The Child With Acute Weakness

Infants and children are commonly brought to the emergency department (ED) with a complaint of acute weakness. A good history and physical are paramount in determining etiology. Once a diagnosis is suspected, tests such as a lumbar puncture and magnetic resonance imaging of the spine will help to further define the etiology and guide therapy. Many causes of acute weakness have the potential for respiratory compromise, and ED practitioners must continually and closely evaluate patients and may choose to electively intubate. This article explores the 2 most common diagnoses made in children presenting with weakness, namely, Guillain-Barré syndrome and transverse myelitis, and briefly discusses other less common etiologies. Effective treatment of these disorders is not possible without prompt recognition of these patterns of weakness and initiation of diagnostic testing in the ED.