Crying Child Clinical Presentation

  • Author: Harold K Simon, MD, MBA; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Mar 22, 2012
 

History

  • The child's medical history, including surgeries, hospitalizations, illnesses, pregnancy complications, allergies, and birth events, should be obtained.
  • Present medicines and recent illnesses should be reviewed.
  • An explanation of events, including feeding habits, bowel movements, urination, fever, sick contacts, level of activity, degree and duration of concerns, and ability to be consoled, should be obtained.
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Physical

  • A complete and thorough physical examination should include the following: overall appearance, ability to be consoled, stability of vital signs, and temperature of the child.
  • Other important aspects by system
    • Rashes, perfusion, or bruising
    • Head, ears, eyes, nose, and throat (HEENT) examination for anterior fontanel fullness, hydration status, scleral color, corneal abrasions, pupillary activity, retinal hemorrhages, otitis, pharyngitis, foreign bodies, or neck tenderness
    • Dental examination for new tooth eruptions
    • Chest evaluation for breath sounds and tachypnea
    • Cardiovascular examination for murmurs, tachycardia, or arrhythmias
    • Abdominal evaluation for tenderness and bowel activity, left lower quadrant (LLQ) masses suggestive of constipation, or vertical sausage mass consistent with intussusception
    • Genitourinary examination for hernias, torsion (eg, a bluish mark within the scrotal contents indicating a torsed epididymal appendix, which is painful but usually self limited), or strangulations by hair tourniquets
    • Rectal examination for blood or fissures
    • Evaluation of extremities for focal tenderness, arthritis, or hair tourniquets
    • Neurologic evaluation for overall activity level, responsiveness, and ability to be consoled
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Causes

Causes of crying and irritability in the young child can vary greatly from relatively benign conditions, such as colic (a diagnosis of exclusion), to life-threatening conditions, such as meningitis or even abuse.[5]

The following is a partial listing, by systems, of potential causes of crying and irritability.

  • Infections
  • Trauma[5]
    • Corneal abrasions
    • Strangulation of extremities or genitalia (by hair)
    • Fractures
    • Abuse (including shaken baby syndrome)
    • Burns
    • Subdural hematomas
    • Foreign bodies
  • Dental/oral
  • Toxic or metabolic causes of irritability include any transient or persistent change in body chemistries.
  • Genitourinary concerns include testicular torsion, hernias, and urinary tract infections.
  • GI causes include life-threatening conditions (eg, intussusception, gastroenteritis) to more self-limiting conditions (eg, fissures, formula intolerance, colic).
  • Cardiovascular concerns include supraventricular tachycardia or other arrhythmias.
  • Other causes of crying and irritability are possible; however, a good system-by-system history and physical examination should help identify or rule out most concerns.
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Contributor Information and Disclosures
Author

Harold K Simon, MD, MBA  Professor of Pediatrics and Emergency Medicine, Associate Division Director of Pediatric Emergency Medicine, Director of Research, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston

Harold K Simon, MD, MBA is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, American Pediatric Society, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Kirsten A Bechtel, MD  Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. Brazelton TB. Crying in infancy. Pediatrics. Apr 1962;29:579-88. [Medline].

  2. Henretig FM. Crying and colic in early infancy. In: Fleisher GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. 1993:144-6.

  3. Bolten MI, Fink NS, Stadler C. Maternal Self-Efficacy Reduces the Impact of Prenatal Stress on Infant's Crying Behavior. J Pediatr. Jan 28 2012;[Medline].

  4. Catherine NL, Schonert-Reichl KA. Children's perceptions and comforting strategies to infant crying: relations to age, sex, and empathy-related responding. Br J Dev Psychol. Sep 2011;29:524-51. [Medline].

  5. King WK, Kiesel EL, Simon HK. Child abuse fatalities: are we missing opportunities for intervention?. Pediatr Emerg Care. Apr 2006;22(4):211-4. [Medline].

  6. Freedman SB, Al-Harthy N, Thull-Freedman J. The crying infant: diagnostic testing and frequency of serious underlying disease. Pediatrics. Mar 2009;123(3):841-8. [Medline].

  7. Pawel B, Henretig F. Crying and colic in early infancy. In: Fleisher G, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. 4th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2000:193-195.

 
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