Crying is normal and research has shown that young infants cry for an average of 2-3 hours per day. Crying develops in the early weeks of life and peaks around 6-8 weeks.
Parents present concerned, distressed, exhausted and confused, having often received conflicting advice from various health professionals and lay sources.
Our role in the Emergency Department is to not only identify those babies with a medical cause for crying but to also reassure, support and assist parents if the diagnosis of physiological crying is made.
A full history and examination should be carried out including birth history, feeding (volume, frequency, type of milk), weight gain, bowel frequency
In young infants, ask about sleeping and awake times
The aim of the assessment is to exclude pathological causes for crying and identify physiological causes
Ask parents what they think the cause is and what they are concerned about. Take their concerns seriously and complete a full examination even if the baby is no longer crying.
It takes a lot of effort to leave the house in the middle of the night with a small child and parents should be supported and feel their concerns are being heard
Crying infants are one of the most common stress factors associated with Shaken Baby Syndrome and this presentation should not be taken lightly. Any concern regarding the cause of crying and parental ability to care should result in admission for observation and support.
Often more acute history and associated clinical signs on examination
Babies may present febrile or hypothermic
Consider in all persistently irritable infants
Cow’s Milk Intolerance
Consider if there is vomiting, evidence of colitis, family history of atopy, significant feeding problems worsening with time
Screaming during feed time with feed refusal after starting a feed is typical
Upright position during feeding, keeping upright after feeding, regular winding during feeds and feed thickeners can help
Proton pump inhibitors are often used but their benefit is uncertain
If the baby is not gaining weight or losing weight then a more detailed investigations should be performed by the General Paediatric Team
Pale, floppy, drawing up of legs and blood in stool is a typical presentation but not always present
Consider diagnosis and exclude on clinical examination