1. Rule out acute meningitis - irritability, high pitch cry, neck stiffness, projectile vomiting, poor feeding, seizure - focal, >15mins, recurrent 2. Electrolyte imbalance - Na, PO4, Mg, Ca, K (not usually) 3. Hypoglycemia - last meal? known DM? 4. Perinatal infection - intrauterine infection, trauma during pregnancy 5. Febrile fit is diagnosis of exclusion