Laboratory Studies
- The history and physical examination findings of the crying child should direct laboratory studies.
- Most children presenting with the chief complaint of crying and irritability can be easily consoled, and a cause can be readily found.
- In other cases, the general appearance of the child and the ability of the child to be consoled can be reassuring. Although an immediate cause may not be found, an immediate workup and precise diagnosis may be unnecessary.
- In contrast, alarming items in the history and/or physical examination may make rapid diagnostic workup and treatment necessary.
- For example, children with fever, temperature instability, lethargy, or inconsolability should have an age-appropriate workup for sepsis.
- At a minimum, this includes a complete blood count (CBC), serum electrolytes, blood culture, urinalysis, and urine culture.
- Also, consider a lumbar puncture if younger than 6 weeks of age or if directed by examination and chest radiography if respiratory symptoms exist.
- Because children with urinary tract infections and gastrointestinal pathology may appear intermittently well, a urinalysis and stool guaiac should be considered even if the child is afebrile and clinically stable. A recent study supports the fact that urinary tract infections can be a common cause for crying even in afebrile children.[6] This is especially true in the very young patients. Therefore, one should consider ruling out urinary tract infections for those with persistent crying, the very young, or ill-appearing patients.
- If abuse or head trauma is suspected, a CT scan of the head and long bone radiographs should be considered.
- Children at risk for corneal abrasions, such as those with untrimmed nails or scratches on the face, should have an eye examination with fluorescein staining.
- An ECG should be obtained if any concern of cardiac instability exists.
- Abdominal ultrasonography and/or barium enema is necessary in suspected cases of intussusception.
- A toxicology screen should be performed if acute or chronic exposures are thought to exist.
- The items discussed above should be performed by individuals comfortable with the ED care of children (or under their consultation) and only if the history or physical examination suggests a disease that the diagnostic test could identify or rule out.
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Henretig FM. Crying and colic in early infancy. In: Fleisher GR, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. 1993:144-6.
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].
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].
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].
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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