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.