| Abdominal distension | Hirschsprung disease, impaction, neuroenteric condition (e.g., pseudo-obstruction) |
| Abnormal neurologic examination findings (tight anal sphincter, absent anal wink, absent cremasteric reflex, decreased lower extremity reflexes or tone) | Spinal cord abnormality, anorectal malformation, Hirschsprung disease |
| Delayed passage of meconium (> 48 hours after birth) | Hirschsprung disease, cystic fibrosis, congenital malformation of anorectum or spine |
| Extraintestinal symptoms (bilious vomiting, fever, ill appearance) | Hirschsprung disease, neuroenteric condition |
| Failure to thrive | Hirschsprung disease, cystic fibrosis, metabolic condition, malabsorption |
| Family history of Hirschsprung disease | Hirschsprung disease |
| Gushing of stool with rectal examination | Hirschsprung disease |
| Intermittent diarrhea and explosive stools | Hirschsprung disease |
| Midline pigmentary abnormalities of lower spine | Spinal cord abnormality |
| Occult blood in stool | Hirschsprung disease, food allergy, necrotizing enterocolitis |
| Onset before 1 month of age | Hirschsprung disease, cystic fibrosis, congenital malformation of anorectum or spine, metabolic or endocrine conditions |
| Perianal fistula, abnormal position of anus | Spinal cord abnormality |
| Pilonidal dimple covered by tuft of hair | Spinal cord abnormality |
| Stool caliber | Organic causes such as Hirschsprung disease (constriction from aganglionic segments in Hirschsprung disease results in narrow stools) |
