Referral guideline – Floppy infant/weakness


Need to differentiate hypotonia (diminished resistance of muscles to passive stretching) from weakness.

GP management

History and examination, looking for:

  • hypotonic
  • 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:

  • CK.

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

Parent service


Contact details

Hospital Switchboard
(Ask for the General Paediatric Registrar)
t: 07 3068 1111


Systematic approach to hypotonia of infancy