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Index of Suspicion

Case 2: Gross Motor Regression in an 18-month-old Girl

Ronish Gupta, Asha Nair and Hugh J. McMillan
Pediatrics in Review February 2017, 38 (2) 95; DOI: https://doi.org/10.1542/pir.2015-0026
Ronish Gupta
*Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Asha Nair
*Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Hugh J. McMillan
*Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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  1. Ronish Gupta, MD*
  2. Asha Nair, MD*
  3. Hugh J. McMillan, MD, MSc*
  1. *Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
  • AUTHOR DISCLOSURE

    Drs Gupta, Nair, and McMillan have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A previously healthy 18-month-old girl presents to the emergency department with refusal to walk. Initially demonstrating only mild exercise intolerance, her weakness has progressed over the past 6 weeks, and she is now no longer able to stand. She has no ataxia, seizures, or oculobulbar weakness, and her language skills remain unaffected. Her growth and neurodevelopment were previously normal.

Further history reveals nonbilious, nonbloody vomiting since age 12 months, initially occurring once or twice per month but gradually increasing to several times per week. She has had no diarrhea, abdominal pain, or fever but has lost 1.0 kg (2.2 lb) of weight during the past month. Results of her remaining history and dietary review are unremarkable. Iron supplements were started empirically by her family physician and are her only medication.

On examination, she appears tired and will not stand without support. Her heart rate is 125 beats/min; respiratory rate, 26 breaths/min; blood pressure, 94/65 mm Hg; oxygen saturation, 96% in room air; and temperature, 100.2°F (37.9°C) measured rectally. Growth parameters were as follows: weight, 25th percentile; height, 50th …

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Pediatrics in Review: 38 (2)
Pediatrics in Review
Vol. 38, Issue 2
1 Feb 2017
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Case 2: Gross Motor Regression in an 18-month-old Girl
Ronish Gupta, Asha Nair, Hugh J. McMillan
Pediatrics in Review Feb 2017, 38 (2) 95; DOI: 10.1542/pir.2015-0026

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Case 2: Gross Motor Regression in an 18-month-old Girl
Ronish Gupta, Asha Nair, Hugh J. McMillan
Pediatrics in Review Feb 2017, 38 (2) 95; DOI: 10.1542/pir.2015-0026
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