How Joint Laxity and Low Muscle Tone Affect

 Fine Motor Skills in Preschool and Kindergarten 

 By Irene Hannam, MS OTR/L 

Introduction:

Low muscle tone (hypotonia) is a condition where muscles have reduced tension or “readiness for action.” In many young learners—especially preschool and kindergarten students—hypotonia may occur alongside joint laxity (loose or hypermobile joints). This combination can make routine classroom tasks far more challenging, like opening containers, cutting with scissors, or coloring with crayons. Early identification and targeted strategies can help these children build strong foundational skills and foster independence.

Understanding Low Muscle Tone in Young Children:

What Is Muscle Tone?

Muscle tone is the mild, continuous contraction that keeps muscles prepared for movement and aids in maintaining good posture. Children with low tone often appear “floppy” or have a softer muscle quality. They typically struggle to sustain muscle contractions required for fine motor tasks and may exhibit:

• Poor Postural Control: Difficulty sitting upright during group activities or table work.
• Delayed Motor Skills: Reaching developmental milestones (both gross and fine) later than peers.

Note for Teachers: A child frequently slumping at the table or quickly tiring during coloring could show signs of hypotonia or joint laxity.

The Challenges of Joint Laxity and Low Tone in the Classroom:

1. Opening Containers and Manipulating Classroom Tools

• Reduced Strength: Children may need extra force to twist or pull lids, leading to frustration.
• Poor Endurance: They tire quickly and might avoid activities that require repetitive fine motor actions (e.g., working with art supplies).

2. Using Scissors, Crayons, and Pencils

Scissor use, coloring, and drawing are staples in preschool and kindergarten classrooms, but hypotonia can lead to:

• Weak Grip: Difficulty maintaining a functional/efficient and consistent utensil grasp or controlling pressure on crayons/pencils.
• Instability: Hands or fingers may shake, affecting precision.
• Immature Grasp Patterns: Reliance on an immature grasp pattern instead of a more refined tripod grasp.

3. Handwriting and Pre-Writing Skills

While formal handwriting instruction typically starts in kindergarten, many preschoolers practice pre-writing strokes. Children with low tone may show:

• Inconsistent Letter/Shape Formation: Variations in size, legibility, or neatness.
• Poor Coordination and Alignment: Trouble aligning letters on or within writing lines or providing adequate or appropriate spacing.
• Slower Pace: Limited endurance can slow their progress, making it hard to keep up with classmates.
• Decreased Endurance: They may lose focus or motivation for pencil-and-paper tasks sooner than their peers.

Recognizing Signs of Low Muscle Tone in the Classroom:

Teachers are often the first to notice when a child struggles with fine motor skills.

Watch for:

• Frequent Dropping of Items: Clumsiness with crayons, puzzle pieces, or small objects.
• Fatigue or pain: Complaints of tired or “hurting” hands after a short time of coloring, drawing, or writing. Slower or incomplete cutting due to continuous grip and release actions.
• Difficulty Coordinating Both Hands: Difficulty stabilizing the paper with the non-writing hand (does not hold the paper firmly or at all). Difficulty holding paper steady with one hand while cutting with the other.
• Difficulty Controlling Pressure: A child might grip a pencil so tightly their knuckles turn white or press down too hard on paper. At the same time, some students may exhibit decreased grip force and wispy strokes.  When coloring, they may exhibit increased pressure. They may struggle with fully closing the scissors or forcing them too hard when cutting.  
• Grading Movements: Applying appropriate force to cut, write, or color neatly without tearing or smudging
• Leaning Heavily on the Table: Propping elbows or head for added stability.
• Excessive Compensatory Movements During Fine Motor Tasks: Stabilizing elbows or arms against the body or table, limiting range of motion but reducing tremors.

When Using Scissors, Crayons, and Pencils:

Watch For:

1. Fisted or Palmar Grips

• Description: The child may use an alternative grip to compensate for weak hand muscles and joint instability. They may wrap their entire hand around the crayon or pencil or use a five-finger grasp. They may have difficulty shifting their grip on a crayon or pencil.
• Why It Happens: Weak small hand muscles make isolating finger movements difficult; using a whole-hand grip offers more stability but less precision.
• Teacher Tip: You might see the student pressing too hard to compensate for the low tone or use alternative grasps such as a five-finger, finger wrap, or interdigital brace grasp.

2. Excessive Wrist and Arm Movement

• Description: Instead of controlled finger or wrist action, the child may move the entire forearm or shoulder when coloring or writing.
• Why It Happens: Limited wrist stability and poor finger strength force reliance on larger muscles.
• Teacher Tip: Look for wide, sweeping motions and awkward arm positioning.

3. Shaky Hands or Finger Tremors

• Description: Mild tremors may cause jagged cut lines or uneven coloring.
• Why It Happens: Sustaining muscle contraction is harder with low tone, leading to mild tremors.
• Teacher Tip: Check for unsteady hands if children are missing the paper’s edge or making uneven lines.

