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In a resource-stressed environment, \u201cspotting the sick child\u201d is essential for appropriate stabilization, treatment, and further management. Overlooking clinical features in a child\u2019s presentation may impede timely care. Complicating factors include the volume of patients seeking care, unfettered access to emergency services, parental perceptions and expectations, and clinician biases. Notwithstanding, after an appropriate history and physical exam, some children do not fall under the standard rubric of \u201csick or not sick\u201d. 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