Hypotonia in Infancy approach
A hypotonic infant can be a typical case in neurology station. It is also likely to see one in your clinic
The following points are mandatory
Points to remember in Prenatal History:
- History of TORCH infections
- History of antenatal Drugs or alcohol
- Any Maternal illness
- Fetal movements- normal or hypoactive?
Points in Neonatal History:
- Complications during Delivery- Prolonged delivery, Blood loss
- Gestation at delivery- Term or preterm or post-term
- Seizures history- Age of presentation, Type of seizures, medications
- Initial presentation of hypotonia- Symptoms and signs
Past Medical History:
- History of presenting symptoms
- Associated symptoms
- Symptoms of the systemic disease
- The rate of symptom progression
- Developmental History
- Delayed milestone attainment
- Loss of milestones
- Motor, social and language incongruence
- Feeding History
Choking or aspiration
Constipation
Family History:
- Other members affected
- Sudden deaths in the family
- Consanguinity
- Developmental delay
- Neurological disease
- Metabolic or genetic diseases
General Physical Examination:
- Obvious deformities
- Dysmorphism?
- Head and neck: Microcephaly/ Hydrocephalus
- Nutritional wasting?
- Systems: Cardiovascular findings
- Liver enlargement
- Splenomegaly
- Skeletal and spine abnormalities
Neurological Examination:
- Muscles: Atrophy/ Hypertrophy
- Cranial nerve observation
- Ptosis
- Facial expression
- Extraocular movements
- Muscles of facial expression
- Fasciculations of tongue
- Tone: Hypotonic/ Hypertonic
- Posture
- Horizontal and vertical suspension
- Scissoring or spasticity
- Power
- Reduced/ Normal
- Proximal versus distal
- Reflexes: Hypotonia/ Hyperactive/ Clonus
The following questions can be asked following the presentation.
Investigations:
- Thyroid functions- TSH, free T4,
- Electrolytes (including calcium)
- Imaging- CT/MRI head
- EEG
- Karyotype
- Metabolic Disease Suspected:
- Urine and serum amino acids
- Urine organic acids
- Blood gas
- Serum ammonia
- Liver function tests
- Creatine kinase