Crying infant

DDx

- occult UTI (consider in excessive crying)

- DPT (excessive crying > 3 hrs)

- corneal abrasion

- strangulation (hair tourniquets on extremities, penis)

- 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

- rule out badness above including shaken baby

- flourescein staining to r/o corneal abrasions

- 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

C. 243 Harwood