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Scarf sign

Scarf sign. Put the child in a supine position and hold one of the infant’s hands. Try to put it around the neck as far as possible around the opposite shoulder. Observe how far the elbow goes across the body. In a floppy infant, the elbow easily crosses the midline. Pull to sit:

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Scarf sign

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  1. Scarf sign Put the child in a supine position and hold one of the infant’s hands. Try to put it around the neck as far as possible around the opposite shoulder. Observe how far the elbow goes across the body. In a floppy infant, the elbow easily crosses the midline. Pull to sit: When pulled up from the supine to the sitting position, the head of the baby lags.

  2. Causes of Floppy Infant Syndrome • Central nervous system Perinatal asphyxia, neonatal, encephalopathy, kernicterus, cerebral palsy (atonic type), intracranial hemorrhage, chromosomal anomalies including down syndrome and inborn errors of metabolism e.g., aminocidurias, mucopolysaccharidosis and cerebral lipidosis. • Spinal cord lesions Anterior horn cell disease – werdnig Hoffman spinal muscular atrophy, poliomyelitis. • Peripheral nervous Acute polyneuropathy, familial dysautonomia, congenital sensory neuropathy. • Myoneural junction Neonatal myasthenia gravis, infantile botulism, following antibiotic therapy.

  3. Muscles Muscular dystrophies, congenital myotonic dystrophies, congenital myopathies (including central core disease and nemalinmyopathy), polymyositis, glycogen storage disease (pompe’s), and arthrogryposis multiplex congenital. • Miscellaneous Protein energy malnutrition, rickets, praderwilli syndrome, malabsorption syndromes, Ehler-Danlos syndrome, cutis laxa, cretinism.

  4. Radiology • Head CT • Head MRI • Electromyogram(EMG) • Nerve Conduction Studies • Serum electrolytes • Serum Calcium • Serum Glucose

  5. CreatinePhosphokinase (CPK) • Toxic scan • Blood Culture • Lumbar Puncture with Cerebrospinal Fluid Examination • Thyroid Function Tests • Labs: Test as indicated • Toxicology screen • Serum Ammonia and Venous pH • Serum amino acids • Urine amino acids and organic acid • Karyotype • TORCH Virus Screening

  6. Duchenne Muscular Dystrophy

  7. INVOLVEMENT • Anterior horn cells • Poliomyelitis • Acute transverse myelitis • Nerve fibres • Postinfectiouspolyneuropathy (GBS syndrome) • Toxins----diphtheria, porphyria

  8. INVOLVEMENT • Neuromuscular junction • Tick toxin • Botulinum toxin • Metabolic causes • Periodic paralysis • Muscular disease • Myositis

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