What physical exam findings suggest congestive heart failure in infants?

The presence of tachypnea, poor feeding, and sweating while feeding are key physical exam findings that indicate congestive heart failure in infants. Tachypnea, or increased respiratory rate, often occurs because of fluid accumulation in the lungs, making it harder for the infant to breathe efficiently. Poor feeding is another common symptom, as infants may have decreased energy and may exhibit struggles with feeding due to respiratory distress or exhaustion. Sweating while feeding can occur because the infant is exerting extra effort to feed, leading to increased metabolic demand and sympathetic nervous system activation, which causes sweating.

In contrast, the other options do not align with the typical signs of congestive heart failure. Increased appetite and excessive sweating, normal respiratory effort with a calm demeanor, and healthy weight gain combined with active behavior would suggest a well-functioning heart and overall good health, rather than the difficulties associated with heart failure. These findings are not typically observed in infants experiencing cardiac distress or inefficiency.