Differential Diagnosis for a 2-year-old Female after a Fall
- Single most likely diagnosis:
- Minor Trauma or Contusion: Given the mechanism of injury (falling down 6-8 steps and landing on her belly) and the symptoms reported (posterior head pain and wrist pain), the most likely diagnosis is a minor trauma or contusion. The fact that she is acting normally and there's no report of loss of consciousness, vomiting, or other severe symptoms supports this diagnosis.
- Other Likely diagnoses:
- Wrist Sprain or Fracture: The reported wrist pain could indicate a sprain or a fracture, especially if the child landed on her outstretched hand during the fall.
- Abdominal Contusion: Landing on her belly could result in an abdominal contusion, which might not be immediately apparent but could cause discomfort or pain.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Intracranial Hemorrhage: Although the mother denies loss of consciousness, it's crucial to consider the possibility of an intracranial hemorrhage, especially given the mechanism of injury. This condition could be life-threatening if not promptly diagnosed and treated.
- Spinal Injury: The fall down the stairs increases the risk of a spinal injury, which could be catastrophic if not recognized and managed properly.
- Internal Abdominal Injury: The impact on the abdomen could potentially cause internal injuries (e.g., spleen or liver laceration) that might not be immediately symptomatic but could lead to severe complications.
- Rare diagnoses:
- Basilar Skull Fracture: Although rare and less likely given the absence of specific symptoms like drainage from ears or nose, a basilar skull fracture is a possibility in significant head trauma and should be considered if the patient's condition changes.
- Child Abuse: In any case of trauma in a child, it's essential to consider the possibility of non-accidental injury, especially if the history provided does not fully explain the extent of the injuries or if there are inconsistencies in the story.