Carefully review the history, especially:

● Family history

● Pregnancy

● Perinatal history

Note abnormalities on other parts of the physical examination, especially:

● Growth

● Development

● Other dysmorphic somatic features

Perform measurements (and plot percentiles), especially:

● Head circumference

● Height

● Weight

Consider the three mechanisms of facial dysmorphogenesis:

● Deformations from intrauterine constraint

● Disruptions from amniotic bands or fetal tissue

● Malformations from intrinsic abnormality in face/head or brain

Examine the parents and siblings:

● Similarity to a parent may be reassuring (e.g., large head) but may also be an indication of a familial disorder

Try to determine whether the facial features fit a recognizable syndrome, comparing with:

● References (including measurements) and pictures of syndromes

● Tables/databases of combinations of features

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