Differential Diagnosis for a 28-Month-Old with Frequent Falls
Single Most Likely Diagnosis
- Normal Developmental Variability: At 28 months, children are still refining their gross motor skills, including balance and coordination. Frequent falls can be a normal part of the learning process as they explore their environment and test physical boundaries.
Other Likely Diagnoses
- Muscle Weakness or Poor Coordination: Conditions such as muscular dystrophy or cerebral palsy can lead to muscle weakness and poor coordination, increasing the likelihood of falls.
- Vision Problems: Uncorrected vision issues, such as refractive errors or strabismus, can affect balance and spatial awareness, leading to frequent falls.
- Developmental Delay: Children with developmental delays may have impaired gross motor skills, making them more prone to falls.
Do Not Miss Diagnoses
- Trauma or Non-Accidental Injury: It's crucial to consider the possibility of trauma or non-accidental injury, especially if the falls seem excessive or if there are other signs of abuse.
- Infections (e.g., Meningitis or Encephalitis): Infections affecting the central nervous system can cause ataxia, leading to frequent falls.
- Metabolic Disorders (e.g., Hypoglycemia): Certain metabolic disorders can cause episodes of weakness or loss of coordination, resulting in falls.
Rare Diagnoses
- Ataxia-Telangiectasia: A rare genetic disorder characterized by progressive ataxia, which could manifest as frequent falls in early childhood.
- Tumors (e.g., Brain Tumors): Although rare, tumors affecting the brain or spinal cord can cause ataxia, weakness, or other symptoms leading to frequent falls.
- Genetic Disorders (e.g., Friedreich's Ataxia): Certain genetic disorders can cause progressive ataxia, starting in early childhood, which would increase the risk of falls.