eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Crying Child: Treatment & Medication

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

Treatment

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.

Medication

No single medication for the treatment of the broad spectrum of illnesses that can cause crying and irritability can be recommended. Specific therapy can be prescribed only after efforts at obtaining a diagnosis are successful. For example, a corneal abrasion would be treated by the appropriate topical ophthalmic antibiotic, while otitis media can be treated by any number of appropriate oral antibiotics.

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
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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.

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Further Reading

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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

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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.

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.

 
 
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