Condition | Clinical features |
General | |
Drug ingestion or overdosage (eg, pseudoephedrine) | History of medication administration |
Hunger/inadequate feeding | Signs of hypovolemia or undernutrition (eg, sunken fontanelle, dry mucous membranes, decreased subcutaneous fat, etc) |
Neonatal abstinence syndrome | Maternal history of prenatal substance use or positive urine screen (maternal or infant) |
Skin | |
Hair tourniquet of digit or penis | Apparent on physical examination |
Open diaper pin poking the skin, diaper rash | Apparent on physical examination |
Trauma (abusive or nonabusive) | Bruising, laceration |
Eyes | |
Corneal abrasion or foreign body | May have photophobia, positive fluorescein examination |
Glaucoma | Chronic or intermittent tearing, photophobia, corneal enlargement, corneal clouding, optic nerve cupping, ocular enlargement |
Ears, nose, oropharynx | |
Otitis media | Bulging tympanic membrane |
Thrush | White plaques on the buccal mucosa, tongue, or palate |
Cardiovascular | |
Anomalous origin of the left coronary artery | Cardiomegaly, heart failure |
Heart failure | Feeding intolerance, tachycardia, poor perfusion, tachypnea |
Supraventricular tachycardia | Pallor, irritability, poor feeding, cyanosis, restlessness |
Gastrointestinal | |
Anal fissures | Apparent on physical examination |
Constipation | Passage of hard stools |
Gastroenteritis | Vomiting, diarrhea |
Gastroesophageal reflux | Vomiting, poor weight gain, feeding refusal, gross or occult blood in the stool |
Gastrointestinal obstruction (eg, pyloric stenosis, intussusception, volvulus) | Vomiting (may or may not be bilious or forceful), gastrointestinal bleeding, forceful vomiting, abdominal tenderness, distension, right-sided sausage-shaped abdominal mass (intussusception), palpable "olive" (pyloric stenosis) |
Inguinal hernia | Bulge in the groin area (may be intermittent), vomiting and abdominal distension may indicate incarceration |
Genitourinary | |
Meatal ulcer | Apparent on examination |
Ovarian torsion | Feeding intolerance, vomiting, abdominal distension, fussiness/irritability |
Testicular torsion | Acute testicular swelling and tenderness |
Urinary tract infection | Fever, suprapubic tenderness, poor feeding, poor weight gain |
Urinary tract obstruction | Abdominal distension (due to enlarged bladder), difficulty voiding, poor urinary stream, straining or grunting during voiding |
Skeletal | |
Fracture | Decreased movement of extremity, asymmetric Moro reflex, localized swelling and crepitation, increased pain response with movement of the extremity |
Osteomyelitis or septic arthritis | Fever, decreased movement of extremity, asymmetric Moro reflex, increased pain response with movement of the extremity |
Neurologic | |
Abusive head trauma | Seizures, respiratory difficulty or apnea, retinal hemorrhages, cutaneous bruising, associated injuries |
Meningitis | Fever, bulging fontanelle, lethargy, irritability, meningismus (often not present in infants) |
Neuromuscular disease, CNS disorder, metabolic disease | Abnormal tone, muscular weakness |
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