Physical Examination
On exam, the infant was in moderate work of breathing with accessory muscle use and tracheal tug. He was afebrile and had the heart rate of 180 beats per minute, respiratory rate of 45 breaths per minute, and a pulse oximetry reading of 98% on room air. Auscultation of the chest revealed air entry bilaterally with scattered inspiratory crepitation. Heart sounds were dual with no additional sounds. The abdomen was soft and movements were symmetrical with normal tone. The right periorbital region was bruised and swollen. There was no obvious proptosis or abnormal eye movements though this was difficult to assess with given his age, so a referral to ophthalmology for further assessment was made. There were no other suggestions for bruising or injury. A mild nappy rash was present. Both body weight and head circumferences were around the 15th percentile.