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.