Clinical Approach to the Floppy Child

The pre-, periand postnatal history is important. Enquire about the quality and quantity of fetal movements, breech presentation and the presence of either polyor oligohydramnios. The incidence of breech presentation is higher in fetuses with neuromuscular disorders as turning requires adequate fetal mobility. Documentation of birth trauma, birth anoxia, delivery complications, low cord pH and Apgar scores are crucial as hypoxic-ischaemic encephalopathy remains an important cause of neonatal hypotonia. Neonatal seizures and an encephalopathic state offer further proof that the hypotonia is of central origin. The onset of the hypotonia is also important as it may distinguish between congenital and aquired aetiologies. Enquire about consanguinity and identify other affected family members in order to reach a definitive diagnosis, using a detailed family pedigree to assist future genetic counselling.