CHIEF COMPLAINT: FEVER

Key Questions to ask:

1. Age of child.

2. Duration of fever.

3. Tmax.

4. Associated symptoms: cough, congestion, vomiting, diarrhea, rash.

5. Hydration and urine output.

6. Sick contacts.

Exam Focus:

• General appearance (toxic vs well appearing).

• Hydration status.

• Ear exam, Throat exam, Lung exam.

• Rash.

Common Causes: Viral URI (most common), Otitis media, Strep pharyngitis, Viral gastroenteritis, UTI (especially in infants).

Management:

• Well appearing + viral symptoms → supportive care.

  • Acetaminophen or ibuprofen for fever.

  • Encourage fluids.

  • Return precautions.

• Bacterial Cause: OME, Strep throat —> Antibiotic course (amoxicillin).

CHIEF COMPLAINT: COUGH/UPPER RESPIRATORY SYMPTOMS

Key Questions to ask:

1. Duration of symptoms.

2. Fever.

3. Difficulty breathing or wheezing.

4. Night cough.

5. Sick contacts.

Exam Focus:

• Work of breathing.

• Lung auscultation.

• Nasal congestion.

• Oropharynx.

Common Causes: Viral URI, Bronchiolitis (infants), Asthma exacerbation, Pneumonia.

Management:

• Viral URI: Nasal saline, humidifier, hydration.

• Bronchiolitis: Supportive care, hydration, suctioning.

• Asthma: Albuterol, steroids if severe.

• Pneumonia: Focal lung findings, fever + tachypnea, treat with antibiotics.

CHIEF COMPLAINT: EAR PAIN

Key Questions to ask:

1. Fever.

2. URI symptoms.

3. Tugging at ear.

4. Hearing changes.

Exam Focus:

• Tympanic membrane: Bulging, erythema, decreased mobility.

Common Causes: Acute Otitis Media (bulging TM or middle ear effusion) or Otitis Externa (pain with tragus movement, canal erythema).

Management:

• AOM: antibiotics (amoxicillin is first line).

• Otitis Externa: topical antibiotic drops.

CHIEF COMPLAINT: SORE THROAT

Key Questions to ask:

1. Fever.

2. Difficulty swallowing.

3. Absence of cough.

4. Sick contacts.

Exam Focus:

• Tonsillar exudates.

• Cervical lymphadenopathy.

• Palatal petechiae.

Major Concern: Group A Strep (use centor criteria)

• Fever.

• Tonsillar exudate.

• Tender anterior cervical nodes.

• No cough.

Management: Rapid strep test; treat positive cases with amoxicillin or penicillin.

CHIEF COMPLAINT: VOMITING/DIARRHEA

Key Questions to ask:

1. Duration.

2. Blood in stool.

3. Sick contacts.

4. Hydration status.

5. Urine output.

Exam Focus:

• Dehydration signs.

• Dry mucous membranes.

• Sunken eyes.

• Decreased cap refill.

Most Common Cause: Viral gastroenteritis.

Management:

• Oral rehydration with small frequent fluids.

• Avoid sugary drinks.

• Ondansetron if persistent vomiting.

• Red Flags: severe dehydration, bilious vomiting, bloody stool.

CHIEF COMPLAINT: ABDOMINAL PAIN

Key Questions to ask:

1. Location.

2. Vomiting.

3. Fever.

4. Bowel habits

Exam Focus:

• Guarding.

• Rebound tenderness.

• RLQ tenderness.

Most Common Cause: Constipation, Viral illness, Mesenteric adenitis.

Rule Out: Appendicitis! (RLQ Pain, Fever) —> Immediate ED transfer.

Management:

• Constipation: Increase fluids and dietary fiber, Polyethylene glycol (Miralax) first-line.

  • Constipation commonly causes periumbilical pain + decreased stool frequency.

• Viral Gastroenteritis: Oral rehydration, supportive care.

  • Most cases improve within 24–72 hours.

CHIEF COMPLAINT: RASH

Key Questions to ask:

1. Fever.

2. Itching.

3. New medications.

4. Sick contacts.

Exam Focus:

• What does the rash look like? (flat, raised, pus/fluid filled, crusting)

• Where is the rash located?

  • Face → trunk spread (viral exanthem)

  • Palms and soles (HFMD, secondary syphilis, RMSF).

  • Flexural areas (eczema).

  • Diaper area (diaper dermatitis, candidiasis).

• Red flags: Petechiae or purpura, Skin peeling, Toxic appearing child.

Most Common Cause:

• Viral exanthem (most common): Supportive care

• Hand Foot Mouth: Vesicles on hands, feet, mouth.

• Impetigo: Honey-colored crusting.

• Urticaria: Raised pruritic wheals.

Management:

• Viral → supportive.

• Impetigo → topical mupirocin.

• Urticaria → antihistamines.