Crying infant: Difference between revisions

Latest revision as of 13:05, 14 May 2022

Background

Mean duration of crying is approximately 2 hrs/day for the first 6 wks^[1]
This decreases to 72 mins/day by age 10-12 wks
As many as 43% of infants experience excessive crying^[2]
5% of crying infants are found to have underlying disease^[3]

Clinical Features

Crying and inconsolable infant

Differential Diagnosis

Crying Infant

Occult infection
- Sepsis
- Meningitis
- UTI
- Otitis media
- Pneumonia
GI
- Intussusception
- GERD
- Incarcerated hernia
- Milk protein intolerance
- Anal fissure
Ophtho
- Corneal abrasion
Occult trauma
- Hair tourniquet (on extremities, penis)
- Non-accidental trauma
- Diaper pin
- Insect bites
- Burns in mouth
Misc
- Colic
- Scorpion envenomation
- SVT
- Testicular torsion
- Drug exposure/overdose (commonly methamphetamine or cocaine)
- Neonatal abstinence syndrome, drug withdrawal

Evaluation

Algorithm for the evaluation of the crying infant

Work-Up

Ocular
- Flourescein staining to rule out corneal abrasions
- Fundoscopic exam
Skin
- Inspect digits for hair tourniquet
- Inspect GU area
Muscluloskeletal
- Examine all bones/joints to rule out fracture, osteomyelitis or septic joint
- Consider skeletal survey & head CT in suspected child abuse
- Rule out badness above including shaken baby syndrome
Infection
- Examine ears to rule out otitis
- Consider occult sepsis
- Evaluate abdomen to rule out surgical abdomen

Diagnosis

Management

If no underlying cause is found attempt the "5 Ss"
- Swaddling
- Side/Stomach position while awake
- Shhhhing to provide soothing sound
- Swinging the baby in parent's arms
- Sucking on breast or pacifier

4% benefit from change to soy formula
rocking, warm compresses to belly feeding, frequent burping, diaper changes

Disposition

May discharge home with precautions if infant becomes consolable and has reassuring exam (and studies, if indicated)
Admit if infant is persistently inconsolable, will not tolerate POs, or has concern for specific pathology

External Links

References

↑ Wolke D, et al. Meta-analysis of fuss/cry durations and colic prevalence across countries. In: Proceedings of the 11th International Infant Cry Research Workshop. 8-10 June 2011. Zeist, The Netherlands.
↑ Reijneveld SA, et al. Excessive infant crying: the impact of varying definitions. Pediatrics. 2001; 108(4):893-897.
↑ Barr, RG. Colic and crying syndromes in infants. Pediatrics. 1998; 102(5):1282-1286.

Authors:

[1] Wolke D, et al. Meta-analysis of fuss/cry durations and colic prevalence across countries. In: Proceedings of the 11th International Infant Cry Research Workshop. 8-10 June 2011. Zeist, The Netherlands.

[2] Reijneveld SA, et al. Excessive infant crying: the impact of varying definitions. Pediatrics. 2001; 108(4):893-897.

[3] Barr, RG. Colic and crying syndromes in infants. Pediatrics. 1998; 102(5):1282-1286.

[1]

[2]

[3]

@@ Line 1: / Line 1: @@
-==DDx==
+==Background==
-# occult UTI (consider in excessive crying)
+*Mean duration of crying is approximately 2 hrs/day for the first 6 wks<ref>Wolke D, et al. Meta-analysis of fuss/cry durations and colic prevalence across countries. In: Proceedings of the 11th International Infant Cry Research Workshop. 8-10 June 2011. Zeist, The Netherlands.</ref>
-# DPT (excessive crying > 3 hrs)
+*This decreases to 72 mins/day by age 10-12 wks
-# corneal abrasion
+*As many as 43% of infants experience excessive crying<ref>Reijneveld SA, et al. Excessive infant crying: the impact of varying definitions. Pediatrics. 2001; 108(4):893-897.</ref>
-# strangulation (hair tourniquets on extremities, penis)
+*5% of crying infants are found to have underlying disease<ref>Barr, RG. Colic and crying syndromes in infants. Pediatrics. 1998; 102(5):1282-1286.</ref>
-# diaper pin
-# insect bites
-# burns in mouth
-# otitis
-# physical abuse
-# anal fissures
-# intussusception
-# incarcerated hernias
-# testicular torsion
-# cocaine exposure or drug withdrawal
-# meningitis
-# SVT
-# PNA, rib fxs
-# GERD
-# ASA OD
-# colic (rule of 3s - healthy infant cry more than 3 hrs/day, > 3 days/wk, for more than 3 weeks)
-##Crying peaks in afternoon & night age 1-3 mo, cows milk allergy? Ends 4-5 mo old
-==Work-Up==
+==Clinical Features==
-# rule out badness above including shaken baby
+[[File:Baby yelling.jpg|thumb]]
-# flourescein staining to r/o corneal abrasions
+*Crying and inconsolable infant
-# fundoscopic exam
-# r/o otitis
-# examine all bones/joints to r/o fx, osteo or septic joint
-# inspect GU area
-# Skeletal survey & head CT in suspected child abuse
-# 4% benefit from change to soy formula
-# rocking, warm compresses to belly feeding, frequent burping, diaper changes
-==Source==
+==Differential Diagnosis==
-C. 243 Harwood
+{{Crying infant DDX}}
-[[Category:Peds]]
+==Evaluation==
+[[File:Crying Infant.png|thumb|Algorithm for the evaluation of the crying infant]]
+===Work-Up===
+*Ocular
+**Flourescein staining to rule out [[corneal abrasions]]
+**Fundoscopic exam
+*Skin
+**Inspect digits for [[hair tourniquet]]
+**Inspect GU area
+*Muscluloskeletal
+**Examine all bones/joints to rule out [[fracture]], [[osteomyelitis]] or [[septic joint]]
+**Consider skeletal survey & head CT in suspected [[child abuse]]
+**Rule out badness above including [[shaken baby syndrome]]
+*Infection
+**Examine ears to rule out [[otitis media (peds)|otitis]]
+**Consider occult sepsis
+**Evaluate abdomen to rule out surgical abdomen
+===Diagnosis===
+==Management==
+*If no underlying cause is found attempt the "5 Ss"
+**'''S'''waddling
+**'''S'''ide/'''S'''tomach position while awake
+**'''S'''hhhhing to provide soothing sound
+**'''S'''winging the baby in parent's arms
+**'''S'''ucking on breast or pacifier
+*4% benefit from change to soy formula
+*rocking, warm compresses to belly feeding, frequent burping, diaper changes
+==Disposition==
+*May discharge home with precautions if infant becomes consolable and has reassuring exam (and studies, if indicated)
+*Admit if infant is persistently inconsolable, will not tolerate POs, or has concern for specific pathology
+==See Also==
+*[[Colic]]
+==External Links==
+==References==
+<references/>
+[[Category:Pediatrics]]