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.

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

Emergencies
Collapse/
Prolonged febrile convulsion157; epilepsy158; meningitis162;
43,
158
convulsions
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.

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Paediatric symptom sorter

Abdo pain205

Bleeding

Breathless/
noisy
breathing/
cough178
Bruising/
non-blanching
rash248
Fever46

Acute
presentations

Fit, faint,
funny do,
collapse157
Headache167

Joint pain/
swelling/limp/
off legs237
Lethargy

Rash244

Swelling or
oedema
Vomiting204

Constipation207; mesenteric adenitis205; gastroenteritis213;

pyelonephritis226; appendicitis206; intussusception 212; recurrent
benign206; migraine206; stress-related103; Henoch Schonlein238;
pneumonia 180; DKA 262
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; Meckels208
- in urine (haematuria)224
UTI226, glomerulonephritis224, recurrent224; trauma; stone226;
tumour224
Asthma182; URTI178; bronchiolitis180; pneumonia180;
croup175; foreign body 181; epiglottitis 175; cardiac failure201;
DKA 262
Trauma144; viral; meningococcal 133; Henoch-Schonlein238; low
platelets 254; other bleeding diathesis253
Viral infection131; bacterial infection (ENT172, chest180, urine226,
blood133, brain162, joint236, other abscess).
If prolonged: Kawasaki 135; occult abscess; TB134;
malignancy257; systemic arthritis237
Syncope161; febrile convulsion157; epilepsy158; reflex anoxic
seizure160; breath-holding161; meningitis162; encephalitis163;
tics160; night terrors105; behavioural100; hypoglycaemia 263;
cardiac arrhythmia 201
Migraine168; meningitis162; trauma140; stress-related103; poor
visual acuity95; dental209; brain tumour 258; brain abscess168;
hypertension 202; carbon monoxide poisoning
Trauma; reactive arthritis237; irritable hip237; arthritis237;
septic arthritis 237; slipped upper femoral epiphysis 240;
Perthes239; fracture; NAI 143; rickets115; Henoch Schonlein238;
malignancy 259; haemophilia 253
Viral infection131; UTI226; gastroenteritis213; meningitis 162;
septicaemia133; DKA262; hypoglycaemia 263; brain tumour 258;
hypothyroid263
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
Nephrotic syndrome224; congestive cardiac failure201;
malnutrition115
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

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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; microcephaly94; 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-Oreflux205; cystic fibrosis186; inhaled foreign body 181;
immunodeficiency129; congenital lung problem76

Tired/pale/
lethargic

Behavioural100; anaemia251; post-viral; diabetes 261;

chronic illness; coeliac215; hypothyroid 263, Crohns 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