Version July 2025
| Historical clues | Potential significance |
| Gastrointestinal symptoms | |
| Chronic diarrhea | Malabsorption (celiac disease, inflammatory bowel disease, cystic fibrosis, secondary lactase deficiency, short bowel syndrome, food protein intolerance [primarily in infants]), excessive use of fructose- or sorbitol-based juices, diets high in sugar or other carbohydrates |
| Chronic constipation | May cause decreased appetite |
| Abdominal pain | Gastroesophageal reflux, esophagitis, chronic constipation |
| Recurrent vomiting | Gastroesophageal reflux, delayed gastric emptying, food allergy/intolerance, self-induced |
| Feeding symptoms | |
| Gagging, tactile hypersensitivity, prolonged feeding time | Oral motor dysfunction |
| Decreased appetite | Excessive juice (or other nonnutritious liquid) intake, chronic disease, medications, stressful psychosocial conditions |
| Red flags for possible child maltreatment | |
| Frequent injuries | May indicate inadequate supervision |
| Many unexplained symptoms | Report of problems in ≥5 organ systems; ≥5 food allergies in the absence of serious congenital anomaly or confirmed genetic disorder suggest the possibility of medical child abuse |
| Miscellaneous | |
| Recent travel to a resource-limited country, camping, housing in shelter, daycare | Infectious diarrhea (eg, giardiasis, nematodes, enteric pathogens) |
| Chronic otitis media | Immune deficiency, cystic fibrosis, cleft palate |
| Frequent infections | Immune deficiency, cystic fibrosis |
| Persistent wheezing | Mechanical obstruction (eg, vascular ring), chronic pulmonary disease |
| Polyuria, polydipsia, polyphagia | Diabetes mellitus |
