Once triage for true neurologic emergencies is complete, the examination should continue by observing the child’s activity Infants should be observed for gaze tracking and maintenance, head control, global tone, and strength of suck Strength and tone can be assessed by holding the infant vertically and allowing them to bear weight on the legs, as well as pulling them up from supine position by the arms Toddlers and older children should be assessed for their ability to sit, stand, walk, and run The muscles themselves should also be inspected for evidence of atrophy from disuse or denervation, hypertrophy or a doughy quality caused by MD, failure to relax appropriately as in myotonic dystrophy, or fasciculations common with lower motor neuron disease such as SMA Tenderness to palpation suggests inflammation or infection consistent with viral myositis, bacterial pyomyositis, or dermatomyositis Focal tenderness of the back may be a clue toward diagnosis of an epidural abscess or transverse myelitis FIGURE 82.4 Approach to subacute, indolent, or chronic weakness Muscle strength of all the major muscle groups should be carefully assessed and documented ( Table 82.6 ) “Give” weakness, whereby the patient resists