| Examination clues | Potential significance |
| Vital signs | |
| Hypotension | Adrenal or thyroid insufficiency |
| Hypertension | Renal disease |
| Tachypnea/tachycardia | Increased metabolic demands |
| General appearance | |
| Pallor | Anemia |
| Drooling | Oral motor dysfunction |
| Cachexia, temporal wasting, sparse hair or alopecia | Significant malnutrition |
| Inadequate adiposity | Indicator of nutritional inadequacy |
| Dysmorphic features | Clinical or genetic syndrome associated with poor weight gain |
| Head and neck | |
| Microcephaly | Neurologic disorder, fetal alcohol syndrome |
| Delayed closure of fontanelle | Vitamin D deficiency, hypothyroidism |
| Short palpebral fissures | Fetal alcohol syndrome |
| Cataracts | Congenital infection, galactosemia |
| Papilledema | Increased intracranial pressure |
| Smooth philtrum | Fetal alcohol syndrome |
| Aphthous stomatitis | Crohn disease |
| Thin vermillion border | Fetal alcohol syndrome |
| Oropharyngeal lesions (eg, caries, tongue enlargement, mandibular hypoplasia, tonsillar hypertrophy, defects in soft or hard palate) | May interfere with eating |
| Delayed tooth eruption | Delayed bone age |
| Thyroid enlargement | Thyroid disease |
| Low hairline | Genetic syndrome (eg, Klippel-Feil) |
| Chest | |
| Wheezing, crackles, prolonged expiratory phase, hyperexpansion | Cystic fibrosis, asthma |
| Cardiac murmur | Congenital or acquired heart disease |
| Abdomen | |
| Abdominal distension, hyperactive bowel sounds | Malabsorption |
| Hepatosplenomegaly | Liver disease, glycogen storage disease, malignancy |
| Genitourinary | |
| Genitourinary abnormalities | Endocrinopathy |
| Rectal fistulae, large perianal skin tags | Crohn disease |
| Musculoskeletal | |
| Clubbing | Chronic hypoxia due to cardiac or pulmonary disorders |
| Bony deformities (craniotabes, beading of the ribs, scoliosis, bowing of the legs or distal radius and ulna, enlargement of the wrist) | Rickets |
| Edema | Protein deficiency |
| Neurologic | |
| Abnormal deep tendon reflexes | Cerebral palsy |
| Hypotonia, weakness, spasticity | May be associated with oral motor dysfunction |
| Neuropathy | Vitamin deficiencies: B12, B3 (niacin), B6 (pyridoxine), E (tocopherol) |
| Skin and mucous membranes | |
| Scaling skin | Zinc deficiency |
| Candidiasis | Immune deficiency |
| Spoon-shaped nails | Iron deficiency |
| Cheilosis | Vitamin deficiency: B2 (riboflavin), B3 (niacin), or B6 (pyridoxine) |
| Chronic diaper rash | Possible neglect |
| Bruises in characteristic patterns | Possible abuse |
