Differential Diagnosis for 10-month-old given Honey Cough Syrup now Favoring Left Side

• Single most likely diagnosis:
  • Botulism: The ingestion of honey, which can contain spores of Clostridium botulinum, is a known risk factor for botulism in infants under 12 months. Symptoms can include weakness, floppiness, and difficulty swallowing, which might initially present as favoring one side due to muscle weakness.
• Other Likely diagnoses:
  • Viral gastroenteritis or other viral infections: These could cause discomfort leading to favoring one side, though the direct connection to honey cough syrup is less clear.
  • Constipation: Sometimes, abdominal discomfort from constipation can cause a child to favor one side.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Intussusception: Although less directly related to the ingestion of honey cough syrup, any abdominal symptom in an infant warrants consideration of intussusception, a condition where a part of the intestine slides into an adjacent part, potentially cutting off blood flow.
  • Appendicitis: Though rare in infants, appendicitis is a surgical emergency that could present with favoring one side due to abdominal pain.
  • Sepsis: Infection from any source, potentially related to the ingestion of contaminated substances, could lead to sepsis, a life-threatening condition.
• Rare diagnoses:
  • Hirschsprung's disease: A congenital condition affecting the large intestine, leading to severe constipation or intestinal obstruction, which might cause a child to favor one side due to discomfort.
  • Volvulus: A condition where the intestine twists, cutting off its blood supply, which is a surgical emergency and could present with sudden onset of abdominal pain and favoring one side.