Which symptom would prompt further assessment for a child with suspected pyelonephritis?

Flank pain and fevers are significant symptoms that prompt further assessment for a child suspected of having pyelonephritis because they are classic indicators of a kidney infection. Pyelonephritis is characterized by inflammation of the kidney due to a bacterial infection, typically ascending from a urinary tract infection.

Flank pain, which is pain in the lower back and sides, occurs due to the infection's impact on the kidney and surrounding tissues. Elevated body temperature or fever is a common symptom of infection, suggesting the body is responding to the pathogens. Together, these symptoms highlight the need for immediate medical evaluation, including potential imaging studies or urine cultures, to confirm the diagnosis and assess the extent of the infection.

In contrast, general malaise, skin rashes, and coughing can be associated with a variety of conditions and are less specific to pyelonephritis. While these symptoms may warrant attention, they do not directly indicate a severe kidney infection like flank pain and fevers do.