Families often first notice something is off in the newborn period: a weak cry, trouble feeding or sucking, and eyelids that seem droopy by the end of a feed. As babies grow, doctors may spot fluctuating muscle weakness—fatigue that worsens with activity and improves with rest—along with delayed motor milestones like holding up the head or rolling over. These early patterns of fatigable weakness are typical first signs of congenital myasthenic syndrome 16 and usually prompt referral to a neuromuscular specialist for testing.