Up to 60% have a diagnosis to be made. Most of diagnosis will be made in the exam.

IT CRIES

Infection

• UTI – low threshold to test even without fever
• Meningitis – irritable, fussy when attempting to console, better when laid down
• Perianal strep/abscess, thrush, diaper rash

Trauma

• NAT – Only 10% of kids rolling by 3 mo, not consistently rolling by 4-6 mo
• Caput vs. Cephalohematoma vs. Subgaleal hemorrhage

Cardiac

• SVT
• CHF

Reflux/Rectal/Reaction to medication

• Reflux – Spitting up after feeds from history
• Rectal – Anal fissures at midline consistent with constipation, fissures off midline concerning for insertional
• Reaction to meds – consider meds baby is taking as well as breast feeding mom is taking

Intussusception

• 6 mo – 36 mo typical age range
• Somnolence due to release of endogenous endorphins

Eyes

• Fluorosceine exam for corneal abrasion
• Consider glaucoma – photophobia, blepharospasm, excess tearing, injection
• Conjunctivitis

Surgical

• Hernias