Hypotonia and Your Child – Interview With A Pediatric Physical Therapist

by Aculbertson

The following is an interview with Dr. Brita DeStefano, a pediatric physical therapist in Denver. You can follow her on Instagram or check out her site Progress Through Play.


Can you tell us a little bit about yourself?

Absolutely. I am a pediatric physical therapist. I have 10 years of experience in the field across various settings, but currently I own a mobile practice in Denver called Progress Through Play. I serve mostly the birth to five population with a big focus on wellness, prevention, early intervention, that type of thing. I’ve also just begun offering virtual sessions as well.


How do you describe hypotonia to parents who’ve never heard of it?

My go-to is the rubber band metaphor describing the spectrum of muscle tone and using that to delineate the difference between muscle tone and muscle strength. We’re talking about how the muscles look at rest and I think that parents usually connect with the rubber band metaphor and it’s easier for them to comprehend that because it’s a very confusing thing to explain to someone who’s never heard of that before.


What misconceptions about hypotonia do you hear most often?

I hear a lot the confusion between muscle tone and strength and also that, “Oh my baby’s just lazy.” And they’re not. There’s nothing about these children that’s lazy.


In a general sense, how does physical therapy help kids who have hypotonia?

Well, in my practice and the way that I treat is always focusing on play because that is a child’s main occupation and improving a child’s ability to participate in that play and their daily activities is really the most important part. While I might be working with that child on coordination and strengthening and improving posture and motor planning and all of these specific goals, my treatment session is always in the context of activities that happen throughout their daily life so the parents can duplicate them. That’s usually in the form of play. I’m really just helping the child gain the strength, coordination, balance, etc. to participate in their daily life.



What role do orthotics, such as Surestep SMOs, play when paired with physical therapy?

With orthotics, and Surestep specifically, we’re looking to give a child the confidence to try something new that they would normally not attempt. I feel like when you offer a strong foundation to build upon, then we see those new skills emerging. In my practice, I’m all about creating building blocks for healthy development. For some children, an orthotic or Surestep would be one of those building blocks that we use to help progress development.


What exercises or at-home activities do you recommend?

I have two fun things that I always like to suggest and climbing is one of them. It’s such a great activity to work on that can help improve so many different things like bilateral coordination, strengthening, and motor planning. And it’s fun, especially when I get to tell kids that they can climb up the slide of the playground, something that they’re always told that they can’t do, but it’s such a great activity for those kids who do have hypotonia. Then another one, which children always love, is creating obstacle courses with just anything you have around your house. So couch cushions, boxes, stepstools. You can use painters’ tape on the floor, just anything you see lying around and creating a fun story or game to go along with it like a scavenger hunt or picking up puzzle pieces along the way. It’s just a simple thing that uses items from around the house and parents can easily incorporate it into their child’s daily play.


And from a clinical perspective, how are these activities helping?

Well, the climbing itself is working on using both sides of their body together, while activating their core to improve postural control. We’re also working on the actual motor planning of the steps of how to get from the bottom of the slide to the top of the slide the same thing with obstacle courses as well. An easy thing to incorporate into the course is balance tasks. A lot of kids with hypotonia have difficulty with balance because they have a hard time coactivating the muscles to stabilize themselves.



What would you say to parents who are deflated because of the struggles their child is facing?

I just posted one of my favorite quotes the other day, which is, “Just because it took you longer than others does not mean that you failed.” I also see you guys post a lot that a developmental delay is a comma and not a period. And so I always just recommend that families meet their child exactly where they are in that moment. We’re not focusing on the past or the future. We’re meeting them exactly where they are today to help them walk along their own developmental pathway.


Anything else you’d like to say?

Well, one of the things that I’m really passionate about is that parents have resources when they do have concerns about their child. Because kids are continuously changing and growing, I don’t think that they can really afford for us to follow that wait and see model. I just want parents to know that if they feel like they are being dismissed by a provider or a pediatrician or they don’t know where to go or who to ask about their child’s development, that that’s why I provide the services that I do because I don’t think that any child should fall through the cracks.

A lot of times children with hypotonia are otherwise very typically developing. They don’t have a medical diagnosis necessarily. They can oftentimes be those children that do fall through the cracks. I just want parents to know that there’s no need to wait for a red flag or a significant delay in milestones before looking for support. I think that parents deserve to have that peace of mind and understanding about their child’s development. That’s why I do what I do.

My family doesn't understand hypotonia. What should I say?