Hypotonic infant

PAEDIATRIC

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    Paediatric

    Hypotonic infant

    • Tachypnoea (signs of respiratory distress such as accessory muscle use are NOT seen in patients with neuromuscular disorders)
    • Feeding difficulties with weight loss
    • If guidance is required regarding appropriate investigations, contact Neurology on call services
    • Refer to HealthPathways or local care pathway
    • In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
    • Referral from a health practitioner other than a General Paediatrician may be accepted if there is limited access to public Paediatric services in the patients' local area
    • A change in patient circumstance (such as condition deteriorating) may affect the urgency categorisation and should be communicated as soon as possible.
    • Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC

    Clinical resources

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • If signs and symptoms suggestive of spinal muscular atrophy, then direct referral to Neurology (and local General Paediatrician, if not already involved at time of consultation) for immediate diagnosis and initiation of treatment
    • Profound head lag
    • Proximal weakness, most marked in lower limbs, especially if less than antigravity
    • Absent deep tendon reflexes
    • Diaphragmatic breathing
    • Tongue fasciculations (not always visible)
  • Age <3 months
  • Weakness less than antigravity movement
  • Plateau or regression of motor skills
  • Absent deep tendon reflexes
  • History of ventilatory support in neonatal period or with illness
  • A child currently in out of home care (OOHC), or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service.
Category 2
(appointment within 90 calendar days)
  • Antigravity power in upper and lower limbs
  • Ongoing gains in motor milestones
  • Reduced or normal deep tendon reflexes
  • Non progressive bulbar dysfunction without weight loss e.g. swallowing problems, poor feeding, sialorrhoea,
  • Chronic non progressive ptosis or ophthalmoplegia
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • History related to hypotonia
  • Neurological examination findings, including tone, contractures, power, deep tendon reflexes, cranial nerve involvement, muscle wasting
  • Confirmation of OOHC (where appropriate)

3. Additional referral information Useful for processing the referral

  • Antenatal history including foetal movements
  • Birth and developmental history
  • Family history, including consanguinity
  • CK, SNP microarray and store DNA (requested but results not required prior to initiation of referral)
  • Growth parameters
  • Medication history (including over-the-counter preparations)
  • Significant psychosocial risk factors
  • Neuroimaging only under advice from Neurology (as it is not necessary if a primary neuromuscular disorder is suspected AND anaesthesia risk maybe high with specific conditions). If neuroimaging has been done, arrange image transfer to PACS at the hospital the patient is being referred to, with the imaging reports. If electronic imaging transfer is not available, then a CD of the neuroimaging and report should be sent to the neurologist named in the referral.
  • Previous investigations – please include copies of results if performed external to Pathology Queensland
  • Allied Therapy reports
  • If the child is in foster care, please provide the name and regional office for the Child Safety Officer who is the responsible case manager.

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 20 December 2021

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