A 2 year old girl is being seen for intermittent fever and almost continuous crying. Her mother reports the child was potty-trained but for the last 2 days, has been incontinent. Also, when the parents try to hold the child to try to comfort her, she screams and cries harder. Formulate the possible diagnoses for this child. Explain why you believe these are the most likely causes of her symptoms. Be sure to include the pathophysiologic basis for your differential diagnoses.

The presenting symptoms of intermittent fever, continuous crying, incontinence, and increased distress when being held in a 2-year-old girl can be indicative of several possible diagnoses. To formulate the most likely causes, we will consider the pathophysiologic basis for these differential diagnoses. It is important to note that this analysis is based solely on the provided information, and a comprehensive evaluation by a healthcare professional is necessary for an accurate diagnosis.

One possible diagnosis is a urinary tract infection (UTI). In young children, UTIs can present with nonspecific symptoms such as fever, irritability, and incontinence. The common pathophysiologic basis of UTIs is the invasion of the urinary tract by bacteria, which triggers an inflammatory response. This can result in increased production of proinflammatory cytokines, leading to fever and discomfort. The irritation and inflammation of the bladder can also cause incontinence due to a loss of control over the bladder muscles. The child’s incontinence, coupled with the intermittent fever, supports the consideration of a UTI as a possible diagnosis.

Another possible diagnosis to consider is an ear infection (otitis media). Otitis media can cause significant pain and discomfort in young children, leading to continuous crying. The pathophysiologic basis of otitis media involves the inflammation and fluid accumulation within the middle ear, often caused by bacterial or viral infections. The resulting pressure and inflammation can cause pain, leading to the child’s distress. Additionally, the discomfort from the ear infection can exacerbate the crying when the child is being held, as the increased pressure on the ear during physical contact may worsen the pain.

A third possible diagnosis is a gastrointestinal infection. Infections such as gastroenteritis can cause fever, irritability, and changes in bowel habits. In this case, the child’s intermittent fever, continuous crying, and recent onset of incontinence may be related to a gastrointestinal infection. The pathophysiologic basis of gastroenteritis involves the invasion of the gastrointestinal tract by pathogens, leading to inflammation. This can disrupt normal digestive processes and bowel function, resulting in changes in stool consistency, frequency, and control. The presence of incontinence in this scenario may be attributed to the underlying infection affecting the child’s bowel control.

Additionally, it is important to consider a psychological or emotional cause for the child’s symptoms. The distress exhibited when being held could indicate separation anxiety or a fear of being touched. These emotional responses may be triggered by various factors, such as changes in the child’s environment, routines, or experiences. Although less likely based on the provided information, psychological causes should still be considered as part of the differential diagnosis.

To determine the most likely cause, a comprehensive evaluation of the child’s medical history, physical examination, and laboratory investigations (such as urine analysis and culture) would be necessary. In this case, it would be prudent to start with a thorough examination of the child’s urinary system to evaluate for possible UTI. Laboratory tests, including a complete blood count and urinalysis, can provide valuable diagnostic information. If the urinary tract infection is confirmed, appropriate antimicrobial treatment can be initiated.

If the initial evaluation does not reveal a clear cause, further investigations, such as a focused examination of the ears to evaluate for otitis media or viral studies to test for gastrointestinal infections, may be required. Additionally, considering the possibility of psychological or emotional causes, a careful assessment of the child’s emotional well-being and any recent changes in her environment should be undertaken.

In conclusion, the possible diagnoses for the 2-year-old child with intermittent fever, continuous crying, incontinence, and distress when being held include urinary tract infection, otitis media, gastrointestinal infection, and psychological or emotional causes. The pathophysiologic basis for each of these differential diagnoses has been discussed. A comprehensive evaluation by a healthcare professional is essential to accurately determine the cause of the child’s symptoms and initiate appropriate management.