The patient is a 4-month-old white male infant born at term to a 21-year-old Rh positive, gravida 1 woman after an unremarkable pregnancy. The labor was spontaneous and the delivery, uncomplicated. Birth weight was 6 lbs 10 oz (3,005 gm), and the only abnormalities noted were bilateral cephalohematomata.The father is 28 years old and in good health. Except for a mild iron deficiency anemia, the mother has also enjoyed good health. Neither parent received any therapeutic or diagnostic xray studies except for an occasional chest film.There were no drugs taken during the gestation except for an oral iron medication. Both maternal and paternal family histories are negative with re¬ gard to congenital malformations, mental retarda¬ tion, or any other recognizable disturbances of growth and development.Received for publication June 1, 1965. From the departments of anatomy and pediatrics, University of Rochester School of Medicine and Dentistry.Reprint requests to 260 Crittenden Blvd, Rochester, NY 14620 (Dr. Townes).The patient evidenced no major difficulties during the neonatorum except for poor weight gain, mild anorexia, somewhat peculiar facies, generalized hypotonia, and lethargy.At the age of 2j/¿ weeks, the patient was seen because of the above complaints and on examina¬ tion was found to be an extremely lethargic, wasted, chronically ill-appearing male infant who evidenced very little spontaneous movement. Ir¬ ritability was minimal and a cry was not elicited even during venipuncture. Vital signs were nor¬ mal. The skin was loose and of poor turgor.The head was grossly normocephalic except for the resolving bilateral parietal cephalohematomata.The anterior fontanelle was of normal size and tension. Although the facies were in no way specifically abnormal, they evidenced the overall lethargy of the infant. Ocular abnormalities were not evident. The mouth and mandible were small and the ears, low set. Chest was symmetrical, without deformity, and clear to percussion and auscultation. Heart sounds were of good quality and without murmur. The abdomen was scaphoid but free of organomegaly and abnormal masses. The genitalia were normal infant male with neither testis palpable in the scrotum or inguinal canals. Neurologic examination revealed no pathologic re¬ flexes, except a Moro was not elicited. Extremities were symmetrical bilaterally; the fingers were relatively long but free of deformity. Hip abduc¬ tion was limited.At 6 weeks of age, the patient weighed 6 lb 13 oz (3,090 gm) and measured 21% inches (56 cm ) in length. At 10 weeks of age the patient weighed 7 lb 8 oz (3,402 gm) and measured 23 inches (58 cm) in length. Physical findings on examination were as previously noted except that the infant appeared less lethargic, less wasted, and he evi¬ denced mild irritability to noxious stimuli. His appetite had improved and he presented no par¬ ticular difficulties at home. The appearance of the infant at this time is shown in Fig 1. A blood sample for chromosome analysis was obtained.