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Floppy Infant
Posture
The floppy infant assumes a frog legged position. On ventral suspension, the baby can not maintain limb posture against gravity and assumes the position of a rag doll.
Movements
The muscles appear flabby. There is diminished resistance to passive movement of the limbs and the range of movement of the peripheral joints is increased.
Scarf Sign
Put the child in a supine position and hold one of the infants hands. Try to put it around the neck as far as possible around the opposite shoulder. Observe how far the elbow goes across the body. In a floppy infant, the elbow easily crosses the midline. Pull to sit: When pulled up from the supine to the sitting position, the head of the baby lags.
Neurology Chapter of IAP
2.
3. 4.
Absent
Fasciculation / fibrillation
Fibrillation
Denervation pattern
Denervation pattern Normal
Peripheral nerve
Decreased
Normal
Decreased
Characteristic
Signs: Perform complete physical examination Infant with decreased muscle tone Exam distinguishes site of disorder Upper motor neuron lesion Lower motor neuron lesion Radiology Head CT Head MRI Look Diagnostic Studies Electromyogram (EMG) for Nerve Conduction Studies Sepsis Labs: Initial Serum electrolytes Serum Calcium Neurology Chapter of IAP Serum Glucose
Creatine Phosphokinase (CPK) Toxic scan Blood Culture Lumbar Puncture with Cerebrospinal Fluid Examination Thyroid Function Tests Looks Labs: Test as indicated Like Toxicology screen Sepsis Serum Ammonia and Venous pH without Serum amino acids Sepsis Urine amino acids and organic acid Karyotype TORCH Virus Screening
Neurology Chapter of IAP
Myasthenia gravis
Mmyasthenia gravis may occur in about 12 percent of the babies born to mothers with the disease. It is characterized by marked hypotonia,
Congenital myopathies
These are rare inherited disorders resulting in a benign congenital hypotonia, with generally good outlook for normal life span. Nemaline myopathy is the most common variant. Other disorders of this group include the central core disease, myotubular myopathy and congenital fiber type disproportion.
Neurology Chapter of IAP
Others
In polyneuritis there is symmetrical weakness of the limbs with sensory changes. The diagnosis of Pompes disease is suspected when the child has macroglossia, cardiomegaly and generalized hypotonia. Babies with prader-willi syndrome are mentally retarded and obese; deep tendon reflexes are diminished. Diabetes mellitus occurs later in life. Testes may be undescended. Ehlers-danlos syndrome is characterized by hyperelasticity of the skin, hyperflexibility of joints and extreme, fragility of skin. Wound healing is delayed and there are frelly movable subcutaneous nodules. In cutis laxa, the child has loose skin hanging in baggy folds.
Neurology Chapter of IAP
13
17 7 1 7 5 4 3 2 11
18.6
24.3 10.0 1.4 10.0 7.1 5.7 4.3 2.9 15.7