Differential Diagnosis for a 28-month Toddler with Tongue Protrusion and Swiping
- Single most likely diagnosis:
- Benign congenital or acquired conditions such as macroglossia (enlarged tongue) or tongue-thrusting habit. The presence of a mild fever and fatigue could be coincidental or related to a common viral infection. The tongue protrusion and swiping might be a habitual behavior or an attempt to self-soothe.
- Other Likely diagnoses:
- Oral or dental issues: Pain or discomfort from teething, tooth abscess, or other oral conditions could cause the child to stick out their tongue or swipe at it.
- Neurodevelopmental disorders: Conditions like cerebral palsy or other motor disorders might lead to abnormal tongue movements or postures.
- Infections: Although the fever is mild, it's possible that the child has a viral or bacterial infection affecting the oral cavity or surrounding tissues, leading to discomfort and tongue swiping.
- Do Not Miss diagnoses:
- Brain tumor or cyst: Although rare, a brain tumor or cyst could cause increased intracranial pressure, leading to abnormal tongue movements or postures.
- Meningitis or encephalitis: Infections like meningitis or encephalitis can present with non-specific symptoms, including fever and abnormal behaviors, and require prompt medical attention.
- Toxic ingestion: Accidental ingestion of a toxic substance could cause neurological symptoms, including abnormal tongue movements.
- Rare diagnoses:
- Dystonic disorders: Conditions like dystonia can cause involuntary muscle contractions, leading to abnormal postures or movements, including tongue protrusion.
- Mitochondrial disorders: Rare genetic disorders affecting mitochondrial function can cause a range of symptoms, including abnormal movements and postures.
- Congenital anomalies: Certain congenital anomalies, such as Pierre Robin sequence, can cause tongue protrusion due to a smaller-than-normal lower jaw.