Clinical approach to a floppy infant

Floppy Infant Syndrome: Overview

“…There are two categories -Central and peripheral disorders. Several studies have shown that central causes account for 60% to 80% of hypotonia cases and that peripheral causes occur in 15% to 30% 7,9 .Conditions where central and peripheral hypotonia may coexist are Familial dysautonomia, Hypoxic-ischemic encephalopathy, infantile neuroaxonal degeneration, Lipid storage diseases, Lysosomal disorders, mitochondrial disorders [10]. CENTRAL CAUSES: Parents commonly complain to physicians that their baby is very passive, that it does not move its limbs like others, that its breathing pattern is abnormal or inquire why the baby cannot be weaned off the ventilator.…”

“…CENTRAL CAUSES: Parents commonly complain to physicians that their baby is very passive, that it does not move its limbs like others, that its breathing pattern is abnormal or inquire why the baby cannot be weaned off the ventilator. 1) Floppy babies in early infancy may present with abnormal posturing of limbs and body, diminished resistance of limbs to passive movement, abnormal range of joint movement and/or ventilator dependency [7,11].…”

“…In central hypotonia; axial weakness is a significant feature. Preservation of muscle power with hypotonia and hyperreflexia favours a central origin to the hypotonia, while the combination of weakness in the antigravity limb muscles and hypo/areflexia together favour a neuromuscular disorder [6,7,24].…”

“…Rehabilitation is an important therapeutic consideration, with the aid of physical and occupational therapists. Nutrition is of primary importance to maintain ideal body weight for the age and sex which is often achieved through the nasogastric route or percutaneous gastrostomy [7].…”

“…However, in early infancy, contrary to the expected increase in muscle tone, the response to an UMN lesion in the early stages is flaccidity and loss of muscle tone [4]. This pattern of hypotonia is usually associated with preserved or hyperactive reflexes and later evolves into spasticity [6,7].…”