Referral guideline – Floppy infant/weakness
Need to differentiate hypotonia (diminished resistance of muscles to passive stretching) from weakness.
History and examination, looking for:
- delay in milestones
- muscle wasting and weakness
- swallowing difficulties
- breathing difficulties
- ptosis or ophthalmoplegia
- abnormal reflexes
- tongue fasciculation
- dysmorphic features
- abnormal growth parameters.
Baseline investigations to consider:
When to refer
- Patients with the following should be referred to the nearest Emergency Department that treats children:
- Acute onset of weakness
- Breathing difficulties
- Swallowing difficulties
- Associated altered consciousness.
- Discuss all patients with an elevated CK>1000IU/L with a paediatric neurologist urgently.
- Refer other patients with concerning history or clinical examination to the nearest general paediatric service.
Essential referral info
- Birth and developmental history
- Family history
- Examination findings
- in particular strength and reflexes
- CK, if performed
- Medicare number
- Parent/carer name and contact details
- Referring clinician details (name, contact details, provider number, date and length of referral)
Helpful referral info
- Height/weight/head circumference/percentile charts
- Medication history
- Significant psychosocial risk factors