with you, contact Kid PT here or Call us at 908-543-4390 to arrange a screening.