DDx

• Feeding difficulty:

  • Low intestinal motility due to prematurity
  • Infection - gastroenteritis, ear, UTI, oral thrush
  • GORD
  • Allergy - cows milk allergy, lactose (usually transient after viral gastro illness)
  • Constipation
  • Structural oral issue - tongue tie, cleft palate/lip
  • Structural GI issue - pyloric stenosis (projectile vomiting), intestinal blockage
  • Neurological impairment - difficulty attaching to breast/bottle or disordered sucking - hypoxic encephalopathy, cerebral palsy, muscular dystrophy
  • Physiological instability - respiratory and cardiac abnormalities
• Faltering growth:

  • Inadequate nutritional intake - maternal malabsorption, IDA, neglect
  • Difficulty feeding - neurological (e.g. cerebral palsy), cleft lip/palate, genetic conditions, pyloric stenosis
  • Malabsorption - CF, coeliac disease, cows milk allergy, chronic diarrhoea
  • Increased energy requirements - hyperthyroidism, chronic disease (e.g. CF, congenital heart disease), malignancy, chronic infections
  • Unable to process nutrients - inborn errors of metabolism (e.g. phenylketonuria), T1DM
• Crying episodes:

  • Colic
  • Teething
  • Boredom or loneliness
  • Discomfort from wet nappy, excessive gas, too hot/cold
  • Hunger or thirst
  • Infection
  • Medications
  • Pain
  • Serious causes such as infection or pain will have other symptoms - fever, unable to sooth, high pitch cry, lethargy
• Vomiting:

  • overfeeding (most common)
  • GOR/GORD
  • Pyloric stenosis (Projectile)
  • CMPA
  • Gastritis or gastroenteritis
  • Appendicitis
  • Infections - UTI, tonsillitis, meningitis
  • Intestinal obstruction - strangulated hernia, intussusception
  • Poisoning
  • Very newborn baby - meconium ileus, Hirschsprung's
• Nasal congestion:

  • Irritants - cigarette smoke
  • Allergies - allergic rhinitis, CMPA
  • Viral infection - RSV
  • Structural abnormalities - polyps, deviated septum, narrow passages
  • Teething
  • GOR/GORD
  • Foreign objects
  • Sinusitis
• Wheezing:

  • Respiratory infections - bronchiolitis, pneumonia
  • Allergies - allergic rhinitis, CMPA
  • GORD
  • Asthma
  • Foreign body
  • Congenital - cystic fibrosis, heart disease (pulmonary oedema)
  • Swallowing difficulties that causes inhalation of food or liquids
• Blood in stool:

  • Benign - swallowed maternal blood
  • Bright red blood on wipe - anal fissure from constipation, severe nappy rash
  • Mixed with stool - intussusception
  • Dark/black) - Oesophagitis from GORD, Meckel's diverticulum
  • Associated pain - fissure
  • Loose stool - bacterial gastroenteritis
  • Change in feeds - CMPA
  • Signs of bruising - bleeding disorder (most common in newborn is vit K deficiency), sexual abuse
  • Bilious vomit/distension- intestinal obstruction
  • Haemangiomas in bowel
• Abdominal distension:

  • Obstruction (often with bilious vomiting)- Hirschsprung disease causing enterocolitis (inflammation and infection), intussusception, volvulus
  • Sepsis
  • Change in formula/quantify - over distended stomach
  • NIV/CPAP - excessive air pushed into stomach
  • Necrotising enterocolitis
  • Dysmotility of prematurity - usually grow out of it
• Cough:

  • Serious - pneumonia, bronchiolitis, whooping cough, airway foreign object
  • URTI (clear chest) - viral bronchitis (common cold), pharyngitis, otitis media, croup, coronavirus
  • Sinusitis
  • Allergies
  • Asthma
  • Air pollution - tobacco smoke
  • Bronchiectasis
  • CF
• Wheeze in different ages:

  • Pneumonia - can affect any age
  • Bronchiolitis - under 2 years
  • Viral induced wheeze - 2 to 5 years
• Neonatal respiratory distress:

  • Transient tachypnoea of newborn (most common)
  • Meconium aspiration
  • Pneumonia
  • Pneumothorax
  • Persistent pulmonary hypertension of the newborn
  • Milk aspiration
  • Airway obstruction
  • Non-pulmonary: heart disease, diaphragmatic hernia, tracheo-oesophageal fistula, severe anaemia, sepsis