Did You Examine the Parents?

A 5-month-old boy presented to the Emergency Department with a febrile illness and respiratory distress of 4 days' duration. He had been delivered at term by cesarean delivery performed due to polyhydramnios, reduced fetal movements, and nonprogression of labor. After birth, he had frequent feeding problems, pooling of secretions, choking after feeds, and repeated hospitalizations for pneumonia. Examination revealed normal head circumference, bitemporal hollowing, bifacial and bulbar weakness, inverted V-shaped upper lip, generalized hypotonia, reduced spontaneous antigravity movements, and hyporeflexia.

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