Red flags	Suggested diagnoses
Onset before one month of age	Congenital malformation of anorectum or spine, Hirschsprung disease, allergy, metabolic/endocrine condition
Delayed passage of meconium (more than 48 hours after birth)	Hirschsprung disease, cystic fibrosis, congenital malformation of anorectum or spine
Failure to thrive	Hirschsprung disease, malabsorption, cystic fibrosis, metabolic condition
Abdominal distension	Hirschsprung disease, impaction, neurenteric problem (e.g., pseudo-obstruction)
Intermittent diarrhea and explosive stools	Hirschsprung disease
Empty rectum	Hirschsprung disease
Tight anal sphincter	Hirschsprung disease, anorectal malformations
Pilonidal dimple covered by tuft of hair	Spinal cord abnormality
Midline pigmentary abnormalities of lower spine	Spinal cord abnormality
Abnormal neurologic examination (absent anal wink, absent cremasteric reflex, decreased lower extremity reflexes and/or tone)	Spinal cord abnormality
Occult blood in stool	Hirschsprung disease, allergy
Extraintestinal symptoms (vomiting, fever, ill-appearance)	Hirschsprung disease, neurenteric problem
Gushing of stool with rectal examination	Hirschsprung disease
No history of withholding or soiling	Hirschsprung disease, neurenteric problem, spinal cord abnormality
No response to conventional treatment	Hirschsprung disease, neurenteric problem, spinal cord abnormality