Skin

Nonblanching rash (ie, petechiae or purpura)

Variety of infections including enterovirus, meningococcemia, and Rocky Mountain spotted fever

Disseminated intravascular coagulation due to sepsis

Vesicular lesions

Varicella virus, herpes simplex virus

Lacelike maculopapular rash on trunk and extremities with slapped-cheek appearance

Erythema infectiosum

Focal erythema with swelling, induration, and tenderness

Cellulitis, skin abscess

Evanescent erythematous morbilliform rash on trunk and proximal extremities

Juvenile idiopathic arthritis

Bull’s-eye erythematous rash, single or multiple lesions

Lyme disease

Erythematous, sandpaper-like rash

Scarlet fever (group A streptococcal infection)

Erythroderma

Toxic shock syndrome, toxin-mediated disease

Fontanelle (infants)

Bulging

Meningitis or encephalitis

Ears

Red, bulging tympanic membrane, loss of landmarks and mobility

Otitis media

Nose

Congestion, discharge

Upper respiratory infection

Sinusitis

Nostril flaring with inspiration

Lower respiratory infection

Throat

Redness

Sometimes exudate or swelling

Sometimes drooling

Pharyngitis (upper respiratory infection or strep infection)

Retropharyngeal abscess

Peritonsillar abscess

Neck

Focal adenopathy with overlying redness, warmth, and tenderness; possible torticollis

Lymphadenitis secondary to Staphylococcus aureus or group A streptococcal infection

Focal adenopathy with limited or no redness, warmth, or tenderness

Cat-scratch disease

Generalized cervical adenopathy

Lymphoma

Viral infection (particularly Epstein-Barr virus)

Pain or resistance to flexion (meningismus*)

Meningitis

Lungs

Coughing, tachypnea, crackles, rhonchi, decreased breath sounds, wheezing

Lower respiratory infection (eg, pneumonia, bronchiolitis, chronic foreign body aspiration)

Heart

New murmur, particularly mitral or aortic regurgitant

Acute rheumatic fever

Endocarditis

Abdomen

Tenderness, distention

Absent bowel sounds

Gastroenteritis

Appendicitis

Pancreatitis

Abdominal abscess

Mass

Tumor

Hepatomegaly

Hepatitis

Splenomegaly

In neonate, Epstein-Barr virus infection, TORCH infections (toxoplasmosis, other pathogens [syphilis, varicella-zoster, parvovirus B19], rubella, cytomegalovirus, herpes simplex virus), coxsackievirus, HIV

Leukemia, lymphoma

Genitourinary

Costovertebral tenderness (less reliable in younger children)

Pyelonephritis

Testicular tenderness

Epididymitis, orchitis

Extremities

Joint swelling, erythema, warmth, tenderness, decreased range of motion

Septic arthritis (very tender)

Lyme arthritis

Rheumatoid or inflammatory disorder

Focal bone tenderness

Osteomyelitis

Swelling of the hands or feet

Kawasaki disease