The Floppy Child (PAP 10)

The Floppy Child (PAP10)

Paediatric Acute Presentation 10
Paediatric Acute Presentation 10

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. has a great podcast on assessment, investigation and management of the undifferentiated sick baby under 3 months. This includes floppy babies. Click here 



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