Crying infant

DDx

1. occult UTI (consider in excessive crying)
2. DPT (excessive crying > 3 hrs)
3. corneal abrasion
4. strangulation (hair tourniquets on extremities, penis)
5. diaper pin
6. insect bites
7. burns in mouth
8. otitis
9. physical abuse
10. anal fissures
11. intussusception
12. incarcerated hernias
13. testicular torsion
14. cocaine exposure or drug withdrawal
15. meningitis
16. SVT
17. PNA, rib fxs
18. GERD
19. ASA OD
20. colic (rule of 3s - healthy infant cry more than 3 hrs/day, > 3 days/wk, for more than 3 weeks)
    1. Crying peaks in afternoon & night age 1-3 mo, cows milk allergy? Ends 4-5 mo old

Work-Up

1. rule out badness above including shaken baby
2. flourescein staining to r/o corneal abrasions
3. fundoscopic exam
4. r/o otitis
5. examine all bones/joints to r/o fx, 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

Source

C. 243 Harwood