The Floppy Child (PAP10)
Notes by Isabel Vielba
Dr Saif Al-Nahas did a presentation concentrating on causes of hypotonia
Can present in the ED as
1) Floppy baby – assess head lag
2) Motor development delay – BMJ Developmental Assessment of children
3) Poor feeding
5 causes of hypotonia:
1) Congenital e.g. Trisomy 21
2) Acquired (genetic) – smooth muscle atrophy:
- Autosomal recessive condition
- classically have bell shaped torso as using abdominal muscles for respiration.
- Different types. -SMA1 usually fatal by 1 year
- May have high CK, hypotonia and absent reflexes.
3) Acquired (autoimmune) – e.g. Myasthenia Gravis
- typified by fluctuating muscle weakness and fatigability
- Give acetlycholinesterase inhibitor
- If Mum has MG – neonates can have transient MG
4) Acquired (metabolic)- Hypothyroidism
- 1:4000 births, very treatable.
- May present with jaundice, weak cry
- Missed diagnosis can lead to significant developmental delay
5) Acquired (other)- Cerebal Palsy
- Common 1:500
- Definition is a disorder of movement and posture caused by non-progressive lesion of the motor pathways.
- Usually noticed due to delayed milestones.
- 70% Spastic 10% Ataxic 10% Dyskinetic 10% mixed
- 85% occur pre-birth, 10% inter-uterine.
EMPEM.org has a great podcast on assessment, investigation and management of the undifferentiated sick baby under 3 months. This includes floppy babies. Click here