Crying infant

Background

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

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

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

See Also

• Colic