Clinical finding | Potential significance |
Growth parameters |
Body weight | - Used to determine degree of dehydration and response to fluid repletion
|
Growth retardation | - Chronic underlying condition (eg, gastrointestinal disease, immune deficiency)
|
Vital signs |
Fever: - ≥38°C (100.4°F) in patient <3 months
- ≥39°C (102.2°F) in patient ≥3 months
| - Temperature elevation tends to be higher in extraintestinal infection or bacterial gastroenteritis (particularly if >40°C [104°F])
|
Rapid, weak, or absent pulse | |
Decreased blood pressure | - Dehydration, shock, sepsis
|
Hypotension disproportionate to apparent illness | |
HEENT |
Sunken anterior fontanelle, sunken eyes | - Moderate to severe dehydration
|
Bulging anterior fontanelle | - Increased intracranial pressure
|
Scleral icterus | |
Bulging tympanic membrane | |
Tacky, dry, or parched mucous membranes | |
Fruity/ketotic breath | |
Exudative tonsillitis/palatal petechiae | - Streptococcal pharyngitis
|
Neck |
Neck stiffness, nuchal rigidity, other meningeal signs | |
Chest |
Deep respirations | - Moderate to severe dehydration, acidosis
|
Tachypnea, crackles, decreased breath sounds | |
Abdomen |
Severe, localized pain, rebound tenderness, marked abdominal distension | - Acute abdomen (eg, appendicitis, bowel obstruction, toxic megacolon)
|
Hypoactive/absent bowel sounds | |
Flank pain or suprapubic tenderness | |
Abdominal mass | - "Olive" at lateral edge of rectus abdominus in RUQ: pyloric stenosis
- "Sausage-shaped" right-sided mass: intussusception
|
Skin |
Cool, mottled, poor capillary refill, decreased turgor | - Moderate to severe dehydration, sepsis
|
Nonblanching lesions (petechiae, purpura, bruises) | - HUS, trauma (intracranial, intra-abdominal)
|
Jaundice | |
Neurologic |
Altered consciousness or focal neurologic abnormalities | - Toxic ingestion, diabetic ketoacidosis, CNS mass, or inborn error of metabolism
|