Hypotonia and NutritionLow muscle tone, or hypotonia, is one of the physical problems often associated with developmental delays; nutrition and low muscle tone are intimately connected.

Children can have generalized hypotonia or it may affect just specific areas such as the hands or upper body.

Hypotonia is clinically significant because in severe cases the muscles are literally too weak to perform important tasks such as holding a pencil or sitting without slumping in a chair.

In milder cases, stamina or precision are affected.

For example, children with severe hypotonia of the hands are reluctant or sloppy writers whose interest in writing or drawing declines in direct correlation with the severity of the low tone.

When the concerns are milder, youngsters may try to overcompensate for difficulties by holding pencils too hard and causing cramps or creating blisters.

Hyptonia Causes

There are two possible causes of hypotonia.

Occupational therapists contend that the vestibular system imbalances are to blame.

The vestibular system is the primitive sensory system that is responsible for gravitational stability.

The ability to walk down a flight of stairs while carrying a load of laundry is a tribute to the gravitational stability provided by a well-functioning vestibular system.

People described as clumsy or children with difficulty climbing or riding bicycles often have vestibular issues.

Good muscle development (or how your body pushes against gravity) is also considered a marker of vestibular development.

From a nutritional perspective, hypotonia represents the poor delivery of nutrients to the muscles.

Diet represents what is consumed, but nutrition is what the tissues actually get.

When soft muscles are present, there is a big gap between diet and nutrition.

The muscles, suffering from nutrient deprivation, remain underdeveloped, or if strong, become fatigued easily.

Congenital hypotonia is not the same as being out of shape.

Those born with low tone can improve their condition but the tendency will remain.

That is, if two people exercise exactly the same amount, the one with hypotonia will have less muscle development as a result.


If the delivery of nutrients is inefficient, there are two basic strategies to better manage the situation; increase the amount of nutrients available for transport and try to regulate the naturally sluggish dispatch system.

Those with hypotonia tend to love sweets as they are a quick form of energy for tired muscles, but in the long run, a diet high in empty calories worsens the deficit.

Controlling the intake of concentrated sugars (candies, sodas, juice, desserts) is the first step followed by the usage of a comprehensive multiple vitamins and minerals.

Because even a perfect diet will not be enough for someone with poor nutrient distribution, extra nutrients will assure that minimum requirements are met.

The use of supplemental nutrients is a long term management tactic, not a quick fix.

Once there are plenty of general nutrients to deliver, one can attempt to strengthen assimilation and usage of nutrients with more sophisticated measures.

Digestive enzymes, carnitine, and co-enzyme Q-10 all may help.

Digestive Enzymes

Digestive enzymes aid the breakdown and assimilation of food.

If used too aggressively, they cause stomach cramps and loose stools.

They are given with meals, preferably lunch and dinner, as the body’s strongest capacity for digestion is in the morning and so they are less needed then.

Vegetable-based enzymes, such as Prevail Children’s Digestion, are gentlest.

In addition to low tone, those who do best with enzymes tend to be picky eaters, have digestive complaints such as stomach aches and/or have constipation or diarrhea.


Carnitine (or L-carnitine, the active form) is critical for regulating fat burning (i.e., energy availability) in muscles.

L-carnitine is made by the liver from the amino acids methionine and lysine with the help of vitamins C, B-6 and niacin.

Dietary sources are muscle and organ meats.

There is no carnitine in vegetables, fruit, or grains.

In diseases with muscle deterioration, carnitine almost always helps and low carnitine is often a marker.

Those with low tone may likewise benefit from carnitine even though their situation is not as profound.  L-carnitine is non-toxic and 500-1000mg is a typical dose range.


The body cannot use food directly for energy but must convert it to an energy holding compound called ATP.

There is only enough ATP stored in the body to provide energy for about 5-8 seconds of non-stop strenuous activity, so it must be constantly re-generated using co-enzyme Q-I0 (or ubiquinone).

Co-enzyme Q-10 nutritional supplementation would, therefore, be important for muscle performance and stamina.

One preliminary study found co-enzyme Q-10 improved muscle work capacity in normal volunteers.

Studies also show that co-enzyme Q-10, appears to improve immune function.

The beginning dose range for co-enzyme Q-10 (like L-carnitine, a nontoxic substance) is usually 30-60 mg.

L-carnitine and co-enzyme Q-10 can be taken safely together with a multiple vitamin to aid in their utilization.

For specific information on supplements for your child, always confer with a health care professional.

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Related Pages

Developmental Delays

Does Mitochondrial Dysfunction Finally Connect the Diverse Medical Symptoms We Now See in Children With Various Health Problems?

How Nutrition Affects Hypotonia

Hypotonia & Hypertonia

Mitochondrial Dysfunction

Mitochondrial Dysfunction and Autism

Mitochondrial Dysfunction and Autism with Dr. Suzanne Goh (webinar replay)


  1. Daniela

    I have been giving my son carnitine and coq10 at breakfast based on this article. His core strength has improved teemendously. The change is wonderful.

  2. Jenn

    My 4 year old has global hypotonia and was previously FTT, with multiple delays. I started him on trace minerals a year and a half ago and he took off in growth, weight, language, and his low tone decreased dramatically. I had taken him off of them for a while and just started back up. My concern is that he is very wild, all big movements, often getting hurt. He still has hypotonia depsite the improvements, but has been discharged from OT and PT. He wears orthotics and his knees hyperextend. I do not have a known cause for his hypotonia but there is a chance I have Ehlers Danlos. I’m wondering if there is another supplement that he could benefit from that I am missing.

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