Differential diagnosis of hypotonia in infants appropriate medical and genetic evaluation. Attention is drawn to the varied manner in which the condition can present, and emphasis is placed upon a detailed assessment of characteristic clinical findings. The initial approach to a floppy infant is to determine whether the problem is of central or peripheral origin table 7a, table 7b. Clinical approach to a floppy infant sri lanka journal of child health. In pediatric physiotherapy arm exercises may be combined with ball works or drawing pictures on a large sheet of paper on the wall. Hypotonia may be the presenting sign for many systemic diseases and diseases of the nervous system. An organized approach is essential when evaluating a floppy infant, as the causes are numerous 1. Hypotonia in infants pediatrics clerkship the university.
Hopefully by the end of this podcast, you will have a basic approach. The present paper discusses a rational, simple and accurate diagnostic approach to hypotonia in infancy, illustrated by the case of a fivemonthold infant girl recently referred to the iwk health centre in halifax, nova scotia. Our aim was to prospectively validate the stepbystep approach and compare it with the rochester criteria. This consultation request usually occurs in 2 different situations. Cerebral hypotonia the coalition against pediatric pain. Key elements in the childs developmental and medical history and physical examination are outlined. Neonatal hypotonia childrens hospital of orange county. The floppy infant syndrome is a wellrecognised entity for paediatricians and neonatologists and refers to an infant with generalised hypotonia presenting at birth.
Paralytic hypotonia with significant weakness suggests a peripheral neuromuscular problem, whereas nonparalytic hypotonia without significant weakness points to a central cause which may be neurological, genetic. Jul 20, 2007 the objectives of our study were to determine the actual frequency of the different disorders causing neonatal hypotonia and to assess the reliability of the first physical examination as well as the contribution of the main standard diagnostic tests. Neurological and physical maturation in normal growth singletons from 37 to 41 weeks gestation. Floppy infant floppy infant refers to those children presenting with generalized hypotonia, most often arising out of an insult incurred during fetal or neonatal period. The floppy infant, jb lippincott co, philadelphia 1980. It is defined as reduced resistance to passive range of. It is a vessel through which child regains skill lost as result of illness or injury. He emphasized 2 main questions when confronted with a.
They are unable to maintain flexed ligaments, and are able to extend them beyond normal lengths. Infants can present with hypotonia that is due to central or peripheral nervous system abnormalities, myopathies, genetic disorders, endocrinopathies, metabolic diseases, and acute or chronic illness table 1. If your baby has it, she will likely feel limp in your arms, like a rag doll. Floppy infant syndrome, sometimes referred to as rag doll syndrome, is a term. Bodensteiner, md the pediatric neurologist is regularly asked to evaluate a hypotonic patient.
The differential diagnosis for neonatal hypotonia is extensive and a methodical approach helps in localizing the problem to a specific region of. Hypotonia is a common symptom associated with disorders of brain, spinal cord, nerves and muscles2. Definition risk factors classification history taking and signs of hypotonia investigations management and prognosis. Approach to floppy infant dr anand singh dch dnb 2. Infants with hypotonia have a floppy quality or rag doll appearance because their arms and legs hang by their sides and they have little or no head control. The floppy infant represents a diagnostic challenge to general pediatricians. Definition risk factors classification history taking and signs. Key points in the history and physical examination are outlined to allow a tailored investigation both for the patient and for other hypotonic infants. Objectives define tone and how it is maintained distinguish bw hypotonia and muscle weakness differences between central and peripheral causes of hypotonia. Hypotonia is characterized by reduced resistance to passive range of motion in joints versus weakness, which is a reduction in the maximum muscle power that can be generated. This commentary does not contain a discussion of an unapproved investigative use of a commercial productdevice. A simplistic approach to a floppy infant is to determine whether the problem is of an upper motor neurone type or of a lower motor neurone type.
A free powerpoint ppt presentation displayed as a flash slide show on. On ventral suspension, the baby can not maintain limb posture against gravity and assumes the position of a rag doll. A structured approach to the assessment of a floppy neonate ahmed. A structured approach to the assessment of a floppy neonate ncbi.
At kid pt we are focused on uncovering hidden potential. Hannibal, md, phd author disclosure drs peredo and hannibal have disclosed no. Floppy child free download as powerpoint presentation. Recognition and management of motor delay and muscle. Posture the floppy infant assumes a frog legged position. The present paper discusses a practical approach to hypotonia in infancy. The objectives of our study were to determine the actual frequency of the different disorders causing neonatal hypotonia and to assess the reliability of the first physical examination as well as the contribution of the main standard diagnostic tests. Victor dubowitz in the late 1960s entitled the floppy infant provided a practical approach to the diagnosis and classification of a child with hypotonia dubowitz 1969. A systematic approach to a child who has hypotonia, paying attention to the history and clinical examination, is paramount in localizing the problem to a specific. Examination shows infant with normal vitals and small growth parameters including head circumference 32 cm. Journal of american academy of child psychiatry, 143. Floppy child neurological disorders epidemiology free.
Pdf initial approach hypotonic syndrome floppy infant. The floppy infant a practical approach to classification victor dubowitz reader in child health and developmental neurology, university of sheffield, the childrens hospital, western bank, sheffield s102th. The differential diagnosis for neonatal hypotonia is extensive and a methodical approach helps in localizing the problem to a specific region of the nervous system. A structured approach to the assessment of a floppy. Infant massage may be used to promote mother infant bonding and sleep. 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. A systematic approach to a child who has hypotonia. Clinical approach to the floppy child the floppy infant syndrome is a wellrecognised entity for paediatricians and neonatologists and refers to an infant with generalised hypotonia presenting at birth or in early life. Evaluation of the floppy infant paediatrics and child health.
