exercises and positioning of the infant so that he or she has to turn from the affected side to see others If this fails, surgical release of the contracture is indicated to prevent secondary facial deformity with growth Infants with this disorder should be carefully assessed for associated hip dysplasia, which coexists in up to 20% of cases The possibility of malignancy must be considered in the differential diagnosis of any child with a cervical mass History regarding the presence of persistent fevers, malaise, night sweats, weight loss, and other constitutional symptoms should be sought, and the child assessed for presence of pallor, petechiae, generalized adenopathy, and hepatosplenomegaly Primary lymphoid malignancies, such as leukemia and lymphoma, may present initially with a rapidly enlarging neck mass In contrast to infectious adenopathy, involved nodes tend to be firm, matted, nontender, and poorly mobile Posterior triangle and supraclavicular masses carry a much higher risk for neoplasm than anterior triangle masses Metastatic tumors, such as rhabdomyosarcoma and neuroblastoma, may also initially manifest as a neck mass If malignancy is suspected, the ED workup should include a complete blood cell count, electrolytes, uric acid, lactate dehydrogenase, liver function studies, heterophile antibody titer, and a chest radiograph to evaluate for mediastinal mass or adenopathy Further evaluation, including imaging and biopsy, should be performed in consultation with a pediatric oncologist SURFACE LESIONS CLINICAL PEARLS AND PITFALLS While most surface lesions are not dangerous, a thorough history and physical examination should be performed to evaluate for associated systemic illnesses Infantile hemangiomas present at a young age and will initially become larger before involuting Acute or persistent bleeding from a pyogenic granuloma often requires cauterization with silver nitrate or application of a hemostatic dressing Neurofibroma can often be distinguished from other soft tissue lesions by their central invagination with digitation pressure (i.e., button holing) Vascular Malformations