Paediatric symptom sorter

‘I am about to see a child with…’

This section lists common presentations and their causes, according to whether you would see them in the resuscitation room (emergencies), acute paediatric unit, or out-patient clinic. The lists are not comprehensive, and often will vary with age, or if there is a pre-existing diagnosis. However, they give you a quick starting point as to what conditions should feature in your differential diagnoses when you start your history and examination.

Conditions commonly causing that presentation are given in bold, while rare causes are in italics. Conditions highlighed with a red flag ( ) are easy to miss, and may have serious consequences if you do.

There is some overlap between acute and clinic presentations, so check both lists. Page numbers direct you to where to find main relevant information in the book. Check the index for a complete listing.

Emergencies

Respiratory failure43, 178

Asthma182; pneumonia180; bronchiolitis180; croup175; pneumothorax 186; foreign body 45, 181; neurological (e.g. head injury140, raised intracranial pressure163); poisoning142

Circulatory failure/shock43

D&V207; sepsis133; DKA262; cardiac failure262; anaphylaxis 128; haemorrhage/trauma (including NAI143), burns141, poisoning142

Collapse/ convulsions43, 158

Prolonged febrile convulsion157; epilepsy158; meningitis162; encephalitis163; brain tumour258; raised intra-cranial pressure163; head injury140; hypoglycaemia 263; hypocalcaemia 116; poisoning142; inborn error 265

Child death4 SIDS146; any of the above

Paediatrics Lecture Notes, Ninth edition. Simon J. Newell and Jonathan C. Darling. © 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd.

Paediatric symptom sorter 309

Acute presentations

Abdo pain205 Constipation207; mesenteric adenitis205; gastroenteritis213; pyelonephritis226; appendicitis206; intussusception 212; recurrent benign206; migraine206; stress-related103; Henoch Schonlein238; pneumonia 180; DKA 262

Bleeding Low platelets254; other bleeding diathesis253; NAI 143

- in vomit (haematemesis)205

Mallory-Weiss205; cracked nipple205; oesophagitis205; varices205

- in stool208

constipation207; invasive gastroenteritis213; inflammatory bowel disease216; Meckel’s208

- in urine (haematuria)224

UTI226, glomerulonephritis224, recurrent224; trauma; stone226; tumour224

Breathless/noisy breathing/cough178

Asthma182; URTI178; bronchiolitis180; pneumonia180; croup175; foreign body 181; epiglottitis 175; cardiac failure201; DKA 262

Bruising/ non-blanching rash248

Trauma144; viral; meningococcal 133; Henoch-Schonlein238; low platelets 254; other bleeding diathesis253

Fever46 Viral infection131; bacterial infection (ENT172, chest180, urine226, blood133, brain162, joint236, other abscess). If prolonged: Kawasaki 135; occult abscess; TB134; malignancy257; systemic arthritis237

Fit, faint, funny do, collapse157

Syncope161; febrile convulsion157; epilepsy158; reflex anoxic seizure160; breath-holding161; meningitis162; encephalitis163; tics160; night terrors105; behavioural100; hypoglycaemia 263; cardiac arrhythmia 201

Headache167 Migraine168; meningitis162; trauma140; stress-related103; poor visual acuity95; dental209; brain tumour 258; brain abscess168; hypertension 202; carbon monoxide poisoning

Joint pain/swelling/limp/off legs237

Trauma; reactive arthritis237; irritable hip237; arthritis237; septic arthritis 237; slipped upper femoral epiphysis 240; Perthe’s239; fracture; NAI 143; rickets115; Henoch Schonlein238; malignancy 259; haemophilia 253

Lethargy Viral infection131; UTI226; gastroenteritis213; meningitis 162; septicaemia133; DKA262; hypoglycaemia 263; brain tumour 258; hypothyroid263

Rash244 Infection130 (any viral or some bacterial (esp strep and staph); impetigo246; drug-related; urticaria/allergic246; eczema245; meningococcal infection 133; Henoch Schonlein 238; low platelets254; eczema herpeticum 246; bruising/NAI143; erythema nodosum247; erythema multiforme247; scabies248

Swelling or oedema

Nephrotic syndrome224; congestive cardiac failure201; malnutrition115

Vomiting204 Overfeeding; GO-reflux; gastroenteritis213; protein intolerance216; appendicitis206; bowel obstruction 210; pyloric stenosis 212; viral infection131; acute otitis172; UTI226; sepsis 133; meningitis 162; poisioning142; space-occupying brain lesion 168

310 Paediatric symptom sorter

Clinic presentations

Abdo pains– recurrent205

Constipation207; stress-related103; recurrent abdo pain of childhood206; migraine206; UTIs226; GO-reflux oesophagitis205; irritable bowel206; inflammatory bowel disease216

Abnormal skin243 Birthmarks (inc strawberry naevus)161; eczema245; neonatal lesions66; other rashes244; infestations248; bruises144; purpura 248; NAI 143; neurodermatoses161

Development/learning delayed or abnormal89

Normal variation81; specific learning problem91; Down Syndrome92; cerebral palsy165; hip dysplasia 235; neurodegenerative disorders169; Duchenne 169; autism spectrum106

Fits, faints and funny dos157

see under acute

Growth excessive118

Obesity114; precocious puberty122; syndromes (Klinefelter121, Marfan121); cushingoid (steroids)264; Cushings264

Growth poor118 Failure to thrive123; constitutional small stature120; delayed puberty122; chronic illness; coeliac disease 215; genetic sydromes (Turner121, Down92); renal failure226; hypothyroid263; neglect142; malnutrition115

Headaches167 Migraine168; stress-related103; dental; poor vision; sinusitis173; hypertension 202; brain tumour 258

Head shape/size abnormal168

Plagiocephaly168; familial large head; craniosynostosis 168; microcephaly 94; hydrocephalus164

Infections – frequent128

Normal frequency for age129; immunodeficiency129; cystic fibrosis186; HIV132; malnutrition115

Loose stools207 Constipation with overflow207; toddler diarrhoea207; food allergy216; coeliac disease215; inflammatory bowel disease 216; malabsorption214

Musculoskeletal problems234

Intoeing235; genu valgum/varum235; rickets115; arthritis237; scoliosis235; club feet235; cerebral palsy165; hip dysplasia235; spina bifida165

Respiratory symptoms – recurrent177

Asthma182; normal URTIs178; post-viral cough179; G-O-reflux205; cystic fibrosis186; inhaled foreign body 181; immunodeficiency129; congenital lung problem76

Tired/pale/lethargic

Behavioural100; anaemia251; post-viral; diabetes 261; chronic illness; coeliac215; hypothyroid 263, Crohn’s 216; renal failure 226; liver disease217; leukaemia 257; malignancy256; chronic fatigue151

Vomiting204 G-O-Reflux205; overfeeding205; cows milk protein intolerance216; food allergy216; behavioural103; coeliac disease215; recurrent obstruction210; space-occupying brain lesion 168

Wetting problems229

Delayed dryness but normal229; urine infections226; constipation207; overactive bladder230; primary nocturnal enuresis229; diabetes mellitus261; diabetes inspidus265