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Infants and young children can be particularly difficult to assess objectively. Localising physical signs may be minimal or entirely absent and so observation of the child's general behaviour and condition is very important. The younger the baby, the lower the GP's threshold should be for requesting an assessment by a paediatrician.
The given symptoms and signs in infants should lead to a prompt and careful assessment and to consideration of the need for admission. These clinical features may not be of immediate significance but infants can deteriorate rapidly over a period of just a few hours. Even if the baby does not seem particularly ill, offer the parents an early review.
Carry out a complete examination of any sick infant with the child fully undressed. Otitis media, inguinal hernia, non-accidental injury or petechial rash may otherwise be missed. A urinary infection should be considered in an undiagnosed illness especially if recurrent.
ref: N Lawrence et al, HB Emergencies in Gen Pract 2e, 1996