Stiffness with stridor

Author: Pediatric Oncall

Question
A one and a half months old boy presented with noisy breathing since birth and an episode of pneumonia 20 days ago for which he was hospitalized for 10 days. There was no suck-rest-suck cycle, excessive sweating over the forehead, or breathlessness. He was the only child of his parents and his birth weight was 2.5 kg with a present weight of 3.5 kg. He was full-term breech delivery and required NICU stay for 7 days for respiratory distress. He was on exclusive breastfeeds. On examination, he was found to have inspiratory stridor with substernal and suprasternal retraction. The chest was clear. The mother noticed that stridor would increase in sleep. The baby was found to have flexed hands and extended legs with increased tone in both upper and lower limbs. The mother also noticed that the baby appeared stiff. The child had achieved a social smile but had not achieved head holding as yet. The child was suspected to have spasticity due to stiffman syndrome or perinatal insult.

Is the diagnosis of spasticity correct in this child?

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