Decreased generalized movements due to pain is a very rare condition. It occurs in patients with pseudoparalysis of Parrot, osteogenesis imperfecta, and in victims of child abuse. Pseudoparalysis of Parrot is due to syphilitic infiltration of bone tissue. Neonates with congenital syphilis are likely to have hepatomegaly, skin rash (Figure 91.1[A]), and nasal discharge (Figure 91.1 [B]). The diagnosis of congenital syphilis is definite if: (1) the organism is identified on dark-field or direct observation in a pathological specimen; (2) there is a four-fold increase in venereal disease research laboratory test (VDRL) or rapid plasma reagin with positive treponemal antibody test in asymptomatic patients; (3) a reactive serum VDRL or treponemal agglutination test occurs in the presence of sniffles, condylomata lata, or osseous lesions; or (4) a reactive VDRL or rapid plasma reagin is present in the cerebrospinal fluid.

Figure 91.1.— Congenital syphilis. [A] Nasal discharge and scalded skin (left shoulder). [B] Skin rash on the palms.

Osteogenesis imperfecta is a hereditary disorder of connective tissue. Osteogenesis imperfecta produces decreased movements due to multiple bone fractures (Figure 91.2 [A]). Osteogenesis imperfecta is diagnosed based on a positive family history, multiple fractures on radiographic bone survey (Figure 91.2 [B]), and blue sclera. Fracture of the ear bones produces deafness.

A	B

Figure 91.2.— Osteogenesis imperfecta. [A] Typical posture of a neonate with osteogenesis imperfecta due to limb deformities. [B] Radiographic evidence of multiple fractures.

Child abuse may produce generalized decreased movements in neonates with multiple fractures. Neonates suffering from child abuse usually have cutaneous (Figure 91.3 [B]) and retinal changes (Figure 91.3 [B]) suggestive of abuse.

A	B

Figure 91.3.— Neonatal abuse. [A] Cutaneous lesions in an abused neonate; lineal bruises over the skin. [B] Retinal hemorrhages.