A one month old infant with a congenital cardiac lesion shows increased sweating during feeding. Which of the following is the sure sign of congestive cardiac failure in this infant?

Congestive hea failure (CHF) is unusual in childhood. When it does present, it is usually as a manifestation of congenital hea disease and is seen in the first year of life. The classic triad of symptoms for pediatric CHF is tachypnea, tachycardia, and hepatomegaly. There may also be a history of poor feeding, sweating or color change with feeding, and poor weight gain. Lower extremity edema and jugular venous distention are less likely in the pediatric population. Ref: Stephan M., Caer C., Ashfaq S. (2011). Chapter 50. Pediatric Emergencies. In R.L. Humphries, C. Stone (Eds), CURRENT Diagnosis & Treatment Emergency Medicine, 7e.