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Head-to-Toe Exam for the Inconsolable Infant

 

Here’s a quick outline for the Head-to-Toe exam for the inconsolable infant:

 

Head

  • Neuro exam – Change in mental status? Hypoglycemia
  • Full fontanelle – Space-occupying lesion? Infection?
  • Hematoma or Ecchymosis – Accidental vs Non-Accidental Trauma?

Eyes

  • Corneal abrasion? Eversion of the eyelid for retained foreign body
  • Red-eye and excessive tearing? Congenital conjunctivitis? Glaucoma?

Ears

  • Acute otitis media, Retained foreign body

Mouth

  • Stomatitis? Thrush? Strawberry tongue? Kawasaki Disease?
  • Mucous Membranes? Dehydration?

Chest

  • Rib fractures, Pneumonia, Pneumothorax

Heart

  • Congenital Heart Disease, Dysrhythmia

Abdomen

  • Medical – UTI, Masses, Hepatosplenomegaly
  • Surgical – Intussusception, Appendicitis, Volvulus, Hirschsprung’s Disease
  • Diaper Region – Testicular/Ovarian Torsion, Appendicitis, Incarcerated Hernia, Hair Tourniquet, Anal fissure

                           

Extremities

  • Hair Tourniquet, fractures, Sickle-Cell Disease, Septic Joint, Post-Vaccination

Skin

  • Cellulitis, Petechiae, Purpura, Toxidromes?

 

 

Conclusion

History and physical examination remain the cornerstone of the evaluation of the crying infant.