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Definition of the Complaint

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The term decreased activity level describes a wide spectrum of existence ranging from boredom to coma. The diagnostic evaluation focuses on encouraging parents to provide a detailed account, particularly with regard to the magnitude and time course of the changes. Clearly, the differential diagnosis of subtle behavioral changes developing during a period of several months differs from that of changes occurring during several hours.

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Complaint by Cause and Frequency

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The causes of decreased level of activity in children vary according to age (Table 2-1), and can be placed into several broad categories (Table 2-2). Additional issues to consider include whether there is depressed sensorium indicating an underlying central nervous system (CNS) disorder, weakness indicating a muscular disorder, or endurance problems suggesting a cardiac or pulmonary issue. Systemic illness may manifest with somnolence or lethargy.

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Table Graphic Jump Location
Table 2-1. Differential Diagnosis of Decreased Activity by Age.
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Table Graphic Jump Location
Table 2-2. Differential Diagnosis of Decreased Activity Level by Etiology.
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Clarifying Questions

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The patient who presents for evaluation of decreased level of activity represents a broad differential. Several important historical questions can help classify the underlying etiology:

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  • What is the time course of decreased level of activity?
    • Infectious etiologies typically present during a shorter time course than do other etiologies, such as iron deficiency anemia or certain types of CNS malignancies.
  • Is the patient febrile?
    • Fever, from an infectious etiology, can cause a decreased level of activity in children. However, hypothermia, particularly in neonates, ...

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