A 4-year-old child who has previously met developmental milestones is not toiled trained. The primary care pediatric nurse practitioner notes decreased reflexes in the lower extremities and observe a dimple above the gluteal cleft. Which diagnosis may be considered for this child?

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Quizplus · Accepted Answer

The decreased reflexes and dimple above the gluteal cleft suggest possible tethered cord syndrome, in which the spinal cord is attached or tethered to surrounding tissues, possibly causing motor and sensory deficits. Arnold-Chiari malformation can cause similar symptoms but typically presents with headache and neck pain. Reye syndrome is a rare but serious condition that affects the liver and brain, usually following a viral infection and use of aspirin-containing products. Spina bifida cystica is a type of neural tube defect that causes a visible protrusion of the spinal cord or meninges, typically in the lumbar or sacral region. While spina bifida can be associated with neurogenic bladder and bowel dysfunction, it would not directly explain the decreased reflexes and dimple in this case.

A 4-Year-Old Child Who Has Previously Met Developmental Milestones Is