A child’s laxity, found in the neonatal and infancy period, is a non-specific symptom that appears in the course of many different diseases. In the early stages of the disease development, it may be the dominant element of the clinical picture, which makes the diagnosis of a flaccid child particularly difficult.
Flaccid child – clinical evaluation
Flaccid child syndrome can be suspected on the basis of the following clinical symptoms:
– incorrect positioning of the child (frog position);
– reduced resistance to passive movements in the joints;
– increased range of motion in the joints.
Assessment of muscle tone on the basis of the child’s position and resistance to passive movements, it is subjective. Several tests are useful in clinical practice to help detect low muscle tone: a traction test, testing for the presence of a scarf symptom, a loose shoulder symptom, and the Landau reflex. In the second half of life, the symptom of a “pocket knife” is characteristic of laxity.
- In order to perform the pull to sit test, the child, lying on its back, should be pulled up by the arms so that the body line forms an angle of 45 ° with the ground (Fig. 14.1). In this position, the head of a healthy infant should be held in line with the torso or bent to the chest. The head drooping back, occurring outside the neonatal period, indicates axial laxity.
- We examine the scarf sign in a child lying on his back by pulling the upper limb across the chest. The possibility of moving the elbow beyond the midline of the body indicates the flaccidity of the shoulder girdle.
- The Landau reflex test (central suspension) consists in placing the child on the examining hand with the belly to the ground and assessing the position of the head, the curvature of the torso and the degree of bend of the limbs. In a healthy newborn baby, the head may droop, the torso is arched, and the limbs hang down in a flexed position. In a limp child in the neonatal period, the straightened limbs hang limp, the torso forms a definite arch, and the head falls. After the neonatal period, a healthy infant holds its head in line with the shoulders, and in the second half of its life – above the shoulder line, it straightens the torso, raises the limbs slightly bent at the elbows and knees. In a flaccid child, we do not observe the next phases of reflex development. Regardless of age, the head drops, the torso forms an arch, and the limbs hang down limp.
- We investigate the shoulder suspension symptom by holding the child under the arms and lifting it. The slender child does not resist resistance and slips away. When performing this maneuver, we also assess the head control, which falls down in flaccid children.
- In children in the second half of their life, we check the presence of the “pocket knife” symptom. When seated, a healthy infant maintains a sitting position, keeps the torso straight, and controls head movements. A slack child arches his back or “folds up” completely, his head drops.
A limp child and diagnostics
Specialists in various fields, such as neonatology, orthopedics, pediatrics, neurology, genetics, metabolic diseases, ophthalmology, nephrology, radiology, take part in making the correct diagnosis, it is also important to conduct a number of additional tests.
The dynamic development of medicine and molecular biology observed in recent years has significantly contributed to the improvement of the diagnosis of a flaccid child. Nevertheless, using the most sophisticated diagnostic methods, the final diagnosis can be established in about 67-85% of cases.
Neuromuscular diseases; Czelej Publishing House