Radiographic and Other Studies

1. CT or MRI scan of spine. Obtain acutely if there is concern of possible spinal cord injury in an infant.

2. Electromyogram. Obtain if muscle weakness is present.

3. MRI scan of head. Consider if laboratory studies do not support diagnosis of myopathy and there is concern of a central CNS process, including tumor, cyst, enlarged ventricles, cerebral atrophy, or congenital malformation.

4. Chest x-ray. If respiratory symptoms are present.

V. Plan. Most children with hypotonia have a chronic or subacute presentation. It is critical to recognize an acute presentation of hypotonia. Thorough history and physical exam allow clinician to narrow the differential diagnosis based on its chronicity and anatomic classification. This in turn allows for systematic and focused evaluation of child.

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