Crying Child Treatment & Management
- Author: Harold K Simon, MD, MBA; Chief Editor: Richard G Bachur, MD more...
Emergency Department Care
- Children presenting with crying and irritability require an extensive history and physical examination by someone comfortable with the care and management of children.
- Crying and irritability are vague symptoms; therefore, the overall appearance and stability of the child should guide the diagnostic workup.
- Even if the child appears healthy and is thought to have a benign, non–life-threatening condition (eg, colic), one needs to provide detailed instructions to the family regarding what signs are concerning and when to return for medical care.
- If the child appears ill, has fever, is inconsolable, is lethargic, or if other concerns of infection exist, a workup for sepsis must be performed.
- The remaining diagnostic concerns should be ruled out by a detailed history and physical examination based on specific findings and a directed evaluation (as outlined).
- Always take the most conservative approach if any significant diagnostic questions remain unanswered. This would include such items as screening laboratory or radiographic studies, especially if concern exists of an occult infection or underlying pathology (eg, intussusception). Under all circumstances, guarantee adequate follow-up care and immediate reevaluation if the concerns change or the child's condition worsens. One might also consider consultation with those who are more comfortable ruling in or ruling out potential concerns.
Consultations
In all cases in which one is not absolutely comfortable with the diagnosis and treatment of a particular child, consult someone comfortable with the emergency care of children or a physician who knows the patient or family.
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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].
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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