Bad Hand Writing

8 year old malay boy was referredby his teacher to the visiting health assistant for his bad hand writing inspite of been a good student in class. He is adapted child from a family of 6 sibilings. He is the youngest and his elder sister is known to be syndromic. The biological mother is from Thailand while father is Kelantanes. They are now living in Thailand.

On examination he is having soft dysmorphism (flat face, flat nasal bridge, no gap at the ear helix, upslanted eye brows), Growth parameters are normal. He has hyper extensibility of fingers and toes, he eats rice with tip of fingers been unable to make a scoup, he has difficulty in walking heel to toe.

Ehlers Danlos Syndrome? unlikely? may be MITIS type, born full term, fontanells closed, no premature loss of teeth, no bowing, no inguinal/abdominal hernia, no history of bruising, no extensive bleeding, skin not hyper elastic, spine is normal, heart - no murmur, no broad atrophic papyraceous scars, no molluscoid tumors. ?frgile cornea?keratoconus, no #, compl- osteoarthritis, dissection of aorta, uterine rupture, colon rupture, advice- not for pregnancy, no trumpet,

Cutis laxa??? skin not loose

Homocystinuria?? no teeth crowding, ?MR, hsd delsyed devellpment, not tall, notthin, no arachnodactyly, no thrombosis. treat trail vit B6, HTN,