Finding	Significance and clinical response
Height and weight	Growth delay or failure to thrive may suggest an underlying disorder, including chronic kidney disease or diabetes mellitus; further evaluation of these conditions is warranted
Head, eyes, ears, nose, and throat
Enlarged adenoids and tonsils	Consider obstructive sleep apnea if snoring and/or daytime somnolence is also present; consider treatment of sleep apnea first
Abdomen
Enlarged bladder or kidneys	Suggest anatomic malformations; consider subspecialist referral
Hard stool in abdomen	Suggests constipation
Genitalia
Physical abnormalities: hypospadias, meatal stenosis, phimosis, labial adhesions	Suggest urinary tract malformations; consider subspecialist referral
Signs of sexual abuse	Perianal and perineal excoriations and vulvovaginitis are concerning for sexual abuse and warrant further evaluation
Rectum
Evidence of fecal soiling on undergarments	Suggests fecal incontinence and constipation
Poor anal sphincter tone	Suggests neurogenic bladder; consider subspecialist referral
Dimple, hair tuft, lipoma, or other finding above gluteal cleft	Suggests spinal dysraphism and neurogenic bladder; consider further evaluation and subspecialist referral
Nervous system (motor, strength, sensory, reflexes, gait)
Gait abnormality, sensory deficit, abnormal reflexes in lower limbs, tight heel cords, hammer or claw toes	Suggest neurologic disorder; consider further evaluation and subspecialist referral