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Data were collected from 413 assessments obtained in 159 low-risk infants assessed at different ages between the age of 3 and 24\u00a0months. The distribution of findings in the low-risk infants was similar to the data previously obtained in low-risk newborns, with all assessments having optimal findings (column 3) on all items. The only item with a small number of findings outside column 3 was tendon reflexes. The module was also applied to a cohort of 57 infants with hypotonia older than 3\u00a0months in order to identify individual items that may be useful in differential diagnosis. Items assessing antigravity movements were the most sensitive to identify neuromuscular disorders. Dysmorphic features and other organ involvement were most suggestive of genetic disorder, while seizures were a reliable indicator of CNS involvement.<\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    : Our findings suggest that the neonatal floppy module can be reliably administered also in infants from the age of 3 months. The pilot application of the module in infants with hypotonia from the age of 3 months also suggested that the module could be used to help the clinician in the differential diagnosis of infants with hypotonia.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Hypotonia is a relatively common finding in the neonatal period and can be due to multiple causes.<\/jats:italic>\n                              \u2022\n                              <jats:italic>As hypotonia can be observed also after the neonatal period and clinicians often face the challenge of differential diagnosis, the question has arisen whether the \u2018floppy module\u2019 validated in newborns could also be used in infants.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Most of the infants with hypotonia, between the age of 3 to 24 months, have a diagnosis of neuromuscular disorders.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Most of the infants with CNS involvement and with genetic diagnosis, who may have shown hypotonia in the neonatal period, by 6 to 12 months have normal or increased tone.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-025-06483-0","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T12:50:32Z","timestamp":1759841432000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Application of the neonatal \u2018floppy module\u2019 to older infants: can it be used for differential diagnosis?"],"prefix":"10.1007","volume":"184","author":[{"given":"Costanza","family":"Cutrona","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Sbarbati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Malaspina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Velli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Sini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Onesimo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgia","family":"Coratti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico M.","family":"Romeo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marika","family":"Pane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugenio","family":"Mercuri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"issue":"1","key":"6483_CR1","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.jpeds.2004.08.047","volume":"146","author":"I Vasta","year":"2005","unstructured":"Vasta I, Kinali M, Messina S, Guzzetta A, Kapellou O, Manzur A, Cowan F, Muntoni F, Mercuri E (2005) Can clinical signs identify newborns with neuromuscular disorders? 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