This article outlines a clinical approach to evaluation of the floppy infant. Attention is drawn to the varied manner in which the condition can present, and emphasis is placed upon recognition of the condition by a detailed assessment for the presence of characteristic clinical findings. A distinction is drawn between central and peripheral causes for hypotonia. Central forms are due to upper motor neurone pathology whilst peripheral forms are due to lower motor neurone pathology. Guidance is given regarding the importance of evaluating the child for signs of weakness. These signs are an important means of diagnosing neuromuscular pathology. Reference is made to situations where peripheral pathology may mimic upper motor neurone disorders. A diagnostic algorithm is outlined for the investigation of neuromuscular disorders, and reference is made to the discrepancy in findings that often exists between electromyography and muscle biopsy findings. Attention is drawn to available therapeutic options, as well as the importance of addressing ethical issues which become of particular importance once a diagnosis is reached.
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