Findings	Possible cause	Other historical clues	Physical examination findings	Diagnostic testing
Diarrhea, intermittent, explosive	Hirschsprung disease	Bilious emesis, chronic constipation, fever, no meconium passed in first 24 hours of life, poor feeding; may coexist with trisomy 21; more common in boys	Abdominal distention or tenderness, jaundice	Abdominal radiography (with or without contrast enema), anorectal manometry, rectal suction biopsy
Scrotal or inguinal swelling	Incarcerated hernia	Abdominal pain, bilious emesis	Abdominal bulging or distention, acute abdomen	Ultrasonography
	Testicular torsion	Acute onset of crying and pain	High-riding testicle, scrotal discoloration, tenderness to palpation	Ultrasonography
Tenderness to palpation in long bones, clavicles, or scalp	Child abuse	History of fall or trauma, lethargy, unwillingness to move extremities	Burns, frenulum tears, geographic scars, retinal hemorrhage, suspicious bruises	Computed tomography to detect intracranial hemorrhage, radiography of extremities
Vomiting, recurrent and/or forceful	Gastroesophageal reflux disease	Apnea, arching of the back with feeding, cough, feeding refusal, hematemesis, irritability, poor weight gain, wheezing	Nonspecific	None required in uncomplicated reflux; 24-hour pH monitoring may be used for complicated reflux; endoscopy for persistent symptoms
	Pyloric stenosis	Normal appetite, progressive nonbilious projectile vomiting; more common in boys; presents at two to six weeks of age	Clinical dehydration, palpable pyloric mass or “olive” in right midepigastrium, visualization of gastric peristalsis with feeding	Ultrasonography of pylorus
No clinical signs or symptoms	Anal fissure	Bloody or painful bowel movements	Fissure	None
	Corneal abrasion	Tearing	Conjunctival erythema, scratches near the eye	Fluorescein testing
	Cow's milk allergy	Bloody stools, constipation, diarrhea, excessive gas, pain with defecation, rash, vomiting	Rash	Fecal occult blood testing, resolution of symptoms after maternal dietary change (in breastfed infants) or formula change
	Hair tourniquet syndrome	Edema of toes, fingers, or penis; hair found curled up near infant	Hair wrapped around finger, toe, or penis	None
	Inadequate bottle feeding	Aggressive feeding	Clinical dehydration, loss of fat from cheeks, weight loss or poor weight gain	Weight increase with increase in formula feedings
	Inadequate breastfeeding	Breasts not emptying with feeding	Poor latch observed; weight loss or poor weight gain	Weight increase with supplemental formula