Crying infant

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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]

Differential Diagnosis

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Algorithm for the evaluation of the crying infant

Crying Infant

Work-Up

  1. rule out badness above including shaken baby
  2. flourescein staining to rule out corneal abrasions
  3. fundoscopic exam
  4. rule out otitis
  5. examine all bones/joints to rule out fracture, osteo or septic joint
  6. inspect GU area
  7. Skeletal survey & head CT in suspected child abuse
  8. 4% benefit from change to soy formula
  9. rocking, warm compresses to belly feeding, frequent burping, diaper changes

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

See Also

References

  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.