Immediate Questions

A. How has infant been acting and feeding? A toxic-appearing child needs to be evaluated for sepsis or acute infection. Irritability and poor feeding may be a sign of neurologic effects of metabolic disorders, severe hepatic decompensation, or infection.

B. Has infant been growing and developing as expected? Many metabolic conditions cause developmental delays. Significant liver disease often results in poor weight gain and growth.

C. Has infant had fever? Sepsis, UTI, and cholangitis may present with fever. Bacterial peritonitis must also be considered in a patient with ascites and fever.

D. Is abdomen distended? Abdominal distention often represents organomegaly or ascites, both seen with progressive liver dysfunction.

E. What is the color of stool and urine? Acholic (clay-colored or pale) stool and dark urine suggest biliary obstruction (eg, biliary atresia), which requires urgent evaluation for timely surgical referral.

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