Q: I gave birth to a daughter a week ago and noticed that she doesn't cry at all. We took her to the doctor and found out that she has Aphonia. This means that her vocal chords don't work at all. I tried to get more information on this, but the doctor was very busy and the nurse knew nothing. We have found general information, but nothing significant to help. She responds to sounds quite well. She responds to my wife's voice. We have tried playing loud music, and she would suddenly wake up, even when the base was very low. What is going to happen to her? My wife and me love our daughter, but we want to know if we need to hire someone special to help teacher her, or if we need to start looking at special schools that can help her. Please advise.

A:Generally, a good, loud cry is considered sign of a healthy baby. There may be situations in which the cry may be weak or absent. The common causes include: 1. Neurological problems like neuromuscular weakness 2. Nerve injuries during difficult deliveries 3. Thyroid problems 4. General ill-health 5. Just a well-behaved baby! True aphonia in a healthy baby is rare. Further information is needed to determine why your baby does not cry. A paediatric neurologist may examine the baby to see if the baby is floppy (with poor muscle tone) or having weakness. In this case, additional tests are needed. Neuromuscular diseases and general ill-health are less likely if the baby is vigorous and active. Thyroid problems may cause weak, hoarse cry and are treatable with early diagnosis. Nerve injuries (of recurrent laryngeal nerve) often get better with age. If neurological examination and thyroid function are normal, it is possible cry may get better with age. There have been reports of many healthy babies who did not have audible cry for few months and subsequently grew normally. I suggest having a complete physical examination of the baby by an experienced paediatric neurologist.