Scribd is the worlds largest social reading and publishing site. Approach to floppy infant weakness electromyography. One hundred and fortyfour infants diagnosed with neonatal hypotonia between january 1st 1999 and june 30th 2005 in our tertiary care facility. The importance of play activities cannot be overstated. Neonatal hypotonia clinical approach to floppy baby osama naga, m. Chapter 160 general approach to the pediatric patient key concepts patterns of illness and injury vary by age. A structured approach to the assessment of a floppy neonate. Approach to floppy infant free download as powerpoint presentation. It is defined as reduced resistance to passive range of motion in joints. In young infants, hypotonia manifested as frog posture. Other symptoms of hypotonia include problems with mobility and posture, breathing and speech difficulties, ligament and joint laxity, and poor reflexes. Neonatal hypotonia clinical approach to floppy baby hypotonia in the newborn is a common presenting feature of systemic illness or neurologic dysfunction at any level of the central or peripheral nervous system. Feedingalertnessresp distresscry developmental history general.
In early infancy, there is decreased muscular activities both spontaneous and in response to postural reflex testing and to passive motion. A systematic approach to a child who has hypotonia, paying attention to the history and clinical examination, is paramount in localizing the problem to a speci. The case of a fivemonthold infant girl, recently seen at the iwk health centre in halifax, nova scotia, provides a basis for discussion. Martin, 2005 based on strong research evidence, central hypotonia accounts for 60% to 80% of cases of hypotonia, whereas peripheral hypotonia is the cause in about 15% to 30% of cases. Sign of both benign and serious conditions exhaustive differential diagnosis rare disorder overwhelming advances in diagnosis and management 3. Aug 25, 2017 the neurological assessment of the preterm and fullterm infant, jb lippincott co, philadelphia 1981. Initial approach hypotonic syndrome floppy infant article pdf available in neurology 108.
Floppy infant syndrome select 5minute pediatrics topics. Hypotonia, commonly known as floppy baby syndrome, is a state of low muscle tone the amount of tension or resistance to stretch in a muscle, often involving reduced muscle strength. Subacute or acute onset of hypotonia 45 day prodrome of constipation, poor feeding, lethargy prior to development of ptosis, decreased eye movements, weakness and areflexia. Case 5 floppy infant full term infant, product of a first pregnancy to a mother with no prenatal care. Treadmill training may be used from 10 months onward, to promote early onset of stepping, walking and improve gait characteristics in children with central hypotonia. The floppy infant syndrome is a wellrecognized entity for pediatricians and neonatologists and refers to an infant with generalized hypotonia presenting at birth or in early life. Ppt neonatal hypotonia clinical approach to floppy baby. Floppy infant floppy infant refers to those children presenting with generalized hypotonia, most often arising out of an insult incurred during fetal or. Chapter 160 general approach to the pediatric patient. The pediatric neurologist is regularly requested to evaluate an infant with hypotonia, and it poses a particular diagnostic challenge owing to the extensive differential diagnosis. The floppy infant is an informal term for generalized hypotonia and is a presenting feature for a wide range of both systemic and neurologic disease. Limbs abducted and very little spontaneous movement.
Hypotonia is not a specific medical disorder, but a potential manifestation of many different diseases and disorders that affect motor nerve control by the brain or muscle strength. Infantile hypotonia an overview sciencedirect topics. The floppy infanta practical approach to classification victor dubowitz reader in child health and developmental neurology, university of sheffield, the childrens hospital, western bank, sheffield s102th. As will be seen later, this is of crucial importance when forming a plan for diagnostic investigations.
Martin, 2005 based on strong research evidence, central hypotonia accounts for 60% to 80% of cases of hypotonia, whereas peripheral hypotonia is the cause in. Orthotics may be used to support foot alignment and improve gait characteristics for ambulatory. A free powerpoint ppt presentation displayed as a flash slide show on id. A structured approach to the assessment of a floppy neonate molla imaduddin ahmed, mehtab iqbal, nahin hussain department of paediatrics, leicester royal infirmary, university hospitals of leicester, leicester, united kingdom. Fraiberg, selma, adelson, edna and shapiro, vivian. The floppy infant syndrome is a wellrecognised entity for paediatricians and neonatologists and refers to an infant with generalised hypotonia presenting at birth or in early life. One hundred and fortyfour infants diagnosed with neonatal hypotonia between january 1st 1999 and june 30th. Uterine dystoniadifficult deliverymalpresentationapgars family history postnatal history. The hypotonic newborn or floppy baby has a vast list of potential etiologies. An organised approach is essential when evaluating a floppy infant, as the causes are numerous.
Muscle tone is maintained at the peripheral level by. Approach to the problems of impaired infant mother relationships. Neonatal hypotonia clinical approach guidelines author. Diagnosis of neuromuscular disorders in young children is often delayed for years after symptoms emerge, resulting in missed opportunities for therapy and genetic counseling.
The floppy infanta practical approach to classification. A sequential approach to young febrile infants on the basis of clinical and laboratory parameters, including procalcitonin, was recently described as an accurate tool in identifying patients at risk for invasive bacterial infection ibi. Floppy neonate, hypotonia, structured approach introduction hypotonia in a newborn poses a diagnostic challenge for neonatologists and pediatricians, as it is a clinical sign suggestive of both benign and serious conditions. The smile approach for children with hypotonia and developmental delays.
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