Differential Diagnosis for 2yo with Fever, Ear Pain, and Fatigue
Single Most Likely Diagnosis
- Acute Otitis Media (AOM): Given the symptoms of ear pain and fever in a 2-year-old, AOM is a highly likely diagnosis, especially considering the recent history of a cold, which can predispose to ear infections.
Other Likely Diagnoses
- Viral Upper Respiratory Tract Infection (URTI): The child was diagnosed with a cold a month ago, and it's possible that the current symptoms are part of a prolonged or recurrent URTI.
- Sinusitis: Although less common in this age group, sinusitis could be considered, especially if the child has persistent nasal symptoms or cough.
- Pharyngitis: Could be a cause of fever and fatigue, especially if there's a sore throat, though ear pain would be less commonly associated.
Do Not Miss Diagnoses
- Meningitis: Although rare, meningitis is a life-threatening condition that can present with fever, fatigue, and sometimes ear pain if there's associated otitis media or mastoiditis. It's crucial to consider, especially if there are signs of severe illness or neurological symptoms.
- Pneumonia: Can present with fever and fatigue, and while ear pain is not a typical symptom, pneumonia is a serious condition that requires prompt diagnosis and treatment.
- Bacteremia or Sepsis: In a febrile child, especially one who appears severely ill, bacteremia or sepsis must be considered, as these conditions can rapidly progress and are life-threatening.
Rare Diagnoses
- Mastoiditis: A complication of otitis media, mastoiditis can cause fever, ear pain, and fatigue, but it's less common and usually associated with more severe symptoms or signs of complications.
- Lymphadenitis or Abscess: Could cause localized pain and fever but would typically be associated with swollen lymph nodes or a palpable mass.
- Juvenile Idiopathic Arthritis (JIA): Although rare, systemic JIA can present with fever and fatigue, and sometimes ear pain if there's associated otitis media, but this would be an unusual initial presentation.