Does underlying process involve brain spine or motor unit

For normal tone to be present, patient must have intact central nervous and peripheral nervous systems.

F. What is child's developmental history? Are milestones delayed? Is the delay in motor milestones, only, or also in speech and cognitive development? Children with hypotonia from a CNS source usually present with more global developmental delay.

G. What is child's birth history? Is there a history of decreased intrauterine movement, distress, hypoxia, apnea, infection, hyperbilirubinemia, and neonatal seizures? In addition to identifying possible causes, this information helps to identify time of onset. Presence of decreased intrauterine movement, fetal distress, polyhydramnios, joint contractures, arthrogryposis, or dislocation of hips noted at birth all provide evidence of probable prenatal onset.

H. What is patient's immunization status? Was child vaccinated against polio? Is there a history of travel with possible polio exposure?

I. Are any family members nonambulatory? Is there a family history of childhood deaths? Family history helps to determine possible congenital causes (eg, glycogen storage disease, hereditary neuromyopathies, spinal muscle atrophy, Ehlers-Danlos syndrome, Tay-Sachs disease, congenital myasthenia gravis, or benign congenital hypotonia).

J. Any history of trauma? Newborn infants with spinal cord injuries can present with hypotonia. This is more common with breech vaginal deliveries but can be seen with cephalic presentations. Abnormal rectal tone, a distended bladder, lack of deep tendon reflexes with no spontaneous movement in the lower extremities, or loss of sensation below the nipple line should alert clinician to spinal cord insult.

K. Any possible exposure to Clostridium botulinum spores? Spores can be found in soil and honey. Exposure to soil disruption such as excavation sites or ingestion of honey would both be

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