Evaluation of the floppy infant

This review outlines a clinical approach to the evaluation of the floppy infant. Attention is drawn to the varied manner in which the condition can present, and emphasis is placed upon a detailed assessment of characteristic clinical findings. A distinction is drawn between central and peripheral causes for hypotonia. Guidance is given regarding the importance of evaluating the child for signs of weakness, which is an important marker of neuromuscular pathology. Reference is made to situations where peripheral pathology may mimic central disorders. A diagnostic algorithm is outlined for the investigation of neuromuscular disorders, and reference is made to the discrepancy in findings that often exists between electromyography and muscle biopsy findings. Attention is drawn to available newer diagnostic and therapeutic options, as well as the importance of addressing ethical issues, which become of particular importance once a diagnosis is reached. In practice points, the emphasis has been given to first line investigations based on clinical clues.