Differential Diagnosis

A. Brain Disorders. Consider toxicity, metabolic encephalopathy, chromosomal disorder (eg, Prader-Willi syndrome, trisomy 21), infection, periventricular leukomalacia, cerebrovascular accident, hypoxic ischemic encephalopathy, trauma (intracranial hemorrhage), cerebral palsy, benign congenital hypotonia, mass (tumor, cyst).

B. Spinal Cord Disorders. Trauma and hypoxic ischemic insult.

C. Anterior Horn Cell Disorders. Poliomyelitis and spinal muscle atrophy.

D. Peripheral Nerve Disorders. Polyneuropathy, Guillain-Barre syndrome, trauma.

E. Neuromuscular Junction Disorders. Infantile botulism, myasthenia gravis, transitory neonatal myasthenia gravis, aminoglycoside antibiotic, hypermagnesemia.

F. Muscle Disorders. Hypothyroidism, metabolic myopathies (eg, acid maltase deficiency, phosphorylase deficiency, glycogen storage disease), muscular dystrophies, polymyositis.

G. Systemic Diseases. Malnutrition, sepsis, intestinal obstruction, cyanotic heart disease, collagen vascular disease.

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