eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Crying Child

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

Introduction

Background

One of the most challenging aspects of pediatric medicine is dealing with a child (usually <1 y of age) presenting with nonspecific symptoms, such as crying and irritability.

Because of the child's inability to localize complaints, these symptoms can indicate a spectrum of disease ranging from a benign process, such as colic, to a life-threatening illness, such as meningitis.1,2

Clinical

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.

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

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.3

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

  • Infections
  • Trauma3
    • 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.

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.