Differential Diagnosis for a 4-year-old Child with Neck Pain and "Sore" Ears after a Fall
- Single most likely diagnosis:
- Traumatic injury to the neck or cervical spine, possibly a strain or minor fracture, given the mechanism of injury (falling onto the buttocks, which can cause a sudden jolt to the spine) and the symptoms of neck pain.
- Other Likely diagnoses:
- Muscular strain or sprain in the neck or back, which could also cause referred pain to the ears due to the complex innervation of the neck and head.
- Minor head injury, including a concussion, which might not immediately present with typical symptoms like loss of consciousness but could cause neck pain and discomfort.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Cervical spine fracture or dislocation, which requires immediate medical attention to prevent further injury, particularly spinal cord damage.
- Atlanto-axial subluxation, a specific type of neck injury that can occur in young children and may not always present with obvious symptoms but can lead to serious complications.
- Basilar skull fracture, which could cause ear pain due to the fracture line affecting the temporal bone and potentially leading to more severe complications like meningitis or cranial nerve injuries.
- Rare diagnoses:
- Spinal epidural hematoma or abscess, which are rare but serious conditions that could present with neck pain and require urgent medical intervention.
- Osteogenesis imperfecta or another bone disorder that could predispose the child to fractures with minimal trauma, presenting with pain out of proportion to the injury.
- Referred pain from an abdominal or thoracic condition, such as a ruptured appendix or pneumonia, which, although rare, can sometimes present with atypical symptoms like neck pain in children.