eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Crying Child: Follow-up

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
Contributor Information and Disclosures

Updated: May 1, 2009

Follow-up

Further Inpatient Care

  • Need for inpatient management is dependent upon the specific cause of crying and irritability.
  • Hospitalization for observation may be necessary for children with unclear etiologies.

Further Outpatient Care

  • In many cases, a specific cause of crying and irritability may not be found.
  • If life-threatening causes can be ruled out through history, physical examination, and appropriate screening studies, patients with resolution of symptoms and excellent follow-up care can usually be observed as outpatients. In these cases, close follow-up care should be arranged and families should be instructed to return immediately if any worsening occurs or if new concerns develop.

Transfer

  • If a crying child is seen by medical personnel unfamiliar with the care or scope of concerns related to a crying or irritable child, transfer to an appropriate facility might be considered.
  • Regional centers with pediatricians or pediatric emergency medicine physicians might be appropriate for the stable child with further concerns but without an obvious source or for children requiring more specialized services than can be provided at the initial site of presentation for care (ie, outlying urgent care centers, general community EDs). Stabilization and initial management should take place for concerning life-threatening conditions (examples being lumbar puncture [LP] and appropriate antibiotics for concerns of possible meningitis).
  • Establishment of a working relationship, potential phone consultations, and/or formal transfer agreements can help support and expedite any required transfers for additional care or treatment. 

Patient Education

  • Parent education and reassurance are often required, especially when the treating physician does not feel a life-threatening condition exists. At the same time, one must guarantee close and appropriate follow-up should the child's condition worsen as well as close follow-up with their primary care provider for routine and ongoing care.

Miscellaneous

Medicolegal Pitfalls

  • Failure to arrange for appropriate follow-up care
  • Failure to adequately observe prior to discharge (~2 h)
  • Failure to completely document a thorough history and physical examination
  • Failure to ask about over-the-counter and nonprescription medications
  • Vague or incomplete discharge instructions to the family
 


More on Pediatrics, Crying Child

Overview: Pediatrics, Crying Child
Differential Diagnoses & Workup: Pediatrics, Crying Child
Treatment & Medication: Pediatrics, Crying Child
Follow-up: Pediatrics, Crying Child
References
[ CLOSE WINDOW ]

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. 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].

  4. 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].

  5. 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.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

crying baby, crying child, irritable child, irritable baby, inconsolable baby, broken bone, dislocation, causes, symptoms, treatment, child abuse, injury in child, colic, teething, trauma

[ CLOSE WINDOW ]

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.

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
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.

CME Editor

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.