Case 8
CASE 8: DESCRIPTION
A previously healthy, term 6 month old baby girl has progressive difficulty breastfeeding over the past month. Mom notes that she often coughs during feeding, drools constantly and it seems that her cry has become more muffled. She has not been able to roll over or to sit up even with support.
SHx: Family identifies as Latino
Vitals: head circumference WNL, weight dropped by 20% since the last visit, other vitals WNL
Respiratory: paradoxical breathing (inspiration causes the rib cage to move inwards and abdomen outwards)
Chest: bell shaped chest deformity
MS: alert
CN: furrowed brow, tracks examiner, fish-mouth appearance, poor suck, drooling, poor gag/cough reflexes, weak cry, tongue fasciculations (See Video 8)
Motor: thin muscles, flaccid, frog-leg posture, floppy with head lag when pulled upwards, unable to sit unsupported
Reflexes: areflexia
Sensation: withdraws to touch
Coordination: no obvious ataxia but difficult to assess