### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
dear sir, my wife delivered a girl child on 15 may 2011 by ceserian, the pregenancy was 8 month and 15 days old. The birth weight of child is 2.7 kg. the child was floopy and has low muscles tone.The child has a breathing problem which automatically recovered after 4 hours.The child was not able to suck the milk of his mother so she is on pipe feeding. The doctor suspect of muscles distrophy and CPK was found 1358 on first day. On 6th day CPK was retested and found 206 and the condition of child is better by almost 25%. So, my question is Can we rule out muscle distrophy and if yes, what may be the other causes?

### output:

Hi...the most important here is to know the neuromuscular development of your baby. At this age your baby should be able to go up and down stairs with one step at a time (like adults). Look whether he is able to get up to a standing position from sitting position without any support. If these parameters are normal then there are no need for screening (if you don't have any family history of muscle dystrophies).  Now coming to the birth history, what I am interested to know is whether your baby cried immediately after birth or not. If the Agar score is available in the discharge then you can look at it. Agar of less than 6 at 1 min or 5 min would indicate birth asphyxia, and then we can attribute the floppiness to that. CPK gets hiked in birth asphyxia, but that is CPK MB not whole CPK. So recheck the report please. If he had really birthed asphyxia then kindly visit and reevaluate from a pediatric neurologist. Want to inform you that the most common muscular dystrophy I.e. Duchess is extremely rare in girls