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Developmental Milestone
Developmental Coordination Disorder
Clumsiness in Children
Muscular Dystrophy
II. Epidemiology
A. Neuromuscular disorders are rare compared to other developmental disorders
1. Neuromuscular disorders occur in early childhood in only 1 in 1000
2. Contrast with Learning Disorders (1 in 15), Autism (1 in 88), Cerebral Palsy (1 in
303)
III. Precautions
A. Early diagnosis is preferred
1. Improved outcomes
2. Improved access to services and reduction in caregiver stress
3. Prompts genetic counseling
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IV. Screening
A. See Developmental Milestone
B. See Developmental Evaluation
C. Using standardized tests is critical to avoid missing cases
D. Bright Futures Forms
1. http://brightfutures.aap.org/tool_and_resource_kit.html
E. CDC Muscular Dystrophy
1. http://www.cdc.gov/ncbddd/musculardystrophy/
V. History
A. Birth history
1. Perinatal Trauma
2. Newborn disorders or signs
B. Family History
1. Weakness
2. Developmental delay
VI. Exam
A. See Developmental Evaluation
B. See Gross Motor Milestone
C. See Developmental Red Flags
D. Infants age 4-6 months
1. Assess for head lag with Pull-to-sit
2. Initiate early intervention if not meeting milestones
a. Head lag persists at 4 months or older
3. Reassess at one month after intervention, and if not meeting Gross Motor
Milestones
a. Obtain Creatinine phosphokinase (CPK)
b. Refer to pediatric neurology
E. Infants age 6-9 months
1. Assess for ability to achieve and maintain sitting position
2. Obtain Creatinine phosphokinase (CPK) and initiate early intervention if not meeting
milestones
a. Not sitting independently by 7 months
b. Not getting into a sitting position by 9 months
3. Reassess at one month after intervention, and if not meeting Gross Motor
Milestones
a. Refer to pediatric neurology
F. Children >12 months
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VII. Symptoms
A. Muscle cramps
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muscle)
1. Typically progressive worsening (often with regression from milestones)
2. Altered chest appearance may be present (bell-shaped)
3. Weak, blunted facial expressions
4. High arched Palate
5. Tongue fasciculations (esp. spinal muscular atrophy)
6. Decreased muscle tone
7. Decreased or absent Deep Tendon Reflexes
8. Hyperlordotic, Waddling Gait
9. Toe walking (as with central causes)
X. Differential Diagnosis
A. Central cause (e.g. Cerebral Palsy)
B. Neuromuscular disorder (e.g. Muscular Dystrophy)
C. Hypothyroidism
D. Congenital Heart Disease
E. Nutritional deficiency
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XIII. Imaging
A. Not typically indicated in isolated weakness
B. Indications for brain imaging: Suspected central nervous system cause
1. Increased muscle tone
2. Suspected Cerebral Palsy
3. Microencephaly
4. Macroencephaly
5. Neurocognitive delay or regression
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XV. Resources
A. Neuromuscular Disorder videos (ChildMuscleWeakness.org)
1. http://www.childmuscleweakness.org/index.php/videos
B. National Task Force for the early identification of childhood neuromuscular disorders
1. http://www.childmuscleweakness.org/index.php/clinical-evaluation
XVI. References
A. Lurio (2015) Am Fam Physician 91(1): 38-44 [PubMed]
These images are a random sampling from a Bing search on the term "Muscle Weakness in
Children." Click on the image (or right click) to open the source website in a new browser window.
Search Bing for all related images
23 Apr 2015
24 Jul 2015
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01 Jan 2016
Risk factors for weakness of the pelvic floor muscles: a systematic review
(http://www.crd.york.ac.uk/prospero/display_record.asp?src=trip&ID=CRD42016039891)
American Journal of Human Genetics
29 Jun 2016
01 Jul 2012
diseases existing at birth and often before birth, which effect the motor neuron, peripheral
nervous system and certain muscular diseases; manifestations include muscle weakness,
fasciculation, atrophy, spasm, myokymia, hypertonic, hypotonia and myalgias.
Concepts
English
Finding (T033)
English
Spanish
Portuguese
French
Dutch
Czech
Italian
German
Motorische Entwicklungsverzoegerung
Japanese
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Hungarian
Finding (T033)
English
Spanish
Portuguese
Dutch
Italian
French
German
Grobmotorik verzoegert
Czech
Japanese
Hungarian
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