NEONATOLOGY N. Linder á M. Tsur á J. Kuint á B. German á E. Birenbaum R. Mazkereth á D. Lubin á B. Reichman á A. Barzilai A simple clinical test for differentiating physiological from pathological head lag in full-term newborn infants Received: 18 February 1997 and in revised form: 30 September 1997 / Accepted: 2 October 1997 Abstract This prospective study was designed to assess the value of a simple clinical test, a ``feeding test'', on the outcome of head lag among term neonates. Of 5718 infants who were examined before their morning meal, 67 had moderate to severe head lag in the absence of predisposing risk factors for head lag. Fifteen minutes following feeding, 62 infants (92%) showed an improvement in or disappearance of head lag with concomitant rise in serum glucose. All of these infants had normal psychomotor development on follow up. In 4 infants in whom no improvement occurred after feeding, an underlying pathological cause for head lag was subsequently diagnosed. Conclusion Use of the feeding test as a screening procedure in apparently healthy newborns with head lag may rule out pathological conditions in over 90% of the cases. Key words Head lag á Hypotonia á Glucose á Newborn Introduction Hypotonia is the most common neonatal motor neuro- logical disorder [1]. Head and neck control is examined in the newborn infant as part of the routine neurological assessment and the presence of severe and persistent head lag may be a useful sign of disorders associated with muscle weakness and hypotonia [2]. The aim of this study was to determine the incidence and severity of head lag in apparently healthy newborns, to evaluate the eect of a simple clinical test, a ``feeding test'', on the persistence of head lag, and to assess the value of this test as a prognostic indicator for an infant's neurological development. Patients and methods All full-term newborn infants born at the Hadassah Medical Centre in Jerusalem, Israel over a period of 2 years, were examined for the presence of head lag. This study included 5718 infants weighing more than 2500 g who were more than 36 weeks of gestation with apparently normal physical and neurological examinations. The study was approved by the hospital ethics committee and per- formed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. Newborns with head lag and with the following clinical prob- lems were excluded from our study: infants delivered by vacuum extraction or forceps, all infants with cephalohaematoma, head circumference >97th percentile, bilirubin level of 13 mg% or higher, suspected sepsis, congenital malformations, chromosomal aberrations, 5-min Apgar score £4, or any neurological abnor- mality. Routine physical examinations were performed on all newborns prior to the 9 a.m. feed on the 3rd day of life. When head lag was Eur J Pediatr (1998) 157: 502±504 Ó Springer-Verlag 1998 N. Linder á M. Tsur á B. German Department of Paediatrics, Hadassah University Hospital and The Hebrew University, Hadassah Medical School, Jerusalem N. Linder á J. Kuint á E. Birenbaum á R. Mazkereth D. Lubin á B. Reichman á A. Barzilai Department of Neonatology, Chaim Sheba Medical Centre and Sackler School of Medicine, Tel Aviv, Israel N. Linder (&) Department of Neonatology, Schneider Children's Medical Center of Israel, Kaplan street 14 , Petach-Tikva 49202, Israel, Tel.: (972)-3-9253753, Fax: (972)-2±5340934