4. Scissor Positioning and Grip

• Description: Fingers may be placed incorrectly in scissor loops, or the child might rely on a palmar grasp to open/close scissors. Cutting along curves or cutting shapes can be very challenging. Synchronizing the opening/closing scissors with repositioning the paper is challenging.
• Why It Happens: Weak hand muscles and poor coordination make isolating the thumb and fingers challenging.
• Teacher Tip: Due to fatigue, children may take longer to cut shapes, produce uneven edges, or require frequent rest.

5. Frequent Hand Switching or Avoidance

• Description: A child may switch tools from one hand to the other hand multiple times or abandon the task early.
• Why It Happens: Low endurance and fatigue set in quickly; hand switching can relieve discomfort.
• Teacher Tip: Notice if the child requests help cutting simple shapes or frequently stops to “rest.”

If these difficulties persist or hinder classroom performance, consulting an occupational therapist can help determine the next steps.

Strategies to Support Students:

1.  Adjust the Task

• Use child-friendly or adaptive scissors (e.g., spring-loaded or loop scissors).
• Break activities into shorter segments with frequent breaks.

2.  Strengthen Hands and Fingers Through Play

• Encourage pinching/squeezing activities like tweezers, clothespins, or putty work.
• Start fine motor tasks with simple hand warm-ups (e.g., finger taps, stretches).

3.  Provide Adaptive Supports

• Pencil Grips: Help position fingers properly and reduce strain and pain. More information on pencil grips will be provided in a separate blog post. However, here are a few options:
  1. Use an adapted tripod grasp. Instead of the pencil resting in the webspace, it rests between the index and middle fingers. Pencil grips are often lost in the classroom. This grip provides stability and good finger positioning; you don’t have to worry about a pencil grip disappearing.
  2. A pencil with a larger diameter is needed to decrease grip force.
  3. Grips: Egg (https://amzn.to/3WslmZX ) to reduce finger DIP (​​Distal Interphalangeal) joint (index finger joint close to the nailbed) or thumb MP (Metacarpophalangeal) joint hyperextension (swan-neck posture); Twist and Write Pencil (https://amzn.to/4hitrbC)
• Modified Paper: Improves alignment, sizing, and visual-motor coordination.

4.  Use Visual Aids and Demonstrations

• Show step-by-step cutting with color-coded lines or shapes.
• Demonstrate how to apply different levels of pressure on crayons or pencils.

5.  Ensure Good Posture and Stability

• Ensure the child’s feet are flat on the floor (or on a footrest).
• Use non-slip mats so the paper doesn’t slide around.

6.  Classroom Strategies for Low Tone

• Incorporate Multi-Sensory Approaches: Try finger painting with shaving cream or sand trays to engage various sensory systems.
• Encourage Heavy Work: Activities like stacking chairs or carrying lightweight items help develop core strength.
• Collaborate and Communicate: Keep an open dialogue with parents and work with occupational therapists for individualized strategies.

Resource: For more information, visit the blog post “When Is a Child Ready to Learn How to Write?”.

Conclusion:

Low tone and joint laxity can significantly influence hand coordination (or “hand skills”). Because children must work harder to stabilize their joints, tasks that require refined movement—such as cutting with scissors or coloring—become more difficult. Recognizing early signs like immature grip patterns, shaky hands, and quick fatigue allows teachers and parents to intervene promptly. Simple but effective strategies—like using adaptive tools, breaking tasks into smaller steps, and incorporating playful strengthening activities—can help young learners build the skills they need to thrive in the classroom. Collaboration among educators, parents, and occupational therapists remains vital for ensuring every child’s success during these formative years.

Key Takeaway:

Children with hypotonia and joint laxity often struggle using scissors, crayons, or pencils. By identifying these challenges early and implementing interventions (e.g., pencil grips, adaptive scissors, or sensory-based play), adults can make a meaningful difference in each child’s fine motor development and confidence.

References:

1. Case-Smith, J., & O’Brien, J. C. (2015). Occupational Therapy for Children and Adolescents (7th ed.). Elsevier.
2. Exner, C. E. (2010). Development of Hand Skills. In J. Case-Smith & J. C. O’Brien (Eds.), Occupational Therapy for Children (6th ed., pp. 273-315). Elsevier.
3. Schneck, C. M., & Henderson, A. (1990). Descriptive Analysis of the Developmental Grasp Patterns Using a Pencil in Preschool Children. American Journal of Occupational Therapy, 44(10), 893-900.
4. Feder, K. P., & Majnemer, A. (2007). Handwriting Development, Competency, and Intervention. Developmental Medicine & Child Neurology, 49(4), 312-317.
5. Case-Smith, J. (2002). Effectiveness of School-Based Occupational Therapy Intervention on Handwriting. The American Journal of Occupational Therapy, 56(1), 17-25.
6. Chu, S. (1997). Occupational Therapy for Children with Handwriting Difficulties: A Framework for Evaluation and Treatment. British Journal of Occupational Therapy, 60(12), 514-520.

Disclaimers: Affiliate links are included in this post. This article is intended for informational purposes and does not replace professional assessment or individualized intervention. If you have concerns about a child’s development or handwriting skills, please consult your pediatrician or an occupational therapist. Joint Laxity and Low Muscle Tone how joint laxity affect low muscle tone affect