Hypotonic infant (Paediatric Neurology)


Useful Management Information

  • If guidance is required regarding appropriate investigations, contact Neurology on call services
  • 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.

Clinician Resources

Minimum Referral Criteria

Does your patient meet the 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
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

If your patient does not meet the minimum referral criteria

  • Assessment and management information may be found on a range of conditions at HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Essential Referral Information

  • History related to hypotonia
  • Neurological examination findings, including tone, contractures, power, deep tendon reflexes, cranial nerve involvement, muscle wasting

Additional Referral Information

  • Antenatal history including foetal movementsBirth 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.

Last updated 19 December 2022

Send Referrals To

Smart Referrals

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Send to: Gold Coast Health Service District

Internal Referrals

Neurology (E-Blueslips)


(07) 5687 4497


Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215


1300 559 083

Related HealthPathways

No directly related pathways found

Service Availability

Dr Saman Heshmat


Gold Coast University Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Child Safety

If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, contact Department of Children, Youth Justice and Multicultural Services . Please consider if mandatory reporting applies.